Preventing further trauma: KINDEX mum screen - assessing and reacting towards psychosocial risk factors in pregnant women with the help of smartphone technologies

The KINDEX mum screen has been designed to be administered by gynecologists and midwives during pregnancy for the assessment of the main psychosocial developmental risk factors, which include traumatic experiences of the parents, intimate partner violence, drug abuse, a history of mental health problems, poverty, acute stress, and others. In addition, we have developed a self-assessment version that runs on tablet computers (iPads). Validation of the KINDEX has been successfully completed in Germany, Spain, Greece, and Peru. Gynecologists or midwives interviewed 80120 pregnant women in each country. A randomized sub sample of respondents was assessed by trained clinical psychologists using standardized structural interviews to assess perceived stress and mental disorders. 14-months after giving birth the new mothers were interviewed again and the predictive value of the KINDEX was assessed by structured clinical interviews and the analysis of the cortisol levels (deposited in hair over a month) of mother and child as indicator for stress. The results show that the KINDEX assesses valid information about existing risk factors through a structured 15-minute interview with the pregnant women or through the application of this instrument as self-rating on a tablet computer. The tablet computer application in addition to the paperpencil version has the advantage of automatic analysis of the data and instant recommendation for further support of the pregnant woman

Women's psychological experiences of physiological childbirth: a meta-synthesis

Objective: To synthesise qualitative studies on women's psychological experiences of physiological childbirth. Design: Meta-synthesis. Methods: Studies exploring women's psychological experiences of physiological birth using qualitative methods were eligible. The research group searched the following databases: MEDLINE, CINAHL, PsycINFO, PsycARTICLES, SocINDEX and Psychology and Behavioural Sciences Collection. We contacted the key authors searched reference lists of the collected articles. Quality assessment was done independently using the Critical Appraisal Skills Programme (CASP) checklist. Studies were synthesised using techniques of meta-ethnography. Results: Eight studies involving 94 women were included. Three third order interpretations were identified: 'maintaining self-confidence in early labour', 'withdrawing within as labour intensifies' and 'the uniqueness of the birth experience'. Using the first, second and third order interpretations, a line of argument developed that demonstrated 'the empowering journey of giving birth' encompassing the various emotions, thoughts and behaviours that women experience during birth. Conclusion: Giving birth physiologically is an intense and transformative psychological experience that generates a sense of empowerment. The benefits of this process can be maximised through physical, emotional and social support for women, enhancing their belief in their ability to birth and not disturbing physiology unless it is necessary. Healthcare professionals need to take cognisance of the empowering effects of the psychological experience of physiological childbirth. Further research to validate the results from this study is necessary. PROSPERO registration number CRD4201603707

Birth as a neuro-psycho-social event: an integrative model of maternal experiences and their relation to neurohormonal events during childbirth

Background: Psychological aspects of labor and birth have received little attention within maternity care service planning or clinical practice. The aim of this paper is to propose a model demonstrating how neurohormonal processes, in particular oxytocinergic mechanisms, not only control the physiological aspects of labor and birth, but also contribute to the subjective psychological experiences of birth. In addition, sensory information from the uterus as well as the external environment might influence these neurohormonal processes thereby influencing the progress of labor and the experience of birth. Methodology: In this new model of childbirth, we integrated the findings from two previous systematic reviews, one on maternal plasma levels of oxytocin during physiological childbirth and one meta-synthesis of women's subjective experiences of physiological childbirth. Findings: The neurobiological processes induced by the release of endogenous oxytocin during birth influence maternal behaviour and feelings in connection with birth in order to facilitate birth. The psychological experiences during birth may promote an optimal transition to motherhood. The spontaneous altered state of consciousness, that some women experience, may well be a hallmark of physiological childbirth in humans. The data also highlights the crucial role of one-to-one support during labor and birth. The physiological importance of social support to reduce labor stress and pain necessitates a reconsideration of many aspects of modern maternity care. Conclusion: By listening to women's experiences and by observing women during childbirth, factors that contribute to an optimized process of labor, such as the mothers' wellbeing and feelings of safety, may be identified. These observations support the integrative role of endogenous oxytocin in coordinating the neuroendocrine, psychological and physiological aspects of labor and birth, including oxytocin mediated. decrease of pain, fear and stress, support the need for midwifery one-to-one support in labour as well as the need for maternity care that optimizes the function of these neuroendocrine processes even when birth interventions are used. Women and their partners would benefit from understanding the crucial role that endogenous oxytocin plays in the psychological and neuroendocrinological process of labor

Birth as a neuro-psycho-social event: An integrative model of maternal experiences and their relation to neurohormonal events during childbirth

Background Psychological aspects of labor and birth have received little attention within maternity care service planning or clinical practice. The aim of this paper is to propose a model demonstrating how neurohormonal processes, in particular oxytocinergic mechanisms, not only control the physiological aspects of labor and birth, but also contribute to the subjective psychological experiences of birth. In addition, sensory information from the uterus as well as the external environment might influence these neurohormonal processes thereby influencing the progress of labor and the experience of birth. Methodology In this new model of childbirth, we integrated the findings from two previous systematic reviews, one on maternal plasma levels of oxytocin during physiological childbirth and one meta-synthesis of women's subjective experiences of physiological childbirth. Findings The neurobiological processes induced by the release of endogenous oxytocin during birth influence maternal behaviour and feelings in connection with birth in order to facilitate birth. The psychological experiences during birth may promote an optimal transition to motherhood. The spontaneous altered state of consciousness, that some women experience, may well be a hallmark of physiological childbirth in humans. The data also highlights the crucial role of one-to-one support during labor and birth. The physiological importance of social support to reduce labor stress and pain necessitates a reconsideration of many aspects of modern maternity care. Conclusion By listening to women’s experiences and by observing women during childbirth, factors that contribute to an optimized process of labor, such as the mothers’ wellbeing and feelings of safety, may be identified. These observations support the integrative role of endogenous oxytocin in coordinating the neuroendocrine, psychological and physiological aspects of labor and birth, including oxytocin mediated. decrease of pain, fear and stress, support the need for midwifery one-to-one support in labour as well as the need for maternity care that optimizes the function of these neuroendocrine processes even when birth interventions are used. Women and their partners would benefit from understanding the crucial role that endogenous oxytocin plays in the psychological and neuroendocrinological process of labor

Women’s psychological experiences of physiological childbirth: a meta-synthesis

Objective To synthesise qualitative studies on women’s psychological experiences of physiological childbirth. Design Meta-synthesis. Methods Studies exploring women’s psychological experiences of physiological birth using qualitative methods were eligible. The research group searched the following databases: MEDLINE, CINAHL, PsycINFO, PsycARTICLES, SocINDEX and Psychology and Behavioural Sciences Collection. We contacted the key authors searched reference lists of the collected articles. Quality assessment was done independently using the Critical Appraisal Skills Programme (CASP) checklist. Studies were synthesised using techniques of meta-ethnography. Results Eight studies involving 94 women were included. Three third order interpretations were identified: ‘maintaining self-confidence in early labour’, ‘withdrawing within as labour intensifies’ and ‘the uniqueness of the birth experience’. Using the first, second and third order interpretations, a line of argument developed that demonstrated ‘the empowering journey of giving birth’ encompassing the various emotions, thoughts and behaviours that women experience during birth. Conclusion Giving birth physiologically is an intense and transformative psychological experience that generates a sense of empowerment. The benefits of this process can be maximised through physical, emotional and social support for women, enhancing their belief in their ability to birth and not disturbing physiology unless it is necessary. Healthcare professionals need to take cognisance of the empowering effects of the psychological experience of physiological childbirth. Further research to validate the results from this study is necessary. PROSPERO registration number CRD42016037072

Madres Sanas, Niños Felices : Evaluación de factores de riesgo psicosociales utilizando el KINDEX, en contextos de salud pública en España, Grecia y el Perú

The present thesis explored the psychometric properties of the KINDEX Spanish and Greek version and the feasibility of prenatal screening for psychosocial risks in public health settings in three countries, Spain, Greece and Peru. The KINDEX, a brief and easy to apply screening instrument, was originally developed by Schauer and Ruf-Leuschner, in the University of Konstanz, and assesses eleven factors that have been identified in the current literature to be risks for both the mother and the fetus. The psychometric properties of the KINDEX German Version have been explored and the validity has been examined through validation studies in Germany (Schauer & Ruf-Leuschner submitted; Ruf-Leuschner & Schauer, submitted). The risks that have been proven to have negative impact on mother’s and fetus health, on pregnancy outcomes, and child’s development, include adolescent pregnancy (Panduro Baron et al., 2012), immigrant and/or ethnic minority parental status (Giscombé & Lobel, 2005), lack of social support (Collins, Dunkel-Schetter, Lobel, & Scrimshaw, 1993; Elsenbruch et al., 2006), poverty and financial difficulties (Tanya Nagahawatte & Goldenberg, 2008; Larson, 2007), high stress levels (Talge, Neal, Glover, & The Early Stress, Translational Research and Prevention Science Network: Fetal and Neonatal Experience on Child and Adolescent Mental Health, 2007; Loomans et al., 2012), negative maternal-fetal attachment (Goecke et al., 2012; Alhusen, Hayat, & Gross, n.d.), substances consumption (O’Leary, Jacoby, Bartu, D’Antoine, & Bower, 2013; Falgreen Eriksen et al., 2012), medical risks, pregnancy complications and physical complaints (Munch, Korst, Hernandez, Romero, & Goodwin, 2010; Okun, Schetter, & Glynn, 2011), traumatic experiences during childhood physical and sexual abuse; (Gilson & Lancaster, 2008; Mezey, Bacchus, Bewley, & White, 2005), intimate partner violence (Silverman, Decker, Reed, & Raj, 2006; Rosen, Seng, Tolman, & Mallinger, 2007) and maternal psychiatric history (Dunkel Schetter & Tanner, 2012; Alder, Fink, Bitzer, Hösli, & Holzgreve, 2007).In the first study the KINDEX was translated and culturally adapted into Spanish and was used by medical staff in the Maternity Hospital of Granada, Spain to interview one hundred nineteen pregnant women. The validity of the KINDEX was examined through validation interviews carried out in the same Hospital using established instruments for the assessment of psychosocial variables. Findings permitted the examination of the psychometric properties and validity of the instrument and confirmed the feasibility of prenatal assessment in public health settings in Spain.The second study applied a similar methodological design in public health settings and a Social-Medical center in Crete Island, Greece. Again, medical staff used the KINDEX to interview pregnant women, nevertheless in this case they were instructed to identify high-risk women through the interview and refer them to the mental health services of the Hospital or medical center the women were attending. From the ninety-three women that were interviewed, thirteen were referred by the medical staff. The results show that decision making of the medical staff was precise and that they correctly identified high-risk women. Validation interviews were once again carried through and findings permitted the exploration of the psychometric properties of the KINDEX and the validity testing of the KINDEX Greek Version.The third study was carried out in a different cultural ambient from the ones in the previous studies; in a suburban crime-ridden area in Lima, Peru. Midwives of the gynecological department of a General Public Hospital interviewed ninety-five pregnant women. These are considered to be a high-risk population due to their low SES and other sociodemographic characteristics such as high percentage of adolescent pregnancy. Clinical Expert interviews were once again carried out, and the feasibility of the KINDEX was assessed in this setting. Additionally we examined the relationship between the KINDEX and the risk areas of maternal perceived stress, psychopathology symptoms during pregnancy and trauma load. The specific relationship between each risk factor assessed by the KINDEX also and the three risk areas assessed in the Clinical Expert Interview was also examined. Results have proven the feasibility of prenatal assessment using the KINDEX in public health settings serving high-risk population in urban Peru. The KINDEX and the specific risks were related significantly with the three risk areas assessed in the Clinical Expert Interview

Healthy mothers, happy children. Prenatal assessment for psychosocial factors in public hospitals of the Republic of Cyprus

Background: Maternal mental health has received an increased research interest as it has direct impact on the mother's psychosocial wellbeing and the fetus/child's health and development. Many psychosocial risks factors have found to interplay a crucial role for pregnancy, maternal and neonatal outcomes. the aim of this study was to explore the psychosocial risk factors that may affect pregnant women and examine the feasibility of the KiNDeX Mum-screen for the early detection of women at risk, in the daily practice of health professionals providing prenatal care in public health settings in Cyprus. MethODs: Mixed-methods design was carried out using the adapted Greek version of KiNDeX questionnaire and reflective diaries by the midwives that conducted the interviews. Three hundred one pregnant women were interviewed in five public hospitals of Cyprus by 14 midwives. Upon conclusion of the interviews, the midwives wrote reflective diaries, and thematic analysis was conducted. RESULTS: The results of the quantitative analysis suggest that the KINDEX sum score was significantly higher for participants reporting a risk factor from the eleven risk areas. The PSS-4 was higher for those participants with financial related concerns in the future and for participants that experienced life-long intimate partner violence. From the analysis of the qualitative data, three main themes emerged: 1) health professionals should have the ability to identify psychosocial factors that affect pregnant women and babies' health in their everyday practice; 2) feasibility of the interview in public health care settings; 3) partnership between women and health professionals. cONcLUsiONs: in Cyprus, where the cesarean rates are reaching 60%, one of the highest worldwide, there are a huge space for improvement in the perinatal care provided. health professionals should have the opportunity to use screening tools and provide evidence based, cost effective, and human rights oriented mental health and social care services. Policy makers should create strategies for promotion of psychosocial well-being of mothers during pregnancy aiming at maximizing the neonatal and perinatal outcomes, including the indirect outcomes, such as mother-child bond and child development. the KiNDeX mum-screen was a well-accepted and user-friendly tool by the midwives, within a challenging public health setting. concluding this study and based on the outcomes we consider that this is a valid prenatal screening tool for identification of psychosocial risk factors