Background: Childbirth confidence is an important marker of women’s coping abilities during labour and birth. This study investigated socio-demographic, obstetric and psychological factors affecting self-efficacy in childbearing women. Method: This paper presents a secondary analysis of data collected as part of the BELIEF study (Birth Emotions – Looking to Improve Expectant Fear). Women (n = 1410) were recruited during pregnancy (≤24 weeks gestation). The survey included socio-demographic details (such as age and partner support); obstetric details including parity, birth preference, and pain; and standardised psychological measures: CBSEI (Childbirth Self-efficacy Inventory), W-DEQ A (childbirth fear) and EPDS (depressive symptoms). Variables were tested against CBSEI first stage of labour sub-scales (outcome expectancy and self-efficacy expectancy) according to parity. Results: CBSEI total mean score was 443 (SD=112.2). CBSEI, W-DEQ, EPDS scores were highly correlated. Regardless of parity, women who reported low childbirth knowledge, who preferred a caesarean section, and had high W-DEQ and EPDS scores reported lower self-efficacy. There were no differences for nulliparous or multiparous women on outcome expectancy, but multiparous women had higher self-efficacy scores (p<.001). Multiparous women whose partner was unsupportive were more likely to report low self-efficacy expectancy (p<.05). Experiencing moderate pain in pregnancy was significantly associated with low self-efficacy expectancy in both parity groups, as well as low outcome expectancy in nulliparous women only. Fear correlated strongly with low childbirth self-efficacy. Conclusion: Few studies have investigated childbirth self-efficacy according to parity. Although multiparous women reported higher birth confidence significant obstetric and psychological differences were found. Addressing women’s physical and emotional wellbeing and perceptions of the upcoming birth may highlight their level of self-efficacy for birth. Trial registration: Australian New Zealand Controlled Trials Registry ACTRN12612000526875, 17 th May 2012.

https://opus.lib.uts.edu.au/bitstream/10453/150249/2/Factors%20associated%20with%20childbirth%20self-efficacy%20in%20Australian%20childbearing%20women.pdf

Factors associated with childbirth self-efficacy in Australian childbearing women.

Background Quantitative sensory testing, including pressure pain threshold (PPT), is seeing increased use in clinical practice. In order to facilitate clinical utility, knowledge of the properties of the tool and interpretation of results are required.

Objectives This observational study used a clinical sample of people with mechanical neck pain to determine: (1) the influence of number of testing repetitions on measurement properties, (2) reliability and minimum clinically important difference, and (3) associations between PPT and key psychological constructs.

Design This study was observational with both cross-sectional and prospective elements.

Methods Experienced clinicians measured PPT in patients with mechanical neck pain following a standardized protocol. Subcohorts also provided repeated measures and completed scales of key psychological constructs.

Results The total sample was 206 participants, but not all participants provided data for all analyses. Interrater and 1-week test-retest reliability were excellent (intraclass correlation coefficients [2,1]=.75–.95). Potentially important differences in reliability and PPT scores were found when using only 1 or 2 repeated measures compared with all 3. The PPT over a distal location (tibialis anterior muscle) was not adequately responsive in this sample, but the local site (upper trapezius muscle) was responsive and may be useful as part of a protocol to evaluate clinical change. Sensitivity values (range=0.08–0.50) and specificity values (range=0.82–0.97) for a range of change scores are presented. Depression, catastrophizing, and kinesiophobia were able to explain small but statistically significant variance in local PPT (3.9%–5.9%), but only catastrophizing and kinesiophobia explained significant variance in the distal PPT (3.6% and 2.9%, respectively).

Limitations Limitations of the study include multiple raters, unknown recruitment rates, and unknown measurement properties at sites other than those tested here.

Conclusions The results suggest that PPT is adequately reliable and that 3 measurements should be taken to maximize measurement properties. The variance explained by the psychological variables was small but significant for 3 constructs related to catastrophizing, depression, and fear of movement. Clinical implications for application and interpretation of PPT are discussed.

/pdf/clinical-pressure-pain-threshold-testing-in-neck-pain-2ropuki1uu.pdf

Clinical pressure pain threshold testing in neck pain: comparing protocols, responsiveness, and association with psychological variables.

Objective To investigate the relation between the duration of the second stage of labour and subsequent early neonatal and maternal morbidity.

Design Retrospective analysis of a regional obstetric database.

Setting 17 maternity units in the North West Thames Health Region.

Subjects Selected from 36 727 consecutive singleton deliveries in 1988. The analysis was confined to the 25 069 women delivered of an infant of at least 37 weeks gestation with a cephalic presentation following the spontaneous onset of labour.

Main outcome measures The relative risk of early maternal morbidity, postpartum haemorrhage (PPH) and postpartum infection, and neonatal morbidity, as judged by low Apgar scores or admission to the special care baby unit (SCBU), in relation to anthropomorphic characteristics (parity and birthweight), interventions (epidural analgesia, episiotomy and operative delivery), signs of fetal compromise (meconium staining of the amniotic fluid or abnormal cardiotocography (CTG)), maternal morbidity in labour (pyrexia) and the duration of the second stage of labour.

Results The duration of the second stage of labour had a significant independent association with the risk of both PPH and maternal infection after adjustment for other factors. However, there was a similar or greater risk of PPH in association with operative delivery or a birthweight greater than .4000 g. Both maternal pyrexia in labour and primiparity were associated with a greater risk of post partum maternal infection than was the duration of the second stage, although all these factors were statistically significant. In contrast, the duration of the second stage was not significantly associated with the risk of a low Apgar score or admission to SCBU after adjustment for other factors.

Conclusions The duration of the second stage of labour has a positive independent association with early maternal morbidity. We could show no such relation between time spent in the second stage of labour and the frequency of low Apgar scores or the rate of admission to SCBU. With current management approaches, in the absence of factors suggesting fetal compromise, second stage labours of up to 3 h duration do not seem to carry undue risk to the fetus.

Neonatal and Maternal Morbidity in Relation to the Length of the Second Stage of Labour

Predictors of staff distress in response to professionally experienced miscarriage, stillbirth and neonatal loss: A questionnaire survey

Effect of early amniotomy on the risk of dystocia in nulliparous women

Evidence based midwifery

/pdf/guidelines-for-midwifery-led-care-in-labour-1di3f9yex1.pdf

Guidelines for midwifery led care in labour

The development and peer review of evidence-based guidelines to support midwifery led care in labour.

This paper is the second in our series following the development of evidence-based guidelines for midwifery-led care in the labour ward of an inner-city university teaching hospital. The first part of the evaluation of the initiative is presented here. It sought midwives' views through group discussions using the SWOT analysis technique and semi-structured interviews with a random and purposive sample and it measured the guidelines against an external appraisal instrument. The midwives were positive about being involved in the process of development and found the guidelines useful in defining and supporting autonomous midwifery practice. They also perceived significant changes in practice. The guidelines complied well with the majority of the criteria in the appraisal tool.

Evidence into practice for midwifery-led care: part 2

A system of Midwifery-Led Care introduced for women receiving maternity care in one NHS Consultant Unit meant that new guidelines were required to support care provided by midwives. This paper describes the process of developing and implementing Evidence-Based Guidelines to support Midwifery-Led Care on the labour ward. The identification of topic areas, literature used in the development of the practice recommendations and the activities held during both development and after the formal launch of the guidelines will be described.

Evidence into practice for midwifery-led care

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