Educational attainment, perception of workplace support and its influence on timing of childbearing for Canadian women: a cross-sectional study.

Under Canada's Employment Insurance system, parents are entitled to receive up to 50 weeks of parental leave at 55 % of salary. Despite this national policy, women with higher education are more likely to delay childbearing. This analysis aimed to assess the association between workplace support, educational attainment and the timing of first births. Women who had recently given birth to their first live-born infant and lived in Alberta, Canada, were randomly selected to participate in a telephone survey. Logistic regression was used to assess the relationship between workplace support, educational attainment and timing of first pregnancy. Among 835 women with a planned pregnancy, 26 % agreed that support or lack of support for pregnant women at their workplace affected their decision about when to begin their family. After controlling for age and income, women who had completed a post-graduate degree were three times (OR 3.39, 95 % CI 1.69-6.81) more likely to indicate that support or lack of support for pregnant women in their workplace affected their childbearing decisions. In spite of national policies, and the potential risks associated with delayed childbearing, workplace support impacts timing of pregnancy, particularly for highly educated women.

Comparing CenteringPregnancy® to standard prenatal care plus prenatal education.

BACKGROUND: There is significant evidence to support the importance of prenatal care in preventing adverse outcomes such as preterm birth and low infant birth weight. Previous studies have indicated that the benefits of prenatal care are not evenly distributed throughout the social strata. In addition, emerging evidence suggests that among particular populations, rates of preterm birth are unchanged or increasing. This suggests that an alternate care model is necessary, one that seeks to addresses some of the myriad of social factors that also contribute to adverse birth outcomes. In previous studies, the group prenatal care model CenteringPregnancy® had been shown to reduce adverse birth outcomes, but to date, no comparison had been made with a model that included prenatal education. This study sought to investigate whether any significant difference remained within the comparison groups when both models accounted for social factors. METHODS: This analysis was based on survey data collected from a prospective cohort of pregnant women through the All Our Babies Study in Calgary, Alberta. RESULTS: At baseline, there were significant differences between the comparison groups in their psychosocial health, with the women in the CenteringPregnancy® group scoring higher levels of depressive symptoms, stress and anxiety. At four months postpartum, the differences between the groups were no longer significant. CONCLUSIONS: These results suggest that CenteringPregnancy® can recruit and retain a demographically vulnerable group of women with a constellation of risk factors for poor pregnancy and birth outcomes, including poverty, language barriers and poor mental health. Post program, the rates of stress, anxiety and depression were similar to other women with more social and financial advantage. These findings suggest that CenteringPregnancy® may be a community based care strategy that contributes to improved mental health, knowledge, and behaviours to optimize outcomes for mothers and children.

A qualitative study of the experience of CenteringPregnancy group prenatal care for physicians.

BACKGROUND: This study sought to understand the central meaning of the experience of group prenatal care for physicians who were involved in providing CenteringPregnancy through a maternity clinic in Calgary, Canada. METHOD: The study followed the phenomenological qualitative tradition. Three physicians involved in group prenatal care participated in a one-on-one interview between November and December 2009. Two physicians participated in verification sessions. Interviews followed an open ended general guide and were audio recorded and transcribed. The purpose of the analysis was to identify meaning themes and the core meaning experienced by the physicians. RESULTS: Six themes emerged: (1) having a greater exchange of information, (2) getting to knowing, (3) seeing women get to know and support each other, (4) sharing ownership of care, (5) having more time, and (6) experiencing enjoyment and satisfaction in providing care. These themes contributed to the core meaning for physicians of "providing richer care." CONCLUSIONS: Physicians perceived providing better care and a better professional experience through CenteringPregnancy compared to their experience of individual prenatal care. Thus, CenteringPregnancy could improve work place satisfaction, increase retention of providers in maternity care, and improve health care for women.

Development of a prenatal psychosocial screening tool for post-partum depression and anxiety.

BACKGROUND: Post-partum depression (PPD) is the most common complication of pregnancy in developed countries, affecting 10-15% of new mothers. There has been a shift in thinking less in terms of PPD per se to a broader consideration of poor mental health, including anxiety after giving birth. Some risk factors for poor mental health in the post-partum period can be identified prenatally; however prenatal screening tools developed to date have had poor sensitivity and specificity. The objective of this study was to develop a screening tool that identifies women at risk of distress, operationalized by elevated symptoms of depression and anxiety in the post-partum period using information collected in the prenatal period. METHODS: Using data from the All Our Babies Study, a prospective cohort study of pregnant women living in Calgary, Alberta (N = 1578), we developed an integer score-based prediction rule for the prevalence of PPD, as defined as scoring 10 or higher on the Edinburgh Postnatal Depression Scale (EPDS) at 4-months postpartum. RESULTS: The best fit model included known risk factors for PPD: depression and stress in late pregnancy, history of abuse, and poor relationship quality with partner. Comparison of the screening tool with the EPDS in late pregnancy showed that our tool had significantly better performance for sensitivity. Further validation of our tool was seen in its utility for identifying elevated symptoms of postpartum anxiety. CONCLUSION: This research heeds the call for further development and validation work using psychosocial factors identified prenatally for identifying poor mental health in the post-partum period.

Getting more than they realized they needed: a qualitative study of women's experience of group prenatal care.

BACKGROUND: Pregnant women in Canada have traditionally received prenatal care individually from their physicians, with some women attending prenatal education classes. Group prenatal care is a departure from these practices providing a forum for women to experience medical care and child birth education simultaneously and in a group setting. Although other qualitative studies have described the experience of group prenatal care, this is the first which sought to understand the central meaning or core of the experience. The purpose of this study was to understand the central meaning of the experience of group prenatal care for women who participated in CenteringPregnancy through a maternity clinic in Calgary, Canada. METHODS: The study used a phenomenological approach. Twelve women participated postpartum in a one-on-one interview and/or a group validation session between June 2009 and July 2010. RESULTS: Six themes emerged: (1) "getting more in one place at one time"; (2) "feeling supported"; (3) "learning and gaining meaningful information"; (4) "not feeling alone in the experience"; (5) "connecting"; and (6) "actively participating and taking on ownership of care". These themes contributed to the core phenomenon of women "getting more than they realized they needed". The active sharing among those in the group allowed women to have both their known and subconscious needs met. CONCLUSIONS: Women's experience of group prenatal care reflected strong elements of social support in that women had different types of needs met and felt supported. The findings also broadened the understanding of some aspects of social support beyond current theories. In a contemporary North American society, the results of this study indicate that women gain from group prenatal care in terms of empowerment, efficiency, social support and education in ways not routinely available through individual care. This model of care could play a key role in addressing women's needs and improving health outcomes.

Do factors that influence pregnancy planning differ by maternal age? A population-based survey.

OBJECTIVE: The objectives of this analysis were to describe factors that influenced the decision to conceive among first-time mothers in two Canadian urban centres and to determine if these differed according to the age at which a woman became a mother. METHODS: Women who had given birth to their first live born infant between July 2002 and September 2003 in Calgary and Edmonton were randomly selected from regional notice of birth databases. Women were contacted by telephone, and those who agreed to participate completed a 20-minute survey over the telephone. This analysis was conducted using data from participants with a planned pregnancy. RESULTS: The top three factors that influenced childbearing among women planning a pregnancy were similar regardless of age. They were being in a secure relationship (97%), feeling in control of one's life (82%), and feeling prepared to parent (77%). Less than 30% of women reported career goals as being "very important" in their decision. Women under 25 years of age were less likely than women 25 years or older to indicate the following as being "very important" in the timing of starting a family: being in a stable job (32%), owning a home (36%), financial security (42%), educational training (36%), and career goals (9%) (all P < 0.001). CONCLUSION: This information provides a basis for developing strategies to support couples in their efforts to balance the age-related biomedical risks of delaying childbearing with a desire for relationship security and other factors that strongly influence childbearing decisions.

Invested in Success: A Qualitative Study of the Experience of CenteringPregnancy Group Prenatal Care for Perinatal Educators.

The objective of this study was to understand the central meaning of the experience of providing CenteringPregnancy for perinatal educators who were facilitators for the group sessions. Four perinatal educators participated in one-on-one interviews and/or a validation focus group. Six themes emerged: (a) "stepping back and taking on a different role," (b) "supporting transformation," (c) "getting to knowing," (d) "working together to bridge the gap," (e) "creating the environment," and (f) "fostering community." These themes contributed to the core phenomenon of being "invested in success." Through bridging gaps and inconsistencies in information received from educators and physicians, this model of CenteringPregnancy provides an opportunity for women to act on relevant information more fully than more traditional didactic approaches to perinatal education.