Caroline J. Hollins Martin

The birth satisfaction scale

PURPOSE The purpose of this paper is to develop a psychometric scale--the birth satisfaction scale (BSS)--for assessing womens birth perceptions. DESIGN/METHODOLOGY/APPROACH Literature review and transcribed research-based perceived birth satisfaction and dissatisfaction expression statements were converted into a scored questionnaire. FINDINGS Three overarching themes were identified: service provision (home assessment, birth environment, support, relationships with health care professionals); personal attributes (ability to cope during labour, feeling in control, childbirth preparation, relationship with baby); and stress experienced during labour (distress, obstetric injuries, receiving sufficient medical care, obstetric intervention, pain, long labour and babys health). RESEARCH LIMITATIONS/IMPLICATIONS Women construct their birth experience differently. Views are directed by personal beliefs, reactions, emotions and reflections, which alter in relation to mood, humour, disposition, frame of mind and company kept. Nevertheless, healthcare professionals can use BSS to assess womens birth satisfaction and dissatisfaction. Scores measure their service quality experiences. SOCIAL IMPLICATIONS Scores provide a global measure of care that women perceived they received during labour. ORIGINALITY/VALUE Finding out more about what causes birth satisfaction and dissatisfaction helps maternity care professionals improve intra-natal care standards and allocate resources effectively. An attempt has been made to capture birth satisfactions generalised meaning and incorporate it into an evidence-based measuring tool.

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 womens perceptions of: (1) quality of care provision, (2) womens 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) womens 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 womens 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.

Concurrent analysis: validation of the domains within the Birth Satisfaction Scale

Background and aim: Measuring women’s satisfaction with their birth experience has been problematic. Recently, an attempt has been made to capture birth satisfaction’s generalised meaning and incorporate it into an evidenced-based tool. Standard procedures for validation have limitations. Qualitative techniques such as domain analysis offer an alternative and assist in better understanding the importance of each item. This article examines the parsimony of the Birth Satisfaction Scale (BSS), which is a 30-item questionnaire designed to measure satisfaction with childbirth, with women’s actual experience of childbirth. Methods: Primary free text data collected from 207 women who originally tested the BSS was concurrently analysed with first-hand accounts of birth satisfaction collected from 19 qualitative papers. Results: The domain analysis confirmed three explanatory items within the BSS: ‘being in control’, ‘things going as planned’, and ‘being supported’. Conclusions: The BSS accounts for all the analysed data, suggesting it is a robust measure of satisfaction in childbirth. Strengths and limitations of the method are discussed, as are implications for practice. With further development, the instrument could be used to establish correlates with other psychometric measures, i.e. self-efficacy, anxiety, depression, locus of control and bonding; and evaluate models or care systems as a standalone instrument, or as a screening test prior to detailed qualitative work.

The psychological impact of Female Genital Mutilation/Cutting (FGM/C) on girls/women’s mental health: a narrative literature review

Background: Female Genital Mutilation/Cutting (FGM/C) is the procedure of removing healthy external genitalia from girls/women for socio-cultural reasons. There is much scientific literature on the adverse physical health complications that can result from having FGM/C, but little is known about its psychological impact and treatment. Objective: To identify psychological problems that may follow from a woman having FGM/C and success of treatment herein, and relate findings to the role of the maternity care professional. Study design: A structured narrative review, which identified 10 studies, was carried out. Findings: Eight of ten studies reported psychological consequences, such as Post-Traumatic Stress Disorder (PTSD) and affective disorders. Also identified were socio-cultural differences in the meaning of perceived consequences for different individuals. Two studies reported inconclusive results regarding the psychological impact of FGM/C on women’s lives. Key conclusion: While these findings provide an indication of adverse psychological effects of women/girls having FGM/C, more studies are needed. In particular, studies that focus on the role that cutting extent, circumstances surrounding the cutting, and girls’ level of knowledge of what was going to take place, and their relationships to psychological outcomes. Implications for Practice: Raising awareness of the risk of negative psychological consequences is important, with maternal health care professionals requiring training on how to treat and care for women/girls who are suffering problems that result from having FGM/C.

Psychometric properties of the Birth Satisfaction Scale-Revised (BSS-R) for US mothers

Objective: The aims of this study were to continue the scale development process of the Birth Satisfaction Scale-Revised (BSS-R) by refining the scale to make it culturally relevant for US participants, examining the factor structure of the BSS-R, and describing the level of birth satisfaction in a sample of US mothers. Background: The Birth Satisfaction Scale (BSS) was developed in the UK to assess satisfaction of the childbearing women’s experiences of labour and its outcomes. One of the goals of the development of the BSS was to make comparisons across cultures. Methods: One hundred and eighty-one first-time US mothers participated in this study. Confirmatory factor analysis was used to examine a one-factor higher-order model containing three lower-order factors. The higher-order factor was hypothesised to be Experience of childbearing; the lower-order factors were hypothesised as Stress, Quality of Care and Women’s attributes. Results: The results of the higher-order factor model indicated good fit, χ2 = 37.72, p = .22; comparative fit index (CFI) = .99; root mean square error of approximation (RMSEA) = .03; standardised root mean square residual (SRMR) = .04. Cronbach’s α indicated the subscales and total scale were reliable for the US sample (α ranged from .74 to .89). The BSS-R total score was 15.52 (SD = 8.35), and the stress, quality of care, and women’s attributes subscales were 7.15 (SD = 3.80), 4.61 (SD = 3.83) and 3.79 (SD = 2.26), respectively. Conclusion: The BSS-R can provide maternal health professionals and researchers with an instrument to quantify childbearing women’s birthing satisfaction, which in turn can assist in heightening the overall patient care experience.

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.

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.

Construct and content validity of the Greek version of the Birth Satisfaction Scale (G-BSS)

Background: ‘Birth Satisfaction’ is a term that encompasses a woman’s evaluation of her birth experience. The term includes factors such as her appraisal of the quality of care she received, a personal assessment of how she coped, and her reconstructions of what happened on that particular day. Her accounts may be accurate or skewed, yet correspond with her reality of how events unfolded. Objective: To evaluate properties of an instrument designed to measure birth satisfaction in a Greek population of postnatal women. Study design: We assessed factor structure, internal consistency, divergent validity and known-groups discriminant validity of the 30-item Greek Birth Satisfaction Scale – Long Form (30-item G-BSS-LF) and its revised version the 10-item Greek-BSS-Revised (10-item-G-BSS-R), using survey data collected in Athens. Participants: A convenience sample of healthy Greek postnatal women (n = 162) aged 22–46 years who had delivered between 34 and 42 weeks’ gestation. Results: The 30-item-G-BSS-LF performed poorly in terms of factor structure. The short-form 10-item-G-BSS-R performed well in terms of measurement replication of the English equivalent version as a multidimensional instrument. The short-form 10-item-G-BSS-R comprises three subscales which measure distinct but correlated domains of: (1) quality of care provision (4 items), (2) women’s personal attributes (2 items), and (3) stress experienced during labour (4 items). Key conclusions: The 10-item-G-BSS-R is a valid and reliable multidimensional psychometric instrument for measuring birth satisfaction in Greek postnatal women.

Crossing borders: discussing the evidence relating to the mental health needs of women exposed to female genital mutilation.

The terms ‘Female Circumcision’ (FC), ‘FG Cutting’ (FGC) and ‘FG Mutilation’ (FGM) refer to procedures involving the partial or total removal of the external female genitalia for non-medical reasons. In practicing countries, FGC/FC is more widely used, as it is believed to be inoffensive, providing more impartial ways of discussing the practice. Positive beliefs about FC/FGC include virginity, marriage prospects, family reputation, or passage to adulthood. Regardless of terminology, the practice exists in at least 28 African counties, and a few Asian and Middle Eastern countries. In Western society, FGM is considered a breach of human rights, being outlawed in a number of countries. With immigration trends, FGC is now prominent in Western society among practicing communities. While the past decade has seen an increase in studies and recommendations for health-care support related to the physical health consequences of FGM, little is known about the psychological impact and its management. For many girls and women, FGC is a traumatic practice, transforming it to FGM and affecting their mental health. This discussion paper focuses on evidence relating to the mental health consequences of FGM, therapeutic interventions, and the mental health nurses role in addressing the needs of this group of women.

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, womens 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 womens experiences of childbirth between variables such as birth types, birth settings and providers.