Panamanian women׳s experience of vaginal examination in labour: A questionnaire validation

Aimto validate a tool that allows healthcare providers to obtain accurate information regarding Panamanian women׳s thoughts and feelings about vaginal examination during labour that can be used in other Latin-American countries.Methodsvalidation study based on a database from a cross-sectional study carried out in two tertiary care hospitals in Panama City, Panama. Women in the immediate postpartum period who had spontaneous labour onset and uncomplicated deliveries were included in the study from April to August 2008. Researchers used a survey designed by Lewin et al. that included 20 questions related to a patient׳s experience during a vaginal examination.Findingsfive constructs (factors) related to a patient׳s experience of vaginal examination during labour were identified: Approval (Alpha Cronbach׳s 0.72), Perception (0.67), Rejection (0.40), Consent (0.51), and Stress (0.20).Conclusionit was demonstrated the validity of the scale and its constructs used to obtain information related to vaginal examination during labour, including patients’ experiences with examination and healthcare staff performance.Implications for practiceutilisation of the scale will allow institutions to identify items that need improvement and address these areas in order to promote the best care for patients in labour.     

Disabled women׳s maternal and newborn health care in rural Nepal: A qualitative study

Objective

there is little evidence about disabled women?s access to maternal and newborn health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and care seeking. Our study explores disabled women?s experiences of maternal and newborn care in rural Nepal.

Design

we used a qualitative methodology, using semi-structured interviews.

Setting

rural Makwanpur District of central Nepal.

Participants

we purposively sampled married women with different impairments who had delivered a baby in the past 10 years from different topographical areas of the district. We also interviewed maternal health workers. We compared our findings with a recent qualitative study of non-disabled women in the same district to explore the differences between disabled and non-disabled women.

Findings

married disabled women considered pregnancy and childbirth to be normal and preferred to deliver at home. Issues of quality, cost and lack of family support were as pertinent for disabled women as they were for their non-disabled peers. Health workers felt unprepared to meet the maternal health needs of disabled women.

Key conclusions and implications for practice

integration of disability into existing Skilled Birth Attendant training curricula may improve maternal health care for disabled women. There is a need to monitor progress of interventions that encourage institutional delivery through the use of disaggregated data, to check that disabled women are benefiting equally in efforts to improve access to maternal health care.     

Women׳s perceptions of induction of labour outcomes: Results of an online-survey in Germany

Objectiveinduction of labour (IOL) is a common procedure in high income countries. It may be conducted for medical as well as non-medical reasons.Women׳s views on induction of labour have not extensively been evaluated as yet. Also, women׳s preferences for certain methods of induction including alternative and complementary methods need further exploration in order to meet their expectations and needs.Design and settingwe published a short online questionnaire on women׳s views and experiences with IOL.Measurements and findingswe asked for indication and gestational age at induction; method of induction, duration of labour and mode of birth. We also asked for the extent of desired, and experienced support and participation in decision-making. Within four weeks of being online, 698 women answered the questionnaire. Most frequent reasons for induction were postmaturity (51.7%), doctor´s recommendation (31.6%) and medical complications (25.6%). Most women were induced with misoprostol or dinoprostone, but nearly half of the respondents were also offered, or asked for, complementary and alternative methods (CAM). 50% or more women would have preferred more information on alternatives to IOL, methods of IOL, side effects of the drugs, information on alternatives (59.2%) and on the medication (55.3%). Many would have wished for more support (49.9%) with decision-making (55.2%), and more time (54.1%).Key conclusionwomen׳s expectations and needs regarding IOL are widely unmet in current clinical practice.Implications for practicethere is a need for evidence-based information and decisional support for pregnant women who need to decide how to proceed once term is reached.     

Survey of women׳s experiences of care in a new freestanding midwifery unit in an inner city area of London,England – 1: Methods and women׳s overall ratings of care

Objective

to describe and compare women?s choices and experiences of maternity care before and after the opening of the Barkantine Birth Centre, a new freestanding midwifery unit in an inner city area.

Design

telephone surveys undertaken in late pregnancy and about six weeks after birth in two separate time periods, Phase 1 before the birth centre opened and Phase 2 after it had opened.

Setting

Tower Hamlets, a deprived inner city borough in east London, England, 2007–2010.

Participants

620 women who were resident in Tower Hamlets and who satisfied the Barts and the London NHS Trust?s eligibility criteria for using the birth centre. Of these, 259 women were recruited to Phase 1 and 361 to Phase 2.

Measurements and findings

women who satisfied the criteria for birth centre care and who booked antenatally for care at the birth centre were significantly more likely to rate their care as good or very good overall than corresponding women who also satisfied these criteria but booked initially at the hospital. Women who started labour care in spontaneous labour at the birth centre were significantly more likely to be cared for by a midwife they had already met, have one to one care in labour and have the same midwife with them throughout their labour. They were also significantly more likely to report that the staff were kind and understanding, that they were treated with respect and dignity and that their privacy was respected.

Key conclusions and implications for practice

this survey in an inner city area showed that women who chose the freestanding midwifery unit care had positive experiences to report. Taken together with the findings of the Birthplace Programme, it adds further weight to the evidence in support of freestanding midwifery unit care for women without obstetric complications.     

Italian women’s childbirth: a prospective longitudinal study of delivery predictors and subjective experience

Background: Previous research has demonstrated that negative childbirth expectations adversely influence perinatal outcomes. The current research builds on this with Italian mothers-to-be. Objective: The present study (1) explored the influence of cognitive and emotional variables on labour and delivery outcomes and (2) examined how individual characteristics, couple adjustment, and medical factors influence the childbirth experience. Method: 121 Italian primiparous women participated in a prospective longitudinal study where participants completed a set of questionnaires between the 32nd and 37th week of pregnancy and again 30–40 days post-delivery. Results: Binary logistic regression analyses revealed that women with negative childbirth expectations were three times more likely to experience an emergency C-section or an instrumental vaginal delivery. Furthermore, childbirth expectations predicted subjective birth experience. This relationship between expectations and delivery type and the subjective childbirth experience was weak while other variables (such as anxiety, depression, couple adjustment) did not significantly influence delivery type or the subjective childbirth experience. Conclusions: The weak relationship between childbirth expectations and perinatal outcomes renders it necessary to question the nature of the relationship found in previous research, especially considering inconsistencies of the literature on the subject. The current research makes it clear that further research is needed to understand better the relationship between expectations and perinatal outcomes in order to better improve the well-being of mothers-to-be during labour and delivery.     

African American and White women׳s perceptions of weight gain,physical activity,and nutrition during pregnancy

ObjectiveTo describe African American and White women’s perceptions of weight gain, physical activity, and nutrition during pregnancy and to explore differences in perceptions by race.DesignQualitative interview study.SettingTwo Ob/Gyn clinics in South Carolina, USA.ParticipantsThirty pregnant women (15 African American, 15 White) between 20 and 30 weeks gestation, equally represented across pre-pregnancy BMI categories (10 normal weight, 10 overweight, and 10 obese).FindingsWhite women more frequently described intentions to meet weight gain, physical activity, and dietary guidelines in pregnancy than African American women. African American women were more concerned with inadequate weight gain while White women more commonly expressed concerns about excessive weight gain. More White women discussed the importance of physical activity for weight management. Regardless of race, few women described risks of excessive weight gain or benefits of physical activity as it relates to the baby’s health. The primary cited barrier of healthy eating was the high cost of fresh produce.Key conclusions and implications for practiceSeveral knowledge gaps as well as race differences were identified in women’s perceptions and intentions toward weight gain, physical activity, and nutrition during pregnancy. Future interventions should seek to educate women about common misperceptions. It may be necessary to culturally tailor gestational weight gain interventions to optimise health outcomes.     

Unique and proforma birth plans: A qualitative exploration of midwives׳ experiences

Background

birth plans detailing a woman?s preferences for intrapartum care are a common feature in British maternity units, and are a means of encouraging the implementation of choice. Proforma versions may be incorporated routinely in antenatal case notes, or the woman may devise her own unique birth plan. Although women?s views of birth plans have been explored, the views of midwives have not to date been evaluated. The growth of midwife-led units in the UK has highlighted different philosophies of care, some of which can be reflected in the different types of birth plan. Given the increasingly diverse nature of UK midwifery workplaces we set out to explore and compare the experience of midwives working in midwife-led and obstetric-led settings in relation to unique and proforma birth plans.

Method

qualitative study using focus groups of midwives in a midwife-led unit (MLU; n=5) and obstetric-led unit (OLU; n=4) in the East of England. We used an interpretative phenomenological analytical approach.

Findings

three main themes arose from the data. Firstly, the term ‘birth plan’ can be misleading, and was criticised for encouraging the belief that birth can be ‘planned’. In addition, midwives claimed that ‘unique’ birth plans, especially those influenced by some consumer advocacy groups, are becoming standardised in their rejection of policies and procedures and requests for intervention-free birth. Secondly, birth plans were a source of irritation for midwives in both groups, although the cause of the irritation differed between groups. Finally, it was found that midwives in both groups felt that birth plans put pressure on them, although again, the source of the pressure, and therefore the way in which midwives reacted to this pressure, differed between groups.

Conclusions

the term ‘birth plan’ can be misleading and create false expectations. If ‘unique’ birth plans are becoming ‘standardised’ in the sense that they routinely request the same things, they are little different to proforma birth plans. Some midwives perceive pressure both from women and the wider multidisciplinary team as a result of birth plans, a perception that causes some irritation.     

Pregnancy outcomes in women with Ebstein’s anomaly

Objectives

To evaluate whether women with Ebstein’s anomaly can tolerate pregnancy and whether the perinatal outcomes are influenced by the severity of Ebstein’s anomaly.

Methods

Data of four women with Ebstein’s anomaly delivered in our unit were collected and analyzed retrospectively.

Results

(1) Two women with Ebstein’s anomaly had uneventful pregnancies, cesarean section and puerperium. (2) The patient with the most serious Ebstein’s anomaly (with central cyanosis and clubbing) had an episode of paroxysmal ventricular tachycardia and spontaneous cardioversion to sinus rhythm on day 4 postpartum. She developed intracerebral hemorrhage on day 25 postpartum. (3) One of them suffered from atrial flutter on 38?+?3?weeks of gestation which was restored to sinus rhythm after being treated with verapamil and remained stable afterward. (4) All neonatal birth weights were more than 2,500?g, and all neonatal Apgar scores were 10 at 1?min. (5) The gestational age at delivery of our cases was from week 36?+?4 to week 38?+?4. The mean duration of follow-up was 56?days postpartum.

Conclusions

(1) The clinical features of pregnant women with Ebstein’s anomaly vary. They might have good perinatal outcomes when given appropriate treatment. (2) Those with cyanosis should be given more attention, as they can have more complications during pregnancy, delivery and puerperium. (3) All women with Ebstein’s anomaly should be offered fetal echocardiography during pregnancy. (4) Vaginal delivery is advised for most cases with Ebstein’s anomaly.     

Do low-risk nulliparous women with abnormal uterine artery Doppler in the third trimester have poorer perinatal outcomes? A longitudinal prospective study on uterine artery Doppler in low-risk nulliparous women and correlation with pregnancy outcomes

Objective: To evaluate uterine artery (UtA) Doppler over the course of pregnancy in low-risk nulliparous women and to analyze whether an abnormal uterine artery pulsatility index (UtA-PI) at a 32–34 week’ scan implies poorer perinatal outcomes.

Methods: An observational prospective study was carried out including 616 low-risk nulliparous women. Women with any of the following were excluded: fetal abnormalities, multiple pregnancy, and heparin, metformin or hypotensive treatment. Maternal characteristics, mean arterial pressure measurements and UtA Doppler findings were recorded longitudinally.

Results: Complete pregnancy data were available for 489/616 women (79.3%). Of these, 385 women had a normal UtA-PI throughout pregnancy (Group 0), while 50 (10.1%) had an UtA-PI?>?95th percentile in the first or the second trimester that normalized in the third trimester (Group 1), and 56 (11.4%) had an abnormal UtA-PI in the third trimester (Group 2). We found that the rate of pre-eclampsia (PE) was higher in Group 2 (7/56 versus 4/435, p?=?0.003) as was the rate of intrauterine growth restriction (IUGR) (6/56 versus 14/435, p?=?0.02).

Conclusions: Low-risk nulliparous women with abnormal UtA Doppler findings in the third trimester are at a higher risk of developing PE and having a baby with IUGR.     

Does stress affect IVF outcomes? A prospective study of physiological and psychological stress in women undergoing IVF

Research questionWhat are the effects of physiological and psychological stress on fertility outcomes for women undergoing IVF?DesignA prospective cohort study of 72 patients undergoing IVF in 2017 and 2018. Physiological stress was assessed by salivary cortisol measurements: (i) pretreatment, when the patient received the IVF protocol; (ii) before oocyte retrieval (follicular cortisol was also measured); and (iii) before embryo transfer. Emotional stress was evaluated at each assessment with the State-Trait Anxiety Inventory and a 1–10 Visual Analogue Scale (VAS, referred to as the ‘Stress Scale’. Correlations between cortisol concentrations, psychological stress and IVF outcome were assessed.ResultsSalivary cortisol concentrations increased by 28% from pretreatment phase (0.46 ± 0.28 μg/dl) to maximum concentration on oocyte retrieval day (0.59 ± 0.29 μg/dl, P = 0.029) and then decreased by 29% on embryo transfer day (0.42 ± 0.23 μg/dl, P = 0.0162). On embryo transfer day, cortisol among women in their first cycle was higher than women who underwent more than one treatment (P = 0.024). Stress Scale score increased by 39% from pretreatment to a maximum score on oocyte retrieval day and then decreased by 12% on embryo transfer day. Salivary cortisol and Stress Scale were not related to subsequent embryo transfer, fertilization rate, embryo quality or clinical pregnancy rate. Follicular cortisol concentration was positively correlated with fertilization rate (r = 0.4, P = 0.004).ConclusionIt can be cautiously concluded that physiological and psychological stress do not negatively affect IVF outcomes. Moreover, high follicular cortisol concentrations might have positive effects on pregnancy rates.     

Does prenatal screening influence anxiety levels of pregnant women? A longitudinal randomised controlled trial

OBJECTIVES: Questions addressed are: (1) Does offering prenatal screening increase anxiety? (2) Does receiving a negative screening result make women less anxious and does a positive screening result make women more anxious? (3) What are the long-term consequences on anxiety of offering screening and receiving a screening result? METHODS: Women were offered prenatal screening or no screening in a randomised controlled trial. State anxiety (STAI) and child-related anxiety (PRAQ-R) were measured. Questionnaires were filled in before prenatal screening was offered (T1), after the offer (T2), after the test result (T3), and in the third trimester of pregnancy (T4). RESULTS: Child-related anxiety levels were higher in women who chose to be screened compared to women who declined screening. Offering prenatal screening did not lead to increased anxiety levels. General anxiety increased in positively screened women, but decreased later in pregnancy. Women who were negatively screened or declined screening scored lower than the control group. CONCLUSION: For most women, offering prenatal screening and receiving the test result do not adversely affect anxiety. Giving pregnant women a choice to have prenatal screening done seems to have a small favourable effect on general feelings of anxiety.     

The inconvenience due to women’s monthly bleeding (ISY) survey: a study of premenstrual symptoms among 5728 women in Europe

Objectives: The aim of the ISY study was to investigate the prevalence of menstrual-related symptoms prior to and/or during menstrual or withdrawal bleeding among women from 12 European countries.

Methods: A 15-min quantitative online survey was conducted in two waves from February to September 2015 among 5728 women aged between 18 and 45 years, with an equal distribution of women using a combined hormonal contraceptive, including regular combined oral contraceptives (COCs) (CHC group, n?=?2739) and women using a non-hormonal contraceptive or no contraceptive (non-HC group, n?=?2989).

Results: The prevalence of at least one menstrual-related symptom was high in CHC users (93%) and in non-HC users (95%) (p?p?Conclusions: Premenstrual and menstrual symptomatology was less frequent, less numerous and less severe (except for headache) in women using CHCs; however, it remains a common concern. Reducing the frequency of menstrual periods could reduce withdrawal-related symptoms.     

Young women’s intentions to delay childbearing: A test of the theory of planned behaviour

Objectives: The general purpose of the present study was to examine the applicability of the theory of planned behaviour (TPB) in accounting for young women’s intentions to delay childbearing. Background: TPB has been successfully applied in numerous studies examining intentions to have/not have a child but, to date, intentions to delay childbearing has not been explicitly examined within this framework. The present study addresses this gap by examining childless women’s intentions to delay motherhood within the framework of the TPB. Methods: Sixty-nine young, childless women (M_age = 21.0) completed a self-administered TPB questionnaire encompassing intentions to delay childbearing past the age of 30 and measures of attitudes, subjective norms, perceived control, as well as the beliefs underlying these global constructs. Results: Attitudes, subjective norms, and perceived control all significantly contributed to account for 61% of the variance in intentions to delay childbearing past the age of 30, but perceived control emerged as the most significant predictor, accounting for 24% of the unique variance. Following a targeted examination of the belief structure underlying perceptions of control over delayed childbearing, five control beliefs emerged as significantly related to the global measure of perceived control. These beliefs were related to personal health, fertility, and belief that one will be in a stable relationship in the future. Confidence in the longevity of fertility was the prime contributor to perceptions of control. Conclusion: The results provide preliminary support for the applicability of the TPB model in accounting for intentions to delay childbearing among a sample of young childless women.