Childbirth Preparation Courses Research Articles

Effects of Drospirenone only pill contraception on postpartum mood disorders: A prospective, comparative pilot study

ObjectiveThe aim of this non-randomized control study was to assess the effect of Drospirenone (DRSP) only pill (DOP) 4 mg, in a 24 active/4 placebo regimen, on the mood of postpartum women who wanted to use a hormonal contraceptive. Study designSeventy-one women in the study group, and 78 in the control group, were included in intention-to-treat analyses. The depression score was assessed using the self-administrated Edinburgh Postnatal Depression Scale (EPDS) at the childbirth preparation course (T0), and at 2 (T1), 12 (T2), and 24 (T3) weeks postpartum follow-ups. ResultsFrom T0 to T1 an increase in the scores was observed in both groups: in the study group from 9.2 ± 2.5 to 10.1 ± 2.4 (p = 0.02), and in the control group from 8.7 ± 2.7 to 10.3 ± 2.2 (p < 0.001). At the T2 follow-up, the EPDS score reduction was statistically significant in the study group (p < 0.001) but not in the control group (p = 0.16). Similarly, at the T3 follow-up, the score was statistically reduced in the study (p < 0.01), but not in the control group (p = 0.35). The intergroup statistical analysis showed no differences between groups at T0 (p = 0.19) and at T1 (p = 0.55). Instead, they were statistically significant at T2 and T3 (p < 0.001). EPDS scores had no significant correlation with the mode of delivery (r = 0.2; p > 0.05) and with the mode of breastfeeding (r = 0.3; p > 0.05). On the other hand, EPDS scores demonstrated a positive correlation with the social status of single (r = 0.99; p < 0.002) and low education level (r = 0.82; p < 0.004). ConclusionPostpartum mood disorders may have persistent effects that compromise the mother's health and newborn development. DRSP, used as DOP, could modulate mood disorders of the postpartum period in women with individual sensitivity to steroid levels.

The dynamics of mental health measures of pre- and postpartum women undergoing assisted reproductive technology

BACKGROUND: The number of infertile women has been increasing since 2015, with a 1015% increase in IVF cycles every year. The data on mental health of women using assisted reproductive technology are contradictory; there is little research on the dynamics of mental health outcomes from pregnancy to postpartum.&#x0D; AIM: The aim of this study was to evaluate the dynamics of mental health measures in the groups of pre- and postpartum women using assisted reproductive technology and to compare these groups with women who conceived spontaneously.&#x0D; MATERIALS AND METHODS: This study had three stages: during pregnancy, within one month after delivery, and in four to nine months after childbirth, and included 59 women who used assisted reproductive technology (34.0 4.60 years old) and 85 women with natural pregnancy (30.6 4.39 years old). All the women had singleton, planned pregnancy, with the most of them at more than 20 weeks pregnant. Drop out within research stages was approximately 2030%. We used the Achenbach System of Empirically Based Assessment, socio-demographic and obstetric data gathering, as well as a postpartum telephone interview.&#x0D; RESULTS: Women in the assisted reproductive technology group were less likely (р = 0.000) to attend or plan to attend childbirth preparation courses. In this study group, emergency (40%) and planned (26%) caesarean sections were used more often (p = 0.001); in 17% of cases, they gave birth before 37 weeks of gestation (vs. 1.9% in the group of women with natural pregnancy); and only 51% of women undergoing assisted reproductive technology used breast feeding (vs. 78% in the group of women with natural pregnancy). No significant differences in Apgar scores and the number of problems in childs health straight after the delivery were shown. In 49 months after the childs birth in the group of women using assisted reproductive technology, the number of somatic disorders was significantly higher (р = 0.046) compared to the group of women with natural pregnancy. The analysis of the dynamics of mental health measures revealed an increase of withdrawal (p = 0.010) and thought problems (p = 0.001) in the group of women using assisted reproductive technology. In the group of women with natural pregnancy, the analysis revealed a decrease in the number of mental health problems such as anxiety / depression, somatic problems, delinquent behavior, as well as DSM-associated anxiety disorder and avoidance (р 0.05).&#x0D; CONCLUSIONS: Mental health measures of women undergoing assisted reproductive technology, their dynamics after childbirth, the number of preterm births and cesarean sections, as well as feeding type altogether may be a risk factor for the mental health and development of the children. These women may require additional support.

Effectiveness of Virtual and In-person Methods of Education on Pregnant Women’s Satisfaction With Childbirth Preparation Classes: A Pilot Study

Background: Childbirth preparation classes are among the most important components of pregnancy education. This pilot study was conducted to compare the level of satisfaction of pregnant women from holding childbirth preparation classes using two methods of virtual and in-person training. Methods: This is a quasi-experimental post-test pilot study that was performed on 30 nulliparous women in Milad Hospital affiliated with Iran’s Social Security Organization, Tehran, Iran from September 2019 to June 2020. The subjects were recruited by convenience sampling and then were assigned voluntarily to two groups of virtual (n=15) and in-person (n=15) training. Both groups received the same educational content on childbirth preparation at 20 to 37 weeks of pregnancy. The virtual educational content was designed based on Mayer’s multimedia principles and shared through the Telegram application. The courses were held in eight 2-hour sessions. The satisfaction questionnaire was completed by the participants at 36-38 weeks of pregnancy. The significance level was set at P≤0.05. Results: There was a significant difference between the total score of satisfaction with childbirth preparation courses between the virtual group compared to the in-person training group (P=0.028). Also, the results showed that the virtual group was able to significantly attract the spouse’s participation in accepting the role of parent compared to the in-person group (P=0.05). Also, 100% and 46.7% of the virtual and in-person groups, respectively, were completely satisfied with the way the educational content was presented (P&lt;0.01). Conclusion: Considering the greater satisfaction of pregnant women with virtual training compared to in-person training and its important role in attracting the participation of the spouse and considering that in-person classes are held as a national routine, virtual classes are recommended to be held alongside in-person classes. It is also recommended to use a larger sample size and random allocation in future studies.

Comparing the effect of childbirth preparation courses delivered both in-person and via social media on pregnancy experience, fear of childbirth, birth preference and mode of birth in pregnant Iranian women: A quasi-experimental study.

Rates of cesarean section in Iran are unnecessarily high largely due to fear of childbirth (FOC), yet this may be reduced through education. Iranian women are keen to obtain information about pregnancy and birth online though sources may not be reliable. Consequently, the present study aimed to compare the effect of childbirth preparation courses delivered both online via the social media platform 'Telegram' and in-person on pregnancy experience, FOC, birth preference, and mode of birth. This quasi-experimental study included 165 primiparous pregnant women referred to the prenatal clinic in Tehran, Iran. Convenience sampling was used to recruit participants, who were subsequently divided into three groups; (A) social media-based educational intervention (n = 53); (B) in-person educational intervention (n = 52), and (C) a control group who received no prenatal education (n = 50). During the 18th and 20th weeks of pregnancy, demographic questions along with the pregnancy experience scale (PES), and version A of the Wijma delivery expectancy/experience questionnaire (WDEQ‑A) were completed. In the 36th and 38th weeks of pregnancy, the PES and WDEQ‑A questionnaires, as well as birth preference form were further completed. Mode of birth was recorded in the first few days of postpartum. The Fisher's exact test, along with ANOVA and Chi-square tests were used to determine associations between variables. A paired t-test was used to examine within-group comparisons. The Kruskal-Wallis non-parametric test was used to investigate the intervening effect of economic status. Post intervention, the mean score of pregnancy experience and FOC did not differ significantly between the three groups. Also, 86.8% of participants in group A, 90.4% of participants in group B, and 62% of participants in the control group preferred to give birth vaginally, which was statistically significant (p = 0.001). Moreover, 66% of participants in group A, 61.5% of participants in group B, and 50% of participants in the control group ultimately gave birth vaginally. None of the participants in group A underwent an elective cesarean section, while this rate was 7.7% and 24% for groups B and control, respectively (p = 0.002). Despite the non-significant differences identified between the three groups in terms of pregnancy experience and FOC, prenatal education delivered via social media may be usefully offered to Iranian women keen to receive education flexibly online. Name of the Registry: Iranian Registry of Clinical Trials. Trial registration number: IRCT20180427039436N2. Date of registration: 15/06/2018. URL of trial registry record: https://www.irct.ir/trial/30890.

The effect of interventions in alleviating fear of childbirth in pregnant women: a systematic review

ABSTRACT Background The Fear of Childbirth (FOC) is regarded as a general problem, which affects women’s health and well-being, justifying demanding caesarean section. Several primary studies have been performed in relation to the interventions performed to reduce the fear of childbirth, which show contradictions between the results of these studies. Objective This review aims to provide a comprehensive review of the different types of interventions used to reduce the fear of childbirth in pregnant mothers. Methods In this study, systematic review of study information related to the effect of different therapies on reducing the fear of childbirth using subject-related keywords and validated with MeSH in SID, MagIran, IranMedex, IranDoc, Embase, ProQuest, Scopus, PubMed, Web of Science (ISI) databases and Google Scholar Search Engine were extracted without any time limit until February 2021. Results After removing duplicates and irrelevant works from among the 5396 articles found, 63 articles remained in the study. The participants in these 63 articles were 5415 cases and 5770 controls. In addition, three studies were on epidural anesthesia, 33 on the effects of psychotherapy, 19 on the effects of education, and eight on the influence of other interventions on alleviating FOC. As shown by the results, psychotherapy intervention and education decreased FOC significantly. Conclusion According to the results of this study, to prevent the fear of childbirth, pregnancy training and prenatal preparation courses are recommended to empower pregnant women. It also seems beneficial to use psychotherapy approaches for women who are afraid of childbirth.

Influence of 5-HTTLPR polymorphism on postpartum depressive and posttraumatic symptoms.

Postpartum depression (PPD) is a multifactor disorder caused by psychological, social, and also biological factors. 5-HTTLPR polymorphism in the promoter region of serotonin transporter gene seems to influence PPD onset. In this study, we examined the effect of 5-HTTLPR polymorphism on prenatal and postnatal symptoms of depression and posttraumatic stress in women. A longitudinal design with three points - time 1 (32-40 weeks gestation); time 2 (2 or 3 weeks after birth), and time 3 (3 months after birth) - was made. A total of 141 women were recruited during childbirth preparation courses. At time 1, women completed the Beck Depression Inventory (BDI) and the Los Angeles Symptoms Checklist (LASC). At time 2, they fulfilled BDI and Edinburgh Postnatal Depression Scale (EDPS), LASC and the Perinatal Posttraumatic stress disorder (PTSD) Questionnaire (PPQ); midwives and nurses collected biological test tubes by blood sampling for the genetic analysis. At time 3, the women were reassessed for BDI, LASC, EDPS, and PPQs. Analysis of variance and moderation analysis were used to correlate genotype and psychological investigations. Results showed that, compared with LL/LS genotypes, SS genotype moderated cognitive depressive symptoms onset at T2 and T3. Moreover, this genotype correlated, directly or indirectly, with PTSD postpartum aspects (re-experience, avoidance, and hyperarousal). Findings revealed that a lower expression of serotonin transporter gene, associated with SS genotype, seems to render women more vulnerable to depressive and PTSD symptoms after childbirth.

Élaboration d’un outil d’information sur l’accouchement : consensus par la méthode Delphi

ObjectiveThe integration of couples in decision making in obstetrics is necessary to improve the experience of giving birth. The objective of this work is to elaborate a new tool to provide information to health professionals. MethodsA 5-round Delphi method was used to define the information points. The 20 multi-disciplinary experts answered 5 surveys on the information to deliver concerning childbirth. The selected items were organized with mind mapping. Results54 items were identified on the first round. 5 were retained after the second survey while the rest were reformulated and submitted for the third round. Amongst the 47 items submitted, 19 were retained, the rest were removed, merged or reworded. The fourth survey included 22 items of which 11 were retained. The fifth survey concerned the 11 remaining items and 2 new ones. During this round, 7 items were retained. This round made it possible to reach the consensus. In total, 42 items reached the consensus of the experts. They were then split into 5 mind maps allowing their visual organization to form the information tool. ConclusionThe tool elaborated in a multi-disciplinary manner offers complementary information to that already given during childbirth preparation courses. It is a framework for the information to be given that leaves the content up to each professional.

Evaluating the Effectiveness of Childbirth Preparation Courses on Women's Self-Efficacy among Ultra-Orthodox Jewish Religious Women in Israel.

Background: This study examined the effectiveness of a birth preparation course on coping with childbirth among primigravid ultra-orthodox Jewish women in Israel. Methods: In total, 130 ultra-orthodox 25–35-week primigravid women were divided into a study (n = 100, participated in birth preparation courses) and a control (n = 30, did not participate in the courses) group. A questionnaire was delivered three times: T1—before the course/delivery, T2—two–three days after delivery, and T3—a month after delivery. Results: At T3, self-efficacy among the study group was higher than in the control group. Differences in self-efficacy were found over time regardless of the group (F(2,246) = 12.83, p < 0.001), as a time–group interaction effect (F(2,246) = 10.20, p < 0.01). Self-efficacy in the study group (Mean, M = 3.40, Standard deviation, SD = 0.63 at T1) dropped to M = 3.06, SD = 0.76 at T2 and rose to M = 3.34, SD = 0.64 at T3. In the control group, self-efficacy (M = 3.53, SD = 0.56 at T1) dropped to M = 3.26, SD = 0.63 at T2 and to M = 2.95, SD = 0.76 at T3. Discussion: The childbirth preparation course was found to be effective in raising self-efficacy among primigravid ultra-orthodox religious women when compared to the control group.

Maternity care through the eyes of Southern European immigrant parents in Norway

ObjectiveTo explore Southern European immigrant mothers and fathers’ experiences of reproductive health services in Norway, and their perceptions of health providers’ beliefs and attitudes regarding pregnancy and childbirth. MethodWe employed a qualitative research methodology with two focus group discussions and 11 in-depth interviews with 4 fathers and 11 mothers from Italy, Spain, Portugal, and Greece, whose children were born in Norway. Thematic Analysis was conducted to identify and analyze patterns across the data. ResultsWe identified three themes as key elements in parents’ experiences: experiences with the coverage and organization of the Reproductive Health Services; relational experiences with health providers; and pregnancy and delivery as a culturally-shaped event. The immigrant parents experienced a clash between their expectations and the procedures and health facility environment encountered in Norway regarding check-ups, diagnosis tests, childbirth preparation courses, and health facilities. Informants perceived that the maternity care practices of the host country were underpinned by the health care providers’ cultural understandings of labor and pregnancy. Particularly, they experienced a less interventionist approach towards pregnancy and childbirth. ConclusionsThe experiences of immigrant parents provide relevant information to improve reproductive health services in a cross-cultural context. Inmigration brings new challenges that must be addressed from a perspective of cultural competence. These services should acknowledge diversity in cultural beliefs around childrearing and involve both fathers and mothers in decision-making.

Vaccination attitude assessment among attendees the birthing preparation course: a pre-post study

Abstract Background Vaccinations are among the most effective and safe ways to prevent the spreading and the complications of infectious diseases. In order to reduce risks and to protect children from the early beginning of their life, most vaccinations are recommended within the 15th month of life. In Italy, the law provides 10 compulsory vaccinations to the 0-16 age group. A training program was carried on by a Public Health specialist during the birthing preparation course, aimed at increasing the attitude to vaccination in maternal-child age. Methods A training session in the birthing preparation course was specifically carried out to raise awareness about vaccination during both pregnancy and puerperium and in early childhood; a questionnaire on vaccination awareness was administered before and after the training session. Results Out of 119 pregnant women attended the birthing preparation course from October 2019 to January 2020. As a result of the interventions, the percentage of the participants who consider the preparatory course a useful tool to obtain information about vaccines increases significantly from 30.34% pre-intervention to 64.56% post-intervention (p &amp;lt; 0.001). There is a significant increase in the mean number of vaccinations that the participants want their children to get, out of the 12 vaccinations proposed in the questionnaire: 9.68/12 pre-intervention versus 10.57/12 post-intervention (p = 0.021). Participants supporting the mandatory vaccinations are 96.04% pre-intervention and rise to 98.73% post-intervention. Conclusions Attitude and knowledge related to vaccination are crucial values for maternal-child health: they significantly increased after a training session dedicated to vaccination as a part of the pregnant pre-birth course, whose aim can be therefore extended to the management of the health of the child, well beyond the period of pregnancy, labor and childbirth, according the life-course approach to health, from the Public Health perspective. Key messages The childbirth preparation courses for pregnant should be valuable as a precious opportunity to raise parents’ awareness and their attitude to vaccinations, if dedicated sessions are included in them. The mandatory nature of vaccines is very well received by pregnant women.

Mediating Role of Labor on the Relationship Between Prenatal Psychopathologic Symptoms and Symptoms of Postpartum Depression in Women Who Give Birth Vaginally

ObjectiveTo investigate how prenatal symptoms of anxiety and depression and clinical aspects of labor (duration of labor, administration of oxytocin and epidural analgesia) interact with each other to contribute to symptoms of postpartum depression in women who give birth vaginally. DesignA longitudinal design with measurement at three different time points: Time 1, 31 to 32 weeks gestation; Time 2, the day of labor and birth; and Time 3, 1 month after birth. SettingMaternity ward of the Misericordia e Dolce Hospital in Prato, Italy. ParticipantsA total of 186 women at 31 to 32 weeks gestation were recruited during childbirth preparation courses at the maternity ward. MethodsAt Time 1, women completed the Beck Depression Inventory and the State portion of the State–Trait Anxiety Inventory. At Time 2, midwives recorded clinical data related to labor, including duration of labor and administration of oxytocin and epidural analgesia. At Time 3, the women completed the Edinburgh Postnatal Depression Scale. Structural equation modeling was performed. ResultsSymptoms of depression (β = 0.36; p < .001; 95% confidence interval [CI] [0.17, 0.49]) and state anxiety (β = 0.25; p < .001; 95% CI = [0.04, 0.27]) during pregnancy positively affected symptoms of depression after birth. Greater levels of these prenatal symptoms predicted a more complicated labor (depression: β = 0.29; p < .01; 95% CI [0.00, 0.19]; anxiety: β = 0.30; p < .01; 95% CI [0.01, 0.14]), which, in turn, positively predicted greater levels of symptoms of depression at 1 month after birth (β = 0.34; p < .001; 95% CI [0.38, 1.51]). Moreover, results highlighted indirect effects that high levels of anxiety symptoms during pregnancy have on postpartum symptoms of depression through the clinical aspects of labor (β = 0.10; p < .01; 95% CI [0.00, 0.13]). These indirect effects were not significant for antenatal symptoms of depression (β = 0.10; p < .05; 95% CI [–0.02, 0.20]). ConclusionOur findings confirm that symptoms of anxiety and depression during pregnancy represent significant risk factors for the clinical aspects of labor and for the development of symptoms of postpartum depression in the first month after childbirth.

Virtual Childbirth Preparation Courses to Reduce the Fear of Childbirth and Improve the Pregnancy Experience in Pregnant Women: Protocol for a Quasi-Experimental Clinical Trial (Preprint)

Virtual Childbirth Preparation Courses to Reduce the Fear of Childbirth and Improve the Pregnancy Experience in Pregnant Women: Protocol for a Quasi-Experimental Clinical Trial (Preprint)

The effects of a childbirth preparation course on birth outcomes among nulliparous Jordanian women

ObjectiveThis study aimed to examine the effectiveness of a childbirth preparation course on birth outcomes among nulliparous Jordanian women. DesignA randomized control trial pre-test/post-test design was used to assess the effects of a childbirth preparation course conducted in a military hospital in Amman, Jordan from 1 July to 15 September 2016. A total of 133 low-risk nulliparous women were recruited and randomly assigned to either (1) a control group who received standard care in antenatal clinics or (2) an intervention group who received standard care in antenatal clinics as well as a childbirth preparation course specifically designed for the purpose of this study. Data were collected at two different time points: at recruitment and within 24 to 48 h after giving birth. The chi-square test and independent sample t-test were used to compare birth outcomes. ParticipantsLow-risk nulliparous women in their third trimester of pregnancy attending antenatal clinics at King Hussein Medical Centre in Amman, the capital of Jordan. Measurements and findingsThe childbirth preparation course had a positive effect on three birth outcomes. Specifically, more women in the intervention group than in the control group had spontaneous onset of labour (89.0% vs 70.3%, p = .02), the average of cervical dilation was greater in the intervention group than in the control group [(mean = 3.8, SD = 1.55) vs (mean = 3.2, SD = 1.61); t = 2.24, p = .03] and there was earlier initiation of breastfeeding in the intervention group than in the control group [(mean = 6.2, SD = 0.4.43) vs (mean = 17.8, SD = 18.08); t = 4.90, p ≤ 01]. Key conclusionsThe findings suggest that the childbirth preparation course increased the likelihood of pregnant women having spontaneous onset of labour and arriving at the maternity ward in active labour. Moreover, it helped them to initiate breastfeeding earlier after birth. No effect was found for other birth outcomes or neonatal outcomes. Further studies with a larger sample are needed to obtain more definitive conclusions. Implication for practiceIt is recommended that policymakers and administrators facilitate the embedding of this childbirth preparation course into antenatal care to improve maternal and neonatal health.

Benefits of preparing for childbirth with mindfulness training: a randomized controlled trial with active comparison

BackgroundChildbirth fear is linked with lower labor pain tolerance and worse postpartum adjustment. Empirically validated childbirth preparation options are lacking for pregnant women facing this problem. Mindfulness approaches, now widely disseminated, can alleviate symptoms of both chronic and acute pain and improve psychological adjustment, suggesting potential benefit when applied to childbirth education.MethodsThis study, the Prenatal Education About Reducing Labor Stress (PEARLS) study, is a randomized controlled trial (RCT; n = 30) of a short, time-intensive, 2.5-day mindfulness-based childbirth preparation course offered as a weekend workshop, the Mind in Labor (MIL): Working with Pain in Childbirth, based on Mindfulness-Based Childbirth and Parenting (MBCP) education. First-time mothers in the late 3rd trimester of pregnancy were randomized to attend either the MIL course or a standard childbirth preparation course with no mind-body focus. Participants completed self-report assessments pre-intervention, post-intervention, and post-birth, and medical record data were collected.ResultsIn a demographically diverse sample, this small RCT demonstrated mindfulness-based childbirth education improved women’s childbirth-related appraisals and psychological functioning in comparison to standard childbirth education. MIL program participants showed greater childbirth self-efficacy and mindful body awareness (but no changes in dispositional mindfulness), lower post-course depression symptoms that were maintained through postpartum follow-up, and a trend toward a lower rate of opioid analgesia use in labor. They did not, however, retrospectively report lower perceived labor pain or use epidural less frequently than controls.ConclusionsThis study suggests mindfulness training carefully tailored to address fear and pain of childbirth may lead to important maternal mental health benefits, including improvements in childbirth-related appraisals and the prevention of postpartum depression symptoms. There is also some indication that MIL participants may use mindfulness coping in lieu of systemic opioid pain medication. A large-scale RCT that captures real-time pain perceptions during labor and length of labor is warranted to provide a more definitive test of these effects.Trial registrationThe ClinicalTrials.gov identifier for the PEARLS study is: NCT02327559. The study was retrospectively registered on June 23, 2014.

The effect of attending a prenatal childbirth preparedness course on labor duration and outcomes.

To evaluate the effect of attending a prenatal childbirth preparation course (CPC) on labor duration and outcomes. A cross sectional study of 53 primiparous women who attended and 54 women who did not attend a CPC was conducted. The state-trait anxiety inventory (STAI) score was used to diagnose anxiety. Clinical and obstetrical data were collected from the perinatal database of our center. Through post-partum interviews, coping strategies were assessed, patients graded their childbirth experience and breastfeeding was evaluated. Data were analyzed using description analyses and a P-value <0.05 was considered statistically significant. The STAI score was significantly lower in the study group compared with controls (P=0.025). The first stage and the entire duration of labor were significantly shorter (P=0.036 and P=0.026, respectively) in women who attended the CPC. No significant differences were found with regard to the mode of delivery, rate of episiotomy, use of analgesics and neonatal outcomes between the groups. Women in the study group rated their labor experience significantly higher (P=0.016) and exhibited significantly higher rates of breastfeeding (P<0.001) than controls. The knowledge acquired in the CPC has positive effects on the course of labor and delivery outcomes as well as higher rates of breastfeeding.

Opinions and attitudes of obstetricians and midwives in Turkey towards caesarean section and vaginal birth following a previous caesarean section.

AimTo determine the opinions and attitudes of Turkish obstetricians and midwives to caesarean section (C-section) and vaginal birth following a C-section.MethodsThe study involved obstetricians and midwives who were working in a state women’s hospital and two private hospitals in Gaziantep, Turkey. Participants were asked to complete questionnaires on sociodemographic data and provide opinions about C-section.ResultsA total of 88 midwives and 22 obstetricians participated in the study. Approximately one-third of midwives believed caesarean rates were high at their institution and more than 50% thought that the rate should be reduced. In contrast, although approximately 80% of obstetricians thought that caesarean rates in their institutions ranged between 25–50%, only 18% believed the rate was high and 68% believed that the rate of should be reduced. Midwives and obstetricians tended to agree on most suggested reasons for high C-section rates. When asked about interventions that may reduce the C-section rates, midwives and obstetricians had opposing views. However, most participants agreed that prenatal childbirth preparation courses would be beneficial.ConclusionsThis study showed that most midwives and obstetricians believe the rate of C-section at their institution is high and should be reduced.

Breastfeeding during the first year of life: estimates using records generated in general pediatrics.

The monitoring of breastfeeding during a child's first year of life is highly recommended. The proportion of children who are exclusively breastfed for at least six months is a strong indicator of breastfeeding promotion in the community. The objectives of the study were to survey the exclusive breastfeeding of children during the first year of life for cohorts born in Trentino (north-eastern Italy) in 2009 to 20013, to evaluate the decrease of exclusive breastfeeding at 6 months and to analyze possible relationships between the maintenance of breastfeeding up to the age of 6 months and certain maternal socio-demographic characteristics, as well as clinical aspects of the pregnancy and birth. Cohorts born in Trentino between 2009 and 2013 were studied, calculating the proportion of infants who were breastfed upon discharge from the hospital (source: data on the CedAP informative flow, that is the Italian Certificate of Delivery Assistance data-base). The data provided on the 12-Month Health Evaluation Form found in the Pediatric Health Booklet, completed by regional family pediatricians, was linked with that of the respective CedAP (96.7% linkage). The trend for exclusive breastfeeding and its monthly decrease was analyzed. The maintenance of exclusive breastfeeding until the age of 6 months was analyzed in relation to citizenship, area of residence, maternal education level and employment status, parity, single or multiple birth, infant exposure to passive smoke and attendance or non-attendance of a state-promoted childbirth preparation course. This final variable was studied solely for primiparous women, who are generally most likely to attend a childbirth preparation course. All results were adjusted for the following potential confounding variables: "birth type," "prematurity" and "feeding method upon discharge from the hospital." CedAP data revealed that 83.5% of live infants were exclusively breastfed and that this percentage decreased to 34.7% by the age of 6 months (35.4% among full-term infants and 27% among premature infants). Data from the Province of Trento demonstrates that exclusive breastfeeding up to the age of 6 months is influenced by the mother's citizenship, area of residence and education level, but not by her employment status. In addition, the study revealed a significant association with parity, passive smoke exposure and attendance of a childbirth preparation course. The Pediatric Health Booklet with its information on the state of health of children (in combination with data from the CedAP) offers a valid tool for monitoring breastfeeding during the first year of life. Data confirmed a decrease in the rate of breastfeeding between birth and the first month of life and between the first and sixth months of living at home. The results regarding the conditions that favour and discourage breastfeeding suggest potential public health care measures to improve children's health.

The effect of childbirth preparation courses on anxiety and self-efficacy in coping with childbirth

Objective: To evaluate the effect of childbirth preparation courses on anxiety and self-efficacy levels in coping with childbirth. Methods: A study was conducted on a convenience sample of nulliparous women. The intervention groups consisted of 31 women who attended a 5-week childbirth preparation course and 39 women who attended a 2-week course. A control group included 32 women who did not attend any of the childbirth preparation courses. Levels of anxiety and self-efficacy were measured before and after childbirth preparation courses. The setting was a large teaching hospital in central Israel. Results: After completing the preparation courses the anxiety level dropped significantly in the long and short course groups ( p = .04 and p = .01, respectively). The anxiety in both groups was significantly related to the self-efficacy for coping with childbirth ( r = -0.26, p = .03 and r = -0.48, p = .001, respectively). Nonetheless, attending the preparation courses did not raise the level of self-efficacy in coping with childbirth. Anxiety and self-efficacy levels in the control group were not significantly different from those of the other groups. Conclusions: Preparation courses are expected to reinforce the self-efficacy of the parturient. The overall impact of the findings indicated that while they had no effect on self-efficacy, they did constitute an anxiety-reducing factor. Midwife postgraduate programs should include training in preparing women for coping with childbirth. These findings are an important contribution to the examination of current strategies of teaching and training of midwives in conducting childbirth preparation courses.

Culture and Maternity Care in Kazakhstan: What New Mothers Expected

Maternity care in the developing nation of Kazakhstan has been characterized as low in quality, with mothers having low levels of health knowledge. Some nongovernmental organizations have been offering childbirth preparation courses to address the lack of knowledge and encourage participation and decision making among expecting mothers. The participants of this study, however, report that information is more for preparation than for decision making, and that the relational aspects of their care, namely, emotional support and trust, are most important. This emphasis reflects the cultural and historical influences that need to be considered when adopting foreign models of care and health education.

Overestimation and underestimation of labor pain

Objective: To define factors affecting the ability of the medical staff to estimate the level of pain during labor. Methods: The study population consisted of 255 consecutive women. All parturients were asked to rate their pain level, using a visual analog scale. At the same time, the caregivers estimated the degree of pain as was exhibited by the parturients, using the same scale. Patients whose pain level was either overestimated or underestimated were compared to patients whose pain was correctly estimated. Results: In about half of the women (50.6%) enrolled in our study the level of pain was estimated correctly by the caregivers, while similar proportions of women had their pain level overestimated (24.3%) and underestimated (25.1%) by the caregivers. While the majority (54.5%) of patients who were in their second or third deliveries were equally estimated by the personnel with regard to their pain intensity levels, most of the grandmultiparous women had their labor pain underestimated by the medical staff. (57.1%, P<0.001). None of the caregivers had more than five children. Although the mostly secular medical staff could properly estimate the pain levels of most secular patients (52.3%), the labor pain of 44% of the religious parturients was underestimated (P=0.003). The ability to estimate properly the patients’ suffering was found to be unaffected by age, family status, educational level, presence of companion during labor and participation in childbirth preparation course. Conclusion: The wider the cultural gap between the caregiver and the patient, the less accurate was the interpretation of patient’s pain.