Predictors of childbirth experience: Prospective observational study in eastern Spain

BACKGROUND

In recent years, birth experience has been highlighted by national and international organisations as a relevant value in measuring maternal health care quality. According to a standardised tool, we aimed to assess which clinical indicators had the most significant influence on the birth experience.

METHODS

This prospective observational study was carried out in fourteen hospitals in eastern Spain. 749 women consented to the collection of birth variables at discharge, and subsequently, at 1-4 months, data were collected on the birth experience as measured by the Spanish version of the Childbirth Experience Questionnaire. Next, a linear regression analysis was performed to determine which clinical birth indicators greatly influence the birth experience measure.

RESULT

The study sample (n = 749) was predominantly Spanish and primipara, with 19.5% vaginal births. The predictors that emerged in the linear regression model were to have a birth companion (B = 0.250, p = 0.028), drink fluids during labour (B = 0.249, p < 0.001), have early skin-to-skin contact (B = 0.213, p < 0.001) and being transferred to a specialised room for the second stage of labour (B = 0.098, p = 0.016). The episiotomy (B = -0.100, p < 0.015) and having an operative birth (B = -0.128, p < 0.008) showed a negative influence.

CONCLUSION

Our study supports that intrapartum interventions recommended according to clinical practice guidelines positively influence the mother's birth experience. Episiotomy and operative birth should not be used routinely as they negatively influence the birth experience.

[Analysis of the status of cardiac rehabilitation in Spain: an exploratory review]

Little is known about the characteristics of the cardiac rehabilitation programs currently implemented in Spain, the aim was therefore to know more about the effectiveness of cardiac rehabilitation in patients with ischemic heart disease in Spain, through an exploratory systematic review of the scientific literature on cardiac rehabilitation carried out in different databases from 2010 to 2018. We reviewed 35 articles whose objective was to measure the effectiveness of cardiac rehabilitation programs from different perspectives. More than twice as many men as women participated and only 8.6% were clinical trials. The studies showed improvements in relation to mortality and physiological and quality of life variables, but with discrepant results in morbidity, moods, maintenance long-term healthy habits and profitability of the programs.

[Design and validation of a complex case evaluation index]

BACKGROUND

The aim was to develop and validate the Complex Case Assessment Index (CCAI), a specific instrument to identify complex patients.

METHODS

Instrumental study in two phases: 1) Development of the scale: the variables extracted from the literature were firstly defined and operationalized, and then submitted for expert judgment. The CCAI included 14 variables divided into two dimensions: complexity of clinical management and complexity of community management. 2) Psychometric study: evaluation of the reliability and validity of the scale by equivalence between observers (Pearson's r), criterion validity with respect to the Clinical Risk Groups (CRG) classification system, and construct validity through known groups and study of hierarchical clusters were examined. The analyses were carried out with the SPSS version 17 statistical package.

RESULTS

Reliability by equivalence between observers was r?=?0.97 for the clinical subscale, r?=?0.74 for the community subscale, and r?=?0.89 for the total score. The CCAI identified 518 cases as complex; 458 of them (88.4%) were categorized by the CRG system in the categories of greatest clinical complexity (levels 6 to 9). The results support the construct validi-ty of the scale. The cluster analysis showed two different, although related, clusters.

CONCLUSION

The CCAI is a fast and easy-to-use index, with good conceptual adequacy and evidence of reliability and validity for screening patients with complex needs.

The Spanish version of the Childbirth Experience Questionnaire (CEQ-E): reliability and validity assessment

BACKGROUND

The Childbirth Experience Questionnaire (CEQ) was originally designed to study women's perceptions of labour and birth. The main objective of our study was to adapt the CEQ to the Spanish context and determine its psychometric properties. This would provide an opportunity to evaluate women's experiences in order to improve evidence in the Spanish context as recommended by national guidelines.

METHODS

The CEQ was translated into Spanish using a standard forward and back translation method (CEQ-E). A convenience sample of 364 women was recruited from 3 Spanish hospitals; all participants were able to read and write in Spanish. Mothers with high risk pregnancies or preterm deliveries were excluded from the study. A self-administered questionnaire on sociodemographic variables was completed by participants before discharge. Data on childbirth variables were obtained from maternity records. Between 1 and 3 months postpartum a postal CEQ-E questionnaire was sent. The CEQ-E structure was examined by a confirmatory factor analysis of polychoric correlations using a diagonally weighted least squares estimator. Reliability was assessed using Cronbach's alpha. Construct validity was conducted by testing differences in CEQ-E scores between known-groups (to differ on key variables).

RESULTS

226 (62.1%) of the recruited participants completed the postal questionnaire. The CEQ-E factor structure was similar to the original one. The Spanish version showed fit statistics in line with standard recommendations: CFI = 0.97; NNFI = 0.97; RMSEA = 0.066; SRMS = 0.077. The internal consistency reliability of the CEQ-E was good for the overall scale (0.88) and for all subscales (0.80, 0.90, 0.76, 0.68 for "own capacity", "professional support", "perceived safety" and "participation", respectively) and similar to the original version. Women with a labour duration ≤ 12 h, women with a labour not induced, women with a normal birth and multiparous women showed higher overall CEQ-E scores and "perceived safety" subscale scores. Women with a labour duration ≤ 12 h and those with previous experience of labour obtained higher scores for the "own capacity" and "participation" subscales.

CONCLUSIONS

The results of this study indicate that the CEQ-E can be considered a valid and reliable measure of women's perceptions of labour and birth in Spain.

[Spanish reference values for the Breastfeeding Self-Efficacy Scale-Short Form BSES-SF]

BACKGROUND

To describe the reference values for the Spanish version of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), considering the differences according to parity and previous breastfeeding experience.

METHODS

Cross-sectional study in five hospitals in Valencia and one in Murcia, Spain, in a convenience sample of 949 in-hospital breastfeeding women, with no medical problems in the mothers or newborns hindering breastfeeding. Data on sociodemographic and obstetric variables, and on breastfeeding self-efficacy, were collected using the BSES-SF. Central tendency, dispersion and percentile data were calculated to generate reference values for the entire sample, and by parity and previous experience.

RESULTS

The level of self-efficacy was significantly lower (p <0.001) among primiparous women (mean =47.67±11.03) or those without previous experience (mean =47.30±11.18) than among multiparas (mean =52.87±10.66) or women with previous experience (mean =53.93±9.93). The P25 and P75 percentiles for the BSES-SF were, respectively, 42 and 59 for the entire sample; 39 and 56 for women without children or without previous experience; 46 and 61 for mothers with children; and 47 and 62 for mothers with previous experience.

CONCLUSIONS

The specific percentiles obtained by parity or previous experience should be considered the reference values for comparing the level of self-efficacy of a given case, and for evaluating and planning educational postpartum support interventions.