The impact of choice of maternity care on psychological health outcomes for women during pregnancy and the postnatal period
Article first published online: 26 MAR 2008
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd
Journal of Evaluation in Clinical Practice
Volume 14, Issue 3, pages 391–398, June 2008
How to Cite
Jomeen, J. and Martin, C. R. (2008), The impact of choice of maternity care on psychological health outcomes for women during pregnancy and the postnatal period. Journal of Evaluation in Clinical Practice, 14: 391–398. doi: 10.1111/j.1365-2753.2007.00878.x
- Issue published online: 26 MAR 2008
- Article first published online: 26 MAR 2008
- Accepted for publication: 11 January 2007
- maternity care;
- psychological outcomes
Rationale Psychological factors are acknowledged to impact on pregnancy, birth, neonatal outcomes and maternal mental health. The importance of psychological well-being is now recognized within maternity care and UK maternity policy advocates choice and control, equating this to increased quality of experience and improved psychological outcomes. There remains, however, lack of substantive and consistent evidence with regard to the psychological benefits of choice in maternity care. The aim of this study is to investigate the impact of choice of maternity care on psychological health outcomes.
Methods 165 antenatal women were recruited and sampled according to their choices for care. Women were assessed utilizing the Hospital Anxiety and Depression Scale (HADS), Edinburgh Postnatal Depression Scale (EPDS), Cambridge Worry Scale (CWS), Multidimensional Health Locus of Control (MHLC), SF-36, Pittsburgh Sleep Quality Index (PSQI) and Culture Free Self-esteem Inventory (CFSEI) at 12 and 32 weeks pregnant and 14 days and 6 months postnatal.
Results No significant differences between groups were revealed on any of the scales or subscales measured. Significant and corresponding differences were identified within groups over time for CWS socio-medical worries, MHLC ‘powerful others’, SF-36 bodily pain, vitality personal health and change in health, PSQI global sleep. An interaction effect for CFSEI general and social self-esteem was revealed between birth centre and midwifery-led care/main unit women at 14 days postnatal.
Conclusions These results demonstrate that pregnancy represents a psychological challenge regardless of care type chosen and choice of no one care option confers greater psychological benefit across the maternity experience as a whole. It is possible, however, that differences in experience or environment at critical times can affect psychological status.