Self-management, care needs and clinical management of primiparous mothers during early labour : a qualitative content analysis

Background: Childbearing women face the problem of managing spontaneous onset of labour without professional support. It is their responsibility to diagnose and react to early labour and subsequently recognise the right time to seek support. Institutional guidelines of clinics aim to admit childbearing women when in established labour. This explains why women in early labour are often advised to stay at home, which can be overwhelming and dissatisfying. This study aims to understand the self- and clinical management of early labour and care needs of first-time mothers during early labour. Methods: A qualitative approach was used involving four focus group discussions with a total of N = 18 mothers. Included were primiparous women who had given birth at term within the last 6 months and who experienced spontaneous onset of labour. Elective caesarean section or induction of labour were thereby exclusion criteria. The interviews followed a semi-structured, literature-based guide. Content analysis was applied. Results: Thirteen codes were summarised within three themes: ‘self-management’, ‘care needs’ and ‘professional management’. Various coping strategies and measures such as positive thinking or taking a bath helped women in managing early labour at home. The need for reassurance, professional guidance and pain management led them to seek professional support, which was initially accompanied by a feeling of inhibition. This negative emotion was mostly unjustified since many women felt well cared for and taken seriously in their needs. Conclusion: Coping strategies and professional care help women going through early labour. Yet, there still exists insecurity about the justified timing in seeking professional support. An individual assessment of the women’s coping resources and their needs is required to promote shared decision making and give high-standard care

Primiparous women's expectations and experiences of early labour : a qualitative study

Objectives: To gain a deeper understanding of primiparous women's preparation for early labour as well as their expectations and experiences of symptoms of onset of labour. Methods: A qualitative study using focus group discussion was conducted with n = 18 first-time mothers within the first six months of giving birth. Discussions were transcribed verbatim and coded and summarised into themes by two researchers using qualitative content analysis. Results: The statements of the participants revealed four themes: 'Preparing for the unpredictable', 'Expectations and reality', 'Perception and wellbeing' and 'Experiencing the beginning of birth'. Many women could not distinguish the preparation for early labour from that for the whole birth. Relaxation techniques to prepare for early labour were found to be very helpful. For some women, it was a big challenge that expectations often did not correspond to the experienced reality. Pregnant women faced many different physical and emotional symptoms of onset of labour with striking variability. Emotions ranged from positively excited to having fears. Not being able to sleep for hours was a huge problem for the labour process of some women. While early labour at home was experienced positively, early labour in hospital was sometimes difficult, because women had the feeling of being in the second rank. Conclusion: The study clearly identified the individual character of experiencing onset of labour and early labour. The variety of experiences highlighted the need for individualised, woman-centred early labour care. Further research should investigate new paths for assessing, advising, and caring for women during early labour

Symptoms of onset of labour and early labour : a scoping review

Background: Early labour care often insufficiently addresses the individual needs of pregnant women leading to great dissatisfaction. In-depth knowledge about symptoms of onset of labour and early labour is necessary to develop women-centred interventions. Question or aim: To provide an overview on the current evidence about pregnant women’s symptoms of onset of labour and early labour. Methods: We conducted a scoping review in the five databases PubMed, Web of Science, CINHAL Complete, PsychInfo and MIDIRS in May 2021 and August 2022 using a sensitive search strategy. A total of 2861 titles and abstracts and 290 full texts were screened independently by two researchers using Covidence. For this article, data was extracted from 91 articles and summarised descriptively and narratively. Findings: The most frequently mentioned symptoms were ‘Contractions, labour pain’ (n =78, 85.7 %), ‘Details about the contractions’ (n =51 articles, 56.0 %), ‘Positive and negative emotions’ (n =50, 54.9 %) and ‘Fear and worries’ (n =48 articles, 52.7 %). Details about the contractions ranged from a slight pulling to unbearable pain and the emotional condition varied from joy to great fear, showing an extraordinary diversity of symptoms highlighting the very individual character of early labour. Discussion: A comprehensive picture of varying and contradicting symptoms of onset of labour and early labour was drawn. Different experiences indicate different needs. This knowledge builds a good basis to develop women-centred approaches to improve early labour care. Conclusion: Further research is necessary to design individualised early labour interventions and evaluate their effectiveness

Translation and validation of the German version of the Mother-Generated Index and its application during the postnatal period.

the Mother-Generated Index (MGI) is a validated tool to assess postnatal quality of life. It is usually administered several weeks or months after birth and correlates with indices of post partum mood states and physical complaints. The instrument had not been translated into German before or validated for use among German-speaking women, nor have the results of the tool been assessed specifically for the administration directly after birth. This paper aims to describe the systematic translation process of the MGI into German and to assess the convergent validity of the German version of the instrument directly after birth and seven weeks post partum

Midwives’ perception of advantages of health care at a distance during the COVID-19 pandemic in Switzerland

Objective: To explore midwives' perceptions of the advantages of telemedicine during the COVID-19 pandemic in Switzerland. Design: Cross-sectional study based on an online survey using quantitative methods. Setting: Midwives working in Switzerland. Participants: Self-selected convenience sample of 630 members of the Swiss Federation of Midwives. Measurement Open questions on advantages of health care at a distance and workrelated characteristics were used in the online questionnaire. The information was coded and integrative content analysis was applied. Findings: A good half of the respondents associated telemedicine with either an advantage beyond the pandemic (“Reduced workload”, “Improved health care provision”, “Greater self-care of clients”), while the others saw a pandemic-related advantage (“Protection from COVID-19”, “Maintaining care/counseling in an exceptional situation”), or no advantage at all. Older, more experienced midwives were less likely to see an advantage beyond the pandemic. The motive “Reduced workload” was positively associated with professionals aged younger than 40 years and midwives with up to 14 years of professional experience, and “Protection from COVID-19” was more likely cited by midwives aged 50 and more and by midwives working solely in hospitals. Midwives who stated “Maintaining care” and “Improved health care provision” as motives to embrace telemedicine were more likely to experience health care at a distance as a positive treatment alternative. Key conclusion: Midwives’ perceptions of the advantages of health care at a distance vary substantially with age and years of professional experience, as well as workrelated characteristics. Further research is necessary to acquire a sound understanding of underlying reasons, including the sources of the general attitudes involved. Implication for practice: Understanding the differences in perceptions of health care at a distance is important in order to improve the work situation of midwives and the health care they provide to women and families. Different sensitivities represent an important source in the ongoing discussion about the future use of telemedicine in health care

Improving the organisation of maternal health service delivery and optimising childbirth by increasing vaginal birth after caesarean section through enhanced women-centred care (OptiBIRTH trial): study protocol for a randomised controlled trial (ISRCTN10612254)

Open Access JournalBackground The proportion of pregnant women who have a caesarean section shows a wide variation across Europe, and concern exists that these proportions are increasing. Much of the increase in caesarean sections in recent years is due to a cascade effect in which a woman who has had one caesarean section is much more likely to have one again if she has another baby. In some places, it has become common practice for a woman who has had a caesarean section to have this procedure again as a matter of routine. The alternative, vaginal birth after caesarean (VBAC), which has been widely recommended, results in fewer undesired results or complications and is the preferred option for most women. However, VBAC rates in some countries are much lower than in other countries. Methods/Design The OptiBIRTH trial uses a cluster randomised design to test a specially developed approach to try to improve the VBAC rate. It will attempt to increase VBAC rates from 25 % to 40 % through increased women-centred care and women’s involvement in their care. Sixteen hospitals in Germany, Ireland and Italy agreed to join the study, and each hospital was randomly allocated to be either an intervention or a control site. Discussion If the OptiBIRTH intervention succeeds in increasing VBAC rates, its application across Europe might avoid the 160,000 unnecessary caesarean sections that occur every year at an extra direct annual cost of more than €150 million

Translation and validation of the German version of the Mother-Generated Index and its application during the postnatal period

a b s t r a c t Objective: the Mother-Generated Index (MGI) is a validated tool to assess postnatal quality of life. It is usually administered several weeks or months after birth and correlates with indices of post partum mood states and physical complaints. The instrument had not been translated into German before or validated for use among German-speaking women, nor have the results of the tool been assessed specifically for the administration directly after birth. This paper aims to describe the systematic translation process of the MGI into German and to assess the convergent validity of the German version of the instrument directly after birth and seven weeks post partum. Design: prospective two-stage survey. Setting: two rural hospitals in the south of Germany and in the north of Switzerland. Participants: all women giving birth between 1st October and 15th December 2012 with sufficient knowledge of German and whose babies were not referred to a neonatal care unit; 226 women were eligible to participate. Measurement instruments: two questionnaires including questions relating to socio-demographic factors and perinatal care, and incorporating the MGI, the Hospital Anxiety and Depression Scale (HADS) and the Postnatal Morbidity Index (PMI). All instruments were subjected to forward and back translation and pilot-tested; the first questionnaire was then administered in the first two days after birth and the second six weeks post partum. Parametric and non-parametric tests were computed using SPSS. Findings: 129 surveys were returned an average of three days after birth and 83 after seven weeks. Higher postnatal quality of life showed a significant correlation with a lower anxiety and depression score (po0.01), fewer maternal physical complaints (po0.05) and more favourable baby adjective scores (po0.05) after birth. Significant associations were found between MGI scores and sufficient help (p¼0.03) as well as ability to cope at home (po0.01). MGI scores three days and seven weeks after birth correlated highly significantly and positively (po0.001). Key conclusions: convergent validity of the MGI with the HADS and the PMI suggests that the German version of the MGI is a valid indicator of physical and emotional post partum well-being. Implication for practice: the German version of the MGI can be used in the post partum period to identify women whose quality of life is impaired during the first days after birth, in order to initiate extended midwifery care and referral if necessary

Postnatal quality of life - A content analysis of qualitative results to the Mother-Generated Index.

BACKGROUND: The Mother-Generated Index (MGI) assesses postnatal quality of life (QoL) without providing a predefined checklist, thus offering mothers the opportunity to identify areas of life affected by having a baby. AIM: To identify: (a) details and particularities of areas of life affected after childbirth and thus specific domains defining postnatal quality of life; (b) changes in the importance of domains specifying QoL within the first weeks postpartum; and (c) the potential role of cultural differences with regard to the nature of QoL definitions. METHODS: Prospective, cross-cultural, longitudinal survey. We applied a qualitative content analysis to Mother-Generated Index data collected in Switzerland and Germany using combined deductively and inductively category building. RESULTS: Women participated at three days (n=124) and six and a half weeks (n=82) postpartum. Eleven domains were identified, each with several subdomains: 'physical well-being' (e.g. fatigue), 'psychological well-being' (e.g. happiness, emotional confusion), 'general well-being', 'motherhood' (e.g. bonding with the baby), 'family and partnership' (e.g. time for partner and children), 'social life' (e.g. friends, being isolated), 'everyday life' (e.g. organisation daily routine), 'leisure' (e.g. less time), 'work life' (e.g. worries about job), 'financial issues' (e.g. less money), and further aspects. The most frequently indicated domains were 'motherhood' and 'family and partnership'. Differences between the stages of assessment and countries were identified. DISCUSSION: Mothers faced challenges in defining their new role but welcomed the slowdown in the rhythm of life and experienced overwhelming maternal feelings. CONCLUSION: Our findings suggest that postnatal quality of life is a concept that changes over time and differs between countries

Process evaluation for OptiBIRTH, a randomised controlled trial of a complex intervention designed to increase rates of vaginal birth after caesarean section

Complex interventions encompassing several interconnecting and interacting components can be challenging to evaluate. Examining the underlying trial processes while an intervention is being tested can assist in explaining why an intervention was effective (or not). This paper describes a process evaluation of a pan-European cluster randomised controlled trial, OptiBIRTH (undertaken in Ireland, Italy and Germany), that successfully used both quantitative and qualitative methods to enhance understanding of the underlying trial mechanisms and their effect on the trial outcome