Predictors of childbirth experience: Prospective observational study in eastern Spain.

BACKGROUND: In recent years, birth experience has been highlighted by national and international organisations as a relevant value in measuring maternal health care quality. According to a standardised tool, we aimed to assess which clinical indicators had the most significant influence on the birth experience. METHODS: This prospective observational study was carried out in fourteen hospitals in eastern Spain. 749 women consented to the collection of birth variables at discharge, and subsequently, at 1-4 months, data were collected on the birth experience as measured by the Spanish version of the Childbirth Experience Questionnaire. Next, a linear regression analysis was performed to determine which clinical birth indicators greatly influence the birth experience measure. RESULT: The study sample (n = 749) was predominantly Spanish and primipara, with 19.5% vaginal births. The predictors that emerged in the linear regression model were to have a birth companion (B = 0.250, p = 0.028), drink fluids during labour (B = 0.249, p < 0.001), have early skin-to-skin contact (B = 0.213, p < 0.001) and being transferred to a specialised room for the second stage of labour (B = 0.098, p = 0.016). The episiotomy (B = -0.100, p < 0.015) and having an operative birth (B = -0.128, p < 0.008) showed a negative influence. CONCLUSION: Our study supports that intrapartum interventions recommended according to clinical practice guidelines positively influence the mother's birth experience. Episiotomy and operative birth should not be used routinely as they negatively influence the birth experience.

[Breastfeeding in women who conceived using fertility treatments: a systematic review].

Women subjected to fertility treatment present needs requiring medical attention and decision-making processes before and after delivery that might influence their behaviour in maternal breastfeeding. This review examined the effect of fertility treatments on the start, duration and exclusiveness of maternal lactation based on all the observational studies that compared some result of maternal lactation according to the form of conception. Two reviewers extracted the data and evaluated the risk of bias. The effect of fertility treatments on the results of maternal lactation was small or not significant, and on occasions contradictory. The evidence is limited due to the low number of articles of sufficient quality included. For the time being, fertility treatments do not seem to influence the start, duration and exclusiveness of maternal lactation, but until more and better studies are available, individualized support is recommended for each mother-child dyad according to its characteristics.

Lactancia materna en mujeres que concibieron mediante tratamientos de fertilidad: una revisión sistemática / Breastfeeding in women who conceived using fertility treatments: a systematic review

Las mujeres sometidas a tratamientos de fertilidad (TF) presentan necesidades de atención médica y procesos de toma de decisiones antes y después del parto que pueden influir sobre los comportamientos de lactancia materna (LM). Esta revisión examinó el efecto de los TF (invasivos como inyección intracitoplasmática y/o fecundación in vitro, y menos invasivos como medicación y/o inseminación intrauterina) sobre el inicio, duración y exclusividad de la LM a partir de los estudios observacionales que compararon algún resultado de LM en función del modo de concepción (TF versus concepción espontánea). El efecto de los TF sobre el inicio, duración y exclusividad de la LM fue pequeño o no significativo y en ocasiones contradictorio. La evidencia es limitada debido al bajo número de artículos incluidos con calidad suficiente. Por ello se recomienda, hasta que se tengan más y mejores estudios al respecto, un apoyo individualizado a cada diada madre-hijo según sus características

Women subjected to fertility treatment present needs requiring medical attention and decision-making processes before and after delivery that might influence their behaviour in maternal breastfeeding. This review examined the effect of fertility treatments on the start, duration and exclusiveness of maternal lactation based on all the observational studies that compared some result of maternal lactation according to the form of conception. Two reviewers extracted the data and evaluated the risk of bias. The effect of fertility treatments on the results of maternal lactation was small or not significant, and on occasions contradictory. The evidence is limited due to the low number of articles of sufficient quality included. For the time being, fertility treatments do not seem to influence the start, duration and exclusiveness of maternal lactation, but until more and better studies are available, individualized support is recommended for each mother-child dyad according to its characteristics

The Spanish version of the Childbirth Experience Questionnaire (CEQ-E): reliability and validity assessment.

BACKGROUND: The Childbirth Experience Questionnaire (CEQ) was originally designed to study women's perceptions of labour and birth. The main objective of our study was to adapt the CEQ to the Spanish context and determine its psychometric properties. This would provide an opportunity to evaluate women's experiences in order to improve evidence in the Spanish context as recommended by national guidelines. METHODS: The CEQ was translated into Spanish using a standard forward and back translation method (CEQ-E). A convenience sample of 364 women was recruited from 3 Spanish hospitals; all participants were able to read and write in Spanish. Mothers with high risk pregnancies or preterm deliveries were excluded from the study. A self-administered questionnaire on sociodemographic variables was completed by participants before discharge. Data on childbirth variables were obtained from maternity records. Between 1 and 3 months postpartum a postal CEQ-E questionnaire was sent. The CEQ-E structure was examined by a confirmatory factor analysis of polychoric correlations using a diagonally weighted least squares estimator. Reliability was assessed using Cronbach's alpha. Construct validity was conducted by testing differences in CEQ-E scores between known-groups (to differ on key variables). RESULTS: 226 (62.1%) of the recruited participants completed the postal questionnaire. The CEQ-E factor structure was similar to the original one. The Spanish version showed fit statistics in line with standard recommendations: CFI = 0.97; NNFI = 0.97; RMSEA = 0.066; SRMS = 0.077. The internal consistency reliability of the CEQ-E was good for the overall scale (0.88) and for all subscales (0.80, 0.90, 0.76, 0.68 for "own capacity", "professional support", "perceived safety" and "participation", respectively) and similar to the original version. Women with a labour duration ≤ 12 h, women with a labour not induced, women with a normal birth and multiparous women showed higher overall CEQ-E scores and "perceived safety" subscale scores. Women with a labour duration ≤ 12 h and those with previous experience of labour obtained higher scores for the "own capacity" and "participation" subscales. CONCLUSIONS: The results of this study indicate that the CEQ-E can be considered a valid and reliable measure of women's perceptions of labour and birth in Spain.

[Spanish reference values for the Breastfeeding Self-Efficacy Scale-Short Form BSES-SF]. / Valores de referencia españoles para la versión reducida de la Escala de Autoeficacia para la Lactancia Materna BSES-SF.

BACKGROUND: To describe the reference values for the Spanish version of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), considering the differences according to parity and previous breastfeeding experience. METHODS: Cross-sectional study in five hospitals in Valencia and one in Murcia, Spain, in a convenience sample of 949 in-hospital breastfeeding women, with no medical problems in the mothers or newborns hindering breastfeeding. Data on sociodemographic and obstetric variables, and on breastfeeding self-efficacy, were collected using the BSES-SF. Central tendency, dispersion and percentile data were calculated to generate reference values for the entire sample, and by parity and previous experience. RESULTS: The level of self-efficacy was significantly lower (p <0.001) among primiparous women (mean =47.67±11.03) or those without previous experience (mean =47.30±11.18) than among multiparas (mean =52.87±10.66) or women with previous experience (mean =53.93±9.93). The P25 and P75 percentiles for the BSES-SF were, respectively, 42 and 59 for the entire sample; 39 and 56 for women without children or without previous experience; 46 and 61 for mothers with children; and 47 and 62 for mothers with previous experience. CONCLUSIONS: The specific percentiles obtained by parity or previous experience should be considered the reference values for comparing the level of self-efficacy of a given case, and for evaluating and planning educational postpartum support interventions.

Valores de referencia españoles para la versión reducida de la Escala de Autoeficacia para la Lactancia Materna BSES-SF / Spanish reference values for the Breastfeeding Self-Efficacy Scale-Short Form BSES-SF

Fundamento: Describir los valores de referencia para la versión española de la Escala de Autoeficacia para la Lactancia Materna en su versión reducida (BSES-SF), considerando las diferencias según la experiencia previa en lactancia y la paridad. Metodología: Estudio transversal realizado en cinco hospitales de Alicante y uno de la Región de Murcia, con una muestra accidental de 949 mujeres que ofrecieron lactancia materna en el posparto, sin problemas médicos, propios o del recién nacido, que dificultaran la lactancia. Se obtuvieron datos sociodemográficos, obstétricos y sobre autoeficacia materna para la lactancia mediante la escala BSES-SF. Se calcularon datos de tendencia central, dispersión y percentiles de las puntuaciones de la escala BSES-SF para generar valores de referencia para toda la muestra y según la paridad y experiencia previa. Resultados: El nivel de autoeficacia fue significativamente menor (p<0,001) entre las mujeres primíparas (media=47,67±11,03) o sin experiencia previa (media =47,30±11,18) que entre las multíparas (media =52,87±10,66) o con experiencia anterior (media =53,93±9,93). La puntuación de los percentiles P25 y P75 de la escala BSES-SF fue, respectivamente, para toda la muestra de 42 y 59; para las mujeres sin hijos o sin experiencia previos de 39 y 56; para madres con hijos de 46 y 61; y para las madres con experiencia previa de 47 y 62. Conclusión. Los percentiles específicos obtenidos, según la paridad o la experiencia previa, pueden considerarse como valores de referencia para comparar el nivel de autoeficacia de un caso dado, evaluar intervenciones educativas y planificar intervenciones de apoyo durante el posparto (AU)

Background: To describe the reference values for the Spanish version of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), considering the differences according to parity and previous breastfeeding experience. Methods: Cross-sectional study in five hospitals in Alicante and one in Murcia, Spain, in a convenience sample of 949 in-hospital breastfeeding women, with no medical problems in the mothers or newborns hindering breastfeeding. Data on sociodemographic and obstetric variables, and on breastfeeding self-efficacy, using the BSES-SF, were collected. Central tendency, dispersion and percentile data were calculated to generate reference values for the entire sample, and by parity and previous experience. Results: The level of self-efficacy was significantly lower (p<0.001) among primiparous women (mean =47.67±11.03) or those without previous experience (mean =47.30±11.18) than among multiparas (mean =52.87±10.66) or women with previous experience (mean =53.93±9.93). The P25 and P75 percentiles for the BSES-SF were, respectively, 42 and 59 for the entire sample; 39 and 56 for women without children or without previous experience; 46 and 61 for mothers with children; and 47 and 62 for mothers with previous experience. Conclusions: The specific percentiles obtained by parity or previous experience should be considered the reference values for comparing the level of self-efficacy of a given case, and for evaluating educational interventions and planning postpartum support interventions (AU)

Lactancia materna en la Región de Murcia. ¿Seguimos con el problema? / Maternal breastfeeding in the Region of Murcia, does the

Objetivo: Conocer la prevalencia y la duración de la lactancia materna (LM) en la Región de Murcia. Método: Estudio transversal (junio de 2007), mediante encuestas a madres de niños menores de 24 meses realizadas en centros de vacunación. El ámbito de estudio estuvo comprendido por 77 zonas de salud de 6 áreas sanitarias de la región, y el muestreo fue proporcional al número de niños nacidos en el área. Se recogieron datos sociosanitarios del niño, de la madre y de la alimentación del niño. Se calculó la prevalencia de LM según las categorías definidas por la Organización Mundial de Salud (OMS) y se estudiaron los motivos de no iniciar y de abandonar la LM. Resultados: Se obtuvieron datos de 1.836 niños, con una tasa de respuesta del 95,2%. Al alta del hospital, un total de 1.643 niños (89,7%) fueron alimentados con LM; de éstos, el 76,7% (n= 1.405) lo hicieron sin suplementos nutritivos. Al tercer mes mantenían la LM completa el 44,4% y al sexto mes el 36,3%. La mediana de duración de LM exclusiva fue de 75 días y para la LM parcial de 129 días. Los motivos de no alimentar con LM fueron: enfermedad/ingreso (46,7%), falta de leche (28,6%) y decisión de la madre (19,3%). Entre las causas de abandono, cabe citar las siguientes: hipogalactia e insaciabilidad (29,3%) y escasa ganancia de peso (11%). Las variables que mostraron una asociación estadísticamente significativa (p <0,05) con la LM fueron el peso del niño, el tipo de parto y el área sanitaria, y, en relación con la madre, la edad, la paridad, la actividad laboral, el lugar de procedencia y el nivel de estudios. Conclusiones: Las cifras de LM en la Región de Murcia son similares a las de nuestro entorno, pero se alejan de las recomendadas por la OMS (AU)

Title: Maternal breastfeeding in the Region of Murcia, does the problem persist? Objective: To study the prevalence and duration of maternal breastfeeding (MB) in the Region of Murcia. Methods: Cross-sectional study (June, 2007). Mothers of infants under 24 months old were surveyed in immunization centers. The study was conducted through the 77 health zones of the 6 health areas of the Region. The sample size was proportion alto the number of newborns in these areas. Breast-fed baby, mother and child feeding social and health data were collected. The MB prevalence was calculated in accordance with the categories defined by the World Health Organization (WHO) and the reasons for not starting and for stopping MB were studied. Results: Data from 1,836 infants (response rate of 95.2%) has been obtained. Upon hospital discharge, the percentage of children fed with MB was of 89.7% (1,643), 76.7% (1,405) of which were breastfed without nourishing supplements. 44.4%of infants exclusively MB at 3 months and 36.3% at 6 months. The median duration of exclusive MB was of 75 days and of129 days for partial MB. The reasons for not being fed by MB were: disease/admission (46.7%), lack of milk (28.6%), and mother’s decision (19.3%). The reasons for discontinuing breastfeeding were: hypogalactia and insatiable appetite (29.3%), and not to put on weight (11%). The variables that showed statistically significant association (p < 0.05) regarding MB were child weight, type of childbirth, and health area, and, regarding the mother, age, parity, occupation, place of origin, and education. Conclusions: The MB figures in the Region of Murcia are similar to those in our environment, but are far from those recommended by the WHO (AU)

Momentos críticos de abandono de la lactancia materna en un seguimiento de 6 meses / Critical moments for weaning in a 6-month follow-up study

Objetivo. Identificar los momentos críticos de la lactancia materna (LM) completa (LMC) y de abandono total de la LM a lo largo de un seguimiento de 6 meses. Método. Estudio descriptivo longitudinal, seguimiento de 6 meses de una muestra accidental de 270 madres con lactantes amamantados sanos. Análisis de supervivencia, cálculo de la densidad de incidencia (DI) de abandono de la LMC y LM por quincenas. Resultados. Pérdida de muestra 10% (4 meses) y 17% (6 meses). Mediana LMC de 120 días (intervalo de confianza [IC] del 95%, 111,17-128,83) y LM de 171 días (IC del 95%, 151,40 a > 180). La mediana de duración de la LM parcial (LMP) fue de 30 días (IC del 95%, 19,49-40,51). Picos de DI de LMC en la primera y segunda semanas y a partir de la semana 17. Los aumentos de DI de LM coinciden con los picos de la LMC e incluyen también las semanas posteriores. Conclusiones. El alta hospitalaria y el final de la prestación por maternidad son los momentos de mayor DI de abandono para la muestra estudiada. El abandono de la LMC y el de la LM están relacionados. Estos resultados sugieren la necesidad de aumentar el apoyo tras el alta, especialmente a las madres que ofrecen LMP y al reiniciar el trabajo

Objective. To identify critical moments for discontinuing full breast feeding (FBF) and any breast feeding (BF) in the first 6 months. Method. We performed an observational, 6-month follow-up study of an accidental sample of 270 mothers with healthy breastfed infants. Survival analyses and the incidence rates (IR) of discontinuance of FBF and ABF every fortnight were obtained. Results. Loss to follow-up: 10% at 4 months and 17% at 6 months. The median length of FBF was 120 days (95%CI = 111.17-128.83) and the median length of BF was 171 days (95% CI =151.40-190.60). The median duration of partial breast feeding (PBF) was 30 days (95% CI=19.49-40.51). IR peaks of BF were found in the first and second weeks and after week 17. Increases of the IR of BF coincided with IR peaks of FBF and also included subsequent weeks. Conclusions. The highest IR for discontinuance of BF were found at hospital discharge and return to work. PBF was related to weaning. These results suggest the need to increase support after discharge, especially to mothers PBF and those returning to work