Risk factors for excessive postpartum blood loss in the cosmos trial of caseload midwifery

Abstract

Introduction: Tertiary maternity services in Western countries are framed in pathogenesis creating a culture of riskmagnification, a sceptical view of labour physiology, a low threshold for labour intervention and increasing rates of caesarean section. The theory of salutogenesis offers an alternative as it focuses on the causes of health rather than the causes of illness. Sense of coherence (SOC), the cornerstone of salutogenic theory, is a predictive indicator of health. Aim: To investigate the relationship between a pregnant woman’s SOC, the childbirth choices she made in pregnancy and her birthing outcomes. Methods: A cross sectional survey was conducted in the ACT where eligible women completed a questionnaire at two time points, one antenatal and one postnatal. The questionnaires provided information on SOC scores, Edinburgh Postnatal Depression (EPDS) scores, Support Behaviour Inventory (SBI) scores, pregnancy choices, birth outcomes and demographics. Results: The first questionnaire was completed by 1074 women and a 75% return rate was achieved on the second questionnaire. Compared to women with low SOC, women with high SOC were less likely to birth by caesarean section, more likely to experience an assisted vaginal birth, were older, were less likely to identify pregnancy conditions, had lower EPDS scores and higher SBI scores. SOC was not associated with women’s pregnancy choices. Conclusion: In this population, pregnant women with high SOC have fewer caesarean sections compared to women with low SOC. SOC is an important predictor of women’s childbearing health and attention should be focused on increasing women’s SOC in the antenatal period through antenatal care and education. More research is required to relate salutogenesis in general, and SOC in particular, to childbearing women.