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The movement towards birth: A study of women's childbirth self-efficacy and early labour
Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. Institutionen för Kvinnors och Barns Hälsa, Karolinska Institutet, Stockholm, Sverige.
2014 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis was to increase the understanding of early labour, the latency phase of labour, based on women’s experiences and ability to handle the situation. Furthermore, the aim was to perform a psychometric testing of an instrument measuring childbirth self-efficacy and to explore the relationships to women´s well-being and number of obstetric interventions and birth outcomes.

Methods: In study I, a grounded theory method was used to obtain a deeper understanding of how women who seek care at an early stage experience the latent phase of labour. The same method, grounded theory was used in study II, but in this study, the aim was to obtain a deeper understanding of how women, who remain at home until the active phase of labour, experience the period from labour onset before admission to maternity ward. In both these studies (I & II) interviews were used to collect data. Study III and IV were cross sectional studies with a  consecutive data collection. In study III, a forward-backward translation was used to translate the childbirth self-efficacy inventory (CBSEI) into a Swedish version. An explorative factor analysis with principal component analysis was used to test the psychometric properties of the inventory and reliability tests with Cronbach's alpha and inter item total correlation was performed. In study IV, chi-2 test, Fisher's exact test and student's t-test for independent samples was performed between women´s estimated childbirth self-efficacy and demographics, obstetric interventions and birth outcomes. Correlations were also performed between different scales measuring well-being during pregnancy and childbirth self-efficacy. Finally a logistic regression analysis was performed to predict the probability for low or high childbirth self-efficacy.

Findings: Being in a safe place is essential for the women in the early labour process. But a safe place has different meanings for different women, depending on how they assess their own ability to handle their impending labour. For some women, the hospital is a secure place, a place where somebody else can take over the responsibility for themselves, the labour process or their child’s well-being. Some women choose to remain in their homes, which they consider as a kind of base camp which they can leave and go back to whenever they please. There is also a difference in how women ascribe ability to their own bodies and women´s belief in their own ability to cope and deal with the impending birth, their self-efficacy. These differences together with the women´s choice of seeking care or not, during the early labour process, affect the women´s experience of the labour process. The women's experience during the early labour process varies from feeling powerful and strong, to perceiving themselves as victims and feeling totally powerless. Women with high self-efficacy as measured by CBSEI had less previous mental illness and had more often been told their sister´s birth story. During the labour process, women with a higher childbirth self-efficacy have a lower frequency of epidural analgesia than women with low childbirth self-efficacy.

Conclusion: Women´s belief in their childbirth self-efficacy affects their choice of place to be, during the early labour process. The place in turn, affects the women´s experiences and the way they handle the early labour process. The early labour process is a sensitive period that requires attention and should not be neglected. Through increased knowledge and understanding of the problematic issues related to the early labour process, the birth preparation and antenatal obstetric care, as well as the care during labour can be improved.

Place, publisher, year, edition, pages
Stockholm: Karolinska institutet , 2014. , 65 p.
Keyword [en]
Childbirth self-efficacy, early labour, factor analysis, grounded theory, logistics regression, pregnancy, well-being
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hh:diva-25949ISBN: 978-91-7549-498-2 (print)OAI: oai:DiVA.org:hh-25949DiVA: diva2:730311
Public defence
2014-06-05, Samuelssonsalen, Schelelaboratoriet, Tomtebodavägen 6, Solna, Stockholm, 13:00 (Swedish)
Opponent
Supervisors
Note

Examen: Medicine doktorsexamen

Available from: 2016-01-22 Created: 2014-06-27 Last updated: 2016-01-22Bibliographically approved
List of papers
1. Swedish women's experiences of seeking care and being admitted during the latent phase of labour: A grounded theory study
Open this publication in new window or tab >>Swedish women's experiences of seeking care and being admitted during the latent phase of labour: A grounded theory study
2007 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 25, no 2, 172-180 p.Article in journal (Refereed) Published
Abstract [en]

Objective: to gain a deeper understanding of how women who seek care at an early stage experience the latent phase of labour.

Design: a qualitative interview study using the grounded theory approach.

Setting: the study was conducted at a hospital in the southwestern part of Sweden with a range of 1600-1700 deliveries per year. The interviews took place in the women's homes two to six weeks after birth.

Participant: eighteen Swedish women, aged 22-36, who were admitted to the tabour ward while they were stilt in the latent phase of tabour.

Findings: 'Handing over responsibility' to professional caregivers emerged as the core category or the central theme in the data. The core category and five additional categories formed a conceptual model explaining what it meant to women being admitted in the early stage of tabour and their experiences of the Latent phase of tabour. The categories, which all related to the core category, were labelled: (1) 'longing to complete the pregnancy,' (2) 'having difficulty managing the uncertainty,' (3) 'having difficulty enduring the stow progress,' (4) 'suffering from pain to no avail' and (5) 'oscillating between powerfulness and powerlessness.'

Conclusions and implications for practice: findings indicate that women being admitted to the tabour ward in the latent phase of tabour experienced a need for handing over responsibility for the tabour, the welt-being of the unborn baby, and for themselves. Midwives have an important role in assisting women with coping during the latent phase of tabour, and in giving the women opportunity to hand over responsibility. This care should include validation of experienced pain and confirmation of the normality of the slow process, information and support. © 2007 Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
Edinburgh: Churchill Livingstone, 2007
Keyword
Experiences, Grounded theory, Latent phase of labour
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:hh:diva-1467 (URN)10.1016/j.midw.2007.02.003 (DOI)000264918800009 ()17600602 (PubMedID)2-s2.0-61749085630 (ScopusID)2082/1847 (Local ID)2082/1847 (Archive number)2082/1847 (OAI)
Available from: 2008-05-30 Created: 2008-05-30 Last updated: 2016-01-26Bibliographically approved
2. Maintaining power: Women's experiences from labour onset before admittance to maternity ward
Open this publication in new window or tab >>Maintaining power: Women's experiences from labour onset before admittance to maternity ward
2011 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, no 1, 86-92 p.Article in journal (Refereed) Published
Abstract [en]

Background: in Sweden pregnant women are encouraged to remain at home until the active phase of labour. Recommendation is based on evidence, that women who seek care and are admitted in the latent phase of labour are subjected to more obstetric interventions and suffer more complications than women who remain at home until the active phase of labour. The aim of this study was to obtain a deeper understanding of how women, who remain at home until the active phase of labour, experience the period from labour onset until admission to labour ward. Method: interviews were conducted with 19 women after they had given birth to their first child. A Constructivist Grounded theory method was used. Findings: 'Maintaining power' was identified as the core category, explaining the women's experience of having enough power, when the labour started. Four related categories: to share the experience with another', to listen to the rhythm of the body', to distract oneself and to be encased in a glass vessel', explained how the women coped and thereby maintained power. Conclusions: the first time mothers in this study, who managed to stay at home during the latent phase of labour, had a sense of power that was expressed as a driving force towards the birth, a bodily and mental strength and the right to decide over their own bodies. This implies that women who maintain power have the ability to make choices during the birth process. The professionals need to be sensitive, supportive and respectful to women's own preferences in the health-care encounter, to promote the existing power throughout the birthing process. © 2010 Elsevier Ltd.

Place, publisher, year, edition, pages
Kidlington, UK: Churchill Livingstone, 2011
Keyword
Experiences, Grounded theory, labour onset, Maintaining power
National Category
Obstetrics, Gynecology and Reproductive Medicine Nursing
Identifiers
urn:nbn:se:hh:diva-14337 (URN)10.1016/j.midw.2010.11.011 (DOI)000299324500013 ()2-s2.0-84855931014 (ScopusID)
Available from: 2011-02-02 Created: 2011-02-02 Last updated: 2016-01-26Bibliographically approved
3. Psychometric properties of the Swedish Child-Birth Self-efficacy Inventory (Swe-CBSEI)
Open this publication in new window or tab >>Psychometric properties of the Swedish Child-Birth Self-efficacy Inventory (Swe-CBSEI)
2014 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 14, no 1, 1Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Previous research has reported that women who are admitted to delivery wards in early labour process before an active stage of labour has started run an increased risk of instrumental deliveries. Therefore, it is essential to focus on factors such as self-efficacy that can enhance a woman's own ability to cope with the first stage of labour. However, there was no Swedish instrument measuring childbirth self-efficacy available. Thus, the aim of the study was to translate the Childbirth Self-efficacy Inventory and to psychometrically test the Swedish version on first- time mothers within the Swedish culture.

METHODS: The method included a forward-backward translation with face and content validity. The psychometric properties were evaluated using a Principal Component Analysis and by using Cronbach's alpha coefficient and inter-item correlations. Descriptive statistics and non-parametric tests were used to describe and compare the scales. All data were collected from January 2011 to June 2012, from 406 pregnant women during the gestational week 35-42.

RESULTS: The Swedish version of the Childbirth Self-Efficacy Inventory indicated good reliability and the Principal Component Analysis showed a three-component structure. The Wilcoxon Signed-Ranks Test indicated that the women could differentiate between the concepts outcome expectancy and self-efficacy expectatancy and between the two labour stages, active stage and the second stage of labour.

CONCLUSIONS: The Swedish version of Childbirth Self-efficacy Inventory is a reliable and valid instrument. The inventory can act as a tool to identify those women who need extra support and to evaluate the efforts of improving women's self-efficacy during pregnancy. © 2014 Carlsson et al.; licensee BioMed Central Ltd.

Place, publisher, year, edition, pages
London: BioMed Central, 2014
Keyword
childbirth, self-efficacy, instrument development, psychometric properties, think aloud
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-24472 (URN)10.1186/1471-2393-14-1 (DOI)24383788 (PubMedID)2-s2.0-84892462354 (ScopusID)
Available from: 2014-01-28 Created: 2014-01-28 Last updated: 2016-01-26Bibliographically approved
4. The relationship between childbirth self-efficacy and aspects of well-being, birth interventions and birth outcomes
Open this publication in new window or tab >>The relationship between childbirth self-efficacy and aspects of well-being, birth interventions and birth outcomes
2015 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 31, no 10, 1000-1007 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: this study aimed to examine how women׳s childbirth self-efficacy beliefs relate to aspects of well-being during the third trimester of pregnancy and whether there was any association between childbirth self-efficacy and obstetric factors.

DESIGN: a cross-sectional design was used. The data was obtained through the distribution of a composite questionnaire and antenatal and birth records.

SETTING: data were recruited from antenatal health-care clinics in Halland, Sweden.

PARTICIPANTS: a consecutive sample of 406 pregnant women was recruited at the end of pregnancy at gestational weeks of 35-42.

MEASUREMENTS: five different measures were used; the Swedish version of Childbirth Self-Efficacy Inventory, the Wijma Delivery Expectancy/Experience Questionnaire, the Sense of Coherence Questionnaire, the Maternity Social Support Scale and finally the Profile of Mood States.

FINDINGS: results showed that childbirth self-efficacy was correlated with positive dimensions as vigour, sense of coherence and maternal support and negatively correlated with previous mental illness, negative mood states and fear of childbirth. Women who reported high childbirth self-efficacy had less epidural analgesia during childbirth, compared to women with low self-efficacy.

KEY CONCLUSIONS: this study highlights that childbirth self-efficacy is a positive dimension that interplays with other aspects and contributes to well-being during pregnancy and thereby, acts as an asset in the context of childbirth. © 2015 Elsevier Ltd.

Place, publisher, year, edition, pages
London: Elsevier, 2015
Keyword
Childbirth, Epidural, Obstetric outcomes, Pregnancy, Self-efficacy, Well-being
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-29233 (URN)10.1016/j.midw.2015.05.005 (DOI)000362093300016 ()26094071 (PubMedID)2-s2.0-84942549892 (ScopusID)
Available from: 2015-08-18 Created: 2015-08-18 Last updated: 2016-11-28Bibliographically approved

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