The Role of Women's Attitudinal Profiles in Satisfaction with the Quality of their Antenatal and Intrapartum Care

doi:10.1111/1552-6909.12221

Journal of Obstetric, Gynecologic & Neonatal Nursing

Volume 42, Issue 4, July 2013, Pages 428-441

https://doi.org/10.1111/1552-6909.12221 Get rights and content

ABSTRACT

Objective

To compare perceptions of antenatal and intrapartum care in women categorized into three profiles based on attitudes and fear.

Design

Prospective longitudinal cohort study using self-report questionnaires. Profiles were constructed from responses to the Birth Attitudes Profile Scale and the Fear of Birth Scale at pregnancy weeks 18 to 20. Perception of the quality of care was measured using the Quality from Patient's Perspective index at 34 to 36 weeks pregnancy and 2 months after birth.

Setting

Two hospitals in Sweden and Australia.

Participants

Five hundred and five (505) pregnant women from one hospital in Västernorrland, Sweden (n = 386) and one in northeast Victoria, Australia (n = 123).

Results

Women were categorized into three profiles: self-determiners, take it as it comes, and fearful. The self-determiners reported the best outcomes, whereas the fearful were most likely to perceive deficient care. Antenatally the fearful were more likely to indicate deficiencies in medical care, emotional care, support received from nurse-midwives or doctors and nurse-midwives’/doctors’ understanding of the woman's situation. They also reported deficiencies in two aspects of intrapartum care: support during birth and control during birth.

Conclusions

Attitudinal profiling of women during pregnancy may assist clinicians to deliver the style and content of antenatal and intrapartum care to match what women value and need. An awareness of a woman's fear of birth provides an opportunity to offer comprehensive emotional support with the aim of promoting a positive birth experience.

Section snippets

Measurement

Several measurement tools compare expectations with experiences to determine levels of satisfaction (Hollins, Fleming, & Fleming, 2009; Symon, McGreavey, & Picken, 2003). The alignment between met and unmet expectations is an important constituent of the experience of an event and satisfaction with care; but a more essential relationship is between subjective importance and perceived reality. Subjective importance reflects how the person “wants” it to be, whereas expectancy ratings reflect how

Design

This exploratory study is one part of a prospective, longitudinal cohort investigation of aspects of pregnancy, birth, and early parenting of women from two hospitals in Sweden and Australia conducted during 2007 to 2009. Women were recruited in midpregnancy and followed up in late pregnancy and 2 months after birth.

Setting and System of Care

The cohorts came from two hospitals: one in the county of Västernorrland, Sweden, and one in the state of Victoria, Australia. The sites were close demographic matches. Both

Participation and Response

Of the 530 Swedish women who were eligible 519 were recruited (98% of those eligible), 386 women returned the questionnaire (74% response rate). The Australian site had 413 women eligible, 168 recruited (41% eligible) and 123 returns, making a response rate of 74% for the first questionnaire. The second questionnaire was completed by 323/368 Swedish women (84%) and 89/123 (72%) of the Australian women. The third questionnaire went to 386 Swedish women with 300 completed (77%) questionnaires and

Discussion

This study investigated perceived deficiencies in the quality of antenatal and intrapartum care by three attitudinal profiles of pregnant women. A number of aspects of antenatal care and intrapartum care exceeded the recommended QPP guidelines of 20% deficient ratings, with differences in responses identified across the profiles.

Overall, the self-determiners were the least likely to perceive problems with their antenatal and intrapartum care, whereas the fearful were the most likely. This

Conclusion

The application of attitudinal profiling was effective in identifying areas of greatest need for improvement in antenatal and intrapartum care for these three profiles of women. Improvements are clearly required in relation to communicating information and providing supportive, respectful care for women irrespective of their profile. Overall, the self-determiners perceived the least deficiency with their antenatal and intrapartum care and the fearful the most. When caring for a fearful woman,

Acknowledgement

Supported by the Australian Government Department of Health and Ageing through the University Departments of Rural Health Program and the Swedish Research Council.

Helen Haines, RN, RM, BN, MPH, PhD, is a lecturer in the Melbourne Medical School, Rural Health Academic Centre, The University of Melbourne, Shepparton, Victoria, Australia; Northeast Health Wangaratta, Victoria, Australia; and the Department of Women's and Children's Health, Obstetrics and Gynaecology, Uppsala University, Uppsala, Sweden.

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Ingegerd Hildingsson, RN, RM, MSc, PhD, is a professor for Mid Sweden University, Östersund, Sweden; senior researcher in the Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden; and senior lecturer in the Department of Women's and Children's Health, Obstetrics and Gynaecology, Uppsala University, Uppsala, Sweden.

Julie Pallant, BA, PhD, is an associate professor and director of Graduate Studies in the Melbourne Medical School, Rural Health Academic Centre, The University of Melbourne, Shepparton, Victoria, Australia.

Christine Rubertsson, RN, RM, MSc, PhD, is an associate professor in the Department of Women's and Children's Health, Obstetrics and Gynaecology, Uppsala University, Uppsala, Sweden.

: The authors report no conflict of interest or relevant financial relationships.

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ResearchThe Role of Women's Attitudinal Profiles in Satisfaction with the Quality of their Antenatal and Intrapartum Care

ABSTRACT

Objective

Design

Setting

Participants

Results

Conclusions

Section snippets

Measurement

Design

Setting and System of Care

Participation and Response

Discussion

Conclusion

Acknowledgement

Journal of Clinical Epidemiology

Journal of Obstetric, Gynecologic, & Neonatal Nursing

Midwifery

Midwifery

Midwifery

Journal of Obstetric, Gynecologic & Neonatal Nursing

Journal of Midwifery and Women's Health

Journal of Obstetric, Gynecologic & Neonatal Nursing

Social Science & Medicine

Social Science & Medicine

Midwifery

Midwifery

An International Journal of Obstetrics & Gynaecology

Journal of Obstetric, Gynecologic & Neonatal Nursing

Midwifery

An International Journal of Obstetrics and Gynaecology

Journal of Psychosomatic Research

Commentary on ‘post-traumatic stress following childbirth: A review of the emerging literature and directions for research and practice

Psychology, Health & Medicine

Womens expectations and experiences of birth

Psychology & Health

Bad is stronger than good

Annual Review of Psychology

Posttraumatic stress disorder in new mothers: Results from a two-stage U.S. national survey

Birth: Issues in Perinatal Care

Satisfaction with team midwifery care for low- and high-risk women: A randomized controlled trial

Birth: Issues in Perinatal Care

The role of factor analysis in the development and evaluation of personality scales

Journal of Personality

Satisfaction with care in labor and birth: A survey of 790 Australian women

Birth: Issues in Perinatal Care

The 1993 Survey of Recent Mothers: Issues in survey design, analysis and influencing policy

International Journal of Quality and Health Care

Having a baby in Victoria 1989–2000: Womens views of public and private models of care

Australia and New Zealand Journal of Public Health

Assessment of social psychological determinants of satisfaction with childbirth in a cross-national perspective

BMC Pregnancy & Childbirth

Annual report for the year 2009

The measurement of satisfaction with health care: Implications for practice from a systematic review of the literature

Health Technology Assessment

Changing childbirth: Report of the expert maternity group (Cumberlege report)

The quality of care: How can it be assessed?

Journal of American Medical Association

Research
The Role of Women's Attitudinal Profiles in Satisfaction with the Quality of their Antenatal and Intrapartum Care