Maggie Redshaw

Fathers’ engagement in pregnancy and childbirth: evidence from a national survey

BackgroundEarly involvement of fathers with their children has increased in recent times and this is associated with improved cognitive and socio-emotional development of children. Research in the area of father’s engagement with pregnancy and childbirth has mainly focused on white middle-class men and has been mostly qualitative in design. Thus, the aim of this study was to understand who was engaged during pregnancy and childbirth, in what way, and how paternal engagement may influence a woman’s uptake of services, her perceptions of care, and maternal outcomes.MethodsThis study involved secondary analysis of data on 4616 women collected in a 2010 national maternity survey of England asking about their experiences of maternity care, health and well-being up to three months after childbirth, and their partners’ engagement in pregnancy, labour and postnatally. Data were analysed using descriptive statistics, chi-square, binary logistic regression and generalised linear modelling.ResultsOver 80% of fathers were ‘pleased or ‘overjoyed’ in response to their partner’s pregnancy, over half were present for the pregnancy test, for one or more antenatal checks, and almost all were present for ultrasound examinations and for labour. Three-quarters of fathers took paternity leave and, during the postnatal period, most fathers helped with infant care. Paternal engagement was highest in partners of primiparous white women, those living in less deprived areas, and in those whose pregnancy was planned. Greater paternal engagement was positively associated with first contact with health professionals before 12xa0weeks gestation, having a dating scan, number of antenatal checks, offer and attendance at antenatal classes, and breastfeeding. Paternity leave was also strongly associated with maternal well-being at three months postpartum.ConclusionsThis study demonstrates the considerable sociodemographic variation in partner support and engagement. It is important that health professionals recognise that women in some sociodemographic groups may be less supported by their partner and more reliant on staff and that this may have implications for how women access care.

Mode of birth and women’s psychological and physical wellbeing in the postnatal period

BackgroundPhysical and psychological problems after childbirth are common, and may have a significant negative and long-term impact on women’s wellbeing and daily functioning. The method of birth may be a particularly important factor influencing women’s health and wellbeing following birth, however, population-wide evidence is limited. This study uses data from 5,332 women who responded to a national survey of women’s experiences of maternity care in England. We examined women’s postnatal wellbeing in the first three months after birth, and whether these varied by mode of birth.MethodsThis is a secondary analysis of survey data using a random sample of women selected from birth registration. We used multinomial logistic regression models to examine the association between women’s self-reported psychological symptoms, health problems and mode of birth.ResultsWomen who had forceps-assisted vaginal births and unplanned caesarean section births reported the poorest health and wellbeing, while those of women who had unassisted vaginal births and planned caesarean section births were less affected by the birth process. Most women’s physical and emotional health appeared to improve with time, however, those who had a forceps-assisted vaginal birth were more likely to report ongoing posttraumatic-type symptoms several months after the birth.ConclusionsMode of birth was associated with differences in outcomes at three months. By comparison to women who had unassisted vaginal births, the risk of reduced postnatal health and wellbeing was higher amongst the women who had forceps-assisted vaginal births but not amongst women who had ventouse-assisted vaginal births. This would suggest that it is important to differentiate the different types of instrumental birth in outcome studies. Of concern was the higher rate of posttraumatic-type symptoms among women who had forceps-assisted vaginal births relative to the other modes of birth. Women who have forceps-assisted births should be monitored carefully by health professionals in the postnatal period, and in the months after childbirth, when they could be offered the opportunity to discuss their labour and birth.

Experiencing maternity care: the care received and perceptions of women from different ethnic groups.

BackgroundAccording to the Office for National Statistics, approximately a quarter of women giving birth in England and Wales are from minority ethnic groups. Previous work has indicated that these women have poorer pregnancy outcomes than White women and poorer experience of maternity care, sometimes encountering stereotyping and racism. The aims of this study were to examine service use and perceptions of care in ethnic minority women from different groups compared to White women.MethodsSecondary analysis of data from a survey of women in 2010 was undertaken. The questionnaire asked about women’s experience of care during pregnancy, labour and birth, and the postnatal period, as well as demographic factors. Ethnicity was grouped into eight categories: White, Mixed, Indian, Pakistani, Bangladeshi, Black Caribbean, Black African, and Other ethnicity.ResultsA total of 24,319 women completed the survey. Compared to White women, women from minority ethnic groups were more likely to be younger, multiparous and without a partner. They tended to access antenatal care later in pregnancy, have fewer antenatal checks, fewer ultrasound scans and less screening. They were less likely to receive pain relief in labour and, Black African women in particular, were more likely to deliver by emergency caesarean section. Postnatally, women from minority ethnic groups had longer lengths of hospital stay and were more likely to breastfeed but they had fewer home visits from midwives. Throughout their maternity care, women from minority ethnic groups were less likely to feel spoken to so they could understand, to be treated with kindness, to be sufficiently involved in decisions and to have confidence and trust in the staff.ConclusionWomen in all minority ethnic groups had a poorer experience of maternity services than White women. That this was still the case following publication of a number of national policy documents and local initiatives is a cause for concern.

Learning the Hard Way: Expectations and Experiences of Infant Feeding Support

BACKGROUNDnBreastfeeding involves learning for women and their infants. For emotional, social, and developmental reasons this type of feeding is recommended for all newborn infants but for those in exceptional circumstances. The objective of this study was to gain a better understanding of what is needed in the early days to enable women to initiate and continue breastfeeding their infants.nnnMETHODSnData from a large-scale national survey of womens experience of maternity care in England were analyzed using qualitative methods, focusing on the feeding-related responses.nnnRESULTSnA total of 2,966 women responded to the survey (62.7% response rate), 2,054 of whom wrote open text responses, 534 relating to infant feeding. The main themes identified were the mismatch between womens expectations and experiences and emotional reactions at this time, staff behavior and attitudes, and the organization of care and facilities. Subthemes related to seeking help, conflicting advice, pressure to breastfeed, the nature of interactions with staff, and a lack of respect for womens choices, wishes, previous experience, and knowledge.nnnCONCLUSIONSnMany women who succeeded felt that they had learned the hard way and some of those who did not, felt they were perceived as bad mothers and women who had in some way failed at one of the earliest tasks of motherhood. What women perceived to be staff perceptions affected how they saw themselves and what they took away from their early experience of infant feeding.

From Antenatal to Postnatal Depression: Associated Factors and Mitigating Influences

INTRODUCTIONnPostnatal depression has a serious impact on new mothers and their children and families. Risk factors identified include a history of depression, multiparity, and young age. The study aimed to investigate factors associated with experiencing antenatal depression and developing subsequent postnatal depression.nnnMETHODSnThe study utilized survey data from 5332 women about their experience and well-being during pregnancy, in labor, and postnatally up to 3 months. Prespecified sociodemographic and clinical variables were tabulated against the incidence of antenatal depression and postnatal depression. Binary logistic regression was used to estimate the effects of the principal underlying variables.nnnRESULTSnRisk factors for antenatal depression were multiparity, black and minority ethnic (BME) status, physical or mental health problems, living in a deprived area, and unplanned pregnancy. Different factors for postnatal depression were evident among women who had experienced antenatal depression: multiparity and BME status were protective, whereas being left alone in labor and experiencing poor postnatal health increased the risk of postnatal depression.nnnCONCLUSIONnThis study confirms previous research on risk factors for antenatal depression and stresses the importance of continuous support in labor and vigilance in the postnatal period regarding the potential ill effects of continuing postnatal health problems.

Who Is Well After Childbirth? Factors Related to Positive Outcome

BACKGROUNDnPoor outcomes after childbirth are associated with physical ill health and with an absence of a positive sense of well-being. Postnatally poor physical health is thought to be influenced by the care received, the nature of the birth, and associated complications. The aim of this study was to estimate the effects of a range of clinical and other factors on positive outcome and well-being 3 months after childbirth.nnnMETHODSnThis study used data on more than 5,000 women from a 2010 National Maternity Survey about their experiences of maternity care, and health and well-being 3 months after childbirth. Positive outcome was defined as women reporting no problems and feeling very well at the time of the survey.nnnRESULTSnIn the univariate analysis, several variables were significantly associated with positive outcome, including sociodemographic, antenatal, intrapartum, and postnatal factors. In the final logistic regression model, young mothers, those without physical disability and those with no or few antenatal or early postnatal problems, were most likely to have positive outcomes. Other significant factors included a positive initial reaction to the pregnancy, not reporting antenatal depression, fewer worries about the labor and birth, and access to information about choices for care.nnnCONCLUSIONSnThis study shows how positive outcomes for women after childbirth may be influenced by health, social, and care factors. It is important for caregivers to bear these factors in mind so that extra support may be made available to those women who are likely to be susceptible to poor outcome.

Family income and child cognitive and behavioural development in the United Kingdom: does money matter?

This study investigates the extent to which family income is associated with an extensive range of child cognitive and behavioural outcomes in a cohort of almost 19u2009000 British children born between 2000 and 2001. Merging the economists and developmental psychologists approaches, it also attempts to identify the main mechanisms through which family economic resources translate into better developmental outcomes for children. The relative and joint relevance of three groups of mediating factors (parental stress, parental investment and other family-related pathways), identified from the recent economic and psychological literature, are examined both in a cross-sectional (mopping-up approach) and in a panel data (fixed effects models) context. Results indicate a weak or absent direct effect of family economic resources on child development after controlling for potential mediating mechanisms. The study also identifies key mediating factors (e.g. maternal depression, a cognitively stimulating home environment, parenting practices and length of breastfeeding) that could be targeted by government initiatives in order to effectively improve childrens intellectual development and behaviour beyond what income redistribution can achieve.

The Oxford Worries about Labour Scale: Women's experience and measurement characteristics of a measure of maternal concern about labour and birth

This study describes the measurement characteristics of a short (9-item) multi-dimensional measure of worry about labour and birth, the Oxford Worries about Labour Scale (OWLS-9), and its use in a large-scale study of womens experience of care. The data utilised were from 2960 women who participated in a national survey of a random sample of women who had recently given birth in England. Exploratory factor analysis revealed three sub-scales within the instrument assessing specific concerns about labour pain and distress, pre-labour uncertainty and interventions. The characteristics of each sub-scale revealed good divergent and discriminant validity. Further, the labour and distress subscale score was found to be significantly associated with both self-reported ‘baby blues’ and self-reported postnatal depression. The study findings suggest that the three sub-scales embedded can be utilised or the OWLS-9 employed as a full-scale instrument. Used antenatally, the OWLS-9 and OWLS sub-scales may offer a relevant and clinically useful measure of worry about labour and birth. Limitations of the study are discussed and the direction of future research indicated.

Women's experience of induction of labor: a mixed methods study.

To investigate womens experience of induction of labor.

Holding the baby: Early mother–infant contact after childbirth and outcomes

AIMnto describe the timing, type and duration of initial infant contact and associated demographic and clinical factors in addition to investigating the impact of early contact on breastfeeding and maternal health and well being after birth.nnnMETHODndata from a recent population survey of women birthing in Queensland, Australia were used to describe the nature of the first hold and associated demographic characteristics. Initial comparisons, with subsequent adjustment for type of birthing facility and mode of childbirth, were used to assess associations between timing, type and duration of initial contact and outcomes. Further analyses were conducted to investigate a dose-response relationship between duration of first contact and outcomes.nnnFINDINGSnwomen who had an unassisted vaginal birth held their infant sooner, and for longer than women who had an assisted vaginal birth or caesarean and were more satisfied with their early contact. Multivariate models showed a number of demographic and clinical interventions contributing to timing, duration and type of first contact with type of birthing facility (public/private), area of residence, and assisted birth as prominent factors. For women who had a vaginal birth; early, skin-to-skin, and longer duration of initial contact were associated with high rates of breastfeeding initiation and breastfeeding at discharge, but not breastfeeding at 13 weeks. Some aspects of early contact were associated with improved maternal well being. However, these associations were not found for women who had a caesarean birth. With longer durations of first contact, a dose-response effect was found for breastfeeding.nnnCONCLUSIONnresults of the study provide a description of current practice in Queensland, Australia and factors impacting on early contact. For vaginal births, findings add to the evidence in support of early skin-to-skin contact for an extended period. It is suggested that all research in this area should consider the effects of early contact separately for women having vaginal and caesarean births.nnnIMPLICATIONS FOR PRACTICEncare providers should consider extending the period of early contact in routine care following vaginal birth and explore the way in which women having a caesarean birth might be better supported in benefitting from early contact with their infant.