Psychosocial outcomes of a randomized controlled trial of outpatient cervical priming for induction of labor

BACKGROUND: Induction of labor, an increasingly common intervention, is often preceded by the application of an agent to “prime” or “ripen” the cervix. We conducted a randomized controlled trial to compare clinical, economic, and psychosocial outcomes of inpatient and outpatient cervical priming before induction of labor. In this paper we present the psychosocial outcomes. METHODS: Women participating in a randomized controlled trial in two Australian metropolitan teaching hospitals completed questionnaires to measure anxiety and depression at enrollment, and to examine satisfaction, experiences, depression, and infant feeding 7 weeks after giving birth. Data analysis was by intention to treat and by having received the intervention as intended (approximately 50% in each group). RESULTS: Of 1,004 eligible women, 85 percent consented (n = 407, outpatient; n = 414 inpatient). No statistically significant or clinically relevant differences were found in immediate anxiety, depression, or infant feeding. Small, statistically significant differences favoring outpatient priming were found in seven of the nine subscales in the 7-week postpartum questionnaire. The direction of the effect was maintained, mostly with a larger effect size in women who received the intervention. CONCLUSION: Women allocated to outpatient priming were more satisfied with their priming experience than women allocated to inpatient priming. Being informed that they could go home after cervical priming did not increase women’s anxiety.Deborah Turnbull, Pamela Adelson, Candice Oster, Robert Bryce, Jennifer Fereday and Chris Wilkinso

Parents’ childhood fever management: community survey and instrument development

Aim: This paper is a report of a study to explore Australian parents’ knowledge, beliefs, practices and information sources about fever management and develop a scale to measure parents’ fever management practices. Background: Parental fever phobia and overuse of antipyretics to reduce fever continue. No scales to measure parents’ fever management practices are available. Method: A community-based, postal survey was carried out in 2005 with 401 Australian parents of well children aged 6 months to 5 years. Respondents were recruited through advertising (48.4%), face-to-face (26.4%) and snowball (24.4%) methods. A 33-item instrument was developed; construct and content validity were determined by an expert panel and item reliability by test-retest. Results: Moderate fever (40.0ºC±1.0ºC) was reported to be harmful (88%), causing febrile convulsions (77.7%). Usual practices targeted temperature reduction, antipyretic administration (87.8%), temperature monitoring (52.5%). Fewer evidence-based practices, such as encouraging fluids (49.0%) and light clothing (43.8%), were reported. Positive changes over time (36.4%) included less concern and delayed or reduced antipyretic use. Negative practice changes (22.7%) included greater concern and increased antipyretic use. Medical advice was sought for illness symptoms (48.7%) and high (37.4%) or persistent (41.5%) fevers. Fever management was learnt from doctors, family and friends and experience, while receiving conflicting information (41.9%) increased concerns and created uncertainty about best practice. Conclusion: Parents need consistent evidence-based information about childhood fever management. The Parental Fever Management Scale requires further testing with difference populations and in different cultures and healthcare systems to evaluate its usefulness in nursing practice and research