Mother Autonomy Research Articles

Measuring autonomy and respect: a qualitative, cross-cultural adaptation of the Mothers Autonomy in Decision Making scale and Mothers on Respect index instruments in Danish

ObjectiveDecision-making is important in user-involved maternity care and patient experience instruments Mothers Autonomy in Decision Making scale (MADM) and Mothers on Respect index (MORi) are used internationally to measure the user involvement quality and users’ experiences of autonomy and respect. This study aimed to translate and qualitatively adapt the original MADM and MORi instruments to the Danish language and culture. MethodsA forward and backward translation using a standard guideline. Subsequently, qualitative interviews to refine the translation and cultural adaptation by pilot testing the scales. ResultsThe translation process showed cultural differences linked to linguistic variations between Danish and English. Cognitive interviews with 14 diverse pregnant women revealed challenges in women's understanding of decision-making in maternity care. Changes in wording and assisting descriptive texts were made. Further, the order of the MADM items was changed to improve the understanding of decision-making. DiscussionPrimarily, the discussion concerns how decision-making can be understood in the context of maternity care and why women's understanding of decision-making in Danish maternity care in the MADM scale items was challenged. ConclusionThe qualitative pilot test using cognitive interviews after translation of the instruments was a valuable method for cultural adaptation providing important knowledge on women's understanding and perceptions of item contents. The cognitive interviews provided a comprehensive understanding of decision-making and contributed to a thoroughly worked Danish version of the MADM and MORi instruments.

Assessing patient autonomy in the context of TeamBirth, a quality improvement intervention to improve shared decision-making during labor and birth.

Respectful maternity care includes shared decision-making (SDM). However, research on SDM is lacking from the intrapartum period and instruments to measure it have only recently been developed. TeamBirth is a quality improvement initiative that uses team huddles to improve SDM during labor and birth. Team huddles are structured meetings including the patient and full care team when the patient's preferences, care plans, and expectations for when the next huddle will occur are reviewed. We used patient survey data (n = 1253) from a prospective observational study at four U.S. hospitals to examine the relationship between TeamBirth huddles and SDM. We measured SDM using the Mother's Autonomy in Decision-Making (MADM) scale. Linear regression models were used to assess the association between any exposure to huddles and the MADM score and between the number of huddles and the MADM score. In our multivariable model, experiencing a huddle was significantly associated with a 3.13-point higher MADM score. When compared with receiving one huddle, experiencing 6+ huddles yielded a 3.64-point higher MADM score. Patients reporting at least one TeamBirth huddle experienced significantly higher SDM, as measured by the MADM scale. Our findings align with prior research that found actively involving the patient in their care by creating structured opportunities to discuss preferences and choices enables SDM. We also demonstrated that MADM is sensitive to hospital-based quality improvement, suggesting that future labor and birth interventions might adopt MADM as a patient-reported experience measure.

Validation of the Greek version of Mother's Autonomy in Decision Making (MADM) scale.

Ensuring expectant mothers have the capacity to make well-informed decisions regarding their prenatal care, encompassing medical interventions, and birthing preferences are crucial for fostering favorable health outcomes for both mother and newborn. The Mother's Autonomy in Decision Making (MADM) scale serves as a commonly utilized tool for evaluating the autonomy of pregnant women in the decision-making processes related to prenatal care and childbirth. The aim of this study is to validate the MADM scale in women who had at least one home childbirth experience in Greece. A retrospective online survey collected data from Greek women with home childbirth experience (January 2010 - December 2023). We utilized a self-administered questionnaire and the Greek version of the MADM scale. The study included 162 women, predominantly of Greek nationality (94.4%) and residing in Attica (54%). The MADM scale showed a median score of 38. The confirmatory factor analysis indicated acceptable fit and reliability (comparative fit index, CFI=0.92; Tucker-Lewis index, TLI=0.91; root mean square error of approximation, RMSEA=0.07; Cronbach's α=0.92). Age correlated weakly negatively with the MADM scale score (Spearman's rho= -0.166, p=0.035). Additionally, women attending antenatal preparation courses with a midwife before their first home birth had higher MADM scores (median 39 vs 35, p=0.037). The study underscores the importance of the MADM scale, demonstrating its reliability and validity for women living in Greece. Younger age and attending antenatal preparation courses with a midwife were associated with higher MADM scores, highlighting education's role in maternal autonomy.

Maternal Ambivalence in Avni Doshi’s Burnt Sugar and Zehra Naqvi’s The Reluctant Mother

ABSTRACT This article examines the concept of maternal ambivalence in the Indian cultural milieu through a critical analysis of Avni Doshi’s Burnt Sugar and Zehra Naqvi’s The Reluctant Mother. These novels illustrate how societal glorification of maternal archetypes imposes significant emotional burdens on mothers who defy established norms, leading to inner conflicts laden with guilt, uncertainty, and the struggle to balance personal aspirations with societal expectations. We demonstrate how the novels subvert the entrenched heteropatriarchal order and advocate for a departure from rigid standards of what Andrea O’Reilly calls ‘patriarchal motherhood’. The article focuses on the mother–child relationship, which is characterised by ‘ambiguous intersubjectivity’ and ethical dilemmas linked to maternal discontent. We argue that a phenomenological exploration of maternal ambivalence, in conjunction with cultural norms, offers valuable insights into the complexities of maternal subjectivity and mirrors the conflicts within the maternal psyche. This approach grounds conceptions of gender and motherhood in lived experiences rather than normative ideals, providing a unique lens to examine social realities beyond individual literary works. We show how maternal ambivalence lies at the heart of the motherhood experience and how these narratives vindicate the individuality and autonomy of mothers.

Influence of Parental Rearing Practices on Prosocial Behavior: The Mediating Role of Emotional Intelligence

This study aimed to explore the relationship between prosocial behavior, emotional intelligence, and perceived parental parenting practices in adolescents. The study employed mediation analysis to examine the underlying processes and mechanisms connecting these variables. A sample of adolescents participated in the study and completed self-report measures assessing perceived parental rearing practices, emotional intelligence, and prosocial behavior. The findings revealed significant positive associations between perceived parental parenting methods, prosocial behavior, and emotional intelligence. Furthermore, emotional intelligence was identified as a mediator between specific parenting practices (mother involvement, mother autonomy support, and father rearing practices) and prosocial behavior. The study also highlighted the importance of parental involvement, autonomy support, and warmth in fostering emotional intelligence and promoting prosocial behavior among adolescents. These findings have implications for interventions and programs aimed at enhancing emotional intelligence and promoting prosocial behavior in adolescents.

Medical ethics in childbirth: a structural equation modeling approach in south of Iran

BackgroundThe existence of a valid instrument to evaluate the attitude of mothers towards compliance with medical ethics during childbirth can lead to appropriate interventions to create a positive attitude. The purpose of this study is to determine the construct validity of the MEAVDQ (Medical Ethics Attitude in Vaginal Delivery Questionnaire).MethodsThe study was carried out with 350 women. The main research instrument was MEAVDQ. This 59-item questionnaire comprises three parts A, B, J. Part A is concerned with the first principles. Part B deals with the second and third principles and part J addresses the fourth principle of medical ethics. Structural Equations Modeling (SEM) was used to determine the construct validity of MEAVDQ.Results The results of SEM revealed that there was a positive correlation between structures A and B. The relationship between structures B and J was also positive and significant. On the other hand, there was a direct and indirect relationship between structures A and J. One-unit increase in structure A led to 0.16 (95% CI: 0.01, 0.33) direct increase in structure J. Also, one-unit increase score increases in structure A caused 0.39 indirect rise (95% CI: 0.26, 0.53) in structure J with the mediating role of the structure B.ConclusionsIt can be suggested to midwifery policy maker and midwives that respect for the first principle of medical ethics and autonomy is the most important principle of medical ethics in childbirth. By respecting the autonomy of mothers, a positive birth experience can be created for them.

Patient-centered respectful maternity care: a factor analysis contextualizing marginalized identities, trust, and informed choice

BackgroundIncreasing rates of maternal mortality and morbidity, coupled with ever-widening racial health disparities in maternal health outcomes, indicate that radical improvements need to be made in the delivery of maternity care. This study explored the provision of patient-centered maternity care from the perspective of pregnant and postpartum people; experiences of respect and autonomy were examined through the multi-dimensional contexts of identity, relational trust, and protection of informed choices.MethodsWe conducted primary data collection among individuals who experienced a pregnancy in the five years preceding the survey (N = 484) using the validated Mothers on Respect Index (MORi) and Mothers Autonomy in Decision Making (MADM) scale. We conducted an exploratory factor analysis (EFA) which produced three factor variables: trust, informed choice, and identity. Using these factor variables as dependent variables, we conducted bivariate and multivariate analysis to examine the relationship between these factor variables and social marginalization, as measured by race, disability, justice-involvement, and other social risk factors, such as food and housing insecurity.ResultsResults of our bivariate and multivariate models generally confirmed our hypothesis that increased social marginalization would be associated with decreased experiences of maternity care that was perceived as respectful and protective of individual autonomy. Most notably, AI/AN individuals, individuals who are disabled, and individuals who had at least one social risk factor were more likely to report experiencing identity-related disrespect and violations of their autonomy.ConclusionsIn light of the findings that emphasize the importance of patient identity in their experience in the healthcare system, patient-centered and respectful maternity care must be provided within a broader social context that recognizes unequal power dynamics between patient and provider, historical trauma, and marginalization. Provider- and facility-level interventions that improve patient experiences and health outcomes will be more effective if they are contextualized and informed by an understanding of how patients’ identities and traumas shape their healthcare experience, health-seeking behaviors, and potential to benefit from clinical interventions and therapies.

Moment-to-moment within-person associations between maternal autonomy support and child defeat predicting child behavioral adjustment.

This study examines mother-child mutual regulation processes during a challenging puzzle task as predictors of preschoolers' behavioral adjustment 6 months later in a Chinese sample (N = 101, 46 boys, Mage = 57.41 months, SD = 6.58). Mother-child mutual regulation was measured by the moment-to-moment bidirectional within-person associations between maternal autonomy support and child defeat (i.e., expression of frustration, incapacity to complete the task, or giving up). Children whose mother provided more autonomy support after increases of child defeat showed lower levels of externalizing problems 6 months later, and children who showed less defeat after increases of maternal autonomy support showed higher levels of prosocial behaviors 6 months later. These predictive effects were significant after controlling for child behavioral adjustment at the initial time point, and mean levels of mother's autonomy support and child's defeat throughout the task. The mutual regulation processes did not significantly predict child internalizing problems. The findings suggest that the coordinated mother-child mutual regulation patterns in real time may have positive implications for preschoolers' behavioral adjustment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Measuring maternal autonomy and its effect on child nutrition in rural India

AbstractThis paper examines the link between a mother's autonomy—the freedom and ability to think, express, make decisions and act independently—and the nutritional status of her children. We treat ‘autonomy’ as a latent variable, and design a novel statistical framework to measure this. This method allows us to separate the direct associations of maternal and family characteristics in our model for nutrition, from their indirect associations that work through maternal autonomy. Using data from India, we explore the sensitivity of our estimates to endogeneity caused by sample selection in the presence of son preference. We find: (i) a one standard deviation (SD) higher autonomy score is associated with a 0.16 SD higher height‐for‐age z‐score (HAZ score); and (ii) a 10% lower prevalence of stunting (HAZ < −2 SD). The latter is equivalent to the prevention of approximately 300,000 children stunting, indicating the important role of maternal autonomy.

Autonomia fetal na fertilização em mulheres de idade avançada

Abstract One of the biggest bioethical dilemmas is when mother autonomy conflicts with that of the conceptus. Many studies have shown that fetuses develop senses during intrauterine life, allowing them to feel and react to the environment where they live. Fetuses must thus have rights to bioethical principles. Recent advances in assisted reproductive technologies have made it possible for older women to conceive. However, a woman’s decisions regarding reproductive choices directly affect the fetus. Besides medical complications, bioethical dilemmas based on the “I can do it, but should I do it?” question have been raised. This systematic review critically evaluated the existing literature on fertilization for older women, especially the approach to fetal bioethics, including fetal autonomy. Most studies approach this subject from the mother’s autonomy, mother and fetus health aspects, and social, legal, and governmental aspects. Only four studies found discussed the biological rights of the fetus. These studies comment on maternal autonomy involving the resulting offspring, the interests of the potential child as a child that does not yet exist, the interests of the child to be mothered by someone whose health could be impaired soon, and the rights and well-being of the future child. In vitro fertilization for older women requires further discussion regarding fetus autonomy.

Validation of a measure to assess decision-making autonomy in family planning services in three low- and middle-income countries: The Family Planning Autonomous Decision-Making scale (FP-ADM).

Integrating measures of respectful care is an important priority in family planning programs, aligned with maternal health efforts. Ensuring women can make autonomous reproductive health decisions is an important indicator of respectful care. While scales have been developed and validated in family planning for dimensions of person-centered care, none focus specifically on decision-making autonomy. The Mothers Autonomy in Decision-Making (MADM) scale measures autonomy in decision-making during maternity care. We adapted the MADM scale to measure autonomy surrounding a woman's decision to use a contraceptive method within the context of contraceptive counselling. This study presents a psychometric validation of the Family Planning Autonomous Decision-Making (FP-ADM) scale using data from Argentina, Ghana, and India. We used cross-sectional data from women in four subnational areas in Argentina (n = 890), Ghana (n = 1,114), and India (n = 1,130). In each area, 20 primary sampling units (PSUs) were randomly selected based on probability proportional to size. Households were randomly selected in Ghana and India. In Argentina, all facilities providing reproductive and maternal health services within selected PSUs were included and women were randomly selected upon exiting the facility. Interviews were conducted with a sample of 360 women per district. In total, 890 women completed the FP-ADM in Argentina, 1,114 in Ghana and 1,130 in India. To measure autonomous decision-making within FP service delivery, we adapted the items of the MADM scale to focus on family planning. To assess the scale's psychometric properties, we first examined the eigenvalues and conducted a parallel analysis to determine the number of factors. We then conducted exploratory factor analysis to determine which items to retain. The resulting factors were then identified based on the corresponding items. Internal consistency reliability was assessed with Cronbach's alpha. We assessed both convergent and divergent construct validity by examining associations with expected outcomes related to the underlying construct. The Eigenvalues and parallel analysis suggested a two-factor solution. The two underlying dimensions of the construct were identified as "Bidirectional Exchange of Information" (Factor 1) and "Empowered Choice" (Factor 2). Cronbach's alpha was calculated for the full scale and each subscale. Results suggested good internal consistency of the scale. There was a strong, significant positive association between whether a woman expressed satisfaction with quality of care received from the healthcare provider and her FP-ADM score in all three countries and a significant negative association between a woman's FP-ADM score and her stated desire to switch contraceptive methods in the future. Our results suggest the FP-ADM is a valid instrument to assess decision-making autonomy in contraceptive counseling and service delivery in diverse low- and middle-income countries. The scale evidenced strong construct, convergent, and divergent validity and high internal consistency reliability. Use of the FP-ADM scale could contribute to improved measurement of person-centered family planning services.

Identifying Racial Inequities in Respect and Autonomy During Delivery Care [ID: 1378253

INTRODUCTION: Measuring patient experience is core to understanding and addressing inequities in obstetric care quality. METHODS: People who gave birth at one of five hospitals in Massachusetts and identified as non-Hispanic Black (NHB) or non-Hispanic White (NHW) were invited to complete a structured survey 7–16 weeks postpartum, from February to September 2022. The survey included two validated patient experience instruments: the Mothers on Respect index, dichotomized as “very respectful” or not and the Mothers Autonomy in Decision Making scale, dichotomized as “high patient autonomy” or not. We report risk ratios of associations between patient characteristics and respectful or autonomous care, adjusting for hospital cluster using Stata v.17. Institutional review board approval was received from the Social and Behavioral Research IRB at Tufts University. RESULTS: Of 417 respondents (response rate: 25%), 245 (59%) were NHW and 172 (41%) were NHB. Most had a bachelor’s degree (62%). 241 (60%) of births were vaginal. Very respectful treatment was reported by 78% of respondents, whereas high patient autonomy was only reported by 64%. Non-Hispanic White people were 1.2 times as likely to report high respect compared to NHB (95% CI: 1.1, 1.4). Respect was also significantly lower for those with lower education and those with vaginal birth compared to those with cesarean birth. Differences in respect by race remained significant in multivariable models (1.2, 95% CI: 1.0, 1.4). Autonomy did not differ by any of the assessed demographic or delivery characteristics. CONCLUSION: Examining patient experience revealed inequities. To identify opportunities for improvement and monitor change, brief, validated, patient reported experience measures need to be incorporated into routine data collection.

A Validity and Reliability Study of The Turkish Version of The Mothers’ Autonomy in Decision Making Scale

Objective: The focus of the study is women's experiences of autonomy while making decisions about their care during pregnancy, labour and birth. The aim of this study is to adapt the Mothers Autonomy in Decision Making Scale (MADM), developed by Vedam et al. in 2017, into Turkish health care culture. Methods: The survey, which was created in the Google form, was conducted between May 15th to August 15th 2019 through social media. 344 women participated in the study and 286 women answered the questionnaire in total. The data were evaluated using the SPSS package software. Findings related to construct validity of the scale were made using exploratory factor analysis method. Results: Reliability of the Turkish form of the scale was performed with Cronbach’s Alfa and the internal consistency value of the scale was found to be 0.91. MADM scores were found to be highest for midwives (33.28±10.10) and lowest for family physicians (23.89±11.44). More than half of the midwives who have been cared for have a high autonomy score on the scale of MADM (%54.4). Conclusion: MADM scale was found to be valid and reliable in Turkey to assess decision-making experiences during maternity care.

The effects of maternal and teacher’s autonomy support on executive function of young children age between 3-5

본 연구의 목적은 어머니와 교사의 자율성지지가 유아의 실행기능에 미치는 영향을 분석하고자 했다. 연구대상은 경기지역 유치원에 재원 중인 만 3, 4, 5세 유아의 어머니 235명, 교사 69명이 연구에 참여했다. 연구를 위한 자료수집을 위해 어머니와 교사의 자율성지지에 대한 측정도구를 배부하고 회수하였으며, 유아의 실행기능에 관한 자료는 교사의 측정에 의해 수집되었다. 자료 분석 결과, 어머니와 교사의 자율성지지는 유아의 실행기능에 긍정적인 영향을 주는 것으로 나타났다. 그리고 3세와 4세 유아의 실행기능에는 어머니의 자율성지지 그리고 교사의 자율성지지, 5세 유아의 실행기능에는 교사의 자율성지지 그리고 어머니의 자율성 지지 순으로 나타났다. 또한 성별에 따른 유아 실행기능에서는 남아에는 어머니의 자율성지지가 여아에게는 교사의 자율성지지가 더 많은 영향을 미치는 것으로 나타났다. 유아 전체에는 교사의 자율성지지 그리고 어머니의 자율성지지 순으로 그 영향을 미치는 것으로 나타났다. 이러한 연구결과는 유아의 실행기능 발달에서 어머니와 교사의 자율성지지가 모두 중요한 변인이나, 그 연령의 증가에 따라 교사의 자율성지지가 강조될 필요성을 시사한다.This study examines the effects of maternal and teacher’s autonomy support on young children’s executive function. The questionnaire survey method was conducted to target 235 mothers and 69 early childhood teachers working at kindergarten for children between age 3-5 in Gyeonggi Province. The questionnaires on maternal and teacher’s autonomy support were distributed and collected among the mothers and teachers. And data on executive function were measured using BRIEF-P by teachers completing the questionnaires. There was significant interrelationship between young children’s executive function, and maternal and teacher’s autonomy support. And maternal and teacher’s autonomy support were positive factors in predicting young children’s executive function. In addition, on the child's execution function according to gender: the mother's autonomy support had greater influence on the boys, whereas the teacher's autonomy support held a bigger impact on the girls. Furthermore, the entire group of children had an increased effect in the order of teacher's autonomy support, and mother’s autonomy support. The results of this research suggest that both mother and teacher’s autonomy support are important variables in the development of children's executive function, but it is necessary to emphasize teacher’s autonomy support as the age of children increases.

Fetal anomaly diagnosis and termination of pregnancy.

The aim of this review was to discuss bioethics in prenatal diagnosis and health care after recent legislative and judicial changes affecting reproductive rights, such as the repeal of 'Roe v. Wade' in the United States. We recognize that abortion involves particular moralities that are not universal or shared by all cultures, groups, and individuals. We reviewed the historical aspects of embryology and personhood, fetal morbidity and mortality, and parental options for prenatal diagnostic testing. We examined relevant ethical issues including informed consent, the emergence of fetal pain, reproductive autonomy, the fiduciary responsibilities of pregnant mothers, and the obligations of physicians caring for the maternal-fetal dyad. The code of medical ethics includes respect for decisional privacy and the protection of information shared in confidence. When a fetal anomaly is diagnosed, pregnant mothers must be informed about the risks, burdens, and alternatives in either continuing or terminating the pregnancy. Parental choice should include the right to refuse testing, the informed choice not to know about certain genetic test results, and the right to make informed decisions about the best interests of the future child. In the diagnosis and care of fetal anomalies, moral dilemmas arise. Before fetal viability, the mother's autonomy, sense of beneficence, and personal values should be trusted and respected. Perinatal palliative care should be available to pregnant mothers whose anomalous fetus is carried to birth.

Understanding maternal choices and experiences of care by skilled providers: Voices of mothers who delivered at home in selected communities of Lusaka city, Zambia.

Significant proportions of women living in urban areas including the capital cities continue to deliver at home. We aimed to understand why mothers in a selected densely populated community of Lusaka city in Zambia deliver from home without assistance from a skilled provider during childbirth. Using a phenomenological case study design, we conducted Focus Group Discussions and In-depth Interviews with mothers who delivered at home without assistance from a skilled provider. The study was conducted between November 2020 and January 2021 among 19 participants. Data were analysed using content analysis. Individual-related factors including the belief that childbirth is a natural and easy process that did not require assistance, lack of transport to get to the health facility, influence and preference for care from older women who were perceived to have the experience and better care, failure to afford baby supplies, and waiting for partner to provide the supplies that were required at the health facility influenced mothers' choices to seek care from skilled providers. Health system-related factors included mistreatment and disrespectful care such as verbal and physical abuse by skilled healthcare providers, stigma and discrimination, institutional fines, and guidelines such as need to attend antenatal care with a spouse and need to provide health facility demanded supplies. Individual and health system access related factors largely drive the choice to involve skilled providers during childbirth. The socioeconomic position particularly contributes to limited decision-making autonomy of mothers, thus, creating challenges to accessing care in health facilities. The health system-related factors found in this study such as mistreatment and disrespectful care suggests the need for redesigning effective and sustainable urban resource-limited context maternal health strategies that are culturally acceptable, non-discriminatory, and locally responsive and inclusive. Rethinking these strategies this way has the potential to strengthening equitable responsive health systems that could accelerate attainment of sustainable developmental goal (SDG) 3 targets.

Determinants of utilization of antenatal care services among recently delivered women residing in urban poor areas of Rishikesh, Uttarakhand, India—a cross-sectional study

Objective: To determine the proportion of women having four or more antenatal care (ANC) visits and to assess associated factors (utilization of ANC services) in poor urban settlements in Rishikesh, Uttarakhand. Material and Methods: This was a community-based cross-sectional study. The study population included females who delivered during the last year residing in the target location. The data were collected through the house-to-house method in the four selected areas using a structured pre-tested expert-validated questionnaire. Data analysis was performed using SPSS version 23 using descriptive and multivariate statistical techniques. Results: There was a 59.66% prevalence of four or more antenatal visits (52.01%-66.97%). Only 26.44% of the participants confirmed their husbands' company during their antenatal visits. Socioeconomic status, type of family, mother's educational status, parity, husband's company during the visit, and mother's autonomy were significant factors (P<0.005) associated with the number of ANC visits. In logistic regression, after adjusting for other covariates, the autonomy of the participants and the husband's involvement during the visit were found to be significantly associated with four or more ANC visits. Conclusions: Approximately 60% of participants in poor urban settlements had four or more ANC visits. The findings of our study affirm the involvement of husbands in antenatal visits and women's autonomy as significant determinants of antenatal care utilization.

Reliability and Validity of a Perinatal Shared Decision-Making Measure: The Childbirth Options, Information, and Person-Centered Explanation

ObjectiveTo develop and test the psychometric properties of a shared decision-making tool: Childbirth Options, Information, and Person-Centered Explanation (CHOICEs). DesignMultiphase instrument development study beginning with item development through a cross-sectional postpartum survey. SettingThe cross-sectional postpartum survey was distributed online through convenience and snowball sampling methods. MethodsWe developed instrument items through an iterative process with key stakeholders. We evaluated reliability based on internal consistency and differential item functioning analysis. We evaluated validity on evidence of construct validity. We used criterion-related item mapping to evaluate whether the measure addressed the full spectrum of shared decision making related to maternity care. ResultsSurveys were completed by 1,171 participants. A Cronbach’s α coefficient of .99 supported internal consistency reliability. Infit and outfit statistics that ranged from 0.92 to 1.55 supported item fit. Differential item functioning analysis showed that CHOICEs scores were invariant between different demographic groups. Significant positive correlations between scores on CHOICEs and the Mothers on Respect index (r = 0.75, p = .01) and the Mothers Autonomy in Decision-Making scale (r = 0.75, p = .01) supported criterion-related validity. Item mapping suggested more items were needed to capture the full spectrum of shared decision making. ConclusionWe recommend using CHOICEs to evaluate shared decision making in maternity care for research and quality improvement projects.

Women’s view on shared decision making and autonomy in childbirth: cohort study of Belgian women

BackgroundHealth care providers have an important role to share evidence based information and empower patients to make informed choices. Previous studies indicate that shared decision making in pregnancy and childbirth may have an important impact on a woman’s birth experience. In Flemish social media, a large number of women expressed their concern about their birth experience, where they felt loss of control and limited possibilities to make their own choices. The aim of this study is to explore autonomy and shared decision making in the Flemish population.MethodsThis is a cross-sectional, non-interventional study to explore the birth experience of Flemish women. A self-assembled questionnaire was used to collect data, including the Pregnancy and Childbirth Questionnaire (PCQ), the Labor Agentry Scale (LAS), the Mothers Autonomy Decision Making Scale (MADM), the 9-item Shared Decision Making Questionnaire (SDM–Q9) and four questions on preparation for childbirth. Women who gave birth two to 12 months ago were recruited by means of social media in the Flemish area (Northern part of Belgium).Linear mixed-effect modelling with backwards variable selection was applied to examine relations with autonomy in decision making.ResultsIn total, 1029 mothers participated in this study of which 617 filled out the survey completely. In general, mothers experienced moderate autonomy in decision-making, both with an obstetrician and with a midwife with an average on the MADM score of respectively 18.5 (± 7.2) and 29.4 (±10.4) out of 42. The linear mixed-effects model showed a relationship between autonomy in decision-making (MADM) for the type of healthcare provider (p < 0.001), the level of self-control during labour and birth (LAS) (p = 0.003), the level of perceived quality of care (PCQ) (p < 0.001), having epidural analgesia during childbirth (p = 0.026) and feeling to have received sufficient information about the normal course of childbirth (p < 0.001).ConclusionsChildbearing women in Flanders experience moderate levels of autonomy in decision- making with their health care providers, where lower autonomy was observed for obstetricians compared to midwives. Future research should focus more on why differences occur between obstetrics and midwives in terms of autonomy and shared decision-making as perceived by the mother.

Assessing Dutch women\u2019s experiences of labour and birth: adaptations and psychometric evaluations of the measures Mothers on Autonomy in Decision Making Scale, Mothers on Respect Index, and Childbirth Experience Questionnaire 2.0

BackgroundThe Mothers Autonomy in Decision Making Scale (MADM) assesses women’s autonomy and role in decision making. The Mothers on Respect Index (MORi) asseses women’s experiences of respect when interacting with their healthcare providers. The Childbirth Experience Questionnaire 2.0 assesses the overall experience of childbirth (CEQ2.0). There are no validated Dutch measures of the quality of women’s experiences in the intrapartum period. Therefore, the aim of this study was to evaluate the psychometric properties of these measures in their Dutch translations.MethodsThe available Dutch versions of the MADM and MORi were adapted to assess experiences in the intrapartum period. The CEQ2.0 was translated by using forward-backward procedures. The three measures were included in an online survey including items on individual characteristics (i.e. maternal, birth, birth interventions). Reliability was assessed by calculating Cronbach’s alphas. Mann-Whitney, Kruskal Wallis or Student T-tests were applied where appropriate, to assess discrimination between women who differed on individual characteristics (known group validity). We hypothesized that women who experienced pregnancy complications and birth interventions would have statistically lower scores on the MADM, MORi and CEQ2.0, compared with women who had healthy pregnancies and physiological births. Convergent validity was assessed using Spearman Rank correlations between the MADM, MORi and/or CEQ2.0. We hypothesized moderate to strong correlations between these measures. Women’s uptake of and feedback on the measures were tracked to assess acceptability and clarity.ResultsIn total 621 women were included in the cross sectional study. The calculated Cronbach’s alphas for the MADM, MORi and CEQ, were ≥ 0.77. Knowngroup validity was confirmed through significant differences on all relevant individual characteristics, except for vaginal laceration repair. Spearman Rank correlations ranged from 0.46-0.80. In total 98% of the included women out of the eligible population completed the MADM and MORi for each healthcare professional they encountered during childbirth. The proportions of MADM and MORi-items which were difficult to complete ranged from 0.0-10.8%, 0.6-2.7%, respectively.ConclusionsThe results of our study showed that the Dutch version of the MADM, MORi and CEQ2.0 in Dutch are valid instruments that can be used to assess women’s experiences in the intrapartum period.