Cross-cultural development and psychometric evaluation of a measure to assess fear of childbirth prior to pregnancy.

BACKGROUND: Assessment of childbirth fear, in advance of pregnancy, and early identification of modifiable factors contributing to fear can inform public health initiatives and/or school-based educational programming for the next generation of maternity care consumers. We developed and evaluated a short fear of birth scale that incorporates the most common dimensions of fear reported by men and women prior to pregnancy, fear of: labour pain, being out of control and unable to cope with labour and birth, complications, and irreversible physical damage. METHODS: University students in six countries (Australia, Canada, England, Germany, Iceland, and the United States, n = 2240) participated in an online survey to assess their fears and attitudes about birth. We report internal consistency reliability, corrected-item-to-total correlations, factor loadings and convergent and discriminant validity of the new scale. RESULTS: The Childbirth Fear - Prior to Pregnancy (CFPP) scale showed high internal consistency across samples (α > 0.86). All corrected-item-to total correlations exceeded 0.45, supporting the uni-dimensionality of the scale. Construct validity of the CFPP was supported by a high correlation between the new scale and a two-item visual analogue scale that measures fear of birth (r > 0.6 across samples). Weak correlations of the CFPP with scores on measures that assess related psychological states (anxiety, depression and stress) support the discriminant validity of the scale. CONCLUSION: The CFPP is a short, reliable and valid measure of childbirth fear among young women and men in six countries who plan to have children.

Midwifery education in Canada.

OBJECTIVE: This article is part of a special series on midwifery education and describes the approach to midwifery education in Canada DESIGN: We begin with an overview of the model of midwifery practice introduced in Canada in the 1990s. We describe the model of midwifery education developed and report how it is implemented, with particular attention to the two longest established programs. SETTING: Midwifery education programs in Ontario and British Columbia. FINDINGS: Midwifery education programs in Canada are offered at the undergraduate baccalaureate level at universities and are typically four years in length. Programs are competence-based and follow a spiral curriculum. The first semesters focus on on core sciences, social sciences and introduction to midwifery concepts. Students spend fifty percent of the program in clinical practices with community-based midwives. Innovative education models enable students to be placed in distant placements and help to align theoretical and practice components. Clinically active faculty adds to the credibility of teaching but bring its own challenges for midwifery educators. CONCLUSIONS: The Canadian model of midwifery education has been very effective with low attrition rates and high demand for the number of places available. Further program expansion is warranted but is contingent on the growth of clinical placements.

Why home birth? A qualitative study exploring women's decision making about place of birth in two Canadian provinces.

OBJECTIVE: the aim of this study was to increase our understanding of why Canadian women choose to give birth at home. Despite on-going debate regarding the safety of home birth, a small number of Canadian women choose home as a place to give birth. The factors influencing a woman's decision to plan a home birth remain poorly understood. DESIGN: a qualitative, grounded theory approach using semi-structured interviews. PARTICIPANTS: a purposive sample of women from two Canadian provinces, who planned to give birth at home in their current pregnancy or who had planned a home birth within the last 2 years. FINDINGS: thematic analysis highlighted key motivating factors as well as a decision-making framework by which women chose home birth. The decision making process includes an exploration of internal motivators for wanting home birth, a phase of information gathering and taking ownership for the decision to give birth at home. KEY CONCLUSIONS: the study showed that women in two geographically distinct parts of Canada approach decision making around home birth in a similar fashion and provides a framework for decision making for choosing to birth at home. IMPLICATIONS FOR PRACTICE: improved understanding of the decision making process for choice of birth place is useful for midwives for the provision of information to their clients and for midwifery policy and practice within Canada.

Birth technology and maternal roles in birth: knowledge and attitudes of canadian women approaching childbirth for the first time.

OBJECTIVE: To describe Canadian nulliparous women's attitudes to birth technology and their roles in childbirth. METHODS: A large convenience sample of low-risk women expecting their first birth was recruited by posters in laboratories, at the offices of obstetricians, family physicians, and midwives, at prenatal classes, and through web-based advertising and invited to complete a paper or web-based questionnaire. RESULTS: Of the 1318 women completing the questionnaire, 95% did so via the web-based method; 13.2% of respondents were in the first trimester, 39.8% were in the second trimester, and 47.0% in the third. Overall, 42.6% were under the care of an obstetrician, 29.3% a family physician, and 28.1% a registered midwife. The sample included mainly well-educated, middle-class women. The planned place of giving birth ranged from home to hospital, and from rural centres to large city hospitals. Eighteen percent planned to engage a doula. Women attending obstetricians reported attitudes more favourable to the use of birth technology and less supportive of women's roles in their own delivery, regardless of the trimester in which the survey was completed. Those women attending midwives reported attitudes less favourable to the use of technology at delivery and more supportive of women's roles. Family practice patients' opinions fell between the other two groups. For eight of the questions, "I don't know" (IDK) responses exceeded 15%. These IDK responses were most frequent for questions regarding risks and benefits of epidural analgesia, Caesarean section, and episiotomy. Women in the care of midwives consistently used IDK options less frequently than those cared for by physicians. CONCLUSIONS: Regardless of the type of care provider they attended, many women reported uncertainty about the benefits and risks of common procedures used at childbirth. When grouped by the type of care provider, in all trimesters, women held different views across a range of childbirth issues, suggesting that the three groups of providers were caring for different populations with different attitudes and expectations.

The attitudes of Canadian maternity care practitioners towards labour and birth: many differences but important similarities.

OBJECTIVE: Collaborative, interdisciplinary care models have the potential to improve maternity care. Differing attitudes of maternity care providers may impede this process. We sought to examine the attitudes of Canadian maternity care practitioners towards labour and birth. METHODS: We performed a cross-sectional web- and paper-based survey of 549 obstetricians, 897 family physicians (400 antepartum only, 497 intrapartum), 545 nurses, 400 midwives, and 192 doulas. RESULTS: Participants responded to 43 Likert-type attitudinal questions. Nine themes were identified: electronic fetal monitoring, epidural analgesia, episiotomy, doula roles, Caesarean section benefits, factors decreasing Caesarean section rates, maternal choice, fear of vaginal birth, and safety of birth mode and place. Obstetrician scores reflected positive attitudes towards use of technology, in contrast to midwives' and doulas' scores. Family physicians providing only antenatal care had attitudinal scores similar to obstetricians; family physicians practising intrapartum care and nurses had intermediate scores on technology. Obstetricians' scores indicated that they had the least positive attitudes towards home birth, women's roles in their own births, and doula care, and they were the most concerned about the consequences of vaginal birth. Midwives' and doulas' scores reflected opposing views on these issues. Although 71% of obstetricians supported regulated midwifery, 88.9% were against home birth. Substantial numbers of each group held attitudes similar to dominant attitudes from other disciplines. CONCLUSION: To develop effective team practice, efforts to reconcile differing attitudes towards labour and birth are needed. However, the overlap in attitudes between disciplines holds promise for a basis upon which to begin shared problem solving and collaboration.