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Postnatal care is the aspect of maternity care with which women in England are least satisfied. Little is known about first-time mothers' expectations of postnatal care, or how these expectations relate to their experiences and appraisal of care. Thirty-two first-time mothers took part in a longitudinal qualitative descriptive study, based on two semi-structured interviews-the first in pregnancy, and the second 2 to 3 months after birth. Trajectory analysis was used to identify the thematic patterns in the relationships between postnatal care expectations, needs, experiences, and confidence. Five trajectories were identified, showing that mothers' satisfaction with postnatal care and confidence were primarily influenced not by the extent to which their expectations were met but the varied extent to which their individual postnatal needs were met. Rapid and responsive assessment of needs both antenatally and postnatally, and appropriate adjustment of care, is key in supporting women effectively at this time.

Background: Disadvantaged mothers and their babies are at increased risk of poor perinatal outcomes and have less positive experiences of maternity care., Aim: To explore the maternity care experiences of mothers with multiple disadvantages., Methods: A qualitative descriptive study based on semi-structured interviews with 40 mothers with multiple disadvantages, using thematic analysis., Findings: Four themes emerged: 'A confusing and frightening time', 'Longing to be respected as an individual', 'The importance of choice and control', and 'Needing trust to feel safe'. Mothers brought feelings of powerlessness and low self-esteem to their encounters with maternity professionals, which could be significantly worsened by disrespectful care. They needed support to navigate the complex maternity system. Positive experiences were much more likely where the mother had received continuity of care from a specialist midwife or small team., Discussion and Conclusion: Mothers with multiple disadvantages value being treated as an individual, making informed choices, and feeling safe, but they may lack the confidence to ask questions or challenge disrespectful treatment. Training and supervision should enable maternity professionals to understand how confusing maternity care can be to very disadvantaged mothers. It should emphasise the need to provide accessible and empowering information and guidance to enable all mothers to make choices and understand the system. Leaders of maternity services need to do more to challenge negative staff attitudes and ensure that that all mothers are treated at all times with kindness, respect and dignity. Specialist midwives can deliver a high quality service to mothers experiencing multiple disadvantages., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: In the UK, changes to legislation in 2003 regarding the free movement of people in the European Union resulted in an increase in immigration from countries that joined the EU since 2004, the Accession countries., Objective: To describe and compare the maternity experiences of recent migrant mothers to those who had been resident in the UK for longer, and to UK-born women, while taking into account their region of origin., Design: Cross-sectional national survey., Setting: England, 2009., Participants: Random sample of postpartum women., Measurements: Questionnaires asked about demographic characteristics, care during pregnancy, labour, birth and postnatally, about country of origin and, if not born in the UK, when they came to the UK. Country of origin was grouped into UK, Accession countries, and rest of the world. Recency of migration was grouped into recent arrivals (0-3 years), and earlier arrivals (4 or more years since arrival). Descriptive statistics and binary logistic regression were used to explore women's experiences of care. Stratified analyses were used to account for the strong correlation between recency of migration and region of origin., Findings: Overall, 5332 women responded to the survey (a usable response rate of 54%). Seventy-nine percent of women were UK-born. Of the 21% born outside the UK, a third were born in Accession countries. All migrants reported a poorer experience of care than UK-born women. In particular, recent migrants from the Accession countries were significantly less likely to feel that they were spoken to so they could understand and treated with kindness and respect., Conclusions: Given the rising population of non-UK-born women of childbearing age resident in the UK and the relatively high proportion from Accession countries, it is important that staff are able to communicate effectively, through interpreters if necessary., Implications for Practice: The differences in clinical practice between women's home countries and the UK should be discussed so that women's expectations of care are informed about the options available to them., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: mental health problems in pregnancy and the postnatal period are relatively common and, in pregnancy, are associated with an increase in adverse outcome. It is recommended that all women are asked about their emotional and mental health and offered treatment if appropriate., Objectives: to describe the care received by women self-identifying with mental health problems in pregnancy, and to describe the effects of support, advice and treatment on outcomes in the postnatal period., Design: this study used cross-sectional survey data collected in 2014 which described women's experience of maternity care., Setting: England PARTICIPANTS: a random sample of women who had a live birth in January 2014., Measurements: the questionnaire asked about sociodemographic characteristics, whether women were asked about emotional and mental health in pregnancy, support and treatment offered, about postnatal wellbeing, and questions relating to attachment to their baby. Descriptive statistics and logistic regression were used to examine the associations between mental health and outcomes taking account of sociodemographic characteristics., Findings: the survey response rate was 47%. Women with antenatal mental health problems were significantly more worried at the prospect of labour and birth, had lower satisfaction with the experience of birth, worse postnatal mental health, and indications of poorer attachment to their baby. They received substantially more care than other women but they did not always view this positively. Support, advice and treatment for mental health problems had mixed effects., Conclusions: this study describes the significant additional care provided to women self-identifying with mental health problems in pregnancy, the mixed effects of support, advice and treatment, and the poor perception of staff interaction among women with mental health problems., Implications for Practice: health care professionals may need additional training to effectively support women with mental health problems during the perinatal period., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Following a perinatal death, a formal standardised multi-disciplinary review should take place, to learn from the death of a baby and facilitate improvements in future care. It has been recommended that bereaved parents should be offered the opportunity to give feedback on the care they have received and integrate this feedback into the perinatal mortality review process. However, the MBRRACE-UK Perinatal Confidential Enquiry (2015) found that only one in 20 cases parental concerns were included in the review. Although guidance suggests parental opinion should be sought, little evidence exists on how this may be incorporated into the perinatal mortality review process. The purpose of the PARENTS study was to investigate bereaved parents' views on involvement in the perinatal mortality review process., Methods: A semi-structured focus group of 11 bereaved parents was conducted in South West England. A purposive sampling technique was utilised to recruit a diverse sample of women and their partners who had experienced a perinatal death more than 6 months prior to the study. A six-stage thematic analysis was followed to explore parental perceptions and expectations of the perinatal mortality review process., Results: Four over-arching themes emerged from the analysis: transparency; flexibility combined with specificity; inclusivity; and a positive approach. It was evident that the majority of parents were supportive of their involvement in the perinatal mortality review process and they wanted to know the outcome of the meeting. It emerged that an individualised approach should be taken to allow flexibility on when and how they could contribute to the process. The emotional aspects of care should be considered as well as the clinical care. Parents identified that the whole care pathway should be examined during the review including antenatal, postnatal, and neonatal and community based care. They agreed that there should be an opportunity for parents to give feedback on both good and poor aspects of their care., Conclusion: Parents were unaware that a review of their baby's death took place in the hospital. Parental involvement in the perinatal mortality review process would promote an open culture in the healthcare system and learning from adverse events including deaths. Further research should focus on designing and evaluating a perinatal mortality review process where parental feedback will be integral.

Objectives: More disabled women are becoming mothers, and yet, their care is rarely the focus of quantitative research. This study aimed to investigate access and quality of maternity care for women with differing disabilities., Design: Secondary analysis was conducted on data from a 2015 national survey of women's experience of maternity care. Descriptive and adjusted analyses were undertaken for five disability groups: physical disability, sensory impairment, mental health disability, learning disability and multiple disability, and comparisons were made with the responses of non-disabled women., Setting: Survey data were collected on women's experience of primary and secondary care in all trusts providing maternity care in England., Participants: Women who had given birth 3 months previously, among whom were groups self-identifying with different types of disability. Exclusions were limited to women whose baby had died and those who were younger than 16 years at the time of the recent birth., Results: Overall, 20 094 women completed and returned the survey; 1958 women (9.5%) self-identified as having a disability. The findings indicate some gaps in maternity care provision for these women relating to interpersonal aspects of care: communication, feeling listened to and supported, involvement in decision making, having a trusted and respected relationship with clinical staff. Women from all disability groups wanted more postnatal contacts and help with infant feeding., Conclusion: While access to care was generally satisfactory for disabled women, women's emotional well-being and support during pregnancy and beyond is an area that is in need of improvement. Specific areas identified included disseminating information effectively, ensuring appropriate communication and understanding, and supporting women's sense of control to build trusting relationships with healthcare providers., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: More women with learning disability (LD) are becoming mothers. Women with LD have rights to equal access to maternity care that meets their needs, however, many have poor pregnancy and birth outcomes compared to other women in the UK. Research is limited in this area., Objectives: The aim of the study was to explore the lived experiences of pregnancy, childbirth, prenatal and postnatal care and services received by this group of women in the UK, including their expressed information and support needs relating to maternity care., Methods: A qualitative study in which data were generated using in-depth semistructured interviews with learning disabled women who were pregnant or had given birth within the last 3 years in the UK; data were analysed using interpretative phenomenological analysis., Results: 9 women with varying levels of cognitive impairment took part. 4 super-ordinate themes were identified: 'I hate being treated differently', 'I find it harder to understand than other people', 'We've had to prove ourselves' and 'Make sure you've got very good support around you'. Subthemes included: 'Negative attitudes and denial of choice', 'Understanding of normal care', 'Written information' and 'Being judged by professionals'., Conclusions: With support from family and services, learning disabled women can become confident and successful parents. Maternity services should make reasonable adjustments when providing care to this group, including adapting to their individual communication and learning needs: allowing sufficient time in appointments, offering clear explanations of each aspect of care and sensitive support for autonomy and fully informed choice. Mothers who will be subject to a social care assessment of their parenting skills need clear information about the process, their choices and the level of skill they must demonstrate, as well as access to sufficient antenatal and postnatal support to give them the best possible chance of passing the assessment., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Background: there have been changes in maternity care policy over the last 20 years and women's experience, continuity and satisfaction with care have become more prominent. However there has been no research examining changes over time in women's reported experience., Methods: this study used secondary analysis of data collected in four postal surveys of maternity care experiences in 1995, 2006, 2010 and 2014. In each case women who had delivered in a specified time period in England were randomly sampled and sent a questionnaire three months after the birth. Women were excluded if they were aged less than 16 years or their infant had died. The majority of questions were comparable over the different surveys. Descriptive statistics and adjusted odds ratios are presented., Findings: in the antenatal period, an increasing proportion of women had early first contact with a healthcare professional, screening for Down's syndrome, both dating and anomaly scans and the total number of ultrasound scans increased over the period. The proportion of women given explanations about screening and choice regarding interventions during labour and birth both appear to have increased. In the postnatal period, length of hospital stay declined over time but the proportion of women who considered their length of stay too short remained constant. The number of postnatal home visits also declined and there was a substantial increase in the proportion of women who would have liked more visits. Overall satisfaction with care remained high especially for care during pregnancy, labour and birth., Conclusions: despite fewer antenatal checks, shorter hospital stays and fewer postnatal home visits, women were generally very positive about their care in pregnancy, labour and birth, and the postnatal period. Maternity care has changed in many respects, with earlier contact with health professionals, more scans and more information. However, reduced continuity of care and a need for support in the early weeks with a new infant was expressed by many women and are issues that may be contributing to some of the dissatisfaction expressed., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: This study fills a gap in the literature with a quantitative comparison of the maternity care experiences of women in different geographic locations in Queensland, Australia., Method: Data from a large-scale survey were used to compare women's care experiences according to Australian Standard Geographical Classification (major city, inner regional, outer regional, remote and very remote)., Results: Compared to the other groups, women from remote or very remote areas were more likely to be younger, live in an area with poorer economic resources, identify as Aboriginal and/or Torres Strait Islander and give birth in a public facility. They were more likely to travel to another city, town or community for birth. In adjusted analyses women from remote areas were less likely to have interventions such as electronic fetal monitoring, but were more likely to give birth in an upright position and be able to move around during labour. Women from remote areas did not differ significantly from women from major cities in their satisfaction with interpersonal care. Antenatal and postpartum care was lacking for rural women. In adjusted analyses they were much less likely to have booked for maternity care by 18 weeks gestation, to be telephoned or visited by a care provider in the first 10 days after birth. Despite these differences, women from remote areas were more likely to be breastfeeding at 13 weeks and confident in caring for their baby at home., Conclusions: Findings support qualitative assertions that remote and rural women are disadvantaged in their access to antenatal and postnatal care by the need to travel for birth, however, other factors such as age were more likely to be significant barriers to high quality interpersonal care. Improvements to maternity services are needed in order to address inequalities in maternity care particularly in the postnatal period., (Copyright © 2014 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: Young motherhood is commonly associated with vulnerabilities, stereotyping of young women's behavior, and poor outcomes for them and their children. The objective was to understand how maternity care is experienced by this group in the transition to parenthood., Methods: Data from a large-scale 2010 survey of women's experience of maternity care were analyzed using qualitative methods with open text responses., Results: Overall, 7,193 women responded to the survey: 237 were aged 20 years or less. Most (83%) of these young women provided open text responses. The main themes were: "being a consumer," "the quality of care," "needing support," and "pride in parenthood" whereas subthemes included "being young" and "how staff made me feel," "testimonials for staff," "not being left," and "it is all worthwhile.", Conclusion: Many young women responding described a positive experience. For many first-time mothers this feeling marked a change in their identity. Nevertheless, staff perceptions and attitudes affected how they saw themselves and what they took away from their experience of maternity care. A key message for other women is offered, supporting and reinforcing their role as active and involved consumers who, in engaging with services, have to stand up for themselves and make their needs and wishes known., (© 2014, Copyright the Authors Journal compilation © 2014, Wiley Periodicals, Inc.)

Background: According to the Office for National Statistics, approximately a quarter of women giving birth in England and Wales are from minority ethnic groups. Previous work has indicated that these women have poorer pregnancy outcomes than White women and poorer experience of maternity care, sometimes encountering stereotyping and racism. The aims of this study were to examine service use and perceptions of care in ethnic minority women from different groups compared to White women., Methods: Secondary analysis of data from a survey of women in 2010 was undertaken. The questionnaire asked about women's experience of care during pregnancy, labour and birth, and the postnatal period, as well as demographic factors. Ethnicity was grouped into eight categories: White, Mixed, Indian, Pakistani, Bangladeshi, Black Caribbean, Black African, and Other ethnicity., Results: A total of 24,319 women completed the survey. Compared to White women, women from minority ethnic groups were more likely to be younger, multiparous and without a partner. They tended to access antenatal care later in pregnancy, have fewer antenatal checks, fewer ultrasound scans and less screening. They were less likely to receive pain relief in labour and, Black African women in particular, were more likely to deliver by emergency caesarean section. Postnatally, women from minority ethnic groups had longer lengths of hospital stay and were more likely to breastfeed but they had fewer home visits from midwives. Throughout their maternity care, women from minority ethnic groups were less likely to feel spoken to so they could understand, to be treated with kindness, to be sufficiently involved in decisions and to have confidence and trust in the staff., Conclusion: Women in all minority ethnic groups had a poorer experience of maternity services than White women. That this was still the case following publication of a number of national policy documents and local initiatives is a cause for concern.

Objectives: Provision for ethnic minority groups has been acknowledged as integral to good maternity care in England and ethnicity has been highlighted as an indicator of both poorer clinical outcomes and poorer experiences. Improving outcomes and services is dependent on understanding women's interaction with both service delivery and provision. The aim of this study was to explore Black and minority ethnic (BME) women's experiences of contemporary maternity care in England., Design: A UK-wide survey which investigated core aspects of maternity care sought the views of BME women about their experiences. A random sample of women were selected by the Office for National Statistics from birth registration in England and invited to complete a questionnaire three months after the birth. In a secondary analysis, text responses to open-ended questions about their maternity care were analysed using thematic analysis., Results: Sixty per cent of the 368 women who self-identified as BME responded with open text. Themes that emerged related to 'feeling cared for,' with subthemes of 'expectations of care' and 'policies, rules and organisational pressures'; 'staff attitudes and communication' with sub-themes of 'please believe me,' 'hospital as a safe place,' 'choices denied' and 'being sensitive and supportive would help,' and 'ethnicity and culture' with sub-themes of 'stereotyping' and 'improving the quality of care.', Conclusion: The findings highlight issues affecting the quality of maternity care that BME women in England receive. Many issues are not unique to BME women; however, the findings reflect some seemingly enduring issues and coherence with other wider international findings, particularly in relation to post-natal care and staff attitudes. Actually being cared for and supported across their child-bearing experience are needs that women themselves identified as critical for care providers to recognise and respond to. The failures of care provision described should inform the development of services.

Background: The death of a newborn baby is devastating. While clinical issues may be a primary concern, interpersonal aspects can impact significantly. Mothers in this situation are not easy to access for research and little quantitative evidence is available. In this study we aimed to describe their experience of care, emphasising associations with infant gestational age. Methods: Secondary analysis of population-based survey data collected through the Office for National Statistics following neonatal death in England in 2012–13. Women were asked about clinical events and care during pregnancy, labour and birth, when the baby died, postnatally and in the neonatal unit. Results: 249 mothers returned completed questionnaires (30% response rate), 50% of births were at 28 weeks’ gestation or less and 66% had babies admitted for neonatal care. 24% of women were left alone and worried during labour and 18% after birth. Only 49% felt sufficiently involved in decision-making at this time. Postnatally only 53% were cared for away from other mothers and babies, 47% could not have their partner stay with them, and 55% were not located close to their baby. Mothers of term babies were significantly less likely to report confidence in staff, feeling listened to and having concerns taken seriously during labour, and postnatally many felt insufficiently informed about their baby’s condition, and that neonatal staff were not always aware of parental needs. However, most mothers (84%) were satisfied with neonatal care. Conclusions: There is room for improvement if women whose babies die in the neonatal period are to receive the care and support they need. Women who have a baby admitted to a neonatal unit should be cared for nearby, with room for their partner and with greater involvement in decision-making, particularly where withdrawal of life support is considered. [ABSTRACT FROM AUTHOR]

Abstract: Background: Most research on women experiencing stillbirth relies on online user group surveys or qualitative interviews. The objective of this study was to investigate the experience of women who are at a higher risk of stillbirth, living in areas of greatest deprivation, and are commonly not well represented. Methods: This study used birth and death registrations in 2012‐2013 to identify a sample of mothers whose babies had died as a result of stillbirth. These women were sent a survey 6‐9 months after the stillbirth. We undertook descriptive analysis of quantitative data and used binary logistic regression with the Index of Multiple Deprivation as a measure of disadvantage. We used thematic analysis to describe free text responses. Results: The survey response rate was 30% (N = 473). Ethnic minority, younger age, and single parenthood were associated with disadvantage. Women residents in the most deprived areas perceived care more negatively: during labor they were significantly less likely to be spoken to by medical staff so they could understand (73% compared with 90%, adjusted odds ratio [aOR] 0.33 [95% confidence interval {CI} 0.18‐0.65]), or treated with respect by midwives (79% compared with 90%, aOR 0.41 [95% CI 0.22‐0.77]). The qualitative themes identified were: “Difficulty in accessing care,” “More could have been done,” “Ineffective communication,” and “Cared for and not cared for” which support the quantitative findings. Conclusion: Women living in the most deprived areas reported poorer experiences of care compared with more advantaged women. All women need compassionate and sensitive care around the time of a stillbirth. [ABSTRACT FROM AUTHOR]

Background: The current study sought to develop a short birth satisfaction indicator utilising items from the Birth Satisfaction Scale-Revised (BSS-R) for use as a brief measure of birth satisfaction and as a possible key performance indicator for perinatal service delivery evaluation. Building on the recently developed BSS-R, the study aimed to develop a simplified version of the instrument to assess birth satisfaction easily that could work as a short evaluative measure of clinical service delivery for labour and birth that is consistent with policy documents, placing women at the centre of the birth experience.Methods: The six item Birth Satisfaction Scale-Revised Indicator (BSS-RI) was embedded within the 2014 National Maternity Survey for England. A random selection of mothers who had given birth in a two week period in England were surveyed three months after the birth. Using a two-stage design and split-half dataset, exploratory factor analysis, confirmatory factor analysis, internal consistency, convergent, divergent and known-groups discriminant validity evaluation were conducted in a secondary analysis of the survey data.Results: Using this large population based survey of recent mothers the short revised measure was found to comprise two distinct domains of birth satisfaction, 'stress and emotional response to labour and birth' and 'quality of care'. The psychometric qualities of the tool were robust as were the indices of validity and reliability evaluated.Conclusion: The BSS-RI represents a short easily administered and scored measure of women's satisfaction with care and the experience of labour and birth. The instrument is potentially useful for researchers, service evaluation and policy makers. [ABSTRACT FROM AUTHOR]

Background Young motherhood is commonly associated with vulnerabilities, stereotyping of young women's behavior, and poor outcomes for them and their children. The objective was to understand how maternity care is experienced by this group in the transition to parenthood. Methods Data from a large-scale 2010 survey of women's experience of maternity care were analyzed using qualitative methods with open text responses. Results Overall, 7,193 women responded to the survey: 237 were aged 20 years or less. Most (83%) of these young women provided open text responses. The main themes were: 'being a consumer,' 'the quality of care,' 'needing support,' and 'pride in parenthood' whereas subthemes included 'being young' and 'how staff made me feel,' 'testimonials for staff,' 'not being left,' and 'it is all worthwhile.' Conclusion Many young women responding described a positive experience. For many first-time mothers this feeling marked a change in their identity. Nevertheless, staff perceptions and attitudes affected how they saw themselves and what they took away from their experience of maternity care. A key message for other women is offered, supporting and reinforcing their role as active and involved consumers who, in engaging with services, have to stand up for themselves and make their needs and wishes known. [ABSTRACT FROM AUTHOR]

Objective: To examine the characteristics of women with antenatal or postnatal anxiety and to investigate aspects of their care that may be associated with it. Background: Positive outcomes following childbirth are associated with good physical and mental health during pregnancy and following childbirth. Although a degree of anxiety is normal in pregnancy, for some women it can become a serious problem. Methods: This study used data on 5332 women from a 2010 national maternity survey which asked about antenatal and postnatal health and well-being three months after childbirth. Women self-identified as experiencing anxiety and other problems during pregnancy and the postnatal period. Results: Antenatal anxiety was reported by 14% of women and postnatal anxiety by 5% of women. Antenatal anxiety was associated with younger age, Black and Minority Ethnic status, single parenthood, living in a disadvantaged area, having an unwanted pregnancy and long-term health problems. Of these factors, only long-term mental health problems were associated with anxiety in the postnatal period. In the logistic regression models long-term mental health problems dominated the findings. Significant differences in the perceptions of the care experienced were evident in the responses from women with anxiety both antenatally and postnatally. Conclusions: This study shows that antenatal and postnatal anxiety are influenced by health and social factors. Asking women about their current physical and psychological health and past history during pregnancy and following up on their well-being in the postnatal period is an essential element in planning and providing care to meet their needs. [ABSTRACT FROM AUTHOR]

Background: It has been estimated that 9.4% of women giving birth in the United Kingdom have one or more limiting longstanding illness which may cause disability, affecting pregnancy, birth and early parenting. No large scale studies on a nationally representative population have been carried out on the maternity experiences of disabled women to our knowledge.Method: Secondary analysis of data from a survey of women in 2010 by English National Health Service Trusts on behalf of the Care Quality Commission was undertaken. 144 trusts in England took part in the postal survey.Women self-identified with disability and were excluded if less than 16 years of age or if their baby had died. The 12 page structured questionnaire with sections on antenatal, labour and birth and postnatal care covered access, information, communication and choice. Descriptive and adjusted analyses compared disabled and non-disabled groups. Comparisons were made separately for five disability subgroups: physical disability, sensory impairment, mental health conditions, learning disability and women with more than one type of disability.Results: Disabled women comprised 6.14% (1,482) of the total sample (24,155) and appeared to use maternity services more than non-disabled women. Most were positive about their care and reported sufficient access and involvement, but were less likely to breastfeed. The experience of women with different types of disability varied: physically disabled women used antenatal and postnatal services more, but had less choice about labour and birth; the experience of those with a sensory impairment differed little from the non-disabled women, but they were more likely to have met staff before labour; women with mental health disabilities also used services more, but were more critical of communication and support; women with a learning disability and those with multiple disabilities were least likely to report a positive experience of maternity care.Conclusion: This national study describes disabled women's experiences of pregnancy, child birth and postnatal care in comparison with non-disabled women. While in many areas there were no differences, there was evidence of specific groups appropriately receiving more care. Areas for improvement included infant feeding and better communication in the context of individualised care. [ABSTRACT FROM AUTHOR]

Background Poor outcomes after childbirth are associated with physical ill health and with an absence of a positive sense of well-being. Postnatally poor physical health is thought to be influenced by the care received, the nature of the birth, and associated complications. The aim of this study was to estimate the effects of a range of clinical and other factors on positive outcome and well-being 3 months after childbirth. Methods This study used data on more than 5,000 women from a 2010 National Maternity Survey about their experiences of maternity care, and health and well-being 3 months after childbirth. Positive outcome was defined as women reporting no problems and feeling 'very well' at the time of the survey. Results In the univariate analysis, several variables were significantly associated with positive outcome, including sociodemographic, antenatal, intrapartum, and postnatal factors. In the final logistic regression model, young mothers, those without physical disability and those with no or few antenatal or early postnatal problems, were most likely to have positive outcomes. Other significant factors included a positive initial reaction to the pregnancy, not reporting antenatal depression, fewer worries about the labor and birth, and access to information about choices for care. Conclusions This study shows how positive outcomes for women after childbirth may be influenced by health, social, and care factors. It is important for caregivers to bear these factors in mind so that extra support may be made available to those women who are likely to be susceptible to poor outcome. ( BIRTH 40:1 March 2013) [ABSTRACT FROM AUTHOR]

Background: Physical and psychological problems after childbirth are common, and may have a significant negative and long-term impact on women's wellbeing and daily functioning. The method of birth may be a particularly important factor influencing women's health and wellbeing following birth, however, population-wide evidence is limited. This study uses data from 5,332 women who responded to a national survey of women's experiences of maternity care in England. We examined women's postnatal wellbeing in the first three months after birth, and whether these varied by mode of birth. Methods: This is a secondary analysis of survey data using a random sample of women selected from birth registration. We used multinomial logistic regression models to examine the association between women's self-reported psychological symptoms, health problems and mode of birth. Results: Women who had forceps-assisted vaginal births and unplanned caesarean section births reported the poorest health and wellbeing, while those of women who had unassisted vaginal births and planned caesarean section births were less affected by the birth process. Most women's physical and emotional health appeared to improve with time, however, those who had a forceps-assisted vaginal birth were more likely to report ongoing posttraumatic-type symptoms several months after the birth. Conclusions: Mode of birth was associated with differences in outcomes at three months. By comparison to women who had unassisted vaginal births, the risk of reduced postnatal health and wellbeing was higher amongst the women who had forceps-assisted vaginal births but not amongst women who had ventouse-assisted vaginal births. This would suggest that it is important to differentiate the different types of instrumental birth in outcome studies. Of concern was the higher rate of posttraumatic-type symptoms among women who had forceps-assisted vaginal births relative to the other modes of birth. Women who have forceps-assisted births should be monitored carefully by health professionals in the postnatal period, and in the months after childbirth, when they could be offered the opportunity to discuss their labour and birth. [ABSTRACT FROM AUTHOR]

Background: Cesarean section is an increasingly common mode of birth, and although clinical care has improved and the risks reduced, less attention has been paid to the effect of the procedure and the care received. The aim of this study was to gain a better understanding by investigating individual women’s recent experiences and reflections on their care. Methods: Views of women who had recently undergone cesarean birth were obtained in a study in which a random sample of women was selected by means of birth registrations in England and invited to complete a questionnaire 3 months after the birth. Text responses to open-ended questions about care during labor and birth, the postnatal period in hospital, and anything else women wished to say about their maternity care were analyzed using qualitative methods. Results: A response rate of 63 percent was achieved; 23 percent of women (n = 682) had a cesarean section birth, 53 percent of which were because of unforeseen problems in labor. A total of 66 percent of women who had a cesarean section responded to one or more open questions. Anticipated themes that were confirmed related to expectations, uncertainty, emotional reactions, pain and discomfort, explanations, support, and adjustment. Emerging themes included “being heard,”“how it might have been different,”“wasted effort,”“just another mother,”“wounds and hurt feelings,” and “needing to talk.” Conclusions: Women responded as individuals and despite different clinical circumstances, the role of the staff and the institutions in which care was provided were key factors in the way most women constructed their cesarean section experience. The themes described present a powerful argument and reminder about why health professionals working in maternity care need to continue to listen to women. (BIRTH 37:2 June 2010) [ABSTRACT FROM AUTHOR]

Background This study describes the psychometric characteristics, validity and reliability of the revised version of the perceptions of care adjective checklist (PCACL-R) with women who had recently given birth. Data were collected from a national survey of women's experiences of maternity care ( n = 2960). Methods Internal consistency, predictive validity, convergent validity, discriminant validity and confirmatory factor analyses were applied to the data. Results Confirmatory factor analysis revealed an excellent fit to a bi-dimensional structure entirely consistent with the negative and positive valencing of adjectives in the measure, supporting the use of the instrument as a two subscale tool comprising positive and negative subscales. The PCACL-R revealed good convergent validity against measures of satisfaction with care and excellent divergent validity characteristics assessed against duration of labour. Discriminant validity was assessed against measures of area-based maternal deprivation, partner status and type of delivery. These analyses revealed commendable discriminant validity of the PCACL-R. Internal consistency characteristics of the positive and negative subscales of the PCACL-R were acceptable. The predictive validity of the PCACL-R was also found to be excellent. Conclusion The PCACL-R is consequently recommended as a valid, reliable, respondent acceptable and easy to administer instrument to assess women's experiences of their care during labour and childbirth. The measurement characteristics of the PCACL-R suggest that the tool could be incorporated into both clinical and research contexts with confidence. The checklist terms used are applicable to other phases of maternity care and indeed to a wide range of health care contexts. Exploratory use in with other user groups is recommended. [ABSTRACT FROM AUTHOR]

The measurement of “satisfaction” has been intrinsic to the models of evaluation of health care. However, a thoughtful approach to its use has not always been evident in which this concept is understood to represent a complex group of theoretical constructs involving attitudes, expectations, and perceptions that may be both positive and critical. These constructs require investigation and evaluation using recognized and developed methodologies. At the same time the importance of listening to patients and to women and their partners in evaluating and carrying out research on maternity care cannot be underestimated if the instruments used are to have construct and face validity. Qualitative data of this kind have a dual function of contributing to a more complex picture of women’s experience and of suggesting that researchers need to explore the issues related to “dissatisfaction” at least as much as those arising from a positive overall view of care. (BIRTH 35:1 March 2008) [ABSTRACT FROM AUTHOR]

Christopher R. Barnes & Elvidina N. Adamson-Macedo Centre for Health and Social Care Improvement, University of Wolverhampton, UK Preterm delivery is a stressful event to parents. Nurturing the mental health of mothers of hospitalised preterms is of concern to all involved with their care. Mental health is acknowledged as a state of psychological wellness characterised by the satisfactory fulfilment of basic human needs such as sense of mastery, self-worth and quality of attachment. Studies have recognised that the sense of touch may play a vital role in relation to the development of the preterm baby. However, there is a lack of research investigating whether sensory interventions provided by the mother to the baby can have any effect in nurturing maternal mental health. This study investigated the role of tactile interventions as mediators of maternal parenting Self-Efficacy, Self-Esteem, and Attachment. Within the quasi-experimental design, a Randomised Cluster Control Trial (RCCT) was used to recruit 60 mothers and their hospitalised preterm neonates equally allocated to one of 3 groups (G 1-3): G1 touch therapy (known as TAC-TIC), G2 toy, and G3 placebo/control (spontaneous touch). The study lasted for 10 days and mothers completed a questionnaire at the beginning and end of the study. Babies were filmed daily for 9 minutes and touched by their mother in the middle 3. The results indicated that (1) mothers in G1 reported significantly higher self-efficacy, self-esteem and attachment scores, and (2) their babies spent longer periods in an alert awake state and gained more weight over the 10 days than the other 2 groups. It is suggested that touching their babies has beneficial effects to both mothers and their babies. [ABSTRACT FROM AUTHOR]

An editorial is presented which discusses challenges pertaining to the diagnosis of psychological conditions in children, mentioning the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and arguing that reductionist approaches involving categorisation may not be as effective as approaches that view psychological experiences along a continuum.

Background: As maternity services evolve and the population of women served also changes, there is a continuing need to effectively document the views of women with recent experience of care. A woman's maternity experience can have a positive or negative effect upon her emotional well-being and health, in the immediate and the long-term, which can also impact the infant and the wider family system. Measuring women's perceptions of maternity services is an important way of monitoring the quality of care provision, as well as providing key indicators to organisations of the services that they are providing. It follows that, without information identifying possible areas in need of improvement, it is not clear what changes should be made to improve the experiences of women during their journey through maternity services from pregnancy to the early weeks at home with a new baby . The objective is to describe the development process and psychometric properties of a measure of women's experience of maternity care covering the three distinctly different phases of maternity - pregnancy, labour and birth, and the early postnatal period.Methods: Data from a national survey of women who had recently given birth (n = 504) were used. Exploratory and confirmatory factor analytic methods were employed. The measure was assessed for underlying latent factor structure, as well as for reliability, internal consistency, and validity (predictive, convergent and discriminant).Results: The models developed confirmed the use of three separate, but related scales about experience of maternity care during pregnancy, labour and birth and the postnatal period. Data reduction was effective, resulting in a measure with 36 items (12 per scale).Conclusion: The need for a psychometrically robust and qualitatively comprehensive measure of women's experience of maternity care has been addressed in the development and validation of this prototype measure. The whole measure can be used at one time point, or the three separate subscales used as individual measures of experience during particular phases of the maternity journey with identified factor structures in their own right. [ABSTRACT FROM AUTHOR]

Background: Disadvantaged pregnant women and new mothers are at increased risk of psychosocial stress, anxiety and depression. As well as affecting birth outcomes and child development, poor maternal emotional wellbeing can inhibit the development of parenting self-efficacy and successful adjustment to the maternal role. Social support is a protective factor against antenatal and postnatal depression, anxiety and stress, and improves mothers' confidence in infant care. Community doula programmes have been developed to meet the social support and information needs of disadvantaged women. In these programmes trained volunteer doulas support mothers during pregnancy, at birth and for a short period postnatally.Methods: This was a descriptive qualitative study, informed by phenomenological social psychology, exploring mothers' and doulas' experiences of antenatal and postnatal community doula support. Semi-structured qualitative interviews were undertaken with 13 disadvantaged mothers and 19 doulas at three community volunteer doula projects in England. Interviews were audio-recorded and transcripts were analysed using inductive thematic analysis.Results: The overarching theme emerging from the analysis was "Supporting the mother to succeed and flourish". There were five subthemes: "Overcoming stress, anxiety and unhappiness", "Becoming knowledgeable and skilful", "Developing self-esteem and self-efficacy", "Using services effectively", and "Becoming locally connected". Doulas believed that their community role was at least as important as their role at births. Their support was highly valued by vulnerable mothers and helped to improve their parenting confidence and skills.Conclusions: Volunteer doula support before and after birth can have a positive impact on maternal emotional wellbeing, by reducing anxiety, unhappiness and stress, and increasing self-esteem and self-efficacy. Doulas help mothers feel more knowledgeable and skilful, support them to make effective use of maternity services, and enable them to build social ties in their community. To facilitate the best service for vulnerable mothers at the end of doula support, doula projects should consider formalising their relationship with other community organisations that can offer ongoing one-to-one or group support. They might also alleviate some of the potential distress caused by the ending of the doula relationship by increasing the flexibility of the ending, or by organising or permitting informal low level contact. [ABSTRACT FROM AUTHOR]

The author discusses various articles within the journal including one on the limited support provided to women who have had miscarriages by Rowlands and Lee, one on a psychological intervention after miscarriage by Callahan and Chabrol and one on pre-eclampsia by Fleury, Parpinelly and Makuch.