Continuous support during labour may improve outcomes for women and infants, including increased spontaneous vaginal birth, shorter duration of labour, and decreased caesarean birth, instrumental vaginal birth, use of any analgesia, use of regional analgesia, low five-minute Apgar score and negative feelings about childbirth experiences. We found no evidence of harms of continuous labour support. Subgroup analyses should be interpreted with caution, and considered as exploratory and hypothesis-generating, but evidence suggests continuous support with certain provider characteristics, in settings where epidural analgesia was not routinely available, in settings where women were not permitted to have companions of their choosing in labour, and in middle-income country settings, may have a favourable impact on outcomes such as caesarean birth. Future research on continuous support during labour could focus on longer-term outcomes (breastfeeding, mother-infant interactions, postpartum depression, self-esteem, difficulty mothering) and include more woman-centred outcomes in low-income settings.

The relatively newly-developed profession of birth doulas, who accompany perinatal women and their families during the birth process, has been in existence since the 1990s. End-of-life (EoL) doulas are another emerging profession in developed Western countries. Doulas provide non-medical support for both childbearing women and people at the EoL, as well as their families. Although birth and death would appear to be opposites, they share common characteristics and challenges, such as tending to be treated in medicalised care settings, and that they both concern vulnerable parties. Doulas, with a holistic view encompassing birth and death, may be able to contribute to the improvement of the healthcare system in modern societies.

Background In Cambodia, the importance of valuing women’s childbirth experiences in improving quality of care has been understudied. This is largely because of absence of reliable Khmer tools for measuring women’s intrapartum care experiences. Generally, cross-cultural development of those tools often involves translation from a source language into a target language. Yet, few earlier studies considered Cambodian cultural context. Thus, we developed the Cambodian version of the Person-Centered Maternity Care (PCMC) scale, by culturally adapting its original to Cambodian context for ensuring cultural equivalence and content validity. Methods Three rounds of cognitive interviewing with 20 early postpartum women were conducted at two governmental health facilities in Cambodia. Cognitive interviewing was composed of structured questionnaire pretesting and qualitative probing. The issues identified in the process of transcribing and translating audio-recorded cognitive interviews were iteratively discussed among study team members, and further analyzed. Results A total of 14 issues related to cultural adaptations were identified in the 31 translated questions for the Cambodian version of the PCMC scale. Our study identified three key findings: (i) discrepancies between the WHO recommendations on intrapartum care and Cambodian field realities; (ii) discrepancies in recognition on PCMC between national experts and local women; and (iii) challenges in correctly collecting and interpreting less-educated women’s views on intrapartum care. Conclusion Not only women’s verbal data but also their non-verbal data and cultural contexts should be comprehensively counted, when reflecting Cambodian women’s intrapartum practice realities in the translated version. This is the first study that attempted to develop the tool for measuring Cambodian women’s experiences during childbirth, by addressing cross-cultural issues.

Purpose: We explored parents' perceptions and judgment formation processes concerning their infants' health-related quality of life (HRQOL). Method: The PedsQL TM Infant Scales-an instrument specifically designed for infants aged 1 -24 months-were translated into Japanese. Forward and backward translations were performed, evaluating the semantic and conceptual equivalencies. Parents with infants younger than two-years-old were recruited and interviewed using think-aloud and probing techniques. Participants completed the questionnaire while speaking aloud about what came to their mind, what they thought each question meant, and how they reached each answer. Results: Seven mothers and three fathers participated. The median age was 33.4 (28 -43) years. Four had infants younger than six-months-old. All infants were healthy. Parents' perceptions of their infants' HRQOL varied across their ages. Some parents with infants younger than six months experienced difficulty discussing "emotional functioning" and "cognitive functioning" because their infants were too young to articulate the actions mentioned in the items. In those cases, the parents responded, "never a problem". Seventy-five percent of parents recalled their infants' daily "physical functioning", while only 58% recalled "physical symptoms". Some parents' perceptions and judgment formation were compromised by their own perceptions. For example, they answered "often a problem" when the items were problematic to themselves instead of to their child. However, many distinguished their infants' HRQOL from their own perceptions, indicating they understood the intention of the questionnaire. Conclusion: Parents

Background Women’s childbirth experience of interpersonal care is a significant aspect of quality of care. Due to the lack of a reliable Cambodian version of a measurement tool to assess person-centered maternity care, the present study aimed to adapt the “Person-Centered Maternity Care (PCMC) scale” to the Cambodian context and further determine its psychometric properties. Methods The PCMC scale was translated into Khmer using the team translation approach. The Khmer version of PCMC (Kh-PCMC) scale was pretested among 20 Cambodian postpartum women using cognitive interviewing. Subsequently, the Kh-PCMC scale was administered in a survey with 300 Cambodian postpartum women at two governmental health facilities. According to the COnsensus-based Standards for the Selection of health status Measurement Instruments (COSMIN) standard, we performed psychometric analysis, including content validity, construct validity, criterion validity, cross-cultural validity, and internal consistency. Results The preliminary processes of Kh-PCMC scale development including cognitive interviewing and expert review ensured appropriate levels of content validity and acceptable levels of cross-cultural validity of the Kh-PCMC scale with four-point frequency responses. The Scale-level Content Validity Index, Average (S-CVI/Avg) of 30-item Kh-PCMC scale was 0.96. Twenty items, however, performed optimally in the psychometric analysis from the data in Cambodia. The 20-item Kh-PCMC scale produced Cronbach’s alpha of 0.86 for the full scale and 0.76–0.91 for the subscales, indicating adequately high internal consistency. Hypothesis testing found positive correlations between the 20-item Kh-PCMC scale and reference measures, which implies acceptable criterion validity. Conclusions The present study produced the Kh-PCMC scale that enables women’s childbirth experiences to be quantitatively measured. The Kh-PCMC scale can identify intrapartum needs from women’s perspectives for quality improvement in Cambodia. However, dynamic changes in and diverse differences of cultural context over time across provinces in Cambodia require the Kh-PCMC scale to be regularly reexamined and, when needed, to be further adjusted.