The development of the Slade–Pais Expectations of Childbirth Scale (SPECS)*

Objective: To develop a valid and reliable English language-based scale to measure pregnant women’s expectations of childbirth.

Background: During pregnancy, most women think about their forthcoming childbirth, and develop expectations of how they think this experience will be. Women with adverse expectations of childbirth have been found to have more negative actual experiences. Measuring expectations is therefore important. Existing measures are limited in their established psychometric properties.

Methods: Items were generated from semi-structured interviews with 18 pregnant women to explore their expectations of their forthcoming childbirth. Content analysis was used to analyse interview data and scale items were developed using the constructs extracted. A population sample of 148 pregnant women completed the initial 85-item version of the Slade–Pais Expectations of Childbirth Scale (SPECS) and the State Trait Anxiety Inventory.

Results: Principal components analysis of the SPECS identified six underlying components labelled ‘coping and robustness to pain’, ‘staff and service responsive to needs’, ‘fear’, ‘out of control and embarrassed’, ‘perceptions of partner’s coping’ and ‘positive anticipation of birth’. Items with poor psychometric properties were excluded. A final 50-item version of the SPECS showed acceptable internal reliability and good content and construct validity.

Conclusion: The SPECS shows promising psychometric robustness for use both as a research and clinical tool. It can be used as a total score, as a shortened scale focussed only on expectations of self, or as a series of subscales covering all domains.     

A Longitudinal Survey of Childbirth‐Related Fear and Associated Factors

ObjectiveTo investigate the prevalence of childbirth‐related fear from pregnancy to one year after childbirth and to identify factors associated with being cured of childbirth‐related fear.DesignA longitudinal regional survey.SettingThree hospitals in a northern part of Sweden.ParticipantsSix hundred ninety‐seven (697) women who completed four questionnaires.MethodsData were collected by questionnaires in mid and late pregnancy and at 2 months and one year after birth. Childbirth related fear was measured 3 times.ResultsThere was a statistically significant increase in childbirth fear from 12.4% in mid‐pregnancy to 15.1% one year after childbirth (p < .001). Women who were cured of childbirth fear reported a better birth experience and would prefer a vaginal birth in a subsequent pregnancy. These women were also more likely to experience a feeling of control during birth and were more satisfied with information about the progress of labor, but there was no difference in prenatal counseling or having an elective cesarean between the groups.ConclusionWomen with prenatal fear of childbirth may be cured of this fear by having a better birth experience. If women feel in control of their bodies and are well informed about the progress of labor, the chances of being cured will increase. Prenatal counseling or having an elective cesarean birth does not seem to be a solution for relieving childbirth fear.     

Self‐Efficacy in Pregnant Women with Severe Fear of Childbirth

ObjectiveTo apply and test the concept of childbirth self‐efficacy to expectations of the upcoming birth in the context of severe fear of childbirth (SFOC).DesignQualitative study using semistructured interviews.SettingA region in the southeast of Sweden.ParticipantsNulliparous pregnant women (N = 17) with SFOC.MethodThe interviews were analyzed according to content analysis using deductive and inductive approaches. The seven domains of The Childbirth Self‐Efficacy Inventory (CBSEI) made up the matrix for the deductive analysis.ResultsBehaviors for coping with labor and childbirth were related to six domains of childbirth self‐efficacy: concentration, support, control, motor/relaxation, self‐encouragement, and breathing. Most of these behaviors referred to capabilities to carry out (self‐efficacy expectancy) rather than to beliefs in effectiveness (outcome expectancy). Five additional subdomains representing defined childbirth self‐efficacy were identified: guidance, the body controls, the professionals’ control, reliance, and fatalism.ConclusionThe domains of childbirth self‐efficacy have been deepened and expanded in relation to SFOC. It is imperative to identify pregnant women with SFOC and their efficacy beliefs to help them find appropriate coping behaviors prior to the onset of labor, and furthermore these behaviors must be supported by health care professionals during labor and childbirth. Support in the form of verbal persuasion emanating from the subdomains of childbirth self‐efficacy ought to be added.     

Does Motherhood Affect the Quality of Life of Adolescents?

Study ObjectiveAssess the quality of life (QOL) of female adolescents with children compared to those without children.DesignCross-sectional.SettingPublic university-affiliated family planning clinic, São Paulo, Brazil.Participants91 female adolescents (16-19 years) of low socio-economic status with and without children.InterventionsThe Portuguese version of the WHOQOL-BREF questionnaire was used.Outcome MeasuresMean scores of the 4 main domains were compared between adolescents with and without children.ResultsBoth mothers (N = 40) and nonmothers (N = 51) had low mean scores (<75%) in most of the QOL domains. Compared to adolescents without children, adolescent mothers scored significantly lower in the physical (52.1 vs 59.4, P = .0137) and social (66.9 vs 77.3, P = .0182) domains.ConclusionAdolescent mothers have a significantly lower quality of life in the physical and in the social relationships domains than nonmothers.     

What Constitutes a Good Childbirth? A Qualitative Study of Pregnant Finnish Women

The aim of this study was to describe pregnant Finnish women's perceptions of a good childbirth. Data were collected through semistructured interviews in maternity health care clinics and maternity hospitals. Data interpretation was based on content analysis. A purposive sample of 24 pregnant women aged 19 to 45, half of them expecting their first child, were interviewed. Five main issues were seen by informants as important in the course of childbirth: 1) unhurried atmosphere, 2) normality, 3) reasonable duration of labor, 4) security, and 5) control. Participants did not expect much from their birth companions, although some mentioned various tasks for them. The three main issues considered important for the role of staff were the professionals'1) personal characteristics, 2) attitudes toward the childbearing woman, and 3) way they acted. The question about the physical environment was found quite irrelevant by some women, and only a few had special wishes related to the birthing environment. None of the participants voiced opposition to obstetric interventions, but some were willing to avoid them if possible. Informed consent for interventions was seen as very important. These results suggest that health care providers are challenged to provide individualized care for every woman.     

Trial of Labor After Cesarean in Adolescents – A Multicenter Study

Study ObjectiveData regarding trial of labor after cesarean delivery (TOLAC) among young women are limited. The aim of this study was to assess the TOLAC success rate and its related factors among adolescent women who had never delivered vaginally.DesignA multicenter retrospective cohort study of all adolescent women aged ≤21 years with a history of 1 previous cesarean delivery, who delivered in 2 tertiary medical centers during 2007-2019. Women were allocated to 2 groups: 1) women who underwent TOLAC, and 2) women who had a repeat cesarean delivery with no trial of labor. Maternal and neonatal outcomes were compared between the two groups. In addition, perinatal outcomes were compared between women with successful and unsuccessful TOLAC.ResultsThe study cohort included 167 women who had a previous caesarean delivery; 117 underwent TOLAC and 50 underwent a repeat cesarean delivery with no trial of labor. Neonatal birthweight (median 2937 vs 3170 g, P = .03) and gestational age at delivery (median 38 weeks vs 39, P = .009) were lower in the repeat cesarean group as compared to those undergoing TOLAC. Overall, 97 of 117 participants (83%) had a successful TOLAC. Failed TOLAC was associated low birthweight as compared to successful TOLAC (5 [25%] vs 7 [7%], odds ratio [OR] 4.3, 95% confidence interval [CI] 1.2-15.3, P = .02), and birthweight difference between current and previous deliveries was higher in the failed TOLAC group (median 315 vs 197 g, P = .04). Rates of neonatal Apgar score at 1 minute < 7 and of neonatal intensive care unit admission were higher in the TOLAC failure group (4 [20%] vs 5 [5%], OR 4.6, 95% CI 1.1-19.0, P = .03, and 4 [20%] vs 4 [4%], OR 5.8, 95% CI 1.3-25.6, P = .02), respectively). In a multivariable logistic regression analysis, only low birthweight was independently associated with TOLAC failure (adjusted OR 9.9, 95% CI 2.1-45.4, P = .003). Two cases of uterine rupture occurred in the no trial of labor group, whereas none were encountered in participants undergoing TOLAC.ConclusionsTOLAC in adolescent women who had never delivered vaginally is associated with a relatively high success rate.     

Adolescents: Is there an association between knowledge of oral contraceptives and profession of provider?

Knowledge about oral contraceptives (OCs) was investigated among young users of OCs by profession of provider, namely, physician or public health nurse. A 44-item questionnaire designed to assess communication about contraception and knowledge of OCs was distributed to students in 11 of 13 high schools in Trondheim, Norway. Data from 688 OC users were eligible for analyses. Knowledge about OCs was measured by means of 15 questions, from which scores on three separate indices and a total index were determined. Separate indices included knowledge about physical changes during OC use (index I), knowledge about the pill's relative efficacy (index II) and knowledge about risks of cancer/thromboembolism (index III). Logistic regression analyses showed that high scores with regard to knowledge indices were predicted by sexual activity and communication about contraception with peers and/or parents. Profession of provider was not associated with high knowledge scores. Information given during brief and annual discussions with health professionals appears to have an insignificant impact as compared with information from other sources. Our results plead for an over-the-counter practice.     

Is the Childbirth Experience Improved by a Birth Plan?

From antenatal clinics in Sweden, 271 women were recruited after week 33 of pregnancy and given a questionnaire designed to assess their attitudes and feelings about the coming childbirth. Thereafter, they formulated a birth plan. The midwife in attendance at the birth was able to refer to this plan. Women who followed this program were compared with women from the same clinics who were asked to complete a questionnaire during the first postpartum week to assess their birth experience. A questionnaire at the end of pregnancy, followed by a birth plan, was not effective in improving women's experiences of childbirth. In the birth plan group, women gave significantly lower scores for the relationship to the first midwife they met during delivery, with respect to listening and paying attention to needs and desires, support, guiding, and respect. Although a birth plan did not improve the experience of childbirth in the overall group, there may be beneficial effects with regard to fear, pain, and concerns about the newborn for certain subgroups of women.     

How Young does Vulvo-Vaginal Pain Begin? Prevalence and Characteristics of Dyspareunia in Adolescents

IntroductionDyspareunia remains under-investigated despite recent population-based studies indicating that its prevalence ranges from 12% to 21% in adult women. Although clinical data suggest that dyspareunia can begin during adolescence, a large-scale epidemiological study has yet to be conducted with this population.AimsTo determine the prevalence and characteristics of dyspareunia in a large-scale sample of adolescents, in addition to the characteristics of vulvo-vaginal insertion pain in nonsexual contexts.MethodsWith written informed consent, data were obtained from 1,425 girls (12–19-year-olds), from seven metropolitan high schools during regular school hours using a self-report questionnaire.Main Outcome MeasuresDyspareunia prevalence was evaluated by asking sexually active participants whether or not they regularly (at least 75% of the time) experienced pain during intercourse. Pain duration, context of onset, location, intensity, and pain during tampon insertion and pelvic exams were evaluated.ResultsResults revealed that 20% of sexually active girls (N = 251) reported having regular pain during intercourse for at least 6 months or more. A primary form of pain was reported by 67% of adolescents and significantly more girls with chronic dyspareunia identified the vaginal opening (39%; $\stackrel{\_}{x}$ = 3.9/10) as being their most painful site compared with internal pain sites (18–29%; $\stackrel{\_}{x}$ 2.9?3.2/10) (P = 0.042). Chronic dyspareunia cases reported significantly more pain during first and usual tampon insertion (P = 0.003; P = 0.009) than pain-free controls, while no difference was found between groups regarding pelvic exams (P = 0.086). Experiencing severe pain at first tampon insertion was linked to a fourfold risk of reporting chronic dyspareunia (P = 0.001).ConclusionsResults mirror prevalence estimates found in population-based studies with adult women and suggest that chronic dyspareunia is a significant sexual health problem in adolescent girls, with pain extending beyond intercourse to nonsexual contexts. Landry T, and Bergeron S. How young does vulvo-vaginal pain begin? Prevalence and characteristics of dyspareunia in adolescents. J Sex Med **;**:**–**.     

Health Care Provider Attitudes about the Safety of “Quick Start” Initiation of Long-Acting Reversible Contraception for Adolescents

Study ObjectiveTo identify characteristics associated with provider attitudes on the safety of “Quick Start” initiation of long-acting reversible contraception (LARC) for adolescents.Design, Setting, Participants, Interventions, and Main Outcome MeasuresWe conducted a cross-sectional survey of providers in public-sector health centers and office-based physicians (n = 2056) during 2013-2014.ResultsOverall, the prevalence of considering “Quick Start” initiation of LARC for adolescents as safe was 70.9% for implants and 64.5% for intrauterine devices (IUDs). Among public-sector providers, those not trained in implant or IUD insertion had lower odds of perceiving the practice safe (adjusted odds ratio [aOR], 0.32; 95% confidence interval [CI], 0.25-0.41 for implants; aOR 0.42; 95% CI, 0.32-0.55 for IUDs), whereas those practicing at health centers that did not receive Title X funding had lower odds of perceiving the practice safe for IUDs (aOR, 0.77; 95% CI, 0.61-0.98). Among office-based physicians, lack of training in LARC insertion was associated with lower odds of perceiving “Quick Start” initiation to be safe for IUDs (aOR, 0.31; 95% CI, 0.12-0.77). Those specializing in adolescent medicine had higher odds of reporting “Quick Start” initiation of LARC as safe (implants: aOR, 2.21; 95% CI, 1.23-3.98; IUDs: aOR, 3.37; 95% CI, 1.39-8.21) compared with obstetrician-gynecologists.ConclusionApproximately two-thirds of providers considered “Quick Start” initiation of LARC for adolescents safe; however, there were differences according to provider characteristics (eg, Title X funding, training in LARC insertion, specialty). Targeted LARC insertion training and dissemination of evidence-based family planning guidance and implementation into facility and practice-level policies might increase access to “Quick Start” initiation of LARC for adolescents.     

Evaluation of the Pro-inflammatory Cytokine Tumor Necrosis Factor-α in Adolescents with Polycystic Ovary Syndrome

BackgroundPatients with polycystic ovary syndrome (PCOS) often suffer from comorbidities associated with chronic inflammation characterized by elevations in pro-inflammatory cytokines. There is limited data on markers of chronic inflammation, in particular Tumor Necrosis Factor-alpha (TNF-α), in adolescents with PCOS.ObjectivesTo compare serum levels of TNF-α in overweight or obese adolescents with PCOS and obese controls. In the PCOS group, to correlate serum TNF-α levels with body mass index (BMI) z-score, severity of hyperandrogenism, degree of insulin resistance, and ovarian ultrasonographic characteristics.MethodsWe performed a cross-sectional retrospective analysis of clinical and biochemical findings in 23 overweight or obese adolescent females with PCOS (mean BMI z-score 2, mean age 15.2 yrs) and 12 obese age- and sex-matched controls (mean BMI z-score 2, mean age 14.1 y). All subjects were post-menarchal. Serum TNF-α levels were compared between groups. In the PCOS group, cytokine levels were correlated with BMI z-score, androgen levels, fasting insulin and glucose levels as well as ovarian ultrasonographic features.ResultsBoth groups were comparable in age, BMI z-score, fasting glucose, and fasting insulin. Mean free testosterone was 9.76 ± 5.13 pg/mL in the PCOS group versus 5 ± 2.02 pg/mL in the control group (P = .0092). Serum TNF-α was 7.4 ± 4 pg/mL in the PCOS group versus 4.8 ± 3.16 pg/mL in the control group (P = .0468). There was no significant correlation between serum TNF-α and BMI z-score, free testosterone, fasting insulin, or fasting glucose. No correlation existed between serum TNF-α and ovarian follicle number, distribution, or volume.ConclusionsSerum TNF-α is elevated in overweight/obese adolescents with PCOS. Chronic inflammation in adolescents with PCOS render them at a potential increased risk for the development of atherosclerosis, type 2 diabetes, cancer, infertility, and other comorbidities. Every effort should be made to identify adolescents with PCOS early and initiate aggressive therapy to prevent future complications.