Factors associated with women's desire for control of healthcare during childbirth: Psychometric analysis and construct validation

Abstract

The desire for control of healthcare is a significant moderator of outcomes related to childbirth. Researchers have shown that a sense of control of healthcare during childbirth is strongly correlated with postpartum maternal well‐being. The aims of this study were to examine (a) the psychometric characteristics of an instrument to assess women's desire for control of healthcare during childbirth, and (b) examine desire for control in relation to parity, medical complications of pregnancy, and women's choices of childbirth providers and setting. The study design was cross‐sectional using two different samples totaling 385 pregnant women. In Sample 1, (n = 193) we conducted an exploratory factor analysis to reduce the initial item pool. In Sample 2, (n = 192) we conducted a confirmatory factor analysis (CFA) of the final 12‐item instrument and examined factors related to the desire for control. Results of the analysis in Sample 1 were supportive of a single‐factor structure reflecting women's desire to influence the childbirth healthcare environment and decision‐making. The final 12‐item instrument had high internal consistency reliability (Cronbach's alpha = 0.93). CFA in Sample 2 was supportive of the single‐factor structure with good model fit. The desire for control was directly correlated with an internal locus of control. Nulliparous women reported a lower desire for control compared with multiparous women. The desire for control among women with self‐reported medical complications of pregnancy was comparable to that among women without pregnancy complications. The desire for control was a predictor of choosing midwives (vs. obstetricians), home or birth center (vs. hospitals), and professional labor support (e.g., doulas). Implications for future research on the impact of desire for control on maternal health outcomes are discussed.

Validation of an instrument assessing certified nurse–midwives' attitudes toward breastsleeping

“…Additionally, the number of solutions suggested by EFA was evaluated with parallel analysis in Stata, similar to the work others have done in instrument development (Holm et al, 2018; Kahn, 2006; Stevens et al, 2019). Parallel analysis has been suggested as the gold standard for reducing dimensions in instrument development (Hayton et al, 2004; Patil et al, 2010).…”

Childbirth Experience in labor–delivery–recovery–postpartum unit: A Qualitative Study

“…Ensuring access to essential interventions in the LDRP is undisputed for those who have experienced pregnancy and childbirth complications. It has been reported that concerns about childbirth complications compel some women to opt for hospitals equipped with medical intervention and facilities [25]. Furthermore, compared to other women, those with a history of birth injuries have reported the need for supportive care and access to medical equipment.…”

“…In this regard, in hospital of many countries, a labor, delivery, recovery, and postpartum (LDRP) unit has been designed for family-centered care. Although women with high-risk pregnancies and complicated deliveries prefer to give birth in well-equipped hospitals [25], the evidence shows that despite the global efforts that have been made toward the development of physiologic delivery in maternity unit, the design of the delivery environment still needs reforms. Safe and satisfying delivery can be accurately planned by studying women's natural childbirth experiences.…”

Women's Perceptions on the Use of Video Technology in Early Labor: Being Able to See

“…Knowledge derived from having a previous labor and birth was described as advantageous for achieving delayed admission, as was having a midwife or doula and self‐directed childbirth education or formalized attendance at community childbirth classes. Experiential knowing, gained from having a previous birth, promotes desire for decisional control during birth 31 . Women having their first birth demonstrated lower desire for control 31 and lower self‐efficacy 32 when compared with multiparous women.…”

“…Experiential knowing, gained from having a previous birth, promotes desire for decisional control during birth 31 . Women having their first birth demonstrated lower desire for control 31 and lower self‐efficacy 32 when compared with multiparous women. However, women having their first birth also describe feeling empowerment resulting from being able to stay home in early labor, which translated to making informed choices during the birth process 23 …”