Key dimensions of women's and their partners' experiences of childbirth: A systematic review of reviews of qualitative studies.

BACKGROUND: The World Health Organization 2018 intrapartum guideline for a positive birth experience emphasized the importance of maternal emotional and psychological well-being during pregnancy and the need for safe childbirth. Today, in many countries birth is safe, yet many women report negative and traumatic birth experiences, with adverse effects on their and their families' well-being. Many reviews have attempted to understand the complexity of women's and their partners' birth experience; however, it remains unclear what the key dimensions of the birth experience are. OBJECTIVE: To synthesize the information from reviews of qualitative studies on the experience of childbirth in order to identify key dimensions of women's and their partners' childbirth experience. METHODS: Systematic database searches yielded 40 reviews, focusing either on general samples or on specific modes of birth or populations, altogether covering primary studies from over 35,000 women (and >1000 partners) in 81 countries. We appraised the reviews' quality, extracted data and analysed it using thematic analysis. FINDINGS: Four key dimensions of women's and partners' birth experience (covering ten subthemes), were identified: 1) Perceptions, including attitudes and beliefs; 2) Physical aspects, including birth environment and pain; 3) Emotional challenges; and 4) Relationships, with birth companions and interactions with healthcare professionals. In contrast with the comprehensive picture that arises from our synthesis, most reviews attended to only one or two of these dimensions. CONCLUSIONS: The identified key dimensions bring to light the complexity and multidimensionality of the birth experience. Within each dimension, pathways leading towards negative and traumatic birth experiences as well as pathways leading to positive experiences become tangible. Identifying key dimensions of the birth experience may help inform education and research in the field of birth experiences and gives guidance to practitioners and policy makers on how to promote positive birth experiences for women and their partners.

Measuring disrespect and abuse during childbirth in a high-resource country: Development and validation of a German self-report tool.

INTRODUCTION: Increasing evidence on disrespect and abuse during childbirth has led to growing concern about the quality of care childbearing women are experiencing. To provide quantitative evidence of disrespect and abuse during childbirth services in Germany a validated measurement tool is needed. RESEARCH AIM: The aim of this research project was the development and psychometric validation of a survey tool in the German language that measures disrespect and abuse of women during childbirth. METHODS: A survey tool was created including the following measures: German adaptations of the short and long form of the "Mothers on Respect" (MOR) index (MOR-7 and MOR-G); the "Mothers' Autonomy in Decision Making" (MADM) scale; a mistreatment-index (MIST-I) comprising indicators of mistreatment during childbirth; and a set of items that measure experiences of discrimination during maternity care. Internal consistency reliability and construct validity of the scales were assessed using Cronbach's alpha, unweighted least squares factor analysis and non-parametric correlation analysis with a scale that measures a related construct, the Posttraumatic Symptom Scale - Self Report (PSS-SR) scale. We distributed the survey online, recruiting through snowball sampling via social media. A selection bias towards women who had experienced disrespect and abuse during their birth was intended and expedient for tool validation. The final sample of participants (n = 2045) had given birth in Germany between 2009 and 2018. FINDINGS: More than 77% of the study participants reported at least one form of mistreatment with non-consented care being the most commonly reported type of mistreatment, followed by physical violence, violation of physical privacy, verbal abuse and neglect. All included scales showed good psychometric properties with high Cronbach's alphas (0.95 for both MOR versions and 0.96 for MADM). Factor analysis generated one factor scales with high factor loadings (0.75 to 0.92 for MOR-7; 0.37 to 0.90 for MOR-G and 0.83 to 0.92 for MADM). MOR-7, MOR-G, MADM and MIST-I scores were significantly (p<0.001) correlated with PSS-SR scores (Spearman's rho -0.70, -0.61 and 0.68 for MOR-G, MADM and the MIST-I, respectively). CONCLUSIONS: This study presents a valid and reliable instrument for the quantitative assessment of disrespect and abuse during childbirth in Germany. Childbearing women's experiences of disrespect and abuse are a relevant phenomenon in German hospital based maternity care. Disrespect and abuse during childbirth appear to contribute to post-traumatic symptoms and may be associated with severe mental health problems postpartum.

A comparison of cognitive function in patients under maintenance treatment with heroin, methadone, or buprenorphine and healthy controls: an open pilot study.

INTRODUCTION: Cognitive impairment has been reported in drug-dependent patients under opioid maintenance treatment. OBJECTIVES: To compare cognitive functioning in healthy controls and in opioid-dependent patients treated with Buprenorphine, Heroin, or methadone maintenance. METHODS: We used the standardized test battery ART-90 to study cognitive function in patients under long-term heroin treatment (n = 20), Bup (n = 22), or Met (n = 24) maintenance treatment and healthy controls (n = 25). RESULTS: Patients receiving heroin performed significantly worse than healthy controls in most domains. Heroin patients performed worse than patients in the other two treatment groups in subtests measuring psychomotor performance under stress conditions and monotony. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Although a number of limitations must be taken into account, this study provides some preliminary evidence that cognitive function may be more impaired in patients under heroin maintenance treatment than in patients receiving Bup or Met and in healthy controls.

Cognitive functioning during methadone and buprenorphine treatment: results of a randomized clinical trial.

Cognitive impairment in drug-dependent patients receiving methadone (MMP) maintenance treatment has been reported previously. We assessed cognitive functioning after at least 14 days of stable substitution treatment with buprenorphine (BUP) or MMP and after 8 to 10 weeks. We performed a randomized, nonblinded clinical trial in 59 drug-dependent patients receiving either BUP or MMP maintenance treatment and healthy normal controls (n = 24) matched for sex, age, and educational level. Thirteen patients dropped out of the study before the second testing was performed (BUP, n = 22; MMP, n = 24). A neuropsychological test battery was used to measure selective attention, verbal memory, motor/cognitive speed, and cognitive flexibility. In addition, subjective perceived stress was assessed with a questionnaire. Patients in both treatment groups performed equally well in all of the cognitive domains tested. Both BUP and MMP patients showed significantly improved concentration and executive functions after 8 to 10 weeks of stable substitution treatment. The control group achieved better results than the BUP and MMP groups in most cognitive domains, indicating cognitive impairment in the patients. Perceived stress did not show any significant change after 8 to 10 weeks of treatment, and no major differences were detected between the 3 groups. No effects of perceived stress on cognitive function were found. Our results indicate a cognitive impairment in patients receiving maintenance treatment with BUP or MMP compared with healthy controls. Selective attention improved in both patient groups during treatment. We propose that the improvement of attention may facilitate rehabilitation of drug-dependent patients.

Less impairment on one portion of a driving-relevant psychomotor battery in buprenorphine-maintained than in methadone-maintained patients: results of a randomized clinical trial.

BACKGROUND: Cognitive impairment in drug-dependent patients under methadone maintenance treatment has been reported before. We assessed whether patients under buprenorphine, a partial mu-opioid agonist, perform better in cognitive tests measuring psychomotor performance as described in previous nonrandomized studies. METHODS: We performed a randomized clinical trial in 62 drug-dependent patients under either buprenorphine or methadone treatment. Sixteen patients dropped out of maintenance therapy, before the testing was performed, after 8 to 10 weeks of treatment. Several subtests of the Act & React Test System test battery were used measuring visual perception, selective attention, vigilance, reactivity, and stress tolerance. FINDINGS: Although there were no differences in cognitive function at baseline, patients under buprenorphine treatment showed partially better results in some of the domains tested. The used tests are relevant when assessing driving ability. There was a significant correlation between dose of buprenorphine and some test results. We also found a correlation between age and reaction time and between duration of opioid dependence and results in some subtests. INTERPRETATIONS (CONCLUSIONS): When comparing both treatments in drug dependent patients, buprenorphine produces partially less impairment on cognitive functions in some of the subtests of the psychomotor battery than methadone. This difference is specially relevant when it comes to driving ability and social functioning.