Marie Hatem

Predictors of Women’s Perceptions of the Childbirth Experience

OBJECTIVE To determine the factors that predict womens perceptions of the childbirth experience and to examine whether these vary with the type of birth a woman experiences. DESIGN Prospective cohort study. SETTING The postpartum units of two eastern Canadian hospitals. PARTICIPANTS Six hundred fifty two women and their newborns. DATA COLLECTION Data were collected in hospital at 12 to 48 hours postpartum using self-report questionnaires and chart review. MAIN OUTCOME MEASURE Perception of the childbirth experience was measured for women having a vaginal and emergency cesarean birth using the Questionnaire Measuring Attitudes About Labor and Delivery and planned cesarean birth using the Modified Questionnaire Measuring Attitudes About Labor and Delivery. RESULTS Of the 20 predictors of womens childbirth perceptions, the strongest were type of birth; degree of awareness, relaxation, and control; helpfulness of partner support; and being together with the infant following birth. CONCLUSIONS Of the predictors of a quality birth experience, most were amenable to nursing interventions: enhancement of patient awareness, relaxation, and control; promotion of partner support; and provision of immediate opportunities for women to be with their babies.

Facilitators and barriers in the humanization of childbirth practice in Japan

BackgroundHumanizing birth means considering womens values, beliefs, and feelings and respecting their dignity and autonomy during the birthing process. Reducing over-medicalized childbirths, empowering women and the use of evidence-based maternity practice are strategies that promote humanized birth. Nevertheless, the territory of birth and its socio-cultural values and beliefs concerning child bearing can deeply affect birthing practices. The present study aims to explore the Japanese child birthing experience in different birth settings where the humanization of childbirth has been indentified among the priority goals of the institutions concerned, and also to explore the obstacles and facilitators encountered in the practice of humanized birth in those centres.MethodsA qualitative field research design was used in this study. Forty four individuals and nine institutions were recruited. Data was collected through observation, field notes, focus groups, informal and semi-structured interviews. A qualitative content analysis was performed.ResultsAll the settings had implemented strategies aimed at reducing caesarean sections, and keeping childbirth as natural as possible. The barriers and facilitators encountered in the practice of humanized birth were categorized into four main groups: rules and strategies, physical structure, contingency factors, and individual factors. The most important barriers identified in humanized birth care were the institutional rules and strategies that restricted the presence of a birth companion. The main facilitators were womens own cultural values and beliefs in a natural birth, and institutional strategies designed to prevent unnecessary medical interventions.ConclusionsThe Japanese birthing institutions which have identified as part of their mission to instate humanized birth have, as a whole, been successful in improving care. However, barriers remain to achieving the ultimate goal. Importantly, the cultural values and beliefs of Japanese women regarding natural birth is an important factor promoting the humanization of childbirth in Japan.

Predictors of Early Parenting Self-efficacy Results of a Prospective Cohort Study

Background: Parenting self-efficacy has been identified as one determinant of positive parenting. The literature is inconsistent regarding the predictors of parenting self-efficacy, and there is limited evidence regarding these predictors in the early postpartum period. Objectives: To determine the factors predictive of parenting self-efficacy at 12 to 48 hr after childbirth and at 1 month postpartum. Method: Six-hundred fifty-two women were recruited consecutively from the postpartum units of two general hospitals on Prince Edward Island, Canada. Data were collected at 12 to 48 hr postpartum using self-report and chart review. On the basis of scoring positive or negative on their childbirth perceptions, 175 of these mothers were assigned to two cohorts. They were visited at home at 1 month postpartum, where data were collected using self-report. Results: Using multiple logistic regression, greater parenting self-efficacy at 12 to 48 hr after childbirth was predicted by multiparity and single marital status and correlated with positive perception of the birth experience, higher general self-efficacy, and excellent partner relationship. Greater parenting self-efficacy at 1 month was predicted by age ≤30 years and multiparity and correlated with excellent partner relationship and maternal perception of infant contentment. Discussion: Birth perception is a correlate of parenting self-efficacy that is modifiable; therefore, nurses have an opportunity to strive to create a positive birth experience for all women to enhance their early parenting self-efficacy. Nurses can also consider assessing women at risk for suboptimal parenting self-efficacy and intervene through teaching, support, and parenting self-efficacy boosting interventions.

Discussions of findings from a Cochrane review of midwife-led versus other models of care for childbearing women: continuity, normality and safety

Health and Social Care Research Division, King’s College, London, UK Departement de Medecine Sociale et Preventive, Universite de Montreal, Montreal, Canada School of Nursing and Midwifery, Aras Moyola, National University of Ireland, Galway, Ireland Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK Warwick Medical School Clinical Trials Unit, University of Warwick, Coventry, UK Corresponding author at: NIHR King’s Patient Safety and Service Quality Research Centre, Florence Nightingale School of Nursing and Midwifery, Waterloo Bridge Wing, 150 Stamford Street, King’s College, London SE1 9NH, UK. E-mail address: jane.sandall@kcl.ac.uk (J. Sandall).

QUARITE (quality of care, risk management and technology in obstetrics): a cluster-randomized trial of a multifaceted intervention to improve emergency obstetric care in Senegal and Mali

BackgroundMaternal and perinatal mortality are major problems for which progress in sub-Saharan Africa has been inadequate, even though childbirth services are available, even in the poorest countries. Reducing them is the aim of two of the main Millennium Development Goals. Many initiatives have been undertaken to remedy this situation, such as the Advances in Labour and Risk Management (ALARM) International Program, whose purpose is to improve the quality of obstetric services in low-income countries. However, few interventions have been evaluated, in this context, using rigorous methods for analyzing effectiveness in terms of health outcomes. The objective of this trial is to evaluate the effectiveness of the ALARM International Program (AIP) in reducing maternal mortality in referral hospitals in Senegal and Mali. Secondary goals include evaluation of the relationships between effectiveness and resource availability, service organization, medical practices, and satisfaction among health personnel.Methods/DesignThis is an international, multi-centre, controlled cluster-randomized trial of a complex intervention. The intervention is based on the concept of evidence-based practice and on a combination of two approaches aimed at improving the performance of health personnel: 1) Educational outreach visits; and 2) the implementation of facility-based maternal death reviews.The unit of intervention is the public health facility equipped with a functional operating room. On the basis of consent provided by hospital authorities, 46 centres out of 49 eligible were selected in Mali and Senegal. Using randomization stratified by country and by level of care, 23 centres will be allocated to the intervention group and 23 to the control group. The intervention will last two years. It will be preceded by a pre-intervention one-year period for baseline data collection. A continuous clinical data collection system has been set up in all participating centres. This, along with the inventory of resources and the satisfaction surveys administered to the health personnel, will allow us to measure results before, during, and after the intervention. The overall rate of maternal mortality measured in hospitals during the post-intervention period (Year 4) is the primary outcome. The evaluation will also include cost-effectiveness.Trial RegistrationThe QUARITE trial is registered on the Current Controlled Trials website under the number ISRCTN46950658 http://www.controlled-trials.com/.

Birth Preparedness and Complication Readiness (BPCR) interventions to reduce maternal and neonatal mortality in developing countries: systematic review and meta-analysis

BackgroundBirth Preparedness and Complication Readiness (BPCR) interventions are widely promoted by governments and international agencies to reduce maternal and neonatal health risks in developing countries; however, their overall impact is uncertain, and little is known about how best to implement BPCR at a community level. Our primary aim was to evaluate the impact of BPCR interventions involving women, families and communities during the prenatal, postnatal and neonatal periods to reduce maternal and neonatal mortality in developing countries. We also examined intervention impact on a variety of intermediate outcomes important for maternal and child survival.MethodsWe conducted a systematic review and meta-analysis of randomized trials of BPCR interventions in populations of pregnant women living in developing countries. To identify relevant studies, we searched the scientific literature in the Pubmed, Embase, Cochrane library, Reproductive health library, CINAHL and Popline databases. We also undertook manual searches of article bibliographies and web sites. Study inclusion was based on pre-specified criteria. We synthesised data by computing pooled relative risks (RR) using the Cochrane RevMan software.ResultsFourteen randomized studies (292 256 live births) met the inclusion criteria. Meta-analyses showed that exposure to BPCR interventions was associated with a statistically significant reduction of 18% in neonatal mortality risk (twelve studies, RR = 0.82; 95% CI: 0.74, 0.91) and a non-significant reduction of 28% in maternal mortality risk (seven studies, RR = 0.72; 95% CI: 0.46, 1.13). Results were highly heterogeneous (I2 = 76%, p < 0.001 and I2 = 72%, p = 0.002 for neonatal and maternal results, respectively). Subgroup analyses of studies in which at least 30% of targeted women participated in interventions showed a 24% significant reduction of neonatal mortality risk (nine studies, RR = 0.76; 95% CI: 0.69, 0.85) and a 53% significant reduction in maternal mortality risk (four studies, RR = 0.47; 95% CI: 0.26, 0.87).Pooled results revealed that BPCR interventions were also associated with increased likelihood of use of care in the event of newborn illness, clean cutting of the umbilical cord and initiation of breastfeeding in the first hour of life.ConclusionsWith adequate population coverage, BPCR interventions are effective in reducing maternal and neonatal mortality in low-resources settings.

Factors associated with postpartum urinary/anal incontinence in primiparous women in Quebec.

OBJECTIVE To identify the factors associated with urinary incontinence (UI), anal incontinence (AI), and combined UI and AI (UI/AI) in primiparous women in Quebec at six months postpartum. METHODS A questionnaire was mailed to 2492 primiparous women at six months postpartum to collect data on incontinence status, sociodemographic characteristics, elimination habits, lifestyle, and severity index scales. Obstetric characteristics were obtained via Quebecs Med-Echo databank. Pearson chi-square, t test, analysis of variance, univariate regression, and stepwise modelling techniques were used for data analysis. RESULTS The prevalence of UI in responders was 29.6%, of AI, 20.6%, and of combined UI/AI, 10.4%. Significant adjusted odds ratios were (1) for UI, English spoken (2.04 [95% confidence intervals 1.13-3.69]) and shoulder dystocia (2.90 [1.09-7.69]); (2) for AI, age > 35 years (2.13 [1.12-4.03]), duration of second stage of labour (1.67 [1.11-2.51]), and third or fourth degree tears (4.00 [2.32-6.89]); and (3) for UI and AI, age (2.00 [1.04-3.83]), English spoken (2.55 [1.25-5.19]), shoulder dystocia (4.91 [1.76-13.71]), instrumental delivery (2.28 [1.30-3.99]), third or fourth degree tears (3.58 [1.95-6.57]), and episiotomy (2.24 [1.162-4.33]). Caesarean section was associated with less UI (0.45 [0.28-0.72]), and smoking was associated with less AI (0.38 [0.19-0.76]). CONCLUSION Combined UI/AI is associated with several obstetrical factors. The association of UI and AI is observed more frequently after complicated delivery (requiring the application of forceps) or involving perineal damage and episiotomy. As most of the identified factors are modifiable, a preventive treatment policy is advisable.

Understanding childbirth practices as an organizational cultural phenomenon: a conceptual framework

Understanding the main values and beliefs that might promote humanized birth practices in the specialized hospitals requires articulating the theoretical knowledge of the social and cultural characteristics of the childbirth field and the relations between these and the institution. This paper aims to provide a conceptual framework allowing examination of childbirth practices through the lens of an organizational culture theory. A literature review performed to extrapolate the social and cultural factors contribute to birth practices and the factors likely overlap and mutually reinforce one another, instead of complying with the organizational culture of the birth place. The proposed conceptual framework in this paper examined childbirth patterns as an organizational cultural phenomenon in a highly specialized hospital, in Montreal, Canada. Allaire and Firsirotu’s organizational culture theory served as a guide in the development of the framework. We discussed the application of our conceptual model in understanding the influences of organizational culture components in the humanization of birth practices in the highly specialized hospitals and explained how these components configure both the birth practice and women’s choice in highly specialized hospitals. The proposed framework can be used as a tool for understanding the barriers and facilitating factors encountered birth practices in specialized hospitals.

Does perception of the childbirth experience predict women's early parenting behaviors?

Evidence regarding the predictors of positive parenting behaviors in the early transition to parenting is inconsistent and limited. In this prospective, cohort study, we examined whether womens perceptions of their childbirth experience, as well as selected demographic, obstetrical, and psychosocial variables, predicted positive parenting behaviors at 1 month postpartum in 175 Canadian mothers. Womens birth experience did not predict early parenting behaviors, however being better educated and having a vaginal birth did. Excellent partner support and maternal mental health were also significantly associated with positive parenting at 1 month. Nurses have a responsibility to assess women for possible risks for sub-optimal parenting, based on the predictors found, and intervene to enhance parenting behaviors.

Postpartum urinary and anal incontinence: a population-based study of quality of life of primiparous women in Quebec.

OBJECTIVE To describe the quality of life of primiparous women with urinary or anal incontinence. METHODS A questionnaire was mailed at six months postpartum to 2492 primiparous women living in Quebec. The prevalence of urinary incontinence was assessed at six months postpartum through the FPSUND severity score index; the prevalence of anal incontinence was assessed by the grading system of Vaizey et al.; the quality of life of women who developed incontinence was assessed using the Shumakers I-QOL for urinary incontinence and Lowrys quality of life instrument for anal incontinence. Descriptive analysis, t-test, analysis of variance, and linear regression were used. RESULTS The prevalence of urinary incontinence was 29.6% and of anal incontinence was 20.6%. Quality of life was affected significantly by the presence of urinary incontinence or both forms of incontinence (P 0.001) and by the type of urinary incontinence (P < 0.001). Women with all types of anal incontinence had significantly lower quality of life scores for access to toilet (P < 0.001), lifestyle (P < 0.01), self-esteem (P = 0.037), and total score (P < 0.001). Quality of life correlated with the severity of both urinary incontinence and anal incontinence: the more severe the urinary or anal incontinence, the lower the quality of life score. CONCLUSION Women who have urinary or anal incontinence, or both, have significant reductions in indicators of quality of life. Research is needed to evaluate strategies for preventing and treating these problems.