Ansiedad y depresión en el embarazo. Variables asociadas durante el periodo de pandemia COVID-19 / Anxiety and depression in pregnancy. Associated variables during the covid-19 pandemic period

Objetivo: Evaluar la asociación entre edad, paridad, nacionalidad, estudios, empleo y apoyo de la pareja con la depresión y ansiedad durante el embarazo. Determinar el impacto de la evolución de la pandemia COVID-19 en los niveles de ansiedad y depresión de las participantes. Método: Estudio descriptivo correlacional transversal realizado en el Osakidetza/Servicio Vasco de Salud, Atención primaria, Bizkaia (España). Participaron 295 gestantes entre ocho y 41 semanas. Se midió la asociación entre edad, paridad, nacionalidad, nivel de estudios, empleo, apoyo de la pareja y tasas de incidencia de COVID-19 durante el periodo del estudio y las puntuaciones de depresión (medido con la Escala de Depresión Posnatal de Edimburgo) y de ansiedad (medido con la subescala de ansiedad estado-rasgo del State-Anxiety Inventory [STAI-S]) durante el embarazo. Se construyó un modelo de regresión logística y se estimaron las odds ratios (OR) y sus intervalos de confianza de 95% (IC 95%). Resultados: La puntuación media en ansiedad fue de 18,75 puntos (DE = 8,69) y en depresión 6,45 puntos (DE = 4,32). Las mujeres que esperaban su segundo hijo o más obtuvieron puntuaciones más altas en depresión (OR 2,51 [IC 95%: 1,26-5,01]) y ansiedad (OR 1,98 [IC 95%: 1,01-3,89]). Haber cursado estudios universitarios se asocia con puntuaciones más bajas en depresión (OR 0,28 [IC 95%: 0,11-0,77]) y ansiedad (OR 0,2 [IC 95%:0,08-0,54]). Una buena calidad en la relación de pareja se asocia con menores niveles de ansiedad (OR 0,45 [IC 95%: 0,24-0,81). La puntuación media en ansiedad y depresión se relacionan con la incidencia de casos COVID-19; la puntuación en ansiedad fue significativamente más alta en los periodos de mayor incidencia. Conclusiones: Mayor atención emocional a las gestantes con bajo nivel de estudios, multíparas y con un débil apoyo de su pareja, permitiría reducir la ansiedad y depresión en el embarazo. Situaciones de emergencia sanitaria afectan a la salud mental durante la ges...(AU)

Objective: To assess the association between age, parity, nationality, educational level, employment and partner support with depression and anxiety during pregnancy. To determine the impact of the evolution of the COVID-19 pandemic on the anxiety and depression levels of the participants. Method: Cross-sectional descriptive correlational study carried out in the Osakidetza/Basque Health Service, Primary Care, Bizkaia (Spain). A total of 295 pregnant women between 8 and 41 weeks participated. The association between age, parity, nationality, educational level, employment, partner support and COVID-19 incidence rates during the study period and depression (measured with the Edinburgh Postnatal Depression Scale) and anxiety (measured with the State-Anxiety Inventory/STAI-S subscale) scores during pregnancy was measured. A logistic regression model was constructed and odds ratios and their 95% confidence intervals were estimated. Results: The mean score was 18.75 points for anxiety (SD 8.69) and 6.45 points for depression (SD 4.32). Women expecting their second or later child had higher scores for depression (OR 2.51 [95%IC: 1.26-5.01]) and anxiety (OR 1.98 [95%IC: 1.01-3.89]). Having completed university studies was associated with lower scores in depression (OR 0.28 [95%IC: 0.11-0.77]) and in anxiety (OR 0,2 [95%IC: 0.08-0.54]). A good relationship with the partner was associated with lower levels of anxiety (OR 0.45 [95%IC: 0.24-0.81]). The mean anxiety and depression scores are related to the incidence of COVID-19 cases; the anxiety score was significantly higher in periods of higher incidence. Conclusions: Greater emotional care for pregnant women with low educational level, multiparous and with weak support from their partner, would reduce anxiety and depression in pregnancy. Health emergency situations affect mental health during gestation.(AU)

Anxiety and depression in pregnancy: associated variables during the COVID-19 pandemic period.

OBJECTIVE: To assess the association between age, parity, nationality, educational level, employment and partner support with depression and anxiety during pregnancy. To determine the impact of the evolution of the COVID-19 pandemic on the anxiety and depression levels of the participants. METHOD: Cross-sectional descriptive correlational study carried out in the Osakidetza/Basque Health Service, Primary Care, Bizkaia (Spain). A total of 295 pregnant women between 8 and 41 weeks participated. The association between age, parity, nationality, educational level, employment, partner support and COVID-19 incidence rates during the study period and depression (measured with the Edinburgh Postnatal Depression Scale) and anxiety (measured with the State-Anxiety Inventory/STAI-S subscale) scores during pregnancy was measured. A logistic regression model was constructed and odds ratios and their 95% confidence intervals were estimated. RESULTS: The mean score was 18.75 points for anxiety (SD=8.69) and 6.45 points for depression (SD=4.32). Women expecting their second or later child had higher scores for depression (OR 2.51[95%IC: 1.26-5.01)) and anxiety (OR 1.98 [95%IC: 1.01-3.89]). Having completed university studies was associated with lower scores in depression (OR 0.28 [95%IC: 0.11-0.77]) and in anxiety (OR 0,2 [95%IC: 0.08-0.54]). A good relationship with the partner was associated with lower levels of anxiety (OR 0.45 [95%IC: 0.24-0.81]). The mean anxiety and depression scores are related to the incidence of COVID-19 cases; the anxiety score was significantly higher in periods of higher incidence. CONCLUSIONS: Greater emotional care for pregnant women with low educational level, multiparous and with weak support from their partner, would reduce anxiety and depression in pregnancy. Health emergency situations affect mental health during gestation.

Does the birth plan match what is relevant to women? Preferences of Spanish women when giving birth.

BACKGROUND: To support women in making shared decisions, it is important to know what is relevant to them. The aim is to explore which of the options included in birth plans (BP) are of most interest to women, and which are more controversial. In addition, the possible association of this variability with personal characteristics. METHODS: The data are part of a cross-sectional descriptive study, carried out in xxx, on the clinimetric characteristics of two instruments to measure women's needs in labour and postpartum. Women were recruited consecutively by their midwives during pregnancy check-ups, receive a link to a digital questionnaire and were allowed to provide links to the questionnaires to other pregnant women. Women were asked to determine their level of agreement with statements about the birth environment, accompaniment, pain relief, medical intervention and neonatal care. The relationship between agreement with each statement, socio-demographic variables and fear of childbirth (W-DEQ-A) was analysed using a combination of descriptive statistics to analyse frequencies, and regression models to test the effect of socio-demographic variables and fear of childbirth on those items with the greatest variability. RESULTS: Two hundred forty-seven women responded. More than 90% preferred a hospital delivery, with information about and control over medical intervention, accompanied by their partner and continuous skin-to-skin contact with the newborn. There are other questions to which women attach less importance or which show greater variability, related to more clinical aspects, like foetal monitoring, placenta delivery, or cord clamping… Various factors are related to this variability; parity, nationality, educational level, risk factor or fear of childbirth are the most important. CONCLUSIONS: Some items referring to the need for information and participation are practically unanimous among women, while other items on technical interventions generate greater variability. That should make us think about which ones require a decision after information and which ones should be included directly. The choice of more interventional deliveries is strongly associated with fear of childbirth.

Development and evaluation of the psychometric properties of a digital questionnaire for the evaluation of perinatal psychosocial needs.

BACKGROUND: If the purpose of maternal education is for women to take control of their own health and that of their family in the process, it is essential to have a simple instrument that allows them to self-assess, globally, how prepared they are to face future childbirth and maternity. As there is nothing similar in our area, the objective of this study was to design a complete, specific measurement questionnaire, with good metric quality and in digital format, for the assessment of perinatal psychosocial needs. METHODS: A cross-sectional study was carried out, to evaluate the psychometric properties of a digital measurement questionnaire. The questionnaire was developed in 4 steps following the recommendations of the International Test Commission. The participants were 263 pregnant women who were recruited in primary health care appointments in the Basque Healthcare Service (Osakidetza); they completed the newly created questionnaire and all the test selected as gold standard. Their mean age was 33.55 (SD = 4.73). The analysis of the psychometric characteristics was based on mixed expert judgment procedures (focus group of healthcare professionals, item assessment questionnaire and interviews with users) and quantitative procedures (EFA, CFA, association with the gold standard and classification agreement index, ordinal alpha and McDonald's omega). RESULTS: The final version of the questionnaire was made up of 55 items that evaluate 8 aspects related to perinatal psychosocial well-being (anxious-depressive symptoms, pregnancy acceptance, partner support, coping, internal locus of control, childbirth self-efficacy, perception of childbirth as a medicalized event, and fear of childbirth). Various tests were made of the validity and reliability of the scores, providing metric guarantees for their use in our context. CONCLUSIONS: The use of this complete, quick-to-use tool with good psychometric properties will allow pregnant women to take stock of their situation, assess whether they have the necessary resources in the psychological and social sphere, and work together with midwives and other health professionals in the areas that are lacking.

Development and evaluation of the psychometric properties of a digital questionnaire for the self-management of health and well-being in the postpartum period.

BACKGROUND: Despite the fact that the Global Strategy for Women's, Children's and Adolescents' Health (2016-2030) recognises the special importance of care for women during the postpartum period, thus highlighting the need to identify and measure any condition that may affect the welfare of pregnant women in any way, this is one of the most neglected stages in the health system. Given the absence in our area of global, efficient instruments, the objective of this study was to design a complete, specific measurement tool with good metric qualities in digital format for the evaluation of self-reported health and well-being during the puerperium, to conform to what was proposed by the ICHOM. METHODS: A cross-sectional study was carried out to evaluate the psychometric characteristics of a digital measurement tool. The development of the tool was carried out in 4 steps, following the recommendations of the International Test Commission. It was tested on 280 puerperas attending primary healthcare appointments in the Basque Healthcare System (Osakidetza), and they did the newly created survey, answering all the questions that had been selected as the gold standard. The average age of the women was 34.93 (SD = 4.80). The analysis of the psychometric characteristics was based on mixed procedures of expert judgment (a focus group of healthcare professionals, an item evaluation questionnaire and interviews with users) and quantitative evaluations (EFA, CFA, and correlation with gold standard, ordinal alpha and McDonald's omega). RESULTS: The final version of the tool comprised 99 items that evaluate functional state, incontinence, sexuality, breastfeeding, adaptation to the role of mother and mental health, and all of these questions can be used globally or partially. It was found that the scores were valid and reliable, which gives metric guarantees for using the tool in our area. CONCLUSIONS: The use of this comprehensive concise tool with good psychometric properties will allow women to take stock of their situation, assess if they have the necessary resources, in psychological and social terms, and work together with midwives and other healthcare professionals on the most deficient areas.

Coping strategies during pregnancy and their relationship with anxiety and depression.

How individuals perceive and cope with stressful situations may determine their level of anxiety or depression. The identification of coping strategies (CS) in pregnancy could help prevent depression and anxiety (D&A), and their consequent effects on the health of the mother and the baby. A cross-sectional descriptive correlational study was conducted to identify the CS most commonly used by pregnant women in a Spanish population and to evaluate the association of these CS with D&A. A consecutive sample of 282 pregnant women over 18 years of age were recruited when attended midwife consultations and through snowball sampling between December 2019 and January 2021 in the Basque public health system. CS were measured using the RevisedPrenatal Coping Inventory (NuPCI) questionnaire, assigning the score to an avoidant, preparatory or spiritual scale. Cutoff points were established to categorize anxiety and depressive symptomatology, using the STAI-S and EPDS scales. Multivariate logistic regression models were constructed to analyze the association between CS and D&A. The results show that the higher the score on the avoidance subscale, the higher the likelihood of having an anxiety disorder (OR: 8.88  (95 percent Confidence Interval [CI] 4.26-20.1), and depressive symptoms (OR: 8.29 (95 percent CI 4.24-17.4). Multiparous women are more likely to have anxiety (OR: 3.41  (95 percent CI 1.58-7.5) or depressive symptomatology (OR: 4.1 (95 percent CI 2.04-8.53) during pregnancy. These results highlight the need to consider the evaluation of CS used during pregnancy to tailor the care provided, but further studies on the implementation and effectiveness of interventions are needed.

EMAeHealth, a digital tool for the self-management of women's health needs during pregnancy, childbirth and the puerperium: protocol for a hybrid effectiveness-implementation study.

INTRODUCTION: EHealth can help health service users take a more active role in decision-making and help health professionals guide the patient in this process. A digital tool has been designed to support maternal education (ME), and it is organised into four areas: (1) information, (2) communication, (3) health self-management and (4) clinical data. The main objective of the study is to evaluate the effectiveness of the EMAeHealth digital tool, and assess its usability and acceptability under routine conditions. METHODS AND ANALYSIS: Hybrid implementation-effectiveness design: (1) A cluster randomised, prospective, longitudinal, multicentre clinical trial to evaluate the effectiveness of EMAeHealth in (A) improving health-related quality of life (primary outcome), (B) improving self-efficacy for labour and childbirth and self-efficacy in breast feeding and (C) reducing the number of visits to the obstetric emergency services and health centre in situations of 'non-pathological pregnancy', 'false labour pains' and 'non-pathological puerperium'. The EMAeHealth intervention plus usual care will be compared with receiving only usual care, which includes traditional ME. N=1080 participants, 540 for each study arm. Two measurements will be made throughout the pregnancy and three in the first 16 weeks post partum. (2) A mixed-method study to evaluate the usability and acceptability of the tool, barriers and facilitators for its use, and implementation in our health system: focus groups (women, professionals and agents involved) and a quantitative analysis of implementation indicators. ANALYSIS: It will be carried out by intention to treat, using mixed models taking into account the hierarchical structure of the data and per protocol to evaluate the effectiveness of the express use of the digital tool. ETHICS AND DISSEMINATION: Clinical Research Ethics Committee of Euskadi, Spain, (Ref: PI2020044) approved this study. The results will be actively disseminated through manuscript publications and conference presentations. TRIAL REGISTRATION NUMBER: NCT04937049.

Attitudes toward medicalization in childbirth and their relationship with locus of control and coping in a Spanish population.

The dominant model of childbirth in most Western countries is medicalized childbirth. Women's beliefs about whether childbirth should be a medicalized process to a greater or lesser degree may be related, in addition to contextual factors, to internal factors. The objective of the study is to find out if women's locus of control (LC) and stress coping strategies (CS) are related to having a more favourable or less favourable attitude towards medicalization (ATMC). A cross-sectional study was carried out with the participation of 248 women recruited in primary care centres by their midwives. All the women filled in answers on a mobile phone app with various different measurement instruments: the questionnaire created by Benyamini to evaluate their ATMC; the Spanish version of the Wallston MLC to evaluate their LC; and the Spanish adaptation of the "Revised Prenatal Coping Inventory (NuPCI)" scale for the assessment of their CS. The women presented a favourable attitude towards medicalization, with a mean ATMC score of 3.42. Both the LC and the CS of women during pregnancy are related to this attitude. Specifically, having an internal LC and using preparative CS both lower the probability of presenting a favourable attitude towards medicalization, while the lack of a paid job raises the probability. For each point in internal locus and preparatory coping, the ATMC score decreased by 0.02 and 0.23 points, respectively, while it increased by 0.18 for not having a paid job. The influence of these psychological factors must be taken into account in the development of content and interventions that promote a more natural birth.

Efectividad de la autotoma del exudado vaginorrectal para el cribado prenatal de la infección por Streptococcus agalactiae. Estudio GALL / Effectiveness of the vagino-rectal exudate self-sampling for prenatal screening of Streptococcus agalactiae infection. GALL study

Objetivo: Evaluar la efectividad de la autotoma del exudado vaginorrectal para el cribado prenatal de la infección por EGB e identificar barreras y facilitadores que encuentra la gestante para esta intervención. Diseño: Estudio transversal de pruebas diagnósticas. Participantes y emplazamiento: Participaron 213 gestantes que acudieron a la consulta de la matrona de atención primaria en 6 centros de salud del Servicio Vasco de Salud/Osakidetza en Bizkaia, que cumplían los criterios de inclusión y aceptaban participar en el estudio. Mediciones principales: Se comparó el resultado del cultivo vaginorrectal obtenido por la gestante con el resultado del cultivo vaginorrectal tomado por la matrona en consulta el mismo día, y se recogieron barreras y facilitadores encontrados por las mujeres en la autotoma. Resultados: Se ha observado que la autotoma como prueba para detectar el EGB tiene una sensibilidad del 93,3% (IC 95%, 78,7-98,2), una especificidad del 99,4% (IC 95%, 96,5-99,9), un valor predictivo positivo del 96% (IC 95% 82,8-99,4) y un valor predictivo negativo del 98,8% (IC 95%, 95,6-99,7). El 27,3% de los encuestadas encontraron alguna dificultad en la recogida, solo el 4,8% no se vieron capacitadas, el 84,2% se sintieron cómodas, el 99,5% consideraron la información proporcionada adecuada y completa, al 94,7% no le resultaron complicados los pasos a seguir, y el 96% están satisfechas con el estudio. Conclusiones: La autotoma del exudado vaginorrectal para la detección del EGB ha resultado ser válida y fiable, lo que permitiría ofrecer esta opción a las gestantes en el cribado sistemático de la infección por EGB.(AU)

Objetive: To evaluate the effectiveness of vagino-rectal swab autotomy for prenatal screening for GBS infection and to identify the barriers and facilitators encountered by the pregnant woman for this intervention. Design: Cross-sectional study of diagnostic tests. Participants and site: A total of 213 pregnant women who attended the primary care midwife's office in 6 health centers of the Basque Health Service/Osakidetza in Bizkaia, who met the inclusion criteria and agreed to participate in the study, participated in the study. Main measurements: The result of the vagino-rectal culture obtained by the pregnant woman was compared with the result of the vagino-rectal culture taken by the midwife in consultation on the same day, and the barriers and facilitators encountered by the women in the self-test were collected. Results: Self-testing as a test for GBS was found to have a sensitivity of 93.3% (95% CI 78.7–98.2), a specificity of 99.4% (95% CI 96.5–99.9), a positive predictive value of 96% (95% CI 82.8–99.4) and a negative predictive value of 98.8% (95% CI 95.6–99.7). 27.3% of respondents encountered some difficulty in the collection, only 4.8% did not feel qualified, 84.2% felt comfortable, 99.5% considered the information provided to be adequate and complete, 94.7% did not find the steps to follow complicated, and 96% were satisfied with the study. Conclusions: Self-collection of vagino-rectal exudate for GBS detection has proved to be valid and reliable, which would make it possible to offer this option to pregnant women in the systematic screening for GBS infection.(AU)

[Effectiveness of the vagino-rectal exudate self-sampling for prenatal screening of Streptococcus agalactiae infection. GALL study]. / Efectividad de la autotoma del exudado vaginorrectal para el cribado prenatal de la infección por Streptococcus agalactiae. Estudio GALL.

OBJETIVE: To evaluate the effectiveness of vagino-rectal swab autotomy for prenatal screening for GBS infection and to identify the barriers and facilitators encountered by the pregnant woman for this intervention. DESIGN: Cross-sectional study of diagnostic tests. PARTICIPANTS AND SITE: A total of 213 pregnant women who attended the primary care midwife's office in 6 health centers of the Basque Health Service/Osakidetza in Bizkaia, who met the inclusion criteria and agreed to participate in the study, participated in the study. MAIN MEASUREMENTS: The result of the vagino-rectal culture obtained by the pregnant woman was compared with the result of the vagino-rectal culture taken by the midwife in consultation on the same day, and the barriers and facilitators encountered by the women in the self-test were collected. RESULTS: Self-testing as a test for GBS was found to have a sensitivity of 93.3% (95% CI 78.7-98.2), a specificity of 99.4% (95% CI 96.5-99.9), a positive predictive value of 96% (95% CI 82.8-99.4) and a negative predictive value of 98.8% (95% CI 95.6-99.7). 27.3% of respondents encountered some difficulty in the collection, only 4.8% did not feel qualified, 84.2% felt comfortable, 99.5% considered the information provided to be adequate and complete, 94.7% did not find the steps to follow complicated, and 96% were satisfied with the study. CONCLUSIONS: Self-collection of vagino-rectal exudate for GBS detection has proved to be valid and reliable, which would make it possible to offer this option to pregnant women in the systematic screening for GBS infection.

Design of the Maternal Website EMAeHealth That Supports Decision-Making During Pregnancy and in the Postpartum Period: Collaborative Action Research Study.

BACKGROUND: Despite the benefit maternal education has for women, it needs new tools to increase its effectiveness and scope, in tune with the needs of current users. OBJECTIVE: We attempted to develop a multifunctional personalized eHealth platform aimed at the self-management of health in relation to maternity, which can be considered a flexible and adaptable maternal education tool. METHODS: The International Patient Decision Aid Standards (IPDAS) were applied. A website prototype was developed for implementation in the public health system using a collaborative action research process, in which experts and patients participate, with qualitative research techniques, as well as focus groups, prioritization, and consensus techniques. RESULTS: We have proposed a website that includes (1) systematically updated information related to clinical practice guidelines, (2) interaction between peers and users/professionals, (3) instruments for self-assessment of health needs as a basis for working on counseling, agreement on actions, help in the search for resources, support in decision-making, and monitoring and evaluation of results, and (4) access for women to their clinical data and the option of sharing the data with other health agents. These components, with different access requirements, would be reviewed through iterative cycles depending on the frequency and effectiveness resulting from their use and would be accessible from any digital device. CONCLUSIONS: A website that supports maternal education should contain not only information, but also resources for individual attention and social support. Its usefulness for the health and satisfaction of women should be evaluated in various different environments.

Development of two instruments for assessing maternity health needs: protocol of a clinimetric study.

BACKGROUND: There is an unquestionable need to adapt health care to the needs of each woman, to foster her self-confidence and provide her with the autonomy to manage her own maternity. This involves empowering her to choose and face her model of childbirth and childcare responsibly. The range of self-management health needs tests offered by the scientific community at this stage of life is practically non-existent. In this project, we intend to develop and evaluate the validity, reliability and ease of use of two self-administered analysis instruments for: 1.- Needs of women preparing for childbirth and 2.- Identification of alarm symptoms in the puerperium. METHODS: This is a descriptive study of the clinimetric characteristics and usability of two developed self-applied digital instruments for measuring needs in childbirth and postpartum based on the recommendations made in the consensus-based standards for the selection of health measurement instruments (COSMIN) and by the International Test Commission (ITC). The study consists of two phases: 1 - Evaluation of the clinimetric properties of the two instruments, which were developed and then altered, based on their comprehensibility and global usability estimated from a pilot study and 2 - Pre-implementation study. DISCUSSION: The final product will be two valid, reliable, usable instruments for self-assessment of health needs that are highly acceptable to young couples and the professionals who serve them. They will be a valuable resource for meeting the needs of the population more efficiently and guiding decision-making, and they will contribute to the greater sustainability of the health system.

Consensus on priorities in maternal education: results of Delphi and nominal group technique approaches.

BACKGROUND: Maternal education is wide-ranging and covers many areas from pregnancy to the immediate postpartum period and childrearing. However, for it to be effective, more resources need to be assigned to key topics. The goal of this study was to identify and prioritize the most important issues in maternal education, so that specific objectives could subsequently be set and learning outcomes evaluated. METHODS: We drew up a comprehensive list of topics addressed in existing maternal education programs, based on a systematic review of information obtained from the Internet and the experience of the research team. The topics were presented to a multidisciplinary panel whose members were asked to rate them from 1 to 9, and consensus of opinion was reached using a two-round Delphi survey, with consensus defined beforehand as 80% agreement among panelists in awarding a score of 7, 8 or 9. The most highly-rated topics were then discussed and again prioritized by a multidisciplinary team of healthcare and non-healthcare experts, using a nominal group technique. RESULTS: Initially, 650 topics were identified and grouped into 80 categories which were then prioritized by 54 healthcare and non-healthcare experts using a Delphi survey with a study participation rate of around 20%. 63 topics were considered very important, so criteria were restricted and only the 24 highest-scoring selected (95% of agreement on scores ≥7 or 80% of agreement on scores ≥8). Using the nominal group technique, a group of 12 experts identified the following priorities: initiation and establishment of breastfeeding, development of a birth plan, identification of problems and self-care postpartum, nutrition and a healthy lifestyle, options for pain management in labor and birth and characteristics of a normal newborn/looking after a newborn baby. CONCLUSION: This study, with a Delphi study and the Consensus among Experts: the nominal group technique, has succeeded in identifying priority topics in maternal education. We need to assess women's needs in relation to these topics, design an intervention to respond to these needs and evaluate its effectiveness.

An evaluation of Spanish and English on-line information sources regarding pregnancy, birth and the postnatal period.

OBJECTIVE: the aim of this study is to evaluate the quality of web pages found by women when carrying out an exploratory search concerning pregnancy, childbirth, the postpartum period and breastfeeding. DESIGN/SETTING: a descriptive study of the first 25 web pages that appear in the search engines Google, Yahoo and Bing, in October 2014 in the Basque Country (Spain), when entering eight Spanish words and seven English words related to pregnancy, childbirth, the postpartum period, breastfeeding and newborns. Web pages aimed at healthcare professionals and forums were excluded. The reliability was evaluated using the LIDA questionnaire, and the contents of the web pages with the highest scores were then described. FINDINGS: a total of 126 web pages were found using the key search words. Of these, 14 scored in the top 30% for reliability. The content analysis of these found that the mean score for "references to the source of the information" was 3.4 (SD: 2.17), that for "up-to-date" was 4.30 (SD: 1.97) and the score for "conflict of interest statement" was 5.90 (SD: 2.16). The mean for web pages created by universities and official bodies was 13.64 (SD: 4.47), whereas the mean for those created by private bodies was 11.23 (SD: 4.51) (F (1,124)5.27. p=0.02). The content analysis of these web pages found that the most commonly discussed topic was breastfeeding, followed by self-care during pregnancy and the onset of childbirth. CONCLUSION: in this study, web pages from established healthcare or academic institutions were found to contain the most reliable information. The significant number of web pages found in this study with poor quality information indicates the need for healthcare professionals to guide women when sourcing information online. As the origin of the web page has a direct effect on reliability, the involvement of healthcare professionals in the use, counselling and generation of new technologies as an intervention tool is increasingly essential.

Framework for the establishment of a feasible, tailored and effective perinatal education programme.

BACKGROUND: Antenatal education needs to be renewed and adapted to the needs of women. OBJECTIVES: to assess women needs, identify factors that influence the desired outcomes, and propose a framework for developing new perinatal education based on the guidance published by the UK Medical Research Council for the development and evaluation of complex interventions in primary care. METHODS: For this study: (a) four focus group sessions were held from October to November 2010 in Bizkaia (Spain) with 30 women exploring their needs during pregnancy and postpartum; (b) two literature reviews were conducted on women's needs at these times and theoretical models of healthcare education; and (c) seven discussion and consensus sessions were run with a group of experts composed of midwifes, gynaecologists, paediatricians, and paediatric and postpartum nurses. RESULTS: Various areas for improvement were identified: needs assessment of each woman/family, consideration of pregnancy and childbirth as normal physiological processes, participation of fathers, establishment of social networks, continuity of postpartum care, better access to and training for midwives, and more flexible format and contents for the programme. We propose a woman-focused framework that includes three exploratory interviews during pregnancy, personalized interventions coordinated between professionals, empowerment to choose the type of birth, and postpartum activities. CONCLUSION: New perinatal education should be on-going and focused on each woman. It is necessary to assess the feasibility of implementing this type of programme, depending on the context, professionals' readiness for change and characteristics of the proposed interventions. Then, its effectiveness and sustainability must be assessed.

Necesidades percibidas por las mujeres respecto a su maternidad. Estudio cualitativo para el rediseño de la educación maternal / Perceived needs of women regarding maternity. Qualitative study to redesign maternal education

OBJETIVO: Explorar las necesidades expresadas por las mujeres a lo largo del proceso de convertirse en madre y sus demandas relacionadas con la educación maternal. DISEÑO: Estudio cualitativo con grupos focales. EMPLAZAMIENTO: Área de salud de Bizkaia, Servicio Vasco de Salud/Osakidetza. PARTICIPANTES: Treinta mujeres seleccionadas de forma consecutiva por matronas de atención primaria de 6 centros de salud diferentes. MÉTODOS: Entre septiembre y noviembre de 2010 se formaron 4 grupos focales estratificados por situación socioeconómica y etapa del proceso (embarazo/puerperio). Para recoger las preocupaciones de las embarazadas, de las puérperas y su opinión sobre la educación maternal se siguió el método de análisis del contenido temático con el apoyo del software ATLAS. ti. RESULTADOS: El foco de preocupación de las mujeres va cambiando con el tiempo. Pasaba de la necesidad de confirmar que 'todo va bien' a necesitar más apoyo emocional y confianza para enfrentarse a sus miedos al parto y al cuidado de los hijos. Necesitaban mayor acompañamiento en el puerperio y menos presión con la lactancia materna. En cuanto a la educación maternal, demandaban un programa de educación perinatal en lugar de solo prenatal, más actualizado, con mayor participación de su pareja, más interactivo y flexible. CONCLUSIÓN: Las mujeres de nuestro entorno perciben necesidades similares a las de los países anglosajones, independientemente de las diferencias culturales. Parece claro la necesidad de rediseñar un programa de educación perinatal extenso, personalizado, dinámico, que empodere a las mujeres para gestionar su propia salud y la de su familia

OBJECTIVES. To assess women's perceptions of their needs during the process of becoming a mother and identify what they want from maternal education. DESIGN: Qualitative study with focus groups. SETTING: Bizkaia health region, Basque Health Service (Osakidetza), Spain. PARTICIPANTS: Thirty one women were recruited consecutively by midwives at six Osakidetza health centres. METHODS: Four sessions were held from September to November 2010 in Bizkaia (Spain), the four groups being stratified by socioeconomic status and stage of the process (pregnancy vs. postnatal period). To collate the information related to the various topics discussed, we used manifest content analysis that was facilitated by use of ATLAS. ti software. RESULTS: The focus of the women worries changes over time. In early pregnancy, women's main concern was for 'everything to go well'. As the pregnancy progressed, they needed more emotional support and wanted to feel confident and be self-reliant to face their fears of the birth and care for their child. They needed greater accompaniment in the puerperium and less pressure concerning breastfeeding. They also wanted an extended programme of perinatal rather than just antenatal education, which was more participatory and flexible and greater participation of their partner. CONCLUSION: Women have the same social and family networks needs, regardless of cultural differences between Anglo-Saxon and Southern European countries. We recommend an perinatal education to empower women to manage their own health and that of their family and link the health system with other networks of personal and social support for women

[Perceived needs of women regarding maternity. Qualitative study to redesign maternal education]. / Necesidades percibidas por las mujeres respecto a su maternidad. Estudio cualitativo para el rediseño de la educación maternal.

OBJECTIVES: To assess women's perceptions of their needs during the process of becoming a mother and identify what they want from maternal education. DESIGN: Qualitative study with focus groups. SETTING: Bizkaia health region, Basque Health Service (Osakidetza), Spain. PARTICIPANTS: Thirty one women were recruited consecutively by midwives at six Osakidetza health centres. METHODS: Four sessions were held from September to November 2010 in Bizkaia (Spain), the four groups being stratified by socioeconomic status and stage of the process (pregnancy vs. postnatal period). To collate the information related to the various topics discussed, we used manifest content analysis that was facilitated by use of ATLAS.ti software. RESULTS: The focus of the women worries changes over time. In early pregnancy, women's main concern was for "everything to go well". As the pregnancy progressed, they needed more emotional support and wanted to feel confident and be self-reliant to face their fears of the birth and care for their child. They needed greater accompaniment in the puerperium and less pressure concerning breastfeeding. They also wanted an extended programme of perinatal rather than just antenatal education, which was more participatory and flexible and greater participation of their partner. CONCLUSION: Women have the same social and family networks needs, regardless of cultural differences between Anglo-Saxon and Southern European countries. We recommend an perinatal education to empower women to manage their own health and that of their family and link the health system with other networks of personal and social support for women.

Antenatal education and breastfeeding in a cohort of primiparas.

AIMS: To assess the association between attendance at antenatal education sessions and breastfeeding during the first year of life. BACKGROUND: Although there is evidence that antenatal education encourages breastfeeding, the size and duration of its effect remain unclear. DESIGN: A prospective cohort study. METHODS: The study was conducted in Bizkaia (North of Spain) between May 2005-June 2007 with a consecutive sample of 614 primiparas. Women were classified into three groups according to whether they had received antenatal education and, if so, how many classes (0, 1-4, or 5 or more). Telephone interviews at 1·5, 3, 6 and 12 months were used to estimate the risk of cessation of any breastfeeding and to compare the groups with Cox proportional hazards regression models adjusted for potential confounders. FINDINGS: Initially, 90% of women breastfed their infants, with no differences between the groups. During the first month, the risk of cessation of any breastfeeding was three times as high among non-attendees and twice as high among women who attended 1-4 classes compared with those who attended 5 or more classes. The risk was, however, similar in the three groups from the end of first month onwards. CONCLUSION: The results suggest that though antenatal education may be associated with higher rates of breastfeeding in our setting this is only the case for the first month after the birth. Further research is necessary to optimize this beneficial effect to achieve long-term continuation of breastfeeding.

The benefits of antenatal education for the childbirth process in Spain.

BACKGROUND: Childbirth has changed dramatically over the past 40 years, although antenatal education (AE) has not. This education has been shown to be beneficial in some countries but not in others. OBJECTIVE: The objective of this study was to assess the benefits of AE during the childbirth process, controlling for the possible confounding effects of other variables and involving a comprehensive assessment of the birth process. METHOD: A prospective observational study was conducted in Bizkaia, Spain, to follow 616 low-risk pregnant nulliparous women aged 18-42 years until childbirth. Women who had attended different numbers of AE sessions were compared in terms of the following: whether they arrived at hospital in established labor, whether they received epidural anesthesia before the active phase of the birth, length of the first and second stages (i.e., dilation and delivery), anxiety (Hospital Anxiety and Depression Scale), type of birth, perineal injury, satisfaction with the experience, and the 5-minute Apgar score. Results were adjusted by age, nationality, educational level, social class, personality, and the hospital where the birth occurred. RESULTS: Spanish women who had attended AE classes experienced less anxiety during birth than those who had not (Hospital Anxiety and Depression Scale score adjusted difference = -1.5, 95% confidence interval = -0.1 to -3.0), whereas the opposite was found for immigrant women (adjusted difference = 2.4; 95% confidence interval = -0.6 to 5.4; AE x Nationality interaction, p = .02). No dose-response relationship was found between AE and anxiety, and no benefits were seen for the other variables. DISCUSSION: Antenatal education is not found to be associated with benefits during childbirth. Subsequent research should be focused on redesigning and assessing AE in light of the current needs of women.

Design and process of the EMA Cohort Study: the value of antenatal education in childbirth and breastfeeding.

BACKGROUND: Antenatal education (AE) started more than 30 years ago with the purpose of decreasing pain during childbirth. Epidural anaesthesia has achieved this objective, and the value of AE is therefore currently questioned. This article describes the protocol and process of a study designed to assess AE results today. METHODS/DESIGN: A prospective study was designed in which a cohort of 616 nulliparous pregnant women attending midwife offices of the Basque Health Service were followed for 13 months. Three exposure groups were considered based on the number of AE sessions attended: (a) women attending no session, (b) women attending 1 to 4, and (c) women attending 5 or more sessions. Sociodemographic, personality, and outcome variables related to childbirth and breastfeeding were measured.It was expected 40% of pregnant women not to have participated in any AE session. However, 93% had attended at least one session. This low exposure variability decreased statistical power of the study as compared to the initially planned power. Despite this, there was a greater than 80% power for detecting as significant differences between exposure groups of, for instance, 10% in continuation of breastfeeding at one and a half months and in visits for false labour. Women attending more sessions were seen to have a mean higher age and educational level, and to belong to a higher socioeconomic group (p < 0.01). Follow-up was completed in 99% of participants. DISCUSSION: Adequate prior estimation of variability in the exposure under study is essential for designing cohort studies. Sociodemographic characteristics may play a confounding role in studies assessing AE and should be controlled in design and analyses. Quality control during the study process and continued collaboration from both public system midwives and eligible pregnant women resulted in a negligible loss rate.