Sally Ferguson

Does antenatal education affect labour and birth? A structured review of the literature

OBJECTIVE To undertake a structured review of the literature to determine the effect of antenatal education on labour and birth, particularly normal birth. METHOD Ovid Medline, CINAHL, Cochrane and Web of Knowledge databases were searched to identify research articles published in English from 2000 to 2012, using specified search terms in a variety of combinations. All articles included in this structured review were assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). FINDINGS The labour and birthing effects on women attending antenatal education may include less false labour admissions, more partner involvement, less anxiety but more labour interventions. CONCLUSION This literature review has identified that antenatal education may have some positive effects on womens labour and birth including less false labour admissions, less anxiety and more partner involvement. There may also be some negative effects. Several studies found increased labour and birth interventions such as induction of labour and epidural use. There is contradictory evidence on the effect of antenatal education on mode of birth. More research is required to explore the impact of antenatal education on womens birthing outcomes.

Getting the first birth right: A retrospective study of outcomes for low-risk primiparous women receiving standard care versus midwifery model of care in the same tertiary hospital

BACKGROUND There is national and international concern for increasing obstetric intervention in childbirth and rising caesarean section rates. Repeat caesarean section is a major contributing factor, making primiparous women an important target for strategies to reduce unnecessary intervention and surgeries in childbirth. AIM The aim was to compare outcomes for a cohort of low risk primiparous women who accessed a midwifery continuity model of care with those who received standard public care in the same tertiary hospital. METHODS A retrospective comparative cohort study design was implemented drawing on data from two databases held by a tertiary hospital for the period 1 January 2010 to 31 December 2011. Categorical data were analysed using the chi-squared statistic and Fishers exact test. Continuous data were analysed using Students t-test. Comparisons are presented using unadjusted and adjusted odds ratios, with 95% confidence intervals (CIs) and p-values with significance set at 0.05. RESULTS Data for 426 women experiencing continuity of midwifery care and 1220 experiencing standard public care were compared. The study found increased rates of normal vaginal birth (57.7% vs. 48.9% p=0.002) and spontaneous vaginal birth (38% vs. 22.4% p=<0.001) and decreased rates of instrumental birth (23.5% vs. 28.5% p=0.050) and caesarean sections (18.8% vs. 22.5% p=0.115) in the midwifery continuity cohort. There were also fewer interventions in this group. No differences were found in neonatal outcomes. CONCLUSION Strategies for reducing caesarean section rates and interventions in childbirth should focus on primiparous women as a priority. This study demonstrates the effectiveness of continuity midwifery models, suggesting that this is an important strategy for improving outcomes in this population.

Sense of Coherence and Childbearing: A Scoping Review of the Literature

OBJECTIVE: To undertake a scoping review of the literature to understand how a woman’s sense of coherence (SOC) score affects her childbearing. METHOD: Ovid MEDLINE, CINAHL, Cochrane, and Web of Science databases were searched to identify articles published in English from 2000 to 2014 using combinations of specified search terms. Included articles were assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Critical Appraisal Skills Programme. FINDINGS: This scoping review identified 15 studies focusing on SOC scores and childbearing. Childbearing women with strong SOC were less likely to smoke and more likely to seek out useful support compared to women with low SOC. Women with strong SOC demonstrated increased emotional health, experiencing less depression, anxiety, stress, and posttraumatic stress disorder. Women with strong SOC were more likely to experience uncomplicated birth and birth at home, identify normal birth as their preferred birth option in pregnancy and identify a desire to avoid epidural anesthesia in labor compared to women with low SOC. CONCLUSION: This scoping review of the literature identified significant associations between strong SOC and positive childbearing, including increased emotional health, improved health behaviors, and increased normal birth choices and outcomes.

WHAT WOMEN VALUE IN THE MIDWIFERY CONTINUITY OF CARE MODEL: A SYSTEMATIC REVIEW WITH META-SYNTHESIS

INTRODUCTION There are a number of qualitative studies indicating women are more satisfied with a continuity model of midwifery care however, their experiences have not been understood to gain an overall picture of what it is they value, appreciate and want in such a model. A metasynthesis was undertaken in order to examine the current qualitative literature to gain a deeper understanding of the womans perspective as a consumer of maternity care in a continuity model. AIM To identify and synthesise research findings presenting childbearing womens perspectives on continuity of midwifery care. METHODS A search using key words was undertaken using the following databases: CINAHL, Cochrane Library, Ovid, Medline, Nursing Reference Centre and Joanna Briggs Institute. Papers were included if they were published since 2006, in English and included qualitative data from the womans perspective. The selection process followed was the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Quality appraisal was conducted by all authors using the Critical Appraisal Skills Programme (CASP) tool as a screening tool. This allowed for each paper to be appraised to determine risk of bias. FINDINGS Thirteen quality appraised papers published between 2006 and 2016 were found which included qualitative data and were related to the womans experience in a continuity model. Six papers were from Australia, three in the United Kingdom, two in New Zealand and one in the United States of America and Denmark. Themes identified included an overarching concept of the relationship which was underpinned by themes of personalised care, trust and empowerment. CONCLUSIONS The midwife-woman relationship is the vehicle through which personalised care, trust and empowerment are achieved in the continuity of midwifery model of care.

Sense of coherence and childbearing choices: A cross sectional survey

BACKGROUND as concern for increasing rates of caesarean section and interventions in childbirth in Western countries mounts, the utility of the risk approach (inherent in the biomedical model of maternity care) is called into question. The theory of salutogenesis offers an alternative as it focuses on the causes of health rather than the causes of illness. Sense of coherence (SOC), the cornerstone of salutogenic theory, is a predictive indicator of health. We hypothesised that there is a relationship between a womans SOC and the childbirth choices she makes in pregnancy. METHODS the study aims to investigate the relationship between SOC and womens pregnancy and anticipated labour choices. A cross sectional survey was conducted where eligible women completed a questionnaire that provided information on SOC scores, Edinburgh Postnatal Depression (EPDS) scores, Support Behaviour Inventory (SBI) scores, pregnancy choices and demographics. FINDINGS 1074 pregnant women completed the study. Compared to women with low SOC, women with high SOC were older, were less likely to identify pregnancy conditions, had lower EPDS scores and higher SBI scores. SOC was not associated with womens pregnancy choices. CONCLUSION this study relates SOC to physical and emotional health in pregnancy as women with high SOC were less likely to identify pregnancy conditions, had less depressive symptoms and perceived higher levels of support compared to women with low SOC. Interestingly, SOC was not associated with pregnancy choices known to increase normal birth rates. More research is required to explore the relationship between SOC and womens birthing outcomes.

Examining the Validity and Reliability of Antonovsky's Sense of Coherence Scale in a Population of Pregnant Australian Women.

Antonovsky’s Orientation to Life questionnaires were developed to measure sense of coherence (SOC). Although the SOC 13 instrument is widely used to measure health in general populations, it has not been assessed in pregnant women. If the SOC 13 is to be used to assess women’s childbearing health, it requires further examination. The purpose of the research is to assess the psychometric properties of Antonovsky’s SOC 13 questionnaire in pregnant women. When administered to 718 pregnant Australian women, the construct validity of the SOC 13 was difficult to establish. The SOC 9 was created by removing 4 items and provided best data fit. The SOC 13 and SOC 9 were found to have sound criterion validity, internal reliability, and equivalence between versions. It is hoped that the present study will stimulate additional research on SOC scales to examine their ability to assess women’s childbearing health.

Sense of coherence and women׳s birthing outcomes: A longitudinal survey.

BACKGROUND in Western countries, caesarean section rates are increasing at an alarming rate. This trend has implications for women׳s health and calls into question the use of pathogenesis to frame maternity services. The theory of salutogenesis offers an alternative as it focuses on health rather than illness. Sense of coherence (SOC), the cornerstone of salutogenesis, is a predictive indicator of health. This study aimed to explore associations between pregnant women׳s SOC, their birthing outcomes and factors associated with SOC changes. METHODS a longitudinal survey was conducted where women completed a questionnaire in the antenatal and postnatal period. Questionnaire one provided information on SOC scores, Edinburgh Postnatal Depression Scale (EPDS) scores, Support Behaviour Inventory (SBI) scores, pregnancy choices and demographics. Questionnaire two provided information on SOC scores, EPDS scores and birthing outcomes. FINDINGS 1074 women completed questionnaire one and 753 women completed questionnaire two. Compared to women with low antenatal SOC, women with high antenatal SOC were less likely to experience caesarean section (OR 0.437 95% CI 0.209-0.915) and more likely to experience assisted vaginal birth (AVB) (OR 3.108 95% CI 1.557-6.203). Higher birth satisfaction, higher antenatal EPDS scores and lower antenatal SOC were associated with an increase in SOC. Epidural, AVB and decreased birth satisfaction were associated with a decrease in SOC. CONCLUSION high sense of coherence in pregnant women is associated with half the likelihood of caesarean section compared to women with low sense of coherence. Women׳s sense of coherence is raised and lowered by degree of satisfaction with their births and lowered by some labour interventions.

The attitudes of healthcare professionals towards women using illicit substances in pregnancy: A cross-sectional study

AIM To assess the attitudes of healthcare professionals towards women who use substances in the maternity setting. BACKGROUND Illicit drug use in pregnancy leads to poor maternal and neonatal outcomes. Early access to antenatal care has been shown to improve outcomes however women who use substances in pregnancy have statistically low attendance rates to appointments. Fear of stigma from healthcare professionals is a commonly stated reason for not accessing maternity health services or not disclosing substance use to care givers, however little research has been conducted which assesses stigma from a healthcare perspective. METHODS A cross-sectional quantitative research design was implemented using a previously validated attitudinal survey tool to assess the attitudes of healthcare practitioners and final year midwifery students. Ethics approval was sought and granted by the relevant institutions. A total of 147 completed questionnaires were returned. Data was analysed using the Statistical Package for the Social Sciences and parametric testing was undertaken. RESULTS Participants had largely positive or neutral attitudes towards women who use substances in pregnancy. Most participants agreed or strongly agreed that the care they provide to can make a real difference to outcomes. Midwifery students had significantly lower mean attitude scores, showing more positive attitudes, than any other group tested. CONCLUSION This research provides useful insight into the attitudes of healthcare professionals. While larger scale research is needed, the positive findings of this study may work towards reducing fear of stigma as a barrier to care for women.

Women's motivation, perception and experience of complementary and alternative medicine in pregnancy: A meta-synthesis

BACKGROUND complementary and Alternative Medicine use during pregnancy is popular in many countries, including Australia. There is currently little evidence to support this practice, which raises the question of womens motivation for use of these therapies and the experiences they encounter. OBJECTIVE this study aims to explore the perceptions, motivations and experiences of pregnant women with regard to their use of Complementary and Alternative Medicine during pregnancy. METHODS a systemic review and meta-synthesis of the available research was conducted. Five databases were explored - CINAHL Plus, Medline, PubMed, AMED and Web of Science using the search terms complementary and alternative medicine; pregnancy; and pregnant. Articles included in this meta-synthesis were screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses tool. FINDINGS ten initial themes were drawn from the six studies. These ten themes were summarised by three cluster themes. The results suggest that women are using Complementary and Alternative Medicine in their pregnancy as a means of supporting their sense of self-determination, to pursue a natural and safe childbirth, and because they experience a close affiliation with the philosophical underpinnings of Complementary and Alternative Medicine as an alternative to the biomedical model. CONCLUSION these findings are important to practitioners, policy makers, governing bodies and researchers, providing insight into the motivations for Complementary and Alternative Medicine use by women in pregnancy.

Social networking sites (SNS) as a tool for midwives to enhance social capital for adolescent mothers

OBJECTIVE to explore ways in which midwives can enhance the support provided by social networking sites for adolescent mothers. DESIGN a narrative approach was employed to guide the research design and processes. Approval was obtained from Edith Cowan University human ethics department. SETTING focus groups and interviews were undertaken with adolescent mothers and midwives in Western Australia. FINDINGS the four key themes identified across both groups were validation by midwives, importance of ownership, enhanced community connections and the importance of guideline development. CONCLUSIONS findings suggest both mothers and midwives consider there are a variety of ways in which healthcare professionals could enhance the support afforded to adolescent mothers by their use of SNS. Midwives were more likely to consider the need for guideline development, but the underlying value of accessible, professionally mediated online support and information was consistent across the two groups. IMPLICATIONS FOR PRACTICE Midwives would benefit from acknowledging the role played by SNS in providing support to adolescent mothers and by considering ways in which this technology can be used to lend further support to this group of mothers.