- Email: [email protected]
Salutogenic midwifery
S46
ACM2015 Poster Presentations / Women and Birth 28S (2015) S39–S56
[P18] Salutogenic midwifery Sally Ferguson *, Deborah Davis, Jenny Browne, Jan Taylor University of Canberra, Canberra, Australia *Corresponding author. Introduction: Tertiary maternity services in Western countries are framed in pathogenesis creating a culture of risk magnification, a sceptical view of labour physiology, a low threshold for labour intervention and increasing rates of caesarean section. The theory of salutogenesis offers an alternative as it focuses on the causes of health rather than the causes of illness. Sense of coherence (SOC), the cornerstone of salutogenic theory, is a predictive indicator of health. Aim: To investigate the relationship between a pregnant woman’s SOC, the childbirth choices she made in pregnancy and her birthing outcomes. Methods: A cross sectional survey was conducted in the ACT where eligible women completed a questionnaire at two time points, one antenatal and one postnatal. The questionnaires provided information on SOC scores, Edinburgh Postnatal Depression (EPDS) scores, Support Behaviour Inventory (SBI) scores, pregnancy choices, birth outcomes and demographics. Results: The first questionnaire was completed by 1074 women and a 75% return rate was achieved on the second questionnaire. Compared to women with low SOC, women with high SOC were less likely to birth by caesarean section, more likely to experience an assisted vaginal birth, were older, were less likely to identify pregnancy conditions, had lower EPDS scores and higher SBI scores. SOC was not associated with women’s pregnancy choices. Conclusion: In this population, pregnant women with high SOC have fewer caesarean sections compared to women with low SOC. SOC is an important predictor of women’s childbearing health and attention should be focused on increasing women’s SOC in the antenatal period through antenatal care and education. More research is required to relate salutogenesis in general, and SOC in particular, to childbearing women. http://dx.doi.org/10.1016/j.wombi.2015.07.146 [P33] Risk factors for excessive postpartum blood loss in the cosmos trial of caseload midwifery Mary-Ann Davey 1, Helen McLachlan 1, Della Forster 1,2,*, Margaret Flood 1 1 Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia 2 Royal Women’s Hospital, Parkville, Australia *Corresponding author.
Introduction: Postpartum haemorrhage is becoming more common in Australia and in other developed countries. The reasons are not fully understood. We collected data on blood loss in a recent randomised controlled trial of caseload midwifery that included 2314 women. Aim: To undertake a secondary analysis of risk factors for postpartum blood loss of 1000 mL or more for women who experienced labour. Methods: Mean postpartum blood loss did not differ between randomised arms (400 mL vs 402 mL), so the data were analysed as
a cohort. Estimated blood loss and other labour and birth data items were collected from the medical record for the 2202 participants who gave birth at the study hospital. Oxytocin infusion in labour was recorded, regardless of whether it was used for induction or for augmentation. Onset of labour was collected separately. Analyses included comparison of proportions and Chi square tests, t-tests and multiple logistic regression to identify risk factors. Results: In total, 5.2% of women who experienced labour had a blood loss of 1000 mL or more. Unadjusted analysis shows that rates were higher for those who had an oxytocin infusion in labour (6.4%, p = 0.027), a 3rd or 4th degree perineal laceration (19.0%, p < 0.001), or an episiotomy (7.0%, p = 0.036). Women who experienced a blood loss of 1000 mL or more were older, had a higher BMI, gave birth to an infant with a higher birthweight, and, for multiparous women only, had a longer second stage (all p < 0.05). Conclusion: Many of the variables associated with a blood loss of 1000 mL or more are not immediately amenable to change (e.g. maternal age, BMI). The association with the use of oxytocin infusions in labour and with perineal damage will be further explored adjusting for important confounders e.g. birthweight, duration of second stage. http://dx.doi.org/10.1016/j.wombi.2015.07.147 [P19] Women’s experience based on a hormonal/ emotional model of labour Anna Fragkoudi *, Rhonda Small, Lester Jones, Michelle Newton La Trobe, Melbourne, Australia *Corresponding author. Introduction: Childbirth is an important event in a woman’s life for which a positive experience is highly desirable. Many studies have shown that emotions and human behaviour in labour are linked to hormones and others have emphasised the need for women be well informed about childbirth and to have support. Over a long period of time childbirth education has aimed to assist women by offering theoretical understanding and practical techniques to reduce labour pain, confront negative emotions, such as fear and stress and enable a more positive experience of labour. Childbirth education comes in many guises and has been the subject of review and evaluation. Despite the importance of hormones in labour, however, there has often been little focus in childbirth education on the hormonal and emotional pathways of labour and birth. An unanswered question is: Can childbirth be a more positive experience if we focus on its hormonal and emotional side/ dimension? Can labour and birth be more pleasurable? Aim: To examine the above questions and focus on the factors known to influence the process of labour and birth drawing insights from the literature and from an ongoing study. Methods: This is an exploratory study of women’s experiences of two childbirth education programs and understand and compare women’s descriptions of their experiences of labour in relation to what they learned in childbirth education. Results: Better understanding of women’s experiences with different childbirth education methods will also have implications for future studies reappraising childbirth education more generally. http://dx.doi.org/10.1016/j.wombi.2015.07.148
ACM2015 Poster Presentations / Women and Birth 28S (2015) S39–S56
[P18] Salutogenic midwifery Sally Ferguson *, Deborah Davis, Jenny Browne, Jan Taylor University of Canberra, Canberra, Australia *Corresponding author. Introduction: Tertiary maternity services in Western countries are framed in pathogenesis creating a culture of risk magnification, a sceptical view of labour physiology, a low threshold for labour intervention and increasing rates of caesarean section. The theory of salutogenesis offers an alternative as it focuses on the causes of health rather than the causes of illness. Sense of coherence (SOC), the cornerstone of salutogenic theory, is a predictive indicator of health. Aim: To investigate the relationship between a pregnant woman’s SOC, the childbirth choices she made in pregnancy and her birthing outcomes. Methods: A cross sectional survey was conducted in the ACT where eligible women completed a questionnaire at two time points, one antenatal and one postnatal. The questionnaires provided information on SOC scores, Edinburgh Postnatal Depression (EPDS) scores, Support Behaviour Inventory (SBI) scores, pregnancy choices, birth outcomes and demographics. Results: The first questionnaire was completed by 1074 women and a 75% return rate was achieved on the second questionnaire. Compared to women with low SOC, women with high SOC were less likely to birth by caesarean section, more likely to experience an assisted vaginal birth, were older, were less likely to identify pregnancy conditions, had lower EPDS scores and higher SBI scores. SOC was not associated with women’s pregnancy choices. Conclusion: In this population, pregnant women with high SOC have fewer caesarean sections compared to women with low SOC. SOC is an important predictor of women’s childbearing health and attention should be focused on increasing women’s SOC in the antenatal period through antenatal care and education. More research is required to relate salutogenesis in general, and SOC in particular, to childbearing women. http://dx.doi.org/10.1016/j.wombi.2015.07.146 [P33] Risk factors for excessive postpartum blood loss in the cosmos trial of caseload midwifery Mary-Ann Davey 1, Helen McLachlan 1, Della Forster 1,2,*, Margaret Flood 1 1 Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia 2 Royal Women’s Hospital, Parkville, Australia *Corresponding author.
Introduction: Postpartum haemorrhage is becoming more common in Australia and in other developed countries. The reasons are not fully understood. We collected data on blood loss in a recent randomised controlled trial of caseload midwifery that included 2314 women. Aim: To undertake a secondary analysis of risk factors for postpartum blood loss of 1000 mL or more for women who experienced labour. Methods: Mean postpartum blood loss did not differ between randomised arms (400 mL vs 402 mL), so the data were analysed as
a cohort. Estimated blood loss and other labour and birth data items were collected from the medical record for the 2202 participants who gave birth at the study hospital. Oxytocin infusion in labour was recorded, regardless of whether it was used for induction or for augmentation. Onset of labour was collected separately. Analyses included comparison of proportions and Chi square tests, t-tests and multiple logistic regression to identify risk factors. Results: In total, 5.2% of women who experienced labour had a blood loss of 1000 mL or more. Unadjusted analysis shows that rates were higher for those who had an oxytocin infusion in labour (6.4%, p = 0.027), a 3rd or 4th degree perineal laceration (19.0%, p < 0.001), or an episiotomy (7.0%, p = 0.036). Women who experienced a blood loss of 1000 mL or more were older, had a higher BMI, gave birth to an infant with a higher birthweight, and, for multiparous women only, had a longer second stage (all p < 0.05). Conclusion: Many of the variables associated with a blood loss of 1000 mL or more are not immediately amenable to change (e.g. maternal age, BMI). The association with the use of oxytocin infusions in labour and with perineal damage will be further explored adjusting for important confounders e.g. birthweight, duration of second stage. http://dx.doi.org/10.1016/j.wombi.2015.07.147 [P19] Women’s experience based on a hormonal/ emotional model of labour Anna Fragkoudi *, Rhonda Small, Lester Jones, Michelle Newton La Trobe, Melbourne, Australia *Corresponding author. Introduction: Childbirth is an important event in a woman’s life for which a positive experience is highly desirable. Many studies have shown that emotions and human behaviour in labour are linked to hormones and others have emphasised the need for women be well informed about childbirth and to have support. Over a long period of time childbirth education has aimed to assist women by offering theoretical understanding and practical techniques to reduce labour pain, confront negative emotions, such as fear and stress and enable a more positive experience of labour. Childbirth education comes in many guises and has been the subject of review and evaluation. Despite the importance of hormones in labour, however, there has often been little focus in childbirth education on the hormonal and emotional pathways of labour and birth. An unanswered question is: Can childbirth be a more positive experience if we focus on its hormonal and emotional side/ dimension? Can labour and birth be more pleasurable? Aim: To examine the above questions and focus on the factors known to influence the process of labour and birth drawing insights from the literature and from an ongoing study. Methods: This is an exploratory study of women’s experiences of two childbirth education programs and understand and compare women’s descriptions of their experiences of labour in relation to what they learned in childbirth education. Results: Better understanding of women’s experiences with different childbirth education methods will also have implications for future studies reappraising childbirth education more generally. http://dx.doi.org/10.1016/j.wombi.2015.07.148