Translation and validation of the Hungarian version of the Birth Satisfaction Scale-Revised (BSS-R).

BACKGROUND: Evidence relating maternal birth experience to a range of maternal and neonatal outcomes is increasingly compelling. Consequently valid and reliable self-report of birth experience from the mothers perspective is critical. AIM: The current study sought to translate and validate a Hungarian-language version of the Birth Satisfaction Scale-Revised (BSS-R). METHOD: Following forward and backwards translation into Hungarian, the Hungarian BSS-R (HU-BSS-R) was administered to women in a major Transylvanian hospital maternity unit within 72 h postpartum. Key psychometric characteristics were then examined in relation to factor structure, divergent and convergent validity, internal consistency, and known-groups discriminant validity. RESULTS: Two-hundred and thirty-two women completed the HU-BSS-R. Confirmatory factor analysis revealed the HU-BSS-R to offer an excellent fit to data for the established tri-dimensional measurement model. The HU-BSS-R was also found to offer excellent convergent and divergent validity and known-groups discriminant validity. No significant differences were observed between internal consistency observations between the current study and the original UK validation study. CONCLUSIONS: The HU-BSS-R is a valid and reliable translation of the original BSS-R, it has proved itself to have excellent psychometric properties and is suitable for use in the Hungarian maternity context.

Translation and validation of Vietnamese version of the Birth Satisfaction Scale-Revised (BSS-R).

BACKGROUND: The 10-item Birth Satisfaction Scale-Revised (BSS-R) is a quick and easy survey instrument recommended by the International Consortium for Health Outcome Measures as the tool of choice for measuring women's birth satisfaction. AIM: To translate and validate a Vietnamese-language version of the BSS-R. METHOD: A quantitative cross-sectional method was used to gather data post translation and back-translation of a Vietnamese version of the BSS-R (VN-BSS-R). Data collected were psychometrically evaluated using key indices of validity and reliability. PARTICIPANTS: Vietnamese women who were within one month postpartum of birth (N = 383) took part in the study. RESULTS: Findings illustrate that a two-factor model offered excellent psychometric properties. With the two-factor VN-BSS-R, five items loaded onto a subscale 'Positive birth experiences' and the other five onto a second subscale 'Negative birth experiences'. This two-factor model offered a fit to data (root mean square error of approximation [RMSEA] = 0.07, 90% confidence interval [CI] [0.05, 0.09], root square mean residual [RMSE] = 0.04 and comparative fit index [CFI] = 0.97). Mean scores for the exploratory factor analysis [EFA]-derived 'positive' and 'negative' sub-scales were 17.12 (SD 2.34) and 8.40 (SD 4.18) respectively. CONCLUSION: The translated and validated VN-BSS-R is a psychometrically robust tool for measuring birth satisfaction in Vietnamese postpartum women.The VN-BSS-R is available for use to measure experiences and perceptions of intrapartum care received by Vietnamese women.

A qualitative descriptive training needs analysis of midwives perceived continuous professional development in providing intranatal respectful maternal care.

BACKGROUND: The Vietnam midwifery report acknowledges that while health services are available in Vietnam, there is growing need to increase levels of respectful maternal care provided to women in labour. OBJECTIVE: In conjunction with newborns Vietnam charity, our objective was to assess the perceived continuous professional development needs of midwives working in Vietnam to inform development of an intranatal respectful maternal care education resource. METHOD: A qualitative exploratory descriptive method was used to conduct a training needs analysis, which identified perceived education requirements of midwives in Vietnam in relation to providing respectful maternal care. PARTICIPANTS: A convenience sample of midwives (n = 49) participated in the study. DATA-COLLECTION: Eight on-line focus groups were carried out in four hospitals (maternity units) across Vietnam using WebEx, with the interview schedule informed by the World Health Organization guide for delivering intrapartum care for a positive birth experience. DATA-ANALYSIS: Data were transcribed into English and analysed using the 6-steps of thematic analysis outlined by Braun and Clark. FINDINGS: Three themes and 9 sub-themes were developed from the data. The first theme addressed aspects that contribute towards creating a positive birth experience; the second theme observed barriers to changing practice; and the third theme noted that there are a variety of preferred teaching methods. CONCLUSIONS: In response to the training needs analysis, a respectful maternal care education resource has been designed to transform selected areas of intranatal care in Vietnam. Integrating the respectful maternal care educational resource into midwives' continuous professional development in Vietnam is intended to increase women's rights to have safe childbirth, which accommodates choice and control, and promotes a positive birth experience. RECOMMENDATIONS FOR PRACTICE: Post-completion and evaluation, we hope that the intranatal respectful maternal care educational resource will be rolled out to all practising midwives in Vietnam.

Translation and validation of the Japanese version of the Birth Satisfaction Scale-Revised.

AIM: This study aimed to develop a Japanese version of the Birth Satisfaction Scale-Revised and evaluate its reliability and validity. METHODS: After translating the Birth Satisfaction Scale-Revised into Japanese, we conducted an Internet-based cross-sectional study with 445 Japanese-speaking women within 2 months of childbirth. Of these, 98 participated in the retest 1 month later. Data were analyzed using the COSMIN study design checklist for patient-reported outcome measurement instruments. Content validity was evaluated through cognitive debriefing during the translation process into Japanese. Confirmatory factor analysis was conducted to verify structural and cross-cultural validities. For hypothesis testing, we tested correlations with existing measures for convergent and divergent validities, and for known-group discriminant validity, we made comparisons between types of childbirth. Internal consistency was calculated using Cronbach's α, and test-retest reliability was evaluated using the intraclass correlation coefficient. RESULTS: For the Japanese-Birth Satisfaction Scale-Revised, the established three-factor model fit poorly, whereas the four-factor model fit better. Full metric invariance was observed in both the nulliparous and multiparous groups. Good convergent, divergent, and known-group discriminant validities and test-retest reliability were established. Internal consistency observations were suboptimal; however for vaginal childbirth, the Cronbach's α of the total score was .71. CONCLUSIONS: The Japanese-Birth Satisfaction Scale-Revised is a valid and reliable scale, with the exception of internal consistency that requires further investigation. If limited to vaginal childbirth, research, clinical applications, and international comparisons can be drawn.

Translation and validation of the Czech Republic version of the Birth Satisfaction Scale-Revised (BSS-R).

BACKGROUND: Satisfaction with the birth experience has been established to be critical for the wellbeing of the mother. The Birth Satisfaction Scale-Revised (BSS-R) is a brief and psychometrically robust multi-dimensional self-report tool designed to assess birth experience. The current investigation sought to translate and validate a Czech Republic version of the BSS-R (CZ-BSS-R). METHODS: Following translation psychometric assessment of the CZ-BSS-R was undertaken using a cross-sectional design. A between-subjects design was incorporated in order to evaluate known-groups validity evaluation of the translated measure. Four hundred and sixty-five Czech-speaking women within the Czech Republic took part in the study. Confirmatory factor analysis was undertaken and divergent and convergent validity and internal consistency characteristics also evaluated. RESULTS: The CZ-BSS-R was observed to have excellent psychometric properties and conceptually and measurement faithful to the original English-language measure. Consistent with previous investigations using the BSS-R significant differences were found in scores as a function of delivery type. CONCLUSIONS: The CZ-BSS-R is a valid, robust and reliable measure of birth experience and suitable for use with Czech-speaking women in the Czech Republic. The study highlighted that instrument and emergency Caesarean section were associated with a lower level of birth satisfaction compared to vaginal delivery.

Translation and validation of the Swedish version of the Birth Satisfaction Scale-Revised (BSS-R).

BACKGROUND: Optimizing women's childbirth experience is essential for development of quality mother infant relationships. The Birth Satisfaction Scale-Revised (BSS-R) can be used to measure birth satisfaction. AIM: The current investigation sought to translate and validate a Swedish version of the BSS-R. METHOD: Following translation, a comprehensive psychometric validation of the Swedish-BSS-R (SW-BSS-R) was carried out using a multi-model, cross-sectional, between- and within-subjects design. PARTICIPANTS: A total of 619 Swedish-speaking women participated, from which 591 completed SW-BSS-R and were eligible for analysis. DATA ANALYSIS: Discriminant, convergent, divergent and predictive validity, internal consistency, test-retest reliability, and factor structure were evaluated. RESULTS: The SW-BSS-R was found to have excellent psychometric properties and hence is a valid translation of the original UK(English)-BSS-R. Important insights into relationships between mode of birth, post-traumatic stress disorder (PTSD), and postnatal depression (PND) were observed. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The SW-BSS-R is a psychometrically valid translation of the original BSS-R and is suitable for use in a Swedish-speaking population of women. The study has also highlighted important dynamics between birth satisfaction and areas of significant clinical concern (i.e., mode of birth, PTSD and PND) in Sweden.

Factor structure and psychometric properties of the Birth Satisfaction Scale-Revised in Portuguese postpartum women.

OBJECTIVE: This study aims to develop a Portuguese-language version of the Birth Satisfaction Scale-Revised (BSS-R) for clinical and research use in Portugal (PT-BSS-R). The factor structure, its invariance across depression levels, and the internal consistency of the PT-BSS-R were analysed. METHOD: A sample of 1373 Portuguese-speaking postpartum women completed a sociodemographic and clinical form, the PT-BSS-R, and the Edinburgh Postnatal Depression Scale through an online survey tool. Four competing models were tested through confirmatory factor analyses and bifactor model-based psychometric indices were calculated. The internal consistency and the divergent/convergent validity are analysed. RESULTS: The psychometric properties of PT-BSS-R were found to be generally excellent. Both the original correlated three-factor model and the bifactor model exhibited a good fit to the data. Results from the bifactor model support the use of both the BSS-R total score and the subscale scores. Exemplary invariance findings were observed between groups stratified on the basis of depression screening. PT-BSS-R has demonstrated both divergent and convergent validity as well as internal consistency. CONCLUSION: PT-BSS-R is a psychometrically robust measure of birth satisfaction appropriate for clinical and research use in Portugal.

Translation and validation of the Hindi-Indian version of the Birth Satisfaction Scale-Revised.

AIM: Critical to maternal outcome and development of a healthy and relationship between mother and baby, is the woman's perception of her birth experience. The Birth Satisfaction Scale-Revised (BSS-R) has been demonstrated to be psychometrically robust, easily administered, and scored self-report measure of birth experience. Aim of the study was to translate the UK-BSS-R into Hindi, collect data, and psychometrically validate an Indian (Hindi)-BSS-R. METHODS: Psychometric assessment of the Indian (Hindi)-BSS-R was undertaken following translation using a cross-sectional design. Evaluation of known-groups validity was undertaken using an embedded between-subjects component. Data were collected from (n = 312) postnatal Hindi speaking women in India. Measurement characteristics were assessed using confirmatory factor analysis, divergent validity and internal consistency analysis. RESULTS: The measurement properties of the Indian (Hindi)-BSS-R were observed to be equivocal, with the established tri-dimensional measurement model not achieving best fit to data. Instead, an alternative two-factor model offered an excellent fit to data. Significant differences were observed between Indian (Hindi)-BSS-R scores and family type and gestation term status, which highlights the relevance of these contextual aspects to the Indian birth experience. Internal consistency was observed to be low on some sub-scales, indicating the potential need for future revision. CONCLUSIONS: The Indian (Hindi)-BSS-R is a measure of birth experience, which accepting some measurement caveats, is acceptable for use with Hindi speaking women in India. Further research is required to determine if modification of some of the items is required to improve internal consistency.

Translation and validation of the Dutch version of the Birth Satisfaction Scale-Revised (BSS-R).

BACKGROUND: Recent observations suggest birth satisfaction may be significantly associated with postpartum post-traumatic stress disorder (PP-PTSD). The Birth Satisfaction Scale-Revised (BSS-R) is increasingly used Internationally as a short, valid and reliable multi-dimensional measure of birth experience. The current study sought to develop a Dutch version of the BSS-R (D-BSS-R) for clinical and research application in the Netherlands. METHODS: Post-translation, a cross-sectional design with an embedded between-subjects component was used to evaluate key indices of validity and reliability of the D-BSS-R in a purposive sampled cohort of 244 Dutch-speaking women in the Netherlands. Confirmatory factor analysis, divergent, convergent and known-groups discriminant validity were evaluated as was the internal consistency of the measure. RESULTS: The D-BSS-R was found to be a generally valid and reliable measure of birth experience with the key measurement characteristics of the original English-language measure transferring well to the Dutch context. Statistically significant negative correlations were observed between all D-BSS-R sub-scales and a validated measure of PTSD. CONCLUSIONS: The D-BSS-R represents a valid and reliable measure of birth experience suitable and appropriate for use in the Netherlands. The study corroborates previous suggestions of linkage between birth satisfaction and PP-PTSD using a robust and diagnostically valid measure of trauma.

A scoping review of therapies used to treat psychological trauma post perinatal bereavement.

BACKGROUND: Up to 39% of women who experience perinatal bereavement proceed to develop Post-Traumatic-Stress-Disorder (PTSD), with this large proportion meriting treatment. Before setting-up a treatment service for postnatal women who are experiencing psychological trauma, it is important to identify what therapies have been used in-the-past to address this problem. AIM: To scope for research that has implemented therapies to treat psychological trauma post perinatal bereavement, for potential inclusion in a flexible treatment package. METHOD: A scoping review mapped coverage, range, and type of research that has reported on prior therapies used to treat psychological trauma post perinatal bereavement. FINDINGS: Due to the dearth of papers that directly addressed perinatal bereavement, we widened the scope of the review to view what treatments had been used to treat psychological trauma post-childbirth. Out of 23 studies that report on effectiveness of therapies used to treat psychological trauma post-childbirth, only 4-focused upon treating PTSD post perinatal bereavement (3 effective/1 ineffective). Successful treatments were reported by Kersting et al. (2013), who found CBT effective at reducing PTSD symptoms post-miscarriage, termination for medical reasons, and stillbirth (n = 33 & n = 115), and Navidian et al. (2s017)) found that 4-sessions of grief-counselling reduced trauma symptoms post-stillbirth in (n = 50) women. One study by Huberty et al. (2020found on-line yoga to be ineffective at reducing PTSD symptoms post-stillbirth. CONCLUSIONS: A dearth of research has explored effectiveness of therapies for treating psychological trauma post perinatal bereavement and post-childbirth, with need to develop and test a research informed flexible counselling package.

Midwife-Led Ultrasound Scanning to Date Pregnancy in Malawi: Development of a Novel Training Program.

The use of ultrasound to determine gestational age is fundamental to the optimum management of pregnancy and is recommended for all women by the World Health Organization. However, this modality remains unavailable to many women in low-income countries where trained practitioners are scarce. Although previous initiatives have demonstrated efficacy in training midwives and technicians to perform antenatal ultrasound, these programs have often been too long and too complex to be realistic within the specific constraints of this context, highlighting the need for a novel and pragmatic approach. We describe the development and piloting of a bespoke course to teach midwives 3 fundamental components of early antenatal ultrasound scanning: (1) to identify the number of fetuses, (2) to confirm fetal viability, and (3) to determine gestational age. Having established that 5 days is insufficient, we propose that the minimum duration required to train ultrasound-naive midwives to competency is 10 days. Our completed program therefore consists of one and one-half days of didactic teaching, followed by 8 and one-half days of supervised hands-on practical training in which trainees are assessed on their skills. This package has subsequently been successfully implemented across 6 sites in Malawi, where 28 midwives have achieved competency. By describing the processes involved in our cross-continental collaboration, we explain how unexpected challenges helped shape and improve our program, demonstrating the value of preimplementation piloting and a pragmatic and adaptive approach.

Factors that influence father's experiences of childbirth and their implications upon postnatal mental health: A narrative systematic review.

AIM: To explore factors that influence fathers' experiences of childbirth and implications for their subsequent postnatal mental health. BACKGROUND: Fathers who attend the birth of their baby often have very rewarding experiences. However, those who witness a difficult birth may progress to develop subsequent mental health problems, e.g., trauma symptoms that can affect future relationships with partner and infant. METHOD: A narrative systematic review of literature was carried out. Two overarching themes were identified, each with 3 underpinning sub-themes: (1) Interpersonal relationships with maternity care professionals; (1b) Communication; (1b) Feeling isolated during labour; (1c) Being prepared; (2) The aftermath; (2a) Support provision; (2b) Effects on relationships; (2c) Psychological trauma. CONCLUSIONS: Findings emphasise that good communication between fathers and midwives is a fundamental part of providing excellent care before, during and post-childbirth, as it can reduce partners' feelings of isolation, improve their relationships and limit development and impact of psychological trauma. RECOMMENDATIONS FOR PRACTICE: It is important to develop more on-line partner sites, parenthood education programmes and support groups, which include education about how to prevent, recognise, support and treat mental health complications. Also, further in-depth qualitative studies would enhance understanding of specific aspects of labour that traumatise fathers.

Loss of the world's smallest forests.

A large number of small forests typically harbor higher biodiversity than a small number of large forests totaling the same area, suggesting that small patches are disproportionately valuable for biodiversity conservation. However, policies often favor protection of large forest patches. Here we demonstrate a global trend of higher deforestation in small than large forest patches: the likelihood that a randomly selected forest plot disappeared between 1992 and 2020 increased with decreasing size of the forest patch containing that plot. Our results imply a disproportionate impact of forest loss on biodiversity relative to the total forest area removed. Achieving recent commitments of the post-2020 Global Biodiversity Framework will require revision of current policies and increased societal awareness of the importance of small habitat patches for biodiversity protection.

ICD-11 complex Post Traumatic Stress Disorder (CPTSD) in parents with perinatal bereavement: Implications for treatment and care.

INTRODUCTION: The 11th revision of the WHO International Classification of Diseases (ICD-11) has identified Complex PTSD (CPTSD) as a new condition. AIM: To explore whether the new diagnosis of CPTSD (ICD11) is relevant to women who have experienced perinatal bereavement and to advance knowledge about the acceptability, feasibility and perceived impact of delivering an innovative flexible Compassionate Focused Therapy (CFT) informed treatment package to alleviate symptoms of this condition. METHODS: A mixed methods study using survey and interviews was conducted. Participants first completed the International Trauma Questionnaire (ITQ) to assess if they met the criteria for PTSD or CPTSD (n=72), and subsequent semi-structured interviews (n=12) identified participants' views about different treatment approaches. PARTICIPANTS: A convenience sample of women who had experienced perinatal bereavement were recruited from one geographical region in Scotland. DATA COLLECTION: Information was gathered about trauma experiences related to perinatal bereavement; participants' levels of PTSD or CPTSD using the ITQ; and views regarding the features of treatment options. In-depth interviews with women (n=12) and a focus group with staff (n=5) were also conducted. FINDINGS: Of 74 participants (n=74) who fully completed the ITQ, 10.8% (n=8) met the criteria for PTSD and 29.7% (n=22) for CPTSD, equating to a total of 40.5% of participants experiencing traumatic stress. Results suggest that CPTSD is a more common condition than PTSD in people with perinatal bereavement, with qualitative data suggesting that CFT and EMDR can be useful and acceptable interventions for this population group. CONCLUSION: A feasibility study is recommended next to evaluate acceptability of trial processes in preparation for a definitive randomised controlled trial of a new flexible CFT informed treatment package to address PTSD and CPTSD in people with perinatal bereavement. RECOMMENDATIONS FOR PRACTICE: Routine assessment of ICD-11 CPTSD is recommended in this population group.

Optimising the continuity experiences of student midwives: an integrative review.

BACKGROUND: In several countries, midwifery students undertake continuity of care experiences as part of their pre-registration education. This is thought to enable the development of a woman-centred approach, as well as providing students with the skills to work in continuity models. A comprehensive overview of factors that may promote optimal learning within continuity experiences is lacking. AIM: To identify barriers and facilitators to optimal learning within continuity experiences, in order to provide a holistic overview of factors that may impact on, modify and determine learning within this educational model. METHODS: An integrative literature review was undertaken using a five-step framework which established the search strategy, screening and eligibility assessment, and data evaluation processes. Quality of included literature was critically appraised and extracted data were analysed thematically. FINDINGS: Three key themes were identified. A central theme was relationships, which are instrumental in learning within continuity experiences. Conflict or coherence represents the different models of care in which the continuity experience is situated, which may conflict with or cohere to the intentions of this educational model. The final theme is setting the standards, which emerged from the lack of evidence and guidance to inform the implementation of student placements within continuity experiences. CONCLUSION: The learning from continuity experiences must be optimised to prepare students to be confident, competent and enthusiastic to work in continuity models, ultimately at the point of graduation. This will require an evidence-based approach to inform clear guidance around the intent, implementation, documentation and assessment of continuity experiences.

The Birth Satisfaction Scale-Revised Indicator (BSS-RI): a validation study in Iranian mothers.

OBJECTIVE: Birth Satisfaction Scale-Revised Indicator (BSS-RI) is a short selfreport instrument designed to measure satisfaction of the childbearing women's experiences of labour and its outcomes. The aim of this study was to examine the reliability and validity of the Persian version of BSS-RI in Iranian mothers. METHODS: This cross-sectional study was conducted on 396 mothers in Tehran, Iran, between July and September 2017. The mothers were administered the BSS-RI, and a demographic questionnaire. Internal consistency of the BSS-RI was examined with Cronbach's alpha, construct validity was evaluated via exploratory factor analysis (EFA), and divergent validity was examined by correlating the BSS-RI with gestational age. RESULTS: The EFA results demonstrated a two-factor structure corresponding to the Stress of Childbearing and Quality of Care domains of the structure proposed by provider. The Cronbach's alpha for Stress of Childbearing and Quality of Care subscales and total BSS-RI were 0.665, 0.847, and 0.563, respectively. The mean of BSS-RI total score was 6.16 (SD = 2.60), and the Stress of Childbearing and Quality of Care subscales were 2.71 (SD = 2.39), and 3.45 (SD = 1.11), respectively. The BSS-RI showed no significant correlation with the gestational age, confirming divergent validity. CONCLUSION: Like the original English version, the Persian version of the BSS-RI is a reliable and valid instrument for measuring birth satisfaction in Iranian mothers. It can also be used as short and easy to administer tool for assessment of birth satisfaction in large sample survey research.

Validation and factor structure of the Italian version of the Birth Satisfaction Scale-Revised (BSS-R).

OBJECTIVE: To validate the Italian-language version of the Birth Satisfaction Scale-Revised (BSS-R) and report key measurement properties of the tool. To evaluate the impact of antenatal class attendance on BSS-R assessed birth satisfaction. BACKGROUND: Maternal satisfaction is one of the standards of care defined by the World Health Organisation (WHO) to improve the quality of services. The BSS-R is a multi-dimensional self-report measure of the experience of labour and birth. METHODS: Cross-sectional instrument evaluation design examining factor structure and key aspects of validity and reliability. Embedded between-subjects design to examine known-group discriminant validity and the impact of antenatal class attendance on BSS-R sub-scale and total scores as dependent variables. After giving birth, 297 women provided data for analysis. RESULTS: The Italian version of the BSS-R (I-BSS-R) was the key study measure. The established three-factor and bi-factor models of the BSS-R were found to offer an excellent fit to the data. Comparison of the tri-dimensional measurement model and the bi-factor model of the BSS-R found no significant differences between models. Women who attended antenatal classes had significantly lower stress experienced during childbearing sub-scale scores (I-BSS-R SE), compared to those who did not. Good convergent, divergent validity and known-groups discriminant validity were established for the I-BSS-R. Internal consistency observations were found to be sub-optimal in this population. CONCLUSIONS: On all key psychometric indices, with the exception of internal consistency that requires further investigation, the I-BSS-R was found to be a valid translation of the original BSS-R. The impact of antenatal classes on birth satisfaction warrants further research.

Psychometric properties of the birth satisfaction scale-revised (BSS-R) in a sample of postpartum Iranian women.

Childbirth satisfaction may positively affect maternal intention to have a future pregnancy and preference to have a cesarean. We translate the UK-Birth-Satisfaction-Scale-Revised (UK-BSS-R) into Persian and validate an Iranian-BSS-R for future use in this population. In total, 784 mothers who were hospitalized in postpartum wards completed the Persian version of the BSS-R. The confirmatory factor analysis on 10-items scale confirmed the conventional three-factor structure. The Cronbach's alpha of the Iranian-BSS-R subscales and the total score were within the range of 0.53-0.76. Our findings provide further evidence that the BSS-R is an internationally reliable and valid instrument to measure birth satisfaction.

Pre- and during-labour predictors of low birth satisfaction among Iranian women: a prospective analytical study.

BACKGROUND: Maternal childbirth dissatisfaction has short- and long-term negative effects on the mothers' health and life, as well as on relation with her child and family. Due to lack of studies in Iran and other counties, we aimed to determine pre- and during- labour predictors of low birth satisfaction. METHODS: Seven hundred women with low risk singleton pregnancy participated in this prospective analytical study. The participants were hospitalized for vaginal delivery with fetus in cephalic presentation and gestational age of 370-416 at two teaching centers in Tabriz (Iran). Woman characteristics, anxiety state (using Spielberger inventory) and dehydration were assessed at cervical dilatation of 4-6 cm. Iranian (Persian) birth satisfaction scale-revised was applied 12-24 h after birth. Multiple linear regression was used to determine the predictors. RESULTS: Excluding 26 women who were outliers, 674 women were analyzed. The mean birth satisfaction score was 23.8 (SD 6.5) from an attainable score of 0-40. The during-labour predictors of low birth satisfaction score were severe and moderate anxiety, labour dystocia, insufficient support by staff, vaginal birth with episiotomy and tear, emergency cesarean section, labour induction and labour augmentation with oxytocin, and woman dehydration. The pre-labour predictors included being primiparous, sexual and emotional violence during pregnancy, gestational age of 400-416, preference for cesarean section, no attendance at pregnancy classes, and insufficient household income. The proportion of the variance explained by the during-labour variables was 75%, by pre-labour variables was 14% and by overall was 76%. CONCLUSIONS: The controllable during-labour predictors explains most of the variance of the satisfaction score. It seems that responding to women's physical and psychological needs during labour and applying less interventions could improve women's childbirth satisfaction.

An exploratory Interpretative Phenomenological Analysis (IPA) of childbearing women's perceptions of risk associated with having a high Body Mass Index (BMI).

BACKGROUND: In 2016, the World Health Organization (WHO) labelled 13% of the world's adult population as obese. This increase in obesity is accompanied by mortality and morbidity problems, with maternal obesity and its accompanying risk for mother and infant requiring to be carefully managed. AIM: To explore childbearing women with a high BMI (>35 kg/m2) perceptions of risk and its potential impacts upon pregnancy and outcome. METHOD: Qualitative Interpretative Phenomenological Analysis (IPA) was used to gain deeper understanding of the lived experiences of childbearing women with a BMI>35 kg/m2 and perceptions of their risk and potential pregnancy outcome. FINDINGS: One of the superordinate themes that emerged was (1) Risk or no risk, and its associated three subthemes of (1a) Emotional consequences of her risky position, (1b) Recognition of high-risk complicationsfinally sinking in, and (1c) Accepting the risk body. RECOMMENDATIONS FOR PRACTICE: In general, health care professionals are uncomfortable about discussing obesity-associated risks with pregnant women. The participants in this study did not classify themselves as obese, with this absence of acknowledgement and 'risky talk' leaving participants' unaware of their obesity-associated risk. This downplaying of obesity related talk requires to be corrected, simply because women in denial will perceive no need to engage with health promotion messages. In response, directives are required to be embedded into policy and practice. CONCLUSION: Specific training is required to teach maternity care professionals how to have difficult, sensitive conversations about obesity related risks with childbearing women with high BMI's. In addition, this risk information needs to be accompanied by relevant advice and support.