Research Issues in the Assessment of Birth Settings Report of a Study (1982) / Chapter Skim
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Appendix D: Research on Childbirth Settings: The Assessment of Psychological Variables
Appendix D: Research on Childbirth Settings: The Assessment of Psychological Variables
Pages 102-148
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From page 102... ...
Thus, explorations of the psychological aspects of childbirth settings might reward those who can overcame the substantive and methodological obstacles to conducting research in this field. After a review of the evidence regarding the importance of psychological variables in the birth process, this paper discusses same methodological issues concerning the assessment of psychological variables.
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From page 103... ...
For these reasons, research on home birth settings that does not include psychological variables may be dismissed as irrelevant by those sympathetic to the home birth movement. Although advocates of nonconventional birth settings have firm beliefs regarding the psychological superiority of these settings, virtually all of the evidence in support of their position is anecdotal
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From page 104... ...
Evidence that psychological factors can influence birth outcomes provides a second reason for including these variables in research on birth settings. For example, the results of numerous studies have suggested that psychological events or conditions during pregnancy can affect the progress of labor and delivery.
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From page 105... ...
Studies in Animals Numerous studies, including those using infrahuman species, have suggested that anxiety and disturbance during labor can result in protracted labor and poor fetal outcome (for reviews, see Myers and Myers, 1979r Newton, 1977)
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From page 106... ...
. There is also evidence that characteristics of the labor setting, which would presumably influence maternal anxiety, can affect the labor process.
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From page 107... ...
. These studies are very relevant to the study of birth settings because the variables found to be important (e.g., presence of a supportive companion and immediate postpartum contact with infant)
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From page 108... ...
epinephrine levels in the waaen, we could begin to speculate about the underlying process involved. MB'l'BODOLOGIES IN 'l'BE ASSESSMBN'l' OF PSYCHOLOGICAL VARIABLES To assess psychological vari·ables in studies on alternative birth settings the investigator must consider nuaerous aethodological issues.
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From page 109... ...
These studies have iaplications for the design of research to assess various birth settings. Hot only are there substantial differences in the attitudes of, and social support available to, women who select different settings, but the settings theaaelves are likely to differ in aany ways (Cohen, 1981)
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From page 110... ...
Given the many differences among the settings, it will be difficult to ascertain which variables are responsible for any differences in outcome. By including careful assessments of background and setting variables in studies of alternative birth settings and by examining a large number of such studies, it may be possible to make some preliminary judgments about the background and setting variables that are most important.
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From page 111... ...
Long-Term Follow-Up Many advocates of home or other nonconventional birth settings have maintained that settings can influence such long-term outcomes as the child's emotional development or the relationship of the child to siblings. However, the evidence for these assertions consists almost exclusively of anecdotal evidence and case-study reports.
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From page 112... ...
Although it will be difficult and expensive to conduct saae of these long-tera studies, their inforaation will be critical to uncovering psychosocial differences due to aspects of different birth settings. Multiple Methods of Assess..nt In assessing psychological variables such as the mother's emotional state during childbirth or the social support available to her, it is extremely important to use multiple aethods of assessment.
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From page 113... ...
MEASURING PSYCHOLOGICAL VARIABLES I~rtant Variables and Available Instruments Once a decision has been made to exaaine psychological variables in studies assessing characteristics of birth settings, the investigator is faced with the following questionsa Which variables should be measured? What scales or measuring instruments are available to assess the variables?
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From page 114... ...
Advocates of nonconventional birth settings have maintained that such births can exert a positive influence on the subsequent relationship of the husband and wife. Yet no research instruments have been developed in this literature with the exception of a few that assess the marital
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From page 115... ...
. A review of observation methods or assessment tools that consider the family as a whole and a discussion of bow such tools might be applied to research on alternative birth settings would be very useful.
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From page 116... ...
Longer-term measures would be very important in the assessment of psychological variablesr thus, it would be highly useful for researchers to have a review of the assessment tools used by developmental psychologists and a discussion of their potential applicability to research on birth settings. Adamson, G
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From page 117... ...
American Journal of Obstetrics and Gynecology 118sl95-199. Ca.pbell, D
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From page 118... ...
1979. The Childbearing Center: An alternative birth setting.
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From page 119... ...
1978. An assessMnt of continuous fetal heart rate monitoring in labora A randoaized trial.
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From page 120... ...
1977. OUtccaes of elective home birthss A aeries of 1,146 cases.
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From page 121... ...
American Journal of Obstetrics and Gynecology 126&470-476. Richardson, P
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From page 122... ...
American Journal of ea.-unity Psychology 7a397-412. Zeskind, P
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From page 123... ...
neaa Streaaful life eventa, paat or pre ..nt Evaluation of prior ..... ..., childbirth experience• w Paychiatric hiatory Paraonality charactariatica Self-eat••• Sex role orientation ..
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From page 124... ...
TABLE 1 Continued Otbe1r Po..tble Refe~rence '!
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From page 125... ...
.nta to be birth, vaaan'a belief in bar Scale rated by tbe ability to control pain -non Lillert-type acalea Bxpectationa of control revarding labor/delivery (e.g., extent to wbicb - n expecta to llnov in advance wbat h done to bar, or have a aay in what procedure• abe baa) Deaire for control (e.g., extent to wbicb vaaan ~ to llnov in advance wbat ia done to bar, or have a aay in what pr~ cedurea abe baa)
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From page 126... ...
liability and Conceptual Variable Perioda Variable 'fool (if any) Inatr-nt Cbaractariatic.tDaacription Validity native doctora, prenatal claaHa, labor/daliYery aattinga Bxtant to vhich voaan baa aougbt infor..
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From page 127... ...
Ob- The t hree scales include: about childbirth experience delivery, Bugen, 1981 perience jective raU119a eubeequent ReU119a COIIPleted by ~r/Delivery evalu- Interit.
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From page 128... ...
Inatc·-nt CbaracteriaticaiDeacription Validity FHUnga about labor and Juat after Davenport-Black Childbirth Self-report 15-.ord adjective checkliat, deUftr:y birth, and IIOylan, lt74 deacdption COIIPdaing auch vorda aa aubaequent "fantaatic,• Mlf-confident,• poatpartu. "wonderful," and •terrified," padod each rated on a 5-point acale 'l'endancy to focua on pain1 dependent ••· independent feaUnga Daftnport-Black and IIOylan, lt74 Cbildbirth teatt.ony or-·· ObMrftr rating teatt.onial account WO..n'a ftrbati• account• of birth experience vera r., corded and acored by expar i~ Mnten for ratio of pain related to goal-related vorda and dependent to independent ....
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From page 129... ...
N tant ••· conflicting \0 Judg8enta about aacb Juat aftar attendant tbat are rale- blrtb Yaftt to tba ~·· fHl illl! la of Matary, control, and lJWOl-t in bar own blrtb' for aaa.pla1 • hrcaptiona tbat - b attendant waa Hlacted br tba -II • hrcaptiona tbat par ticular attandanta wra -aaary • hrcaption of aacb attendant aa re aponaift to bar auggaationa or de airaa • Perception of certain attendant• aa teo intrualft • .
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From page 130... ...
bat .... of Infoc..tion on AeMa-nt DhcuaMa 'ftlia AeMa-nt Type of Reliability and Conceptual Variable Periods Variable Tool (if any)
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From page 131... ...
• Self-reported pain in teneity in each •tate of labor Self-reported judpent of dietre•• fraa tbe pain during each •tete of labor • Requeete for pain aedi cation Perception• of pain a• controllable • Perceptione of pain ·a a anticipated, nor. .l, or neceeeary • axteat to wbich coping atratetiee are ueed to reduce or control pain • Perception& r1111arding own role in controllift9 pain • Satiafaction or f ..
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From page 132... ...
. Ju•t aftar birtb Pealing• of affective- Ju•t after n••• and ca.patance birth Behavioral reaction• during Buttal at al., ObMrwr rating " - " ' • behavior obaerved Ilona reported labor and delivery 1172 of CCIIIPlainta and tban aoored on a 5 and tan•ion point acala for caaplaint• and another for tendon c:c.pucation• • Por aacb caaplication that occurred, the - · • _,tional reaction to the Cllr' plication C•·9·• a1111iaty)
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From page 133... ...
At tbi• •tat•• it - l d be Ulportant to ••..•• tba .otbar'• fear• revarding tba infant -- i.e., wbatbar tba infant 1a nor.al and baaltby) reeling• of pride During labor/ dalivery1 8Ub aaquant poat partu• PHling• of Nti•faction Dul'ing labor/ ravarding one'• own par- daliftl')
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From page 134... ...
'bat • - of Infor.ation on A8Ha-nt Di8CUaHa ftia AaHa-nt of 'l'ype Reliability and Conceptual Variable Parioda Variable 'I'Ool (if any) Inatr-nt Cbaractariatica/Deacription Validity Perception• or !
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From page 135... ...
aetroepective aaternal Juat after Brantley and •When 11y Child Self-report in- raotor analaia re¥aalact Teat-reteat relia reaction• and perceived birth Clifford, 1180 lfaa Born• atr-ntl 32 3 factor•• .. ternal bility waa .83 paternal reaction• to birth i t - with poaltlve affect, paternal of child 11Ultlple-cboice poeitive affect, and foraat parental anxiety Adjuat.ent of waaan during Schaefer and Poatnatal Self-report Contain• 25 it•• on -ther'a poetp.rt• period Manbet..er, U60 ReHarcb In- health aince delivery, 60 ventory it•• on baby'a health, and 91 it•• on attitude• and f ..linga.
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From page 136... ...
Gratification froa tbe parent Juat aftec -...u, 1174 Gcatiflo.tion A 12-itea Mlf- Parente are aaked to obeok lnte~rit.
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From page 137... ...
tala AaHa-nt 'JYpe of JallablUty and Conceptual Vadable Perloda Vadable 'fool ( 1f ·~) Inatr-nt Cbaracterlatlc-tDeacrlptlon validity JUft AnSa 81112'11 Maternal bebavlor Subaequent ltlaua et al., PbotQ9rapba were !
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From page 138... ...
deairable ceponMa) Avaranaaa of diatiDCtiva Bubaaquant feature• of the newborn postpartum Plaaaura or enj~nt Subsequent of contact witb tba infant postpartum latiafaction witb MX Subsequent of infant postpartum Reaction to infant'• Subsequent c~i~ postpartwa Willi~naaa to let otbara Subsequent care for tba infant postpartua 8UUIIQUDI'l' TO !
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From page 139... ...
Maternal acceptance Cbaabarlain, 1976 'ftla Dubee- Q-sort s• 'ftla o-sort consists of Mona raportacl Miohaal Child atat...nta about child's Behavior Q-Sort1 babavior. Motbar sorts tba• Darbeaand into 11 pilaa aooorcli119 to Micbaal, 1170 tha way sba psrcaivea bar ....
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From page 140... ...
lone .otberr tbe infant birrth 1173 herrMlf with 5 otherr carre takerra (e.g,, fatherr, grrancJ -therr, expedencecl ~herr, pecliatrrio IIIIJrM, ancJ clootOl') on e.ch of 6 carretaking taaka (e.g., calaill9 orr feecling tbe baby)
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From page 142... ...
TABLE 4 Psychological Research on the Father Otbar Po••ible Reference 'l'bat • - of Infor-tion on A8H8-nt Diec:u•H• 'l'hi• AaH•-nt 'l'ypa of Reliability and Conceptual Variable Period• Variable 'I'Ool ( if any) In•tr-nt Characteri•tic•/Daec:ription Validity PJIIOR 'lO PRBGIWICY !
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From page 144... ...
Contact witb infant 8ubeaquant poetpa~tPla..ura in o~ enjo,.ant 8ubeaquant of CXIIItact witb infant poatparta 8atiefection with ... of 8ubeaquant infant poetpa~t 8atiefection witb in- SubMquant fant'• appea~ poetpa~t a.a~anaee of dietincti..
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From page 145... ...
Patber'• inwol....nt in llallion, 1977 ...bi' • • 'l'ypical 8elf-report Contain• queationa on tba Autbor noted tbat faaa infant caretaklnv Day• fatber'a participatica in and oontant validity oaratakinv actlvltiaa durinv bad been eatabliabad an arbitrarily cboaan tt.a in a pilot atudy, but (e.g,, bow aany tt.aa in no dataila are given tba pravioua - k ba bad batbed, diapered, rocked, and fad tba babi' I Patber'a at~nt to Peter- at al., Obeener ratinva ObMrvera nota extant to Intarobaarver agrae infant 1979 baaed on ob- wbicb father inter.ctad and Mnta of .85 ware ob aervatlon of cared for infant, fatbar'a tained fatber'a be- oonfidence in oadnv for baYlor and baby, father'• fnUnva of reaponaea to cloaanaaa to tba babi', and interview fatbar'a tendency to inter queatiODa .ct witb babi' in a . .y tbat ia plaaaurabla for botb(a,g., oauainv botb to laugb)
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From page 146... ...
of Info~Uon on aaa.-nt Di-aftb Aaae-nt of 'l'ype . .liability and Conceptual Vadable Pedoda vuiable 'l'Ool ( U any)
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From page 147... ...
A factor anelyaia of etc., a• ..11 tbeae rat1n9• r.,.aled two at factor• •jor dt.tnaionaa a tbat elicit tbe "diacoafort" factor and a cry and per- MOOne! factor oonveyin9 tbe cantata of tt.t "aick" nature of tbe cry apent cryin9.
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From page 148... ...
tion on AaHa-nt Dillcu..ea 'l'llia AaHa-nt of '1'ype Reliability and Conceptual Variable Perioda Variable Tool (if any) Inatru.ent Characteriatica/Deacription Validity SUBSIIQUBIIT TO TIIB POS'l'PAR'l'UM PERIOD Infant t.-per...nt Juat after carey, 1970 Self-report in- Iteas caapriae 9 acalea, in- Several aothera were birth ventory de- cluding activity, rhytha- interviewed and coa aigned for icity, adaptability, pleted queation babiaa 4-8 approach, threahold, inten- nairea, the author 110ntha old can aity, IIOod, diatractibility report• the reaulta be cc.pleted by and peraiatence.
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