Sigal Levy

Indications for Emergency Intervention, Mode of Delivery, and the Childbirth Experience

Background Although the impact of emergency procedures on the childbirth experience has been studied extensively, a possible association of childbirth experience with indications for emergency interventions has not been reported. Objectives To compare the impacts on childbirth experience of ‘planned’ delivery (elective cesarean section and vaginal delivery) versus ‘unplanned’ delivery (vacuum extraction or emergency cesarean section); the intervention itself (vacuum extraction versus emergency cesarean section); and indications for intervention (arrest of labor versus risk to the mother or fetus). Study design A total of 469 women, up to 72 hours post-partum, in the maternity ward of one tertiary health care institute completed the Subjective Childbirth Experience Questionnaire (score: 0–4, a higher score indicated a more negative experience) and a Personal Information Questionnaire. Intra-partum information was retrieved from the medical records. One-way analysis of variance and two-way analysis of variance, followed by analysis of covariance, to test the unique contribution of variables, were used to examine differences between groups in outcome. Tukeys Post-Hoc analysis was used when appropriate. Results Planned delivery, either vaginal or elective cesarean section, was associated with a more positive experience than unplanned delivery, either vacuum or emergency cesarean section (mean respective Subjective Childbirth Experience scores: 1.58 and 1.49 vs. 2.02 and 2.07, P <0.01). The difference in mean Subjective Childbirth Experience scores following elective cesarean section and vaginal delivery was not significant; nor was the difference following vacuum extraction and emergency cesarean section. Interventions due to immediate risk to mother or fetus resulted in a more positive birth experience than interventions due to arrest of labor (Subjective Childbirth Experience: 1.9 vs. 2.2, P <0.01). Conclusions Compared to planned interventions, unplanned interventions were shown to be associated with a more negative maternal childbirth experience. However, the indication for unplanned intervention appears to have a greater effect than the nature of the intervention on the birth experience. Women who underwent emergency interventions due to delay of birth (arrest of labor) perceived their birth experience more negatively than those who underwent interventions due to risk for the mother or fetus, regardless of the nature of the intervention (vacuum or emergency cesarean section). The results indicate the importance of follow-up after unexpected emergency interventions, especially following arrest of labor, as negative birth experience may have repercussions in a womans psychosocial life and well-being.

The association of birth model with resilience variables and birth experience: Home versus hospital birth

OBJECTIVEnto study home, natural hospital, and medical hospital births, and the association of these birth models to resilience and birth experience.nnnDESIGNncross-section retrospective design.nnnSETTINGnparticipants were recruited via an online survey system. Invitations to participate were posted in five different Internet forums for women on maternity leave, from September 2014 to August 2015.nnnPARTICIPANTSnthe sample comprised 381 post partum healthy women above the age of 20, during their maternity leave. Of the participants: 22% gave birth at home, 32% gave birth naturally in a hospital, and 46% of the participants had a medical birth at the hospital.nnnMEASUREMENTSnlife Orientation Test Revised (LOT-R), General Self-Efficacy Scale, Sense of Mastery Scale, Childbirth Experience Questionnaire (CEQ).nnnFINDINGSnwomen having had natural births, whether at home or at the hospital, significantly differed from women having had medical births in all aspects of the birth experience, even when controlling for age and optimism. Birth types contributed to between 14% and 24% of the explained variance of the various birth experience aspects.nnnKEY CONCLUSIONSnhome and natural hospital births were associated with a better childbirth experience. Optimism was identified as a resilience factor, associated both with preference as well as with childbirth experience.nnnIMPLICATIONS FOR PRACTICEnphysically healthy and resilient women could be encouraged to explore the prospect of home or natural hospital births as a means to have a more positive birth experience.

Direct and Indirect Effects of Personality Traits on Psychological Distress in Women With Pelvic Floor Disorders

Objectives The diagnosis and treatment of pelvic floor disorders may involve subjective self-report symptom measures that may be related to personality traits. We aimed to construct a model that integrates pelvic floor disorders, personality variables (optimism and neuroticism), psychological distress, and related demographic variables. Methods In a cross-sectional study, conducted between August 2014 and June 2015, 155 women following an intake to an urogynecology outpatient clinic of a tertiary health center completed personality questionnaires of optimism and neuroticism (Life Orientation Test–Revised, 10-item Big Five Inventory), pelvic floor symptoms (Pelvic Floor Distress Inventory Short Form), psychological distress (18-item Brief Symptom Inventory), and a demographic questionnaire. Results A path analysis mediation model showed that patients who had more pelvic floor symptoms felt more psychological distress and that psychological distress increased as the level of neuroticism increased. As for optimism, the correlation to pelvic floor symptoms was nearly significant. Optimism and neuroticism had indirect effects on psychological distress through pelvic floor symptoms in women with urinary incontinence and pelvic organ prolapse. Neuroticism had a direct effect on psychological distress in these women as well. Conclusions Our suggested statistical path analysis model supports the important role of personality traits in pelvic floor disorder self-reports and the effect of these traits on psychological distress. Therefore, the optimal treatment for pelvic floor symptoms should include psychological interventions in addition to traditional medical or surgical therapy in hope of reducing psychology distress associated with urinary incontinence and pelvic organ prolapse.

Personality, preterm labor contractions, and psychological consequences

PurposeResearch of psychological factors associated with imminent preterm labor (PTL) is sparse, compared with considerable research of preterm birth. We explored state and trait psychological variables associated with PTL, both pre- and postpartum.MethodsDuring 2012–2014, 56 women hospitalized due to PTL, and 33 pregnant women without PTL, responded during gestational week 20–33, to a demographic questionnaire, the Big-Five Inventory (BFI), the Brief Symptom Inventory (BSI), the Fear of Childbirth Questionnaire, and the Maternal-Fetal Attachment Inventory (MFAS). At 4–6xa0weeks postpartum, 35 and 23 of the women in the respective groups responded online to the Edinburgh Postnatal Depression Scale (EPDS) and the Mother to Infant Bonding Scale (MIBS).ResultsCompared to women without PTL, women with PTL scored higher on neuroticism, openness to experience, and MFAS (pxa0<xa00.01 each), scored lower on consciousness and agreeableness (pxa0<xa00.01 each), and showed greater fear of childbirth (pxa0<xa00.05). Significant differences were not found in the postpartum variables of EPDS and MIBS. In the PTL group, MFAS (βxa0=xa00.36, pxa0<xa00.01), but not fear of childbirth (βxa0=xa00.08, pxa0=xa0NS), remained higher, after controlling for demographic variables and neuroticism.ConclusionsPTL was associated with personality variables, but not with psychological consequences, other than elevated prepartum attachment to the fetus.

Body image among three denominations of Jewish women in Israel

ABSTRACT Religious identity has been shown to be related to women’s healthy body image, though research is still scarce, with most of it having been carried out in the context of the Christian religion. We used measures of positive body image (Body Appreciation Scale) and negative body image (Body Image Concern Inventory) as well as body care attitude (Body Care Subscale) to study 230 women belonging to three Jewish denominations in Israel in mid 2013. Compared to modern-Orthodox and secular Jewish women, ultra-Orthodox Jewish women were found to possess a more positive and less negative body image; they also exhibited more positive attitudes regarding body care. Regarding body satisfaction, modern-Orthodox women were shown to be significantly more satisfied than were the secular women. This reflects a continuum, ranging between secular, modern-Orthodox, and ultra-Orthodox women regarding body image in all its aspects. The possible protective power of religion regarding body image is discussed in light of possible underlining mechanisms.

The impact of genital self-image on sexual function in women with pelvic floor disorders

OBJECTIVEnThere is conflicting evidence regarding the impact of urinary incontinence and pelvic organ prolapse on overall sexual function. However, psychological variables thought to be associated with sexual function, have not been fully explored. We assessed the sexual functioning of women with pelvic floor disorders while measuring for psychological factors such as distress and genital self-image.nnnSTUDY DESIGNnIn a cross-sectional study, 155 women in an urogynecology outpatient clinic of a tertiary health center completed a demographic questionnaire, the Brief Symptom Index-18 (BSI-18), Pelvic Floor Distress Inventory-20 (PFDI-20), Genital Self-Image Scale-20 (GSIS-20) and the Female Sexual Function Index (FSFI).nnnRESULTSnLinear regression showed that when controlling for age and depression, GSIS significantly predicted FSFI total score (Beta=0.38, p<0.001) and the Desire subscale (Beta=0.55, p<0.001). Due to the low response rate in the GSIS and FSFI questionnaires, a preliminary analysis was conducted to characterize the responders. On univariate logistic regression, response to the GSIS was negatively correlated with age (OR=0.94, p=0.02) and being in a relationship (OR=2.3, p=0.016), yet the effect of being in a relationship was diminished in a multivariate model that included age.nnnCONCLUSIONnThe main variable associated with overall sexual function in women with pelvic floor disorders was low genital self-image. This variable is more important than self-reported symptoms, type of specific disorder or other demographic variables. Older women tended not to complete the scales concerning more intimate matters. We suggest that urogynecologists should inquire about genital self-image as well as sexual function in this population.

Body-image, quality of life and psychological distress: a comparison between kidney transplant patients and a matching healthy sample

Abstract The purpose of the current study was to assess the uniqueness of the condition of kidney transplant recipients in comparison to a sample of matching healthy peers in relation to body-image dissatisfaction and identification, quality of life and psychological distress. Participants were 45 kidney transplant recipients who were under follow-up care at a Transplant Unit of a major Medical Center, and a sample of 45 matching healthy peers. Measures were taken using self-report questionnaires [Body-Image Ideals Questionnaire (BIIQ), Body Identification Questionnaire (BIQ), Brief Symptoms Inventory (BSI), and the SF-12]. The major findings were the following: (i) kidney transplant recipients reported lower levels of quality of life and higher levels of PsD when compared to their healthy peers; (ii) no difference in body-image dissatisfaction was found between the two studied groups; (iii) significant correlations between body-image dissatisfaction quality of life and PsD were found only in the kidney transplant recipients. The kidney transplantation condition has a moderating effect in the association between body-image dissatisfaction PsD but not in the association between body-image dissatisfaction and quality of life; (iv) kidney transplant recipients experienced higher levels of body identification than did their healthy peers. Taken together, these findings highlight the unique condition of kidney transplant recipients, as well as the function that body-image plays within the self.

Mode of delivery, childbirth experience and postpartum sexuality

PurposeAlthough childbirth has been studied extensively with regard to postpartum sexuality, the association between the psychological aspects of childbirth and postpartum sexuality has rarely been examined. This research is aimed at studying the possible association of mode of delivery, childbirth experience, sexual functioning, and sexual satisfaction.MethodsThree hundred seventy-six primiparous and nulliparous women completed this web-based survey 100–390xa0days postpartum. The participants completed a socio-demographic and delivery details questionnaire, the Childbirth Perception Questionnaire (CPQ), the Index of Sexual Satisfaction (ISS) and the Sexual Function Questionnaire’s Medical Impact Scale (SFQ-MIS).ResultsStructural equation modeling showed that there are indirect effects of mode of delivery on sexual functioning and sexual satisfaction through childbirth experience. Specific significant indirect paths were found: mode of delivery to sexual functioning through childbirth experience [Bxa0=xa0− 0.26, pxa0=xa00.023, 95% CIxa0=xa0(− 0.40, − 0.10)] and from mode of delivery to sexual satisfaction through childbirth experience [Bxa0=xa00.11, pxa0=xa00.013, 95% CIxa0=xa0(0.05, 0.21)]. No significant direct effects were found between mode of delivery and sexual functioning or sexual satisfaction.ConclusionsThe results point to the association of the psychological experience of childbirth, sexual functioning and sexual satisfaction. In addition, we found a possible indirect link between mode of delivery and postpartum sexuality. It can be concluded that the psychological factors associated with childbirth are important to the understanding of postpartum sexuality.

Information seeking and perceptions of anxiety and pain among women undergoing hysterosalpingography

OBJECTIVEnHysterosalpingography (HSG) is an accepted diagnostic tool for infertility workup and is considered an invasive procedure that is generally regarded as uncomfortable and painful, though research on psychological consequences is scarce and outdated. The study objective was to investigate womens experience of HSG in terms of fear, anxiety and pain, as compared to colposcopy.nnnSTUDY DESIGNnThis cross sectional questionnaire study was conducted at two public womens health clinics in Israel between January 2013 and March 2014. 137 women were included in the study. 42 consecutively sampled women referred for outpatient HSG and 95 consecutively sampled women referred for outpatient diagnostic colposcopy. The main outcome measures were: state-trait anxiety, information seeking behavior, fear of pain, fear of the results, retrospective pain.nnnRESULTSnCompared to those undergoing colposcopy, women undergoing HSG expressed significantly higher anxiety prior to the procedure, feared the pain involved more, and rated the procedure as more painful retrospectively. HSG patients tended to report a higher degree of information seeking. Information seeking was correlated with higher anxiety among HSG but not colposcopy patients.nnnCONCLUSION(S)nHSG is a highly stressful procedure associated with fear, anxiety, pain and information seeking. Research is needed to find possible ways of ameliorating these emotions and behaviors as they may have negative impact on patient cooperation.

Multidimensional associations of pain and anxiety before and after colposcopy

To assess the effect of pre‐procedural variables on post‐procedural outcomes following colposcopy.