A qualitative descriptive training needs analysis of midwives perceived continuous professional development in providing intranatal respectful maternal care

BACKGROUND

The Vietnam midwifery report acknowledges that while health services are available in Vietnam, there is growing need to increase levels of respectful maternal care provided to women in labour.

OBJECTIVE

In conjunction with newborns Vietnam charity, our objective was to assess the perceived continuous professional development needs of midwives working in Vietnam to inform development of an intranatal respectful maternal care education resource.

METHOD

A qualitative exploratory descriptive method was used to conduct a training needs analysis, which identified perceived education requirements of midwives in Vietnam in relation to providing respectful maternal care.

PARTICIPANTS

A convenience sample of midwives (n = 49) participated in the study.

DATA-COLLECTION

Eight on-line focus groups were carried out in four hospitals (maternity units) across Vietnam using WebEx, with the interview schedule informed by the World Health Organization guide for delivering intrapartum care for a positive birth experience.

DATA-ANALYSIS

Data were transcribed into English and analysed using the 6-steps of thematic analysis outlined by Braun and Clark.

FINDINGS

Three themes and 9 sub-themes were developed from the data. The first theme addressed aspects that contribute towards creating a positive birth experience; the second theme observed barriers to changing practice; and the third theme noted that there are a variety of preferred teaching methods.

CONCLUSIONS

In response to the training needs analysis, a respectful maternal care education resource has been designed to transform selected areas of intranatal care in Vietnam. Integrating the respectful maternal care educational resource into midwives' continuous professional development in Vietnam is intended to increase women's rights to have safe childbirth, which accommodates choice and control, and promotes a positive birth experience.

RECOMMENDATIONS FOR PRACTICE

Post-completion and evaluation, we hope that the intranatal respectful maternal care educational resource will be rolled out to all practising midwives in Vietnam.

Translation and validation of the Hungarian version of the Birth Satisfaction Scale-Revised (BSS-R)

BACKGROUND

Evidence relating maternal birth experience to a range of maternal and neonatal outcomes is increasingly compelling. Consequently valid and reliable self-report of birth experience from the mothers perspective is critical.

AIM

The current study sought to translate and validate a Hungarian-language version of the Birth Satisfaction Scale-Revised (BSS-R).

METHOD

Following forward and backwards translation into Hungarian, the Hungarian BSS-R (HU-BSS-R) was administered to women in a major Transylvanian hospital maternity unit within 72 h postpartum. Key psychometric characteristics were then examined in relation to factor structure, divergent and convergent validity, internal consistency, and known-groups discriminant validity.

RESULTS

Two-hundred and thirty-two women completed the HU-BSS-R. Confirmatory factor analysis revealed the HU-BSS-R to offer an excellent fit to data for the established tri-dimensional measurement model. The HU-BSS-R was also found to offer excellent convergent and divergent validity and known-groups discriminant validity. No significant differences were observed between internal consistency observations between the current study and the original UK validation study.

CONCLUSIONS

The HU-BSS-R is a valid and reliable translation of the original BSS-R, it has proved itself to have excellent psychometric properties and is suitable for use in the Hungarian maternity context.

Translation and validation of Vietnamese version of the Birth Satisfaction Scale-Revised (BSS-R)

BACKGROUND

The 10-item Birth Satisfaction Scale-Revised (BSS-R) is a quick and easy survey instrument recommended by the International Consortium for Health Outcome Measures as the tool of choice for measuring women's birth satisfaction.

AIM

To translate and validate a Vietnamese-language version of the BSS-R.

METHOD

A quantitative cross-sectional method was used to gather data post translation and back-translation of a Vietnamese version of the BSS-R (VN-BSS-R). Data collected were psychometrically evaluated using key indices of validity and reliability.

PARTICIPANTS

Vietnamese women who were within one month postpartum of birth (N = 383) took part in the study.

RESULTS

Findings illustrate that a two-factor model offered excellent psychometric properties. With the two-factor VN-BSS-R, five items loaded onto a subscale 'Positive birth experiences' and the other five onto a second subscale 'Negative birth experiences'. This two-factor model offered a fit to data (root mean square error of approximation [RMSEA] = 0.07, 90% confidence interval [CI] [0.05, 0.09], root square mean residual [RMSE] = 0.04 and comparative fit index [CFI] = 0.97). Mean scores for the exploratory factor analysis [EFA]-derived 'positive' and 'negative' sub-scales were 17.12 (SD 2.34) and 8.40 (SD 4.18) respectively.

CONCLUSION

The translated and validated VN-BSS-R is a psychometrically robust tool for measuring birth satisfaction in Vietnamese postpartum women.The VN-BSS-R is available for use to measure experiences and perceptions of intrapartum care received by Vietnamese women.

Translation and validation of the Japanese version of the Birth Satisfaction Scale-Revised

AIM

This study aimed to develop a Japanese version of the Birth Satisfaction Scale-Revised and evaluate its reliability and validity.

METHODS

After translating the Birth Satisfaction Scale-Revised into Japanese, we conducted an Internet-based cross-sectional study with 445 Japanese-speaking women within 2 months of childbirth. Of these, 98 participated in the retest 1 month later. Data were analyzed using the COSMIN study design checklist for patient-reported outcome measurement instruments. Content validity was evaluated through cognitive debriefing during the translation process into Japanese. Confirmatory factor analysis was conducted to verify structural and cross-cultural validities. For hypothesis testing, we tested correlations with existing measures for convergent and divergent validities, and for known-group discriminant validity, we made comparisons between types of childbirth. Internal consistency was calculated using Cronbach's α, and test-retest reliability was evaluated using the intraclass correlation coefficient.

RESULTS

For the Japanese-Birth Satisfaction Scale-Revised, the established three-factor model fit poorly, whereas the four-factor model fit better. Full metric invariance was observed in both the nulliparous and multiparous groups. Good convergent, divergent, and known-group discriminant validities and test-retest reliability were established. Internal consistency observations were suboptimal; however for vaginal childbirth, the Cronbach's α of the total score was .71.

CONCLUSIONS

The Japanese-Birth Satisfaction Scale-Revised is a valid and reliable scale, with the exception of internal consistency that requires further investigation. If limited to vaginal childbirth, research, clinical applications, and international comparisons can be drawn.

Translation and validation of the Czech Republic version of the Birth Satisfaction Scale-Revised (BSS-R)

BACKGROUND

Satisfaction with the birth experience has been established to be critical for the wellbeing of the mother. The Birth Satisfaction Scale-Revised (BSS-R) is a brief and psychometrically robust multi-dimensional self-report tool designed to assess birth experience. The current investigation sought to translate and validate a Czech Republic version of the BSS-R (CZ-BSS-R).

METHODS

Following translation psychometric assessment of the CZ-BSS-R was undertaken using a cross-sectional design. A between-subjects design was incorporated in order to evaluate known-groups validity evaluation of the translated measure. Four hundred and sixty-five Czech-speaking women within the Czech Republic took part in the study. Confirmatory factor analysis was undertaken and divergent and convergent validity and internal consistency characteristics also evaluated.

RESULTS

The CZ-BSS-R was observed to have excellent psychometric properties and conceptually and measurement faithful to the original English-language measure. Consistent with previous investigations using the BSS-R significant differences were found in scores as a function of delivery type.

CONCLUSIONS

The CZ-BSS-R is a valid, robust and reliable measure of birth experience and suitable for use with Czech-speaking women in the Czech Republic. The study highlighted that instrument and emergency Caesarean section were associated with a lower level of birth satisfaction compared to vaginal delivery.

A scoping review of therapies used to treat psychological trauma post perinatal bereavement

BACKGROUND

Up to 39% of women who experience perinatal bereavement proceed to develop Post-Traumatic-Stress-Disorder (PTSD), with this large proportion meriting treatment. Before setting-up a treatment service for postnatal women who are experiencing psychological trauma, it is important to identify what therapies have been used in-the-past to address this problem.

AIM

To scope for research that has implemented therapies to treat psychological trauma post perinatal bereavement, for potential inclusion in a flexible treatment package.

METHOD

A scoping review mapped coverage, range, and type of research that has reported on prior therapies used to treat psychological trauma post perinatal bereavement.

FINDINGS

Due to the dearth of papers that directly addressed perinatal bereavement, we widened the scope of the review to view what treatments had been used to treat psychological trauma post-childbirth. Out of 23 studies that report on effectiveness of therapies used to treat psychological trauma post-childbirth, only 4-focused upon treating PTSD post perinatal bereavement (3 effective/1 ineffective). Successful treatments were reported by Kersting et al. (2013), who found CBT effective at reducing PTSD symptoms post-miscarriage, termination for medical reasons, and stillbirth (n = 33 & n = 115), and Navidian et al. (2s017)) found that 4-sessions of grief-counselling reduced trauma symptoms post-stillbirth in (n = 50) women. One study by Huberty et al. (2020found on-line yoga to be ineffective at reducing PTSD symptoms post-stillbirth.

CONCLUSIONS

A dearth of research has explored effectiveness of therapies for treating psychological trauma post perinatal bereavement and post-childbirth, with need to develop and test a research informed flexible counselling package.

Translation and validation of the Swedish version of the Birth Satisfaction Scale-Revised (BSS-R)

BACKGROUND

Optimizing women's childbirth experience is essential for development of quality mother infant relationships. The Birth Satisfaction Scale-Revised (BSS-R) can be used to measure birth satisfaction.

AIM

The current investigation sought to translate and validate a Swedish version of the BSS-R.

METHOD

Following translation, a comprehensive psychometric validation of the Swedish-BSS-R (SW-BSS-R) was carried out using a multi-model, cross-sectional, between- and within-subjects design.

PARTICIPANTS

A total of 619 Swedish-speaking women participated, from which 591 completed SW-BSS-R and were eligible for analysis.

DATA ANALYSIS

Discriminant, convergent, divergent and predictive validity, internal consistency, test-retest reliability, and factor structure were evaluated.

RESULTS

The SW-BSS-R was found to have excellent psychometric properties and hence is a valid translation of the original UK(English)-BSS-R. Important insights into relationships between mode of birth, post-traumatic stress disorder (PTSD), and postnatal depression (PND) were observed.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The SW-BSS-R is a psychometrically valid translation of the original BSS-R and is suitable for use in a Swedish-speaking population of women. The study has also highlighted important dynamics between birth satisfaction and areas of significant clinical concern (i.e., mode of birth, PTSD and PND) in Sweden.

Translation and validation of the Dutch version of the Birth Satisfaction Scale-Revised (BSS-R)

BACKGROUND

Recent observations suggest birth satisfaction may be significantly associated with postpartum post-traumatic stress disorder (PP-PTSD). The Birth Satisfaction Scale-Revised (BSS-R) is increasingly used Internationally as a short, valid and reliable multi-dimensional measure of birth experience. The current study sought to develop a Dutch version of the BSS-R (D-BSS-R) for clinical and research application in the Netherlands.

METHODS

Post-translation, a cross-sectional design with an embedded between-subjects component was used to evaluate key indices of validity and reliability of the D-BSS-R in a purposive sampled cohort of 244 Dutch-speaking women in the Netherlands. Confirmatory factor analysis, divergent, convergent and known-groups discriminant validity were evaluated as was the internal consistency of the measure.

RESULTS

The D-BSS-R was found to be a generally valid and reliable measure of birth experience with the key measurement characteristics of the original English-language measure transferring well to the Dutch context. Statistically significant negative correlations were observed between all D-BSS-R sub-scales and a validated measure of PTSD.

CONCLUSIONS

The D-BSS-R represents a valid and reliable measure of birth experience suitable and appropriate for use in the Netherlands. The study corroborates previous suggestions of linkage between birth satisfaction and PP-PTSD using a robust and diagnostically valid measure of trauma.

Translation and validation of the Hindi-Indian version of the Birth Satisfaction Scale-Revised

AIM

Critical to maternal outcome and development of a healthy and relationship between mother and baby, is the woman's perception of her birth experience. The Birth Satisfaction Scale-Revised (BSS-R) has been demonstrated to be psychometrically robust, easily administered, and scored self-report measure of birth experience. Aim of the study was to translate the UK-BSS-R into Hindi, collect data, and psychometrically validate an Indian (Hindi)-BSS-R.

METHODS

Psychometric assessment of the Indian (Hindi)-BSS-R was undertaken following translation using a cross-sectional design. Evaluation of known-groups validity was undertaken using an embedded between-subjects component. Data were collected from (n = 312) postnatal Hindi speaking women in India. Measurement characteristics were assessed using confirmatory factor analysis, divergent validity and internal consistency analysis.

RESULTS

The measurement properties of the Indian (Hindi)-BSS-R were observed to be equivocal, with the established tri-dimensional measurement model not achieving best fit to data. Instead, an alternative two-factor model offered an excellent fit to data. Significant differences were observed between Indian (Hindi)-BSS-R scores and family type and gestation term status, which highlights the relevance of these contextual aspects to the Indian birth experience. Internal consistency was observed to be low on some sub-scales, indicating the potential need for future revision.

CONCLUSIONS

The Indian (Hindi)-BSS-R is a measure of birth experience, which accepting some measurement caveats, is acceptable for use with Hindi speaking women in India. Further research is required to determine if modification of some of the items is required to improve internal consistency.

Factor structure and psychometric properties of the Birth Satisfaction Scale-Revised in Portuguese postpartum women

OBJECTIVE

This study aims to develop a Portuguese-language version of the Birth Satisfaction Scale-Revised (BSS-R) for clinical and research use in Portugal (PT-BSS-R). The factor structure, its invariance across depression levels, and the internal consistency of the PT-BSS-R were analysed.

METHOD

A sample of 1373 Portuguese-speaking postpartum women completed a sociodemographic and clinical form, the PT-BSS-R, and the Edinburgh Postnatal Depression Scale through an online survey tool. Four competing models were tested through confirmatory factor analyses and bifactor model-based psychometric indices were calculated. The internal consistency and the divergent/convergent validity are analysed.

RESULTS

The psychometric properties of PT-BSS-R were found to be generally excellent. Both the original correlated three-factor model and the bifactor model exhibited a good fit to the data. Results from the bifactor model support the use of both the BSS-R total score and the subscale scores. Exemplary invariance findings were observed between groups stratified on the basis of depression screening. PT-BSS-R has demonstrated both divergent and convergent validity as well as internal consistency.

CONCLUSION

PT-BSS-R is a psychometrically robust measure of birth satisfaction appropriate for clinical and research use in Portugal.

Midwife-Led Ultrasound Scanning to Date Pregnancy in Malawi: Development of a Novel Training Program

The use of ultrasound to determine gestational age is fundamental to the optimum management of pregnancy and is recommended for all women by the World Health Organization. However, this modality remains unavailable to many women in low-income countries where trained practitioners are scarce. Although previous initiatives have demonstrated efficacy in training midwives and technicians to perform antenatal ultrasound, these programs have often been too long and too complex to be realistic within the specific constraints of this context, highlighting the need for a novel and pragmatic approach. We describe the development and piloting of a bespoke course to teach midwives 3 fundamental components of early antenatal ultrasound scanning: (1) to identify the number of fetuses, (2) to confirm fetal viability, and (3) to determine gestational age. Having established that 5 days is insufficient, we propose that the minimum duration required to train ultrasound-naive midwives to competency is 10 days. Our completed program therefore consists of one and one-half days of didactic teaching, followed by 8 and one-half days of supervised hands-on practical training in which trainees are assessed on their skills. This package has subsequently been successfully implemented across 6 sites in Malawi, where 28 midwives have achieved competency. By describing the processes involved in our cross-continental collaboration, we explain how unexpected challenges helped shape and improve our program, demonstrating the value of preimplementation piloting and a pragmatic and adaptive approach.

Translation and Validation of the Birth Satisfaction Scale-Revised in Urdu for Use in Pakistan

BACKGROUND

Satisfaction with the birth experience is increasingly recognized as critical to the well-being of mother and baby and thus accurate assessment of this key dimension is essential. The Birth Satisfaction Scale-Revised (BSS-R) has been shown to be a robust, valid, and reliable measure of birth experience. The current study sought to develop an Urdu version of the measure to be used in Pakistan.

METHODS

Following translation, a cross-sectional design was used to examine the measurement properties of the Pakistan (Urdu)-BSS-R (P-BSS-R). Participants were a purposive sample of Pakistani postnatal women (n = 200). Key psychometric properties were examined using Confirmatory Factor Analysis (CFA), internal consistency evaluation, and known-groups discriminant validity testing.

RESULTS

The majority of measurement parameters for clinical application of the P-BSS-R were found to be acceptable with good known-groups discriminant validity and data fit to the tri-dimensional theoretical model of the BSS-R observed. However, some idiosyncratic observations were highlighted, including unexpected low internal consistency.

CONCLUSIONS

The P-BSS-R was found to be a generally valid and reliable measure of the experience, a caveat being low internal consistency warranting further investigation.

ICD-11 complex Post Traumatic Stress Disorder (CPTSD) in parents with perinatal bereavement: Implications for treatment and care

INTRODUCTION

The 11th revision of the WHO International Classification of Diseases (ICD-11) has identified Complex PTSD (CPTSD) as a new condition.

AIM

To explore whether the new diagnosis of CPTSD (ICD11) is relevant to women who have experienced perinatal bereavement and to advance knowledge about the acceptability, feasibility and perceived impact of delivering an innovative flexible Compassionate Focused Therapy (CFT) informed treatment package to alleviate symptoms of this condition.

METHODS

A mixed methods study using survey and interviews was conducted. Participants first completed the International Trauma Questionnaire (ITQ) to assess if they met the criteria for PTSD or CPTSD (n=72), and subsequent semi-structured interviews (n=12) identified participants' views about different treatment approaches.

PARTICIPANTS

A convenience sample of women who had experienced perinatal bereavement were recruited from one geographical region in Scotland.

DATA COLLECTION

Information was gathered about trauma experiences related to perinatal bereavement; participants' levels of PTSD or CPTSD using the ITQ; and views regarding the features of treatment options. In-depth interviews with women (n=12) and a focus group with staff (n=5) were also conducted.

FINDINGS

Of 74 participants (n=74) who fully completed the ITQ, 10.8% (n=8) met the criteria for PTSD and 29.7% (n=22) for CPTSD, equating to a total of 40.5% of participants experiencing traumatic stress. Results suggest that CPTSD is a more common condition than PTSD in people with perinatal bereavement, with qualitative data suggesting that CFT and EMDR can be useful and acceptable interventions for this population group.

CONCLUSION

A feasibility study is recommended next to evaluate acceptability of trial processes in preparation for a definitive randomised controlled trial of a new flexible CFT informed treatment package to address PTSD and CPTSD in people with perinatal bereavement.

RECOMMENDATIONS FOR PRACTICE

Routine assessment of ICD-11 CPTSD is recommended in this population group.

Crisis, What Crisis? Replicability of the Key Measurement Characteristics of the Australian Version of the Birth Satisfaction Scale—Revised

BACKGROUND

Behavioral and medical science is currently in the grip of a “replication crisis,” circumscribed by the failure to replicate a large proportion of key studies and a consequential impact on confidence in the veracity of the scientific method. Given the contemporary nature of the debate it is surprising that the psychometric properties of commonly used outcome measures have not been evaluated in this context, despite the obvious potential for the measurement characteristics of the measures themselves to be a source of error within a study.

The current investigation sought to replicate the original validation study of the Australian version of the 10-item Birth Satisfaction Scale—Revised (A-BSS-R) with respect to key psychometric aspects and the issues of replicability.

METHODS

A replication study of all quantitative aspects of Jefford et al. (2018) with an increased sample size. Participants were a purposive sample of Australian postnatal women (n = 445).

RESULTS

Most key quantitative aspects of the original validation study were found to be replicable and consistent with Jefford et al. (2018), the A-BSS-R was found to have excellent psychometric properties fundamentally mirroring the measurement characteristics observed previously. However, a small number of instances of nonreplicability were found.

CONCLUSIONS

The A-BSS-R is a valid and reliable measure of birth satisfaction. Replicability, at least in part, is influenced by participant group characteristics, statistical power and sample size. More focus is required on the influence of self-report measures themselves on the germane aspects of successful study replication.

Validation and factor structure of the Italian version of the Birth Satisfaction Scale-Revised (BSS-R)

OBJECTIVE

To validate the Italian-language version of the Birth Satisfaction Scale-Revised (BSS-R) and report key measurement properties of the tool. To evaluate the impact of antenatal class attendance on BSS-R assessed birth satisfaction.

BACKGROUND

Maternal satisfaction is one of the standards of care defined by the World Health Organisation (WHO) to improve the quality of services. The BSS-R is a multi-dimensional self-report measure of the experience of labour and birth.

METHODS

Cross-sectional instrument evaluation design examining factor structure and key aspects of validity and reliability. Embedded between-subjects design to examine known-group discriminant validity and the impact of antenatal class attendance on BSS-R sub-scale and total scores as dependent variables. After giving birth, 297 women provided data for analysis.

RESULTS

The Italian version of the BSS-R (I-BSS-R) was the key study measure. The established three-factor and bi-factor models of the BSS-R were found to offer an excellent fit to the data. Comparison of the tri-dimensional measurement model and the bi-factor model of the BSS-R found no significant differences between models. Women who attended antenatal classes had significantly lower stress experienced during childbearing sub-scale scores (I-BSS-R SE), compared to those who did not. Good convergent, divergent validity and known-groups discriminant validity were established for the I-BSS-R. Internal consistency observations were found to be sub-optimal in this population.

CONCLUSIONS

On all key psychometric indices, with the exception of internal consistency that requires further investigation, the I-BSS-R was found to be a valid translation of the original BSS-R. The impact of antenatal classes on birth satisfaction warrants further research.

Psychometric properties of the birth satisfaction scale-revised (BSS-R) in a sample of postpartum Iranian women

Childbirth satisfaction may positively affect maternal intention to have a future pregnancy and preference to have a cesarean. We translate the UK-Birth-Satisfaction-Scale-Revised (UK-BSS-R) into Persian and validate an Iranian-BSS-R for future use in this population. In total, 784 mothers who were hospitalized in postpartum wards completed the Persian version of the BSS-R. The confirmatory factor analysis on 10-items scale confirmed the conventional three-factor structure. The Cronbach's alpha of the Iranian-BSS-R subscales and the total score were within the range of 0.53-0.76. Our findings provide further evidence that the BSS-R is an internationally reliable and valid instrument to measure birth satisfaction.

Pre- and during-labour predictors of low birth satisfaction among Iranian women: a prospective analytical study

BACKGROUND

Maternal childbirth dissatisfaction has short- and long-term negative effects on the mothers' health and life, as well as on relation with her child and family. Due to lack of studies in Iran and other counties, we aimed to determine pre- and during- labour predictors of low birth satisfaction.

METHODS

Seven hundred women with low risk singleton pregnancy participated in this prospective analytical study. The participants were hospitalized for vaginal delivery with fetus in cephalic presentation and gestational age of 37⁰-41⁶ at two teaching centers in Tabriz (Iran). Woman characteristics, anxiety state (using Spielberger inventory) and dehydration were assessed at cervical dilatation of 4-6 cm. Iranian (Persian) birth satisfaction scale-revised was applied 12-24 h after birth. Multiple linear regression was used to determine the predictors.

RESULTS

Excluding 26 women who were outliers, 674 women were analyzed. The mean birth satisfaction score was 23.8 (SD 6.5) from an attainable score of 0-40. The during-labour predictors of low birth satisfaction score were severe and moderate anxiety, labour dystocia, insufficient support by staff, vaginal birth with episiotomy and tear, emergency cesarean section, labour induction and labour augmentation with oxytocin, and woman dehydration. The pre-labour predictors included being primiparous, sexual and emotional violence during pregnancy, gestational age of 40⁰-41⁶, preference for cesarean section, no attendance at pregnancy classes, and insufficient household income. The proportion of the variance explained by the during-labour variables was 75%, by pre-labour variables was 14% and by overall was 76%.

CONCLUSIONS

The controllable during-labour predictors explains most of the variance of the satisfaction score. It seems that responding to women's physical and psychological needs during labour and applying less interventions could improve women's childbirth satisfaction.

An exploratory Interpretative Phenomenological Analysis (IPA) of childbearing women's perceptions of risk associated with having a high Body Mass Index (BMI)

BACKGROUND

In 2016, the World Health Organization (WHO) labelled 13% of the world's adult population as obese. This increase in obesity is accompanied by mortality and morbidity problems, with maternal obesity and its accompanying risk for mother and infant requiring to be carefully managed.

AIM

To explore childbearing women with a high BMI (>35 kg/m²) perceptions of risk and its potential impacts upon pregnancy and outcome.

METHOD

Qualitative Interpretative Phenomenological Analysis (IPA) was used to gain deeper understanding of the lived experiences of childbearing women with a BMI>35 kg/m² and perceptions of their risk and potential pregnancy outcome.

FINDINGS

One of the superordinate themes that emerged was (1) Risk or no risk, and its associated three subthemes of (1a) Emotional consequences of her risky position, (1b) Recognition of high-risk complicationsfinally sinking in, and (1c) Accepting the risk body.

RECOMMENDATIONS FOR PRACTICE

In general, health care professionals are uncomfortable about discussing obesity-associated risks with pregnant women. The participants in this study did not classify themselves as obese, with this absence of acknowledgement and 'risky talk' leaving participants' unaware of their obesity-associated risk. This downplaying of obesity related talk requires to be corrected, simply because women in denial will perceive no need to engage with health promotion messages. In response, directives are required to be embedded into policy and practice.

CONCLUSION

Specific training is required to teach maternity care professionals how to have difficult, sensitive conversations about obesity related risks with childbearing women with high BMI's. In addition, this risk information needs to be accompanied by relevant advice and support.

The Birth Satisfaction Scale-Revised Indicator (BSS-RI): a validation study in Iranian mothers

OBJECTIVE

Birth Satisfaction Scale-Revised Indicator (BSS-RI) is a short selfreport instrument designed to measure satisfaction of the childbearing women's experiences of labour and its outcomes. The aim of this study was to examine the reliability and validity of the Persian version of BSS-RI in Iranian mothers.

METHODS

This cross-sectional study was conducted on 396 mothers in Tehran, Iran, between July and September 2017. The mothers were administered the BSS-RI, and a demographic questionnaire. Internal consistency of the BSS-RI was examined with Cronbach's alpha, construct validity was evaluated via exploratory factor analysis (EFA), and divergent validity was examined by correlating the BSS-RI with gestational age.

RESULTS

The EFA results demonstrated a two-factor structure corresponding to the Stress of Childbearing and Quality of Care domains of the structure proposed by provider. The Cronbach's alpha for Stress of Childbearing and Quality of Care subscales and total BSS-RI were 0.665, 0.847, and 0.563, respectively. The mean of BSS-RI total score was 6.16 (SD = 2.60), and the Stress of Childbearing and Quality of Care subscales were 2.71 (SD = 2.39), and 3.45 (SD = 1.11), respectively. The BSS-RI showed no significant correlation with the gestational age, confirming divergent validity.

CONCLUSION

Like the original English version, the Persian version of the BSS-RI is a reliable and valid instrument for measuring birth satisfaction in Iranian mothers. It can also be used as short and easy to administer tool for assessment of birth satisfaction in large sample survey research.

Disempowered midwives and traumatised women: Exploring the parallel processes of care provider interaction that contribute to women developing Post Traumatic Stress Disorder (PTSD) post childbirth

BACKGROUND

Around 4% of women develop Post Traumatic Stress Disorder Post Childbirth (PTSD-PC). During childbirth a woman's perception of her care provider's interpersonal verbal and nonverbal relationship behaviours, termed 'Quality of Provider Interaction' are significantly associated with the development of PTSD-PC.

AIMS

To understand how women who develop PTSD-PC and midwives, experience their interactions during care provision. In particular, how they feel during their interactions and what this means to them.

METHODS

The qualitative method of Interpretative Phenomenological Analysis that incorporates a reflective approach, was used to gain deep understanding of the lived experience of care provider interaction. Six women who met full diagnostic criteria for PTSD-PC and six midwives who provided intrapartum care, participated in individual face-to-face interviews.

RESULTS

Two key findings were identified: 1) Failing to recognise and meet the human needs of both women and midwives, results in poor quality interactions from midwives and poor perception of care provider interaction by women; 2) The study groups of women and midwives both identified the quality of their relationship as central to positive interactions. RECOMMENDATIONS FOR PRACTICE: (1) Raise the status of psychological wellbeing for childbearing women and make it of equal importance to physical wellbeing, with clear focus upon care provider interaction; (2) Create a midwife centred system that enables midwives to provide optimal care provider interaction and improve relationship-based care; and (3) Challenge underlying toxic cultures that currently persist in the maternity services system, which undermine the work of midwives and consequently the experience of women.

CONCLUSION

Failure to recognise and meet the human and relationship needs of both childbearing women and midwives contributes to poor care provider interactions offered by midwives and negative perceptions of care provider interactions by women. In response, NHS maternity services need to highlight the importance of the quality of care provider interaction alongside perinatal psychological wellbeing. This requires improved working environments for midwives, so they can optimise their quality of interaction with childbearing women. This will in turn impact upon the incidence and levels of trauma and PTSD-PC experienced by women.

A scoping review to determine themes that represent perceptions of self as mother ('ideal mother' vs 'real mother')

Background: Postnatal depression (PND) is a key cause of maternal morbidity, with current systems of initial recognition in the UK detecting only 50% of cases. In attempts to predict those potentially at risk, this review suggests a novel approach. Aim: Implementing the concept of 'ideal mother' versus 'real mother', and asking the woman to compare their 'ideal self' against 'existent self', the aim of this instrument development review was to determine themes from the literature that relate to women's perceptions of self as a mother, and from this identification develop questions for inclusion within a proposed new measure entitled the Self-Image as Mother Scale (SIMS). Method: A scoping review of the literature was carried out to identify themes considered to affect perception of self as mother, and from this identification, evidence-based questions for inclusion in the SIMS were developed. Findings: Themes identified included (1) marital dissatisfaction, (2) inadequate partner support, (3) lack of family support, (4) socioeconomic status and associated poverty, (5) concern about infant, (6) antenatal/postnatal complications, (7) acceptance of infant gender, (8) history of mental health problems, (9) unplanned pregnancy. Conclusions: From this scoping review 18 questions were developed for inclusion in the SIMS, which will then be evaluated for psychometric properties, scale refinement and validation.

The Birth Satisfaction Scale - Revised (BSS-R): should the subscale scores or the total score be used?

OBJECTIVE AND BACKGROUND

The 10-item Birth Satisfaction Scale - Revised (BSS-R) is increasingly being used internationally as the instrument of choice for the assessment of birth satisfaction. There remains conjecture over the most appropriate way to score the instrument; subscale scores overall total score, or both approaches. The current study sought to clarify this issue by examining the measurement characteristics of the United States version of the BSS-R from a large data set.

METHODS

Secondary analysis of a data matrix from a large sample US BSS-R validation study (N = 2116) using structural equation modelling.

RESULTS

A bi-factor model revealed an excellent fit to data (χ²_(df = 25) = 208.21, p < 0.001, CFI = 0.98, RMSEA = 0.06, SRMR = 0.04), demonstrating relative independence of the BSS-R quality of care subscale, while in contrast the women's attributes and stress experienced during childbearing subscales could be explained more plausibly by a general factor of experience of childbirth.

CONCLUSION

Consistent with the recommendations of the original BSS-R validation study, the current investigation found robust empirical evidence to support the use of both the subscale scoring system and the total score. Researchers and clinicians can therefore select either approach (or both) with confidence.

Measurement and structural invariance of the US version of the Birth Satisfaction Scale-Revised (BSS-R) in a large sample

BACKGROUND

The 10-item Birth Satisfaction Scale-Revised (BSS-R) is being increasingly used internationally. The use of the measure and the concept has gathered traction in the United States following the development of a US version of the tool. A limitation of previous studies of the measurement characteristics of the BSS-R is modest sample size. Unplanned pregnancy is recognised as being associated with a range of negative birth outcomes, but the relationship to birth satisfaction has received little attention, despite the importance of birth satisfaction to a range of postnatal outcomes.

AIM

The current investigation sought to evaluate the measurement characteristics of the BSS-R in a large postpartum sample.

METHODS

Multiple Groups Confirmatory Factor Analysis (MGCFA) was used to evaluate a series of measurement and structural models of the BSS-R to evaluate fundamental invariance characteristics using planned/unplanned pregnancy status to differentiate groups.

FINDINGS

Complete data from N=2116 women revealed that the US version of the BSS-R offers an excellent fit to data and demonstrates full measurement and structural invariance. Little difference was observed between women on the basis of planned/unplanned pregnancy stratification on measures of birth satisfaction.

DISCUSSION

The established relationship between unplanned pregnancy and negative perinatal outcomes was not found to extend to birth satisfaction in the current study. The BSS-R demonstrated exemplary measurement and structural invariance characteristics.

CONCLUSION

The current study strongly supports the use of the US version of the BSS-R to compare birth satisfaction across different groups of women with theoretical and measurement confidence.

A pilot study exploring the relationship between self-compassion, self-judgement, self-kindness, compassion, professional quality of life and wellbeing among UK community nurses

BACKGROUND

Compassion fatigue and burnout can impact on performance of nurses. This paper explores the relationship between self-compassion, self-judgement, self-kindness, compassion, professional quality of life, and wellbeing among community nurses.

AIM

To measure associations between self-compassion, compassion fatigue, wellbeing, and burnout in community nurses.

METHOD

Quantitative data were collected using standardised psychometric questionnaires: (1) Professional Quality of Life Scale; (2) Self-Compassion Scale; (3) short Warwick Edinburgh Mental Wellbeing Scale; (4) Compassion For Others Scale, used to measure relationships between self-compassion, compassion fatigue, wellbeing, and burnout.

PARTICIPANTS

A cross sectional sample of registered community nurses (n=37) studying for a postgraduate diploma at a University in the North of England took part in this study.

RESULTS

Results show that community nurses who score high on measures of self-compassion and wellbeing, also report less burnout. Greater compassion satisfaction was also positively associated with compassion for others, and wellbeing, whilst also being negatively correlated with burnout.

CONCLUSION

High levels of self-compassion were linked with lower levels of burnout. Furthermore when community nurses have greater compassion satisfaction they also report more compassion for others, increased wellbeing, and less burnout. The implications of this are discussed alongside suggestions for the promotion of greater compassion.

Birth Satisfaction Scale/Birth Satisfaction Scale-Revised (BSS/BSS-R): A large scale United States planned home birth and birth centre survey

OBJECTIVE

to explore the prevalence of birth satisfaction for childbearing women planning to birth in their home or birth centers in the United States. Examining differences in birth satisfaction of the home and birth centers; and those who birthed in a hospital using the 30-item Birth Satisfaction Scale (BSS) and the 10-item Birth Satisfaction Scale-Revised (BSS-R).

STUDY DESIGN

a quantitative survey using the BSS and BSS-R were employed. Additional demographic data were collected using electronic linkages (Qualtrics^™).

PARTICIPANTS

a convenience sample of childbearing women (n=2229) who had planned to birth in their home or birth center from the US (United States) participated. Participants were recruited via professional and personal contacts, primarily their midwives.

RESULTS

the total 30-item BSS score mean was 128.98 (SD 16.92) and the 10-item BSS-R mean score was 31.94 (SD 6.75). Sub-scale mean scores quantified the quality of care provision, women's personal attributes, and stress experienced during labour. Satisfaction was higher for women with vaginal births compared with caesareans deliveries. In addition, satisfaction was higher for women who had both planned to deliver in a home or a birth centre, and who had actually delivered in a home or a birth center.

KEY CONCLUSIONS

total and subscale birth satisfaction scores were positive and high for the overall sample IMPLICATIONS FOR PRACTICE: the BSS and the BSS-R provide a robust tool to quantify women's experiences of childbirth between variables such as birth types, birth settings and providers.

An exploratory qualitative analysis of student midwives views of teaching methods that could build their confidence to deliver perinatal bereavement care

BACKGROUND

Equipping student midwives with confidence to deliver bereavement care to childbearing women is a challenge for midwifery lecturers.

OBJECTIVE

To explore qualitative data provided by student midwives who evaluated the workbook Bereavement care for childbearing women and their families (Hollins Martin & Forrest, 2013) to explore their views of potential teaching strategies that could build their confidence to deliver real bereavement care.

METHOD

An exploratory qualitative thematic analysis was used to provide, analyse and report themes identified within data collected in a prior study.

PARTICIPANTS

Participants were student midwives (n=179) in their second/third year of a midwifery degree program at 1 of 3 universities in the UK were included in the study.

DATA COLLECTION/ANALYSIS

Data to evaluate effectiveness of the bereavement workbook as a teaching method was collected using a survey instrument. It was the comments written under questions by participants that were analysed in the present study.

FINDINGS

Three themes emerged: (1) increasing classroom interaction, (2) the importance of reflecting on emotions, and (3) need for experience.

DISCUSSION

Although this study has addressed delivery of education that relates to midwives, the findings are cross transferable to other healthcare educators, practitioners, and students. Several solutions are proposed that could potentially build student confidence to deliver bereavement care: lecturers should (1) encourage group discussion in the classroom to help build student confidence to emotionally cope during real bereavement events; (2) ensure students gain exposure by encouraging qualified midwives to include them in real bereavement events early on in their training, and (3) develop packages of perinatal bereavement scenarios for simulation and rehearsal in the clinical skills laboratory. Post-implementation, it is recommended that these teaching strategies be evaluated.

Compassion for others, self-compassion, quality of life and mental well-being measures and their association with compassion fatigue and burnout in student midwives: A quantitative survey

BACKGROUND

compassion fatigue and burnout can impact on the performance of midwives, with this quantitative paper exploring the relationship between self-compassion, burnout, compassion fatigue, self-judgement, self-kindness, compassion for others, professional quality of life and well-being of student midwives.

METHOD

a quantitative survey measured relationships using questionnaires: (1) Professional Quality of Life Scale; (2) Self-Compassion Scale; (3) Short Warwick and Edinburgh Mental Well-being Scale; (4) Compassion For Others Scale.

PARTICIPANTS

a purposive and convenience sample of student midwives (n=103) studying at university participated in the study.

RESULTS

just over half of the sample reported above average scores for burnout. The results indicate that student midwives who report higher scores on the self-judgement sub-scale are less compassionate towards both themselves and others, have reduced well-being, and report greater burnout and compassion fatigue. Student midwives who report high on measures of self-compassion and well-being report less compassion fatigue and burnout.

CONCLUSION

student midwives may find benefit from 'being kinder to self' in times of suffering, which could potentially help them to prepare for the emotional demands of practice and study.

IMPLICATIONS

developing, creating and cultivating environments that foster compassionate care for self and others may play a significant role in helping midwives face the rigours of education and clinical practice during their degree programme.

The development and validation of an activity monitoring system for use in measurement of posture of childbearing women during first stage of labor

INTRODUCTION

There is limited understanding of the type and extent of maternal postures that midwives should encourage or support during labor. The aims of this study were to identify a set of postures and movements commonly seen during labor, to develop an activity monitoring system for use during labor, and to validate this system design.

METHODS

Volunteer student midwives simulated maternal activity during labor in a laboratory setting. Participants (N = 15) wore monitors adhered to the left thigh and left shank, and adopted 13 common postures of laboring women for 3 minutes each. Simulated activities were recorded using a video camera. Postures and movements were coded from the video, and statistical analysis conducted of agreement between coded video data and outputs of the activity monitoring system.

RESULTS

Excellent agreement between the 2 raters of the video recordings was found (Cohen's κ = 0.95). Both sensitivity and specificity of the activity monitoring system were greater than 80% for standing, lying, kneeling, and sitting (legs dangling).

DISCUSSION

This validated system can be used to measure elected activity of laboring women and report on effects of postures on length of first stage, pain experience, birth satisfaction, and neonatal condition. This validated maternal posture-monitoring system is available as a reference-and for use by researchers who wish to develop research in this area.

A method of teaching critical care skills to undergraduate student midwives using the Maternal-Acute Illness Management (M-AIM) training day

The most recent Confidential Enquiry into Maternal Deaths (CMACE, 2011) identified human errors, specifically those of midwives and obstetricians/doctors as a fundamental component in contributing to maternal death in the U.K. This paper discusses these findings and outlines a project to provide training in Maternal-Acute Illness Management (M-AIM) to final year student midwives. Contents of the program are designed to educate and simulate AIM skills and increase confidence and clinical ability in early recognition, management and referral of the acutely ill woman. An outline of the Maternal-AIM program delivered at the University of Salford (Greater Manchester, UK) is presented to illustrate how this particular institution has responded to a perceived need voiced by local midwifery leaders. It is proposed that developing this area of expertise in the education system will better prepare student midwives for contemporary midwifery practice.

Development and psychometric properties of the Birth Satisfaction Scale-Revised (BSS-R)

OBJECTIVE

to assess factor structure, validity and reliability of the Birth Satisfaction Scale (BSS) and to develop a short-form version of the tool.

DESIGN

a quantitative design focused on evaluating psychometric properties of the BSS using factor structure, internal consistency, divergent reliability and known groups validity.

SETTING

Ayrshire Maternity Unit community midwife bases that serve the obstetric population of Ayrshire, Scotland (UK).

PARTICIPANTS

a convenience sample of healthy women (n=228) <10 days post partum who had delivered a term infant. Data was collected from October 2010 to January 2011.

MEASUREMENT

the BSS contains 30 self report items, rated on a 5-point Likert scale that measure women's perceptions of: (1) quality of care provision, (2) women's personal attributes, and (3) stress experienced during labour (8, 8 and 14 items per factor).

FINDINGS

post data analysis the BSS was reconfigured into the 10 item BSS-Revised (BSS-R) comprised of three sub-scales that measure distinct but correlated domains of: (1) quality of care provision, (2) women's personal attributes, and (3) stress experienced during labour. These domains now consist of relatively few items (4, 2 and 4 items per factor), but offer a good fit to the data.

KEY CONCLUSIONS

the BSS-R would appear to be a robust, valid and reliable multidimensional psychometric instrument for measuring postnatal women's birth satisfaction. Further research to confirm the veracity of the instruments measurement properties highlighted in the current study is desirable. The BSS-R is available for use at a national/international level from the first author.

The Understanding Bereavement Evaluation Tool (UBET) for midwives: factor structure and clinical research applications

BACKGROUND

The NMSF (2009) survey reported that bereavement midwife care was inadequate in a number of UK NHS Trusts. Using a small grant from the Scottish government, 3 experienced midwifery lecturers designed an interactive workbook called "Shaping bereavement care for midwives in clinical practice" for the purpose of improving delivery of bereavement education to student midwives. An instrument called the Understanding Bereavement Evaluation Tool (UBET) was designed to measure effectiveness of the workbook at equipping students with essential knowledge.

AIM

To assess validity and reliability of the UBET at measuring midwives' self-perceptions of knowledge surrounding delivery of bereavement care to childbearing women, partners and families who have experienced childbirth related bereavement.

METHOD

An evaluative audit using the UBET was undertaken to explore student midwives' (n=179) self perceived knowledge levels before and after the workbook intervention. Validity tests have shown that the UBET, (6-item version), could be considered a psychometrically robust instrument for assessing students' knowledge gain. PCA identified that the UBET comprised two sub-scales (theoretical knowledge base - Q 1, 2 & 3 and psychosocial elements of care delivery - Q 4, 5 & 6).

DISCUSSION

Data has shown that the easy to administer and short 6-item UBET is a valid and reliable tool for educators to measure success at delivering education using the "Shaping bereavement care for midwives in clinical practice" work book.

Using Compassionate Mind Training as a Resource in EMDR: A Case Study

This case study examines the contribution of compassionate mind training (CMT) when used as a resource in the eye movement desensitization and reprocessing (EMDR) treatment of a 58-year-old man, who presented after a recent trauma with psychological distress and somatic symptoms—an inability to sign his name. Self-report questionnaires (Hospital Anxiety and Depression Scale [HADS], Impact of Events Scale-R [IES-R], and Self-Compassion Scale [SCS]) were administered at pretherapy, midtherapy, posttherapy, and 9-month follow-up. EMDR with CMT facilitated recall of forgotten memories about his sister’s traumatic death decades previously, with related emotions of shame and grief, creating insight into how these past events linked to his current signature-signing phobia. Eight sessions of therapy resulted in an elimination of the client’s signature-signing phobia and a reduction in trauma-related symptoms, elevation in mood, and increase in self-compassion. Effects were maintained at 9-month follow-up. The “Discussion” section highlights the value of working collaboratively with clients to best meet their individual needs.