Perceived Reality and Subjective Importance of Shared Decision-Making During Perinatal Care.

Aim: The aim of the study is to explore perceived reality and subjective importance of shared decision-making (SDM) during antenatal, intrapartum, and/or postpartum care, provided by the midwife and/or obstetrician. Methods: A cross- sectional study was conducted among women in Flanders, Belgium. SDM was measured with the Observing PatienT InvOlvemeNt scale. Tests examined the differences between perceived reality and subjective importance of SDM. A multivariate generalized linear model tested the main and interaction effects between SDM and the maternity care providers and the perinatal care periods. Bonferroni post hoc tests examined further significance. Results: A total of 1,216 pregnant and postpartum participants completed 1,987 self-reports of perceived reality and subjective importance of SDM. The community midwives' SDM was evaluated 924/1,987 times, the hospital midwives' SDM 309/1,987 times, and the obstetricians' SDM 754/1,987 times. Perceived reality and subjective importance of SDM showed significant differences between care professionals (p < .001; p < .001), explained by the differences between community and hospital midwives' SDM (p < .001, d85; p < .001; d28) and between community midwives and obstetricians' SDM (p < .001, d72; p < .001; d31). Conclusions: The findings indicate optimizing the decision-making process during perinatal care by aligning subjective importance and perceived reality of SDM throughout the perinatal care episodes. Community midwives seem to be benchmarkers of shared decision-making during perinatal care.

Virtual Reality as a Method to Cope With Labor Pain: What Do Women Want?

This study aimed to determine what childbearing women want when using virtual reality as an intrapartum pain management method. Researchers performed a qualitative exploratory study using content analysis. Two focus groups were organized including pregnant women anticipating a vaginal birth and women who recently had given birth, no longer than 6 months ago. The focus groups included a 30-minute virtual reality demo. In total, 10 women participated. Five themes emerged: (1) "try, test and explore": the need to receive information and to get acquainted with virtual reality during the antenatal period; (2) "variety and diversity in physical and digital options": the preference for a variety in virtual content and view virtual reality as a complementary method to methods for intrapartum pain management; (3) "distraction versus focus": virtual reality as a method to distract from pain, from the clinical context or to help them focus; (4) "comfort both physical and digital": measures to ensure a comfortable physical and virtual experience; and (5) "birthing partner": the potential need to include partners. This study is an essential step informing the development, implementation, and research of labor-specific virtual reality and informing antenatal healthcare providers when offering women virtual reality as intrapartum pain management.

Evaluation of a web-based intervention to optimize perinatal emotional wellbeing: A nested case-control study / Evaluación de una intervención basada en la web para optimizar el bienestar emocional perinatal: un estudio de casos y controles anidado

Background/Objective: WazzUp Mama© is a remotely delivered web-based tailored intervention to prevent and reduce perinatal emotional distress, originally developed in the Netherlands. The current study aimed to evaluate the adapted WazzUp Mama© intervention in a Flemish (Dutch-speaking part of Belgium) perinatal population. Methods: A 1:3 nested case-control study was performed. A data set including 676 participants (169 cases/507 controls) was composed based on core characteristics. Using independent t-test and chi-square, the two groups were compared for mean depression, self and perceived stigma, depression literacy scores, and for positive Whooley items and heightened depression scores. The primary analysis was adjusted for covariates. Results: The number of positive Whooley items, the above cut-off depression scores, mean depression, perceived stigma, and depression literacy scores showed statistically significant differences between cases and controls, in favor of the intervention group. When adjusting for the covariates, the statistically significant differences between cases and controls remained for depression, perceived stigma, and depression literacy, for the positive Whooley items and for above cut-off depression scores. Conclusion: WazzUp Mama© indicates to have a moderate to large positive effect on optimizing perinatal emotional wellbeing, to positively change perceived stigma and to increase depression literacy.(AU)

The midwife's support during transition to motherhood: A modified Delphi study among care providers and childbearing women.

OBJECTIVE: To reach consensus between care providers and childbearing women about the midwife's relevant and appropriate domains and elements to support transition to motherhood. METHODS: A modified web-based Delphi study was conducted in Flanders (Belgium). After performing a systematic literature review, searching the grey literature and an online poll, a set of 79 items was generated. In two rounds, the items were presented to an expert panel of (1) care providers from various disciplines providing services to childbearing women and (2) to pregnant women and postpartum women up to 1-year postpartum. Consensus was defined when 70% or more of the experts scored ≥6, 5% or less scored ≤3, and a standard deviation of ≤1.1. FINDINGS: In the first Delphi round, 91 experts reached consensus on 24 items. Seventeen round one items that met one or two consensus objectives were included in round two and were scored by 64 panel experts, reaching consensus on three additional items. The final 27 items covered seven domains: attributes, liaison, management of care from a woman-centred perspective, management of care from the midwife's focus, informational support, relational support, and the midwife's competencies. CONCLUSION: The shared understanding between childbearing women and care providers shows that the midwife's transitional support is multifaceted. Our findings offer midwives a standard of care, criteria, guidance, and advice on how they can support childbearing women during transition to motherhood, beyond the existing recommendations and current provision of transitional care.

Deferred cord clamping to improve neonatal blood values: A systematic review and meta-analysis.

BACKGROUND: Practices related to umbilical cord clamping at birth should be evidence-based. Deferred cord clamping, compared to immediate cord clamping, shows benefits for preterm neonates but this may also apply to healthy term neonates. Different blood sampling techniques are used to measure effect of deferred and immediate cord clamping. OBJECTIVE: To assess the statistical and effect size differences between blood biomarkers from umbilical cord and capillary blood samples of healthy term neonates following either immediate or deferred cord clamping. DESIGN: Systematic review and meta-analysis. METHODS: The databases PubMed, Medline, CENTRAL, CINAHL and EMBASE were systematically searched. We included studies with a randomised clinical trial design comparing deferred and immediate cord clamping among healthy term neonates born by a spontaneous vaginal birth, reporting on blood biomarkers. Studies including caesarean births and premature births/neonates were excluded. Study attributes, sampling technique, blood biomarkers, mean differences, and standard deviations were extracted. The standardised mean differences (SMD) and sampling errors were calculated for effect size estimation. Meta-analyses were performed if ≥2 studies reported the same outcome using RevMan 5. Subgroup analyses distinguished effects from umbilical cord and capillary blood samples. Moderator tests and publication bias analyses were performed using JASP. RESULTS: Fifteen studies were included for analysis. The biomarkers haematocrit, haemoglobin, and bilirubin were reported in ≥2 studies and thus eligible for pooling. No differences were found in haemoglobin (SMD -0.04, 95%CI -0.57 to 0.49) or bilirubin values (SMD 0.13, 95%CI -0.03 to 0.28) between umbilical cord blood samples collected after deferred or immediate cord clamping. Deferred cord clamping led to lower haematocrit values (SMD -0.3, 95%CI -0.53 to -0.07). Higher haematocrit (SMD 0.67, 95%CI 0.37 to 0.97) and haemoglobin values (SMD 0.76, 95%CI 0.56 to 0.97) from capillary blood samples, collected 2 to 72 h postpartum, showed when cord clamping was deferred. No effect was found on bilirubin values (SMD 0.13, 95%CI -0.03 to 0.28) irrespective of the sampling technique. CONCLUSIONS: Blood collected after deferred umbilical cord clamping showed increased haemoglobin and haematocrit values up to 72 h after birth, opposed to bilirubin values. Clinical evaluation of blood biomarkers from the umbilical cord shows different values compared to capillary blood. Sampling time and technique therefore seem essential in estimating the effects of deferred cord clamping. TWEETABLE ABSTRACT: This meta-analysis shows that sampling time and technique are essential in estimating the effects of deferred cord clamping on neonatal blood values.

Factors associated with the intention of pregnant women to give birth with epidural analgesia: a cross-sectional study.

BACKGROUND: In Belgium most women receive epidural analgesia during labour. Although, it offers satisfactory pain relief during labour, the risk on a series of adverse advents has been reported. The objective of this study was to determine factors associated with the intention of pregnant women, anticipating a vaginal birth, of requesting epidural analgesia during labour. METHODS: A cross-sectional study, using an online self-report questionnaire was performed, including socio-demographic and personal details. Associated factors were examined with the HEXACO-60 questionnaire, the Mental Health Inventory-5, the Tilburg Pregnancy Distress Scale and the Labour Pain Relief Attitude Questionnaire for pregnant women. The level of intention to request epidural analgesia was based on two questions: Do you intend to ask for epidural analgesia (1) at the start of your labour; (2) at some point during labour? Data were collected predominantly during the second and third trimester of pregnancy. Descriptive analysis and a multiple linear regression analysis were performed. RESULTS: 949 nulliparous (45.9%) and multiparous (54.1%) pregnant women, living in Flanders (Dutch-speaking part of Belgium) anticipating a vaginal birth completed the questionnaires. Birth-related anxiety (ß 0.096, p < 0.001), the attitude that because of the impact of pregnancy on the body, asking for pain relief is normal (ß 0.397, p < 0.001) and feeling more self-confident during labour when having pain relief (ß 0.034, p < 0.001) show a significant positive relationship with the intention for intrapartum epidural analgesia. The length of the gestational period (ß - 0.056, p 0.015), having a midwife as the primary care giver during pregnancy (ß - 0.048, p 0.044), and considering the partner in decision-making about pain relief (ß - 0.112, p < 0.001) show a significant negative relationship with the intention level of epidural analgesia. The explained variability by the multiple regression model is 54%. CONCLUSIONS: A discussion during pregnancy about the underlying reason for epidural analgesia allows maternity care providers and partners to support women with pain management that is in line with women's preferences. Because women's intentions vary during the gestational period, pain relief should be an issue of conversation throughout pregnancy.

On cloud nine? Maternal emotional wellbeing six weeks up to one year postpartum - A cross-sectional study.

BACKGROUND: Little is known about the full scope of emotional wellbeing of mothers up to one year postpartum, to adequately support women during transition to motherhood. Reduced emotional wellbeing (REW) affects women's adaption to the changes and challenges in becoming a mother. We aimed to increase the knowledge and understanding of mothers' emotional wellbeing and the influencing factors. METHODS: This cross-sectional study includes 385 Flemish mothers up to one year postpartum. Online data were collected with the General Health Questionnaire-12, Postpartum Bonding Questionnaire, Personal Well-Being Index-Adult, The Basic Psychological Needs Scale, Sense of Coherence-13 and Coping Operations Preference Enquiry. RESULTS: A total of 63.9% of the participants reported REW. Mothers with REW more often had (a history of) psychological problems compared to mothers with healthy emotional wellbeing (p = 0.007). Multiple linear regression analysis showed negative associations between emotional wellbeing and satisfaction (p = 0.002; p < 0.001), comprehensibility (p = 0.013) and positive associations between emotional wellbeing and bonding (p < 0.001), manageability (p = 0.033), problem solving (p = 0.030) and avoidance (p = 0,011) - with an explained variance of 55.5%. LIMITATIONS: Some limitations of our study are the GHQ-12 cut-off value, the nature and implication of (a history of) psychological problems and the self-selected population. CONCLUSION: It would be of worth for midwives to discuss with mothers (to be) what to expect. This - to support mothers in making sense of their life as a mother and how various factors might influence their emotional wellbeing. The high prevalence of REW is worrying, but needs to be interpreted with caution.

Digital adaptability competency for healthcare professionals: a modified explorative e-Delphi study.

AIM: To establish items of the digital adaptability competency for healthcare professionals. BACKGROUND: While the application and deployment of eHealth has continued at a rapid pace, healthcare professionals are expected to keep up and join the digital evolution. The implementation of eHealth requires a change in the healthcare professionals' competencies of which the ability to adapt to technological change is fundamental. There's more needed than just ICT skills, overall competencies to be digitally adaptable between patientcare and the use of eHealth are needed. Today, a distinct and relevant list of items for healthcare professionals related to the competency of digital adaptability is missing. DESIGN: An exploratory modified e-Delphi study. METHODS: This study was conducted in Flanders, Belgium. An expert group (n = 12) consisting of 2 policymakers of the Belgian federal government, 3 eHealth managers of large organizations in the Belgian healthcare sector, 1 nurse, 1 midwife, 2 health service users and 3 researchers specialized in eHealth research. Through a literature review an initial list of items was developed, consisting of 67 statements. A two-round Delphi survey was performed where experts could rate the relevance of each item. The third round comprised an online meeting, where the expert group discussed the remaining items until agreement was reached to retain, modify, or eliminate the item. RESULTS: In round 1, eleven items were included to the final document. In round 2, ten items were included. In round 3, the panel unanimously agreed to add six items, one item was modified into two separate items. In total, 29 items were included in the final document. CONCLUSIONS: The rather abstract concept of digital adaptability is now transformed into a more pragmatic concept of 29 items, reflecting the practical competencies of healthcare professionals necessary to be digital adaptable.

Emotional wellbeing of student midwives during COVID-19.

BACKGROUND: Mental health of students in higher education was affected during the COVID-19 pandemic. AIM: To examine the emotional wellbeing of midwifery students in the Netherlands and Flanders (Belgium) during COVID-19. METHODS: A cross-sectional online-based survey with 619 Dutch and Flemish midwifery students. Sociodemographic details were obtained. Anxiety and depression were measured twice (T1, T2) during the COVID-19 pandemic. FINDINGS: Flemish students had significantly higher mean depression and anxiety scores than Dutch students during the total period of study (p < .001; p < .001). Total group mean depression and anxiety scores were significantly higher at T2 compared to T1 (p < .001; p < .001). In the Dutch student group, there was a significant increase of depression from T1 to T2 (p < .001). In the Flemish student group, both depression and anxiety scores significantly increased from T1 to T2 (p < .001; p < .001). A history of psychological problems predicted both depression and anxiety, irrespective of COVID-19 period or country (p < .001; p < .001). Being single (p.015) and having a job (p.046) predicted depression, irrespective of period or country. A history of psychological problems predicted depression (p.004; p < .001) and anxiety (p.003; p.001) during the total period of study. Being single also predicted depression during T2 (p.024). CONCLUSION: These findings inform how emotional wellbeing of midwifery students was affected during the COVID-19 pandemic and identify those students that might need extra attention after the pandemic, during another pandemic or similar situations with social restrictions.

Psychological health of pregnant and postpartum women before and during the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic is likely to influence psychological health of pregnant and postpartum women. METHODS: We conducted a non-concurrent cross-sectional study among 1145 women living in the Dutch-speaking part of Belgium, 541 pregnant and 604 postpartum women. We measured psychological health with the Whooley questions, Generalized Anxiety Disorder 2-item (GAD-2) and the Edinburgh Postnatal Depression Scale (EPDS) and compared the scores of pregnant and postpartum women before and during the COVID-19 pandemic. RESULTS: No differences were observed in the Whooley, GAD-2 or EPDS scores among pregnant women. The postpartum total GAD-2 scores before vs during the pandemic showed significant differences. Controlling for confounders, we observed a small main positive effect of having an infant during time of COVID-19 (F(1.13) = 5.06, p.025, d.27). The effect was significantly larger for women with (a history of) perinatal psychological problems (F(1.12) = 51.44, p < .001, d.82). Emotional support was significantly related to GAD-2 scores of postpartum women during the pandemic (F(1.90) = 35.54, p < .001). Postpartum women reported significant higher effects of the pandemic on their behavior compared to pregnant women (p.034). CONCLUSION: The COVID-19 pandemic seems to have a positive effect on postpartum women during the first year postpartum, in particular for women with (a history of) perinatal psychological problems and for those women who experienced emotional support. The findings suggest that less external stimuli caused by lockdown restrictions might have a positive effect on postpartum women's emotional wellbeing. The sample consisted of white, educated women in a relationship and information regarding the extent of exposure to adverse COVID-19 consequences was lacking. We relied on self-selection and self-report. The postpartum pandemic sample was small.

Midwifery Practice and Education in Antwerp: Forecasting Its Future With Scenario Planning.

BACKGROUND: Midwifery across the world is facing changes and uncertainties. By recognizing plausible future options, a contemporary and strategic scope of midwifery practice and education can be established. The city of Antwerp, Belgium, was the indicative case for this study. Key drivers were identified to serve as input for scenarios. METHOD: Structuration theory and intuitive logics scenario planning methods were used to structure contextual midwifery scenarios. RESULTS: Six certain and six uncertain variables were identified. A two-dimensional framework showed these factors: (a) maternity care services and organization and (b) the society of child-bearing women and their families. Three scenarios described the plausible future of midwifery: (a) midwife-led care monitoring maternal health needs, (b) midwife-led holistic care, and (c) midwife/general practitioner-led integrated maternity care. CONCLUSION: All of the scenarios show the direction of change with a strategic focus, the importance of midwifery authenticity, and digital adaptability in maternity services. Also, the coronavirus disease 2019 (COVID-19) pandemic cannot be ignored in future midwifery. [J Contin Educ Nurs. 2022;53(1):21-29.].

The experiential knowledge of migrant women about vulnerability during pregnancy: A woman-centred mixed-methods study.

PROBLEM: Within maternity care policies and practice, pregnant migrant women are regarded as a vulnerable population. BACKGROUND: Women's experiential knowledge is a key element of woman-centred care but is insufficiently addressed in midwifery practice and research that involves migrant women. AIM: To examine if pregnant migrant women's experiential knowledge of vulnerability corresponds with sets of criteria of vulnerability, and to explore how migrant women make sense of vulnerability during pregnancy. METHODS: A sequential two-phased mixed-methods study, conducted in the Netherlands, integrating survey data of 89 pregnant migrant women and focus group data obtained from 25 migrant mothers - living in deprived areas according to the Dutch socio-economic index. RESULTS: Criteria associated with vulnerability were reported by 65.2% of the participants and 62.9% of the participants reported adverse childhood experiences. On a Visual Analogue Scale, ranging from 0 (not vulnerable) to 10 (very vulnerable), participants self-reported sense of vulnerability showed a mean score of 4.2 (±2.56). Women's experiential knowledge of vulnerability significantly correlated with the mean sum score of clinical criteria of vulnerability (r .46, p .002) and with the mean sum score of adverse childhood experiences (r .48, p<.001). Five themes emerged from the focus group discussions: "Look beyond who you think I am and see and treat me for who I really am", "Ownership of truth and knowledge", "Don't punish me for being honest", "Projection of fear" and "Coping with labelling". CONCLUSION: Pregnant migrant women's experiential knowledge of vulnerability is congruent with the criteria. Calling upon experiential knowledge is an attribute of the humane woman-midwife relationship.

Flemish midwives' perspectives on supporting women during the transition to motherhood - A Q-methodology study.

OBJECTIVE: In this study we aimed to reveal midwives' distinct perspectives about midwifery support of women in their transition process during the continuum from pregnancy to one-year postpartum. DESIGN: A Q-methodology study, a mixed quantitative-qualitative approach, was conducted. Participants (P-set) rank-ordered 36 statements (Q-set) about how midwives provide support during the woman's transition to motherhood, followed by interviews to motivate their ranking. To extract the perspectives/factors on support during this transition process, centroid by-person factor analysis and varimax rotation was used. The transcripts of the interviews were interpreted per factor. SETTING: Independent (self-employed) and employed, community and hospital-based practising midwives in Flanders, Belgium. PARTICIPANTS: 83 practicing midwives participated, selected on: variation in practice setting, years of experience, views on the woman's domestic role in family life, and motherhood status. FINDINGS: Two distinct perspectives (factors) on supporting women in transition to motherhood emerged. The job-focused midwife acts according to evidence, knowledge and guidelines and adheres to the scope and tasks within the professional profile (Factor 1). The woman-focused midwife acts within a relationship of trust emphasizing the one-on-one connection while supporting transition to motherhood and the woman's needs (Factor 2). Both factors showed an explained total variance of 59% of the Q-set. KEY CONCLUSIONS: Both the job-focused midwife and the woman-focused midwife represent distinct perspectives about the midwife's execution of supporting transition to motherhood, including salotugenic elements. This provides an understanding of midwives' thoughts and experiences about why and how support is given. IMPLICATIONS FOR PRACTICE: More awareness about the subjective distinct ways of thinking about supporting transition to motherhood should be integrated in practice, midwifery education and professional development.

Proactive behaviour in midwifery practice: A qualitative overview based on midwives' perspectives.

BACKGROUND: Midwifery practice is in the process of continuing developments and contemporary working conditions asking for proactive behaviour, which could increase work-efficiency, job satisfaction, commitment and coping attitudes towards stress resistance. This study aims to provide an in depth exploration of midwives' perceptions of facilitators and/or barriers of proactive behaviour in midwifery practice. METHODS: A qualitative descriptive study, using individual semi-structured interviews, was undertaken within a sample of 102 Flemish and Dutch midwives who were interviewed from September to December 2017 using a four-item topic-list. RESULTS: Six influencing factors emerged from the data consisted of the causal, contextual and conditional factors faced by the midwives in order to show proactive behaviour in midwifery practice. Midwives elaborated the need for team consultations, a safe organizational culture, an appreciative midwifery leader and an attitude of lifelong learning. Furthermore, midwives are looking for a way to deal with both challenges in healthcare and the competitive societal system. CONCLUSION: This inductive study confirmed, supported and expanded previous deductive research and provided additional insights of proactive behaviour in midwifery. Providing midwives with knowledge of the influencing factors, required to successfully effecting proactive behaviour in midwifery, this study has subsequently merit for future research in the transfer of recommendation in daily midwifery practice, education and policymaking.

Proactive behavior in midwifery: A qualitative overview from midwifery student's perspective.

In the process of continuing developments and contemporary working conditions, this study provides an in depth exploration of proactive behavior in midwifery. Exploring 55 midwifery students' perceptions on facilitators and/or barriers of proactive behavior in midwifery practice, this study uncloses additional insights of proactive behavior in midwifery and aims to confirm and/or supplement previous results. Four key themes were identified: 1) Nature-nurture, supported by good communication and lifelong learning. 2) Willingness, regulated by the midwife's norms and values and the organizational culture of the midwifery team. 3) The impact of awareness and feedback on the reflective tendencies to strengthen the midwife's beliefs and convictions to behave proactively. 4) Time was identified as something gained in the presence of proactive behavior as well as a barrier if time was limited. Providing midwives with knowledge of the key factors required to successfully effect proactive behavior in midwifery, this study has merit for future midwifery education, policy and practice. Strengthening intrinsic motivation of midwives integrated into midwifery education, focus on feedback as part of the daily routine of the midwife and the gaining of time as an effect of proactive behavior, needs clear attention in midwifery practice.

Study protocol for 'PROMIsE': Implementation of a curriculum to stimulate PROactive behavior in MIdwifery Education.

INTRODUCTION: Proactive behavior shows promise in the challenges of midwifery students in adapting quickly and effectively to different clinical settings. The antecedents of rolebreadth self-efficacy, control appraisal and trust in peers have demonstrated a potential for significant benefit to proactive behavior in midwifery education. A new midwifery educational program, 'PROMIsE', was developed to influence these antecedents and so enhance proactive behavior. METHODS: A pre-test/post-test cohort study of midwifery students' antecedents in proactive behavior will be conducted from September 2018 until June 2022. All new starting midwifery students (n = estimated at 150) at one Belgian University College will be included. Data will be collected using a validated questionnaire at four time points: the entry point in the new midwifery curriculum, after one year, two years and at the end of the curriculum. A proportional odds logistic regression analysis will be used to clarify the association between these antecedents and the probability to observe proactive behavior within this group at different time points. RESULTS: A historical comparison will be made with this cohort study and two previous cross-sectional studies. With 'PROMIsE' it is assumed that this cohort, which underwent the intervention of 'PROMIsE', will score significantly higher than the cross-sectional study groups. CONCLUSIONS: 'PROMIsE' aims to support the individual guidance of midwifery students towards proactive behavior in midwifery in order to cope with the numerous challenges in reproductive healthcare.

A cross-sectional pilot study of student's proactive behavior in midwifery education: Validation of a developed questionnaire.

OBJECTIVES: Midwifery students face major challenges in adapting quickly and effectively to different clinical settings. Proactive behavior, triggered by various individual and/or contextual antecedents, could be a significant added value to cope with these challenges. DESIGN: A cross-sectional pilot study was conducted to investigate prognostic factors in proactive behavior in a group of midwifery students. SETTINGS: The setting was a Belgian University College for midwifery education. PARTICIPANTS: All second and third year midwifery students (n=156). METHODS: Students were questioned regarding several prognostic factors: four personal characteristics, seven individual antecedents and three contextual antecedents that might trigger proactive behavior. A proportional odds logistic regression analyses was used to describe the association between prognostic factors and the probability to observe proactive behavior within the group. The strength of the newly developed questionnaire was tested. RESULTS: Of all tested prognostic factors, nationality, role breadth self-efficacy, referring to the self-confidence of a midwifery-student to perform tasks that exceed expectations, and control appraisal, describing the importance attached to one's perceived control, were significantly associated with proactive behavior. The overall strength of the questionnaire was ratified. Two of the original questions were deleted, two re-formulated and for one prognostic factor the answer-options were re-formulated. CONCLUSIONS: Findings from this pilot study show that midwifery students who have a high role breadth self-efficacy and low control appraisal are more likely to show proactive behavior. Additionally, Dutch students are more likely to show proactive behavior in relation to Belgian students. The questionnaire's feasibility was examined and adjustments were made for future research in a larger study to confirm these outcomes. This study can be a support in the individual guidance of midwifery students towards proactive behavior in midwifery.

A concept analysis of proactive behaviour in midwifery.

AIM: To report an analysis of the concept of proactive behaviour and apply the findings to midwifery. BACKGROUND: Proactive behaviour is a universal phenomenon generalizable to multiple professions. The purpose of this work was to establish a link with midwifery. DESIGN: Concept analysis by Walker and Avant's method. DATA SOURCES: Literature was searched in PubMed, ERIC, NARCIS, Emerald and reference lists of related journal articles with a timeline of 1990 - April 2015 in the period of November 2014 - June 2015. Next key words were combined by the use of Boolean operators: 'proactive behaviour', 'midwifery', 'midwife', 'proactivity' and 'proactive'. Fifteen studies were included. METHODS: A focused review of scientific publications in midwifery, health care, healthcare education and social sciences, which highlighted the concept of proactive behaviour. RESULTS: In the studied literature, several attributes of proactive behaviour were cited. These attributes were narrowed by applying it on a midwifery model case, borderline case and contrary case. Related concepts were elaborated and distinguished of the concept of proactive behaviour in midwifery. Proactive behaviour is triggered by different individual and contextual antecedents and has consequences at multiple levels. CONCLUSION: A midwife who behaves proactive would not look at changes as a boundary, persistently improves things she experienced as wrong, anticipates future barriers and looks for viable alternatives to carry out her work as efficiently and effectively as possible. Various individual and/or contextual antecedents trigger proactive behaviour in midwifery, and this behaviour could cause multiple future benefits for the constant evolving reproductive health care.

Maternal position and other variables: effects on perineal outcomes in 557 births.

BACKGROUND: Damage to the perineum is common after vaginal delivery, and it can be caused by laceration, episiotomy, or both. This study investigated the effects of maternal position (lateral vs lithotomy) and other variables on the occurrence of perineal damage. METHODS: A retrospective study included the examination of hospital records from 557 women. The effects of demographic characteristics, gravidity, parity, duration of pregnancy, reason for admission, and mode of labor on perineal outcomes were investigated through univariate (independent sample t test, chi-square test) and multivariate analysis (logistic regression analysis). RESULTS: Considering episiotomy as perineal damage, univariate analysis showed a protective effect of the lateral position (45.9% vs 27.9%, p > 0.001), and fewer episiotomies were performed (6.7% vs 38.2%) with this position. This protective effect for perineal damage disappeared on excluding women undergoing episiotomy from analysis. Multivariate analysis including all participants showed an increase of 47 percent in the likelihood of an intact perineum for the lateral position when compared with the lithotomy position (OR: 0.53; 95% CI: 0.36-0.78). Parity was associated with a reduction of 44 percent in perineal damage (OR: 0.56; 95% CI: 0.47-0.78, p < 0.001). Moreover, the lithotomy position was associated with significantly more episiotomies than the lateral position (7% vs 38%, p < 0.001). The odds of perineal damage increased in deliveries performed by physicians (OR: 2.92; 95% CI: 1.79-4.78). CONCLUSIONS: Childbirth in the lateral position resulted in less perineal trauma when compared with childbirth in the lithotomy position, even after correcting for parity and birth attendant. The probability of an intact perineum increased in deliveries performed by midwives. (BIRTH 39:2 June 2012).