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Role and Experience Perceptions as Predictors of Nulliparas’ Childbirth Preferences

Role and Experience Perceptions as Predictors of Nulliparas’ Childbirth Preferences. Adriana Arcia, PhD, RN September 14, 2012. Introduction. Background & Significance. High cesarean rates are associated with: Increased maternal and neonatal morbidity and mortality 1

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Role and Experience Perceptions as Predictors of Nulliparas’ Childbirth Preferences

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  1. Role and Experience Perceptions as Predictors of Nulliparas’ Childbirth Preferences Adriana Arcia, PhD, RN September 14, 2012

  2. Introduction

  3. Background & Significance • High cesarean rates are associated with: • Increased maternal and neonatal morbidity and mortality1 • Disruption of attachment and breastfeeding2 • Increased costs – $3.5 billion or more per year3 • There are many potential strategies to reduce the cesarean rate. One is to increase the uptake of midwifery and home birth services. Understanding maternal preference is a prerequisite to fostering demand. Chart: U.S. National Center for Health Statistics Deneux-Tharaux et al., 2006; Hansen et al., 2007; Harper et al., 2003; Lauberau, 2004; Liu et al., 2007; MacDorman et al., 2008 Pérez-Ríos et al., 2008; Rowe-Murray & Fisher, 2001, 2002; Zanardo et al., 2010 Sakala & Corry, 2008

  4. Aim • To describe the childbirth preferences of nulliparous women in early pregnancy and develop a model of predictors of those preferences. • Childbirth Preferences: • Provider type • Birth setting • Mode of delivery • Use or avoidance of pain medication

  5. Methods

  6. Study Design Inclusion Criteria • Cross-sectional • Descriptive • Self-administered • Web-based survey • Anonymous data • Informed consent obtained • IRB approved • Women, aged 18-44 • Within 50 US states and DC • Currently pregnant • ≤ 20 weeks’ gestation • No prior pregnancies beyond 13 weeks’ gestation • Nulliparous • Read & understand English • Internet access

  7. Recruitment • Facebook advertisements targeted to women, aged 18-44, living in the US • Utah Test for the Childbearing Year (UTCY) • Outcome questions re: childbirth preferences • Descriptive and demographic items Instrumentation

  8. Data Analysis • Factor Analysis Mplus 5.21

  9. Data Analysis • Structural Equation Modeling Mplus 5.21

  10. Results

  11. Sample Demographics • Mean weeks’ gestation: 11.5 (SD 5.8) • Mean age: 20.9 (SD 4.0) • 52% were 18-19 years old • <10% older than 26 • Race: • 77.4% White • 20.5% African American • Ethnicity: • 10% Hispanic • Marital Status: • 38% single • 25% living with partner • 23% married • Annual Household Income: • 54% reported <$15K • 32% reported $15K - $50K • 15% reported >$50K • Employment: • 31.3% not employed, looking for work • 28.6% student • Education: • 15% some high school • 37% high school/GED • 33% some college • 15% associate’s degree or higher

  12. Geographic Distribution

  13. Internet Use & Information Seeking • 92.4% used a home computer for Internet access • 96% self-rated “intermediate” or “expert” Internet users • 64.7% sought pregnancy/childbirth info online several times/week or daily

  14. Birth Setting 4.2%

  15. Provider Type 13.4%

  16. Mode of Delivery Pain Medication

  17. Factor Analysis & Scale Reliability • Confirmatory factor analysis yielded poor fit to the data. Exploratory factor analysisled to a three-factor solution: • The measure was reduced from 61 to 33 items.

  18. Structural Model • χ2(1) = 0.014, p = .907 • CFI = 1.000 • RMSEA < .001 • SRMR = .001 • Variance explained: Provider – 18.1% Setting – 18.6% • Mode – 14.5% Medication – 10.5%

  19. Structural Model, Simplified

  20. Conclusions

  21. Predictors of Nulliparas’ Childbirth Preferences

  22. Noteworthy Findings • Women’s role perceptions are effective predictors of their preferences • There is unmet demand for midwifery and planned home birth • Fewer than 5% prefer cesarean delivery • Pregnant women have substantial learning needs • Learning needs are met through frequent consultation of the Internet sites and other sources of information on pregnancy and childbirth

  23. Implications for Nursing • The model of predictors and preferences can be used to inform patient teaching and anticipatory guidance. • Nurses must, at a minimum, be aware of existing information sources and ideally, be involved in the development of evidence-based online resources • Legal, logistical, and financial obstacles may need to be cleared away in order for women to be able to exercise a full range of maternity care options. • Future research questions: • Are role perceptions are modifiable? • If role perceptions are modified, do preferences change?

  24. Acknowledgments Grant Funding Beta Tau Chapter, Sigma Theta Tau Int’l Florida Nurses Foundation Institutional Support University of Miami School of Nursing and Health Studies

  25. Questions?

  26. References • Deneux-Tharaux, C., Carmona, E., Bouvier-Colle, M-H., & Breart, G. (2006). Postpartum maternal mortality and cesarean delivery. Obstetrics & Gynecology, 108(3), 541-548. • Hansen, A. K., Wisborg, K., Uldbjerg, N., & Henriksen, T. B. (2007). Elective caesarean section and respiratory morbidity in the term and near-term neonate. ActaObstetricia et Gyenecologica, 86, 389-394. doi: 10.1080/00016340601159256 • Harper, M.A., Byington, R. P., Espeland, M. A., Naughton, M., Meyer, R., & Lane, K. (2003). Pregnancy-related death and health care services. Obstetrics & Gynecology, 102(2), 273-278. doi: 10.1016/S0029-7844(03)00408-3 • Laubereau, B., Filipiak-Pittroff, B., von Berg, A., Grübl, A., Reinhardt, D., Wichmann, H. E., & Koletzko, S. (2004). Caesarean section and gastrointestinal symptoms, atopic dermatitis, and sensitisation during the first year of life. Archives of Disease in Childhood, 89, 993-997. doi: 10.1136/adc.2003.043265 • Liu, S., Liston, R. M., Joseph, K. S., Heaman, M., Sauve, R., & Kramer, M. S. (2007). Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. Canadian Medical Association Journal, 176(4), 455-460. doi: 10.1503/cmaj.060870 • MacDorman, M. F., Declercq, E., Menacker, F., & Malloy, M. H. (2008). Neonatal mortality for primary cesarean and vaginal births to low-risk women: Application of an "intention-to-treat" model. Birth, 35(1), 3-8. doi:10.1111/j.1523-536X.2007.00205.x • Pérez-Ríos, N., Ramos-Valencia, G., & Ortiz, A. P. (2008). Cesarean delivery as a barrier for breastfeeding initiation: The Puerto Rican experience. Journal of Human Lactation, 24(3), 293-302. doi: 10.1177/0890334408316078 • Sakala, C., & Corry, M. P. (2008). Evidence-based maternity care: What it is and what it can achieve. New York: Milbank Memorial Fund. Retrieved from http://www.milbank.org/reports/0809MaternityCare/0809/MaternityCare.htm • Zanardo, V., Svegliado, G., Cavallin, F., Giustardi, A., Cosmi, E., Litta, P. & Trevisanuto, D. (2010). Elective cesarean delivery: Does it have a negative effect on breastfeeding? Birth, 37, 275-279.

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