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The Labor Agentry Scale Control in Childbirth

The Labor Agentry Scale Control in Childbirth. European Perinatal Epidemiology Network Measuring the outcome of pregnancy in Europe 3 rd October 2003, Oxford . Jane Sandall Jane.sandall@kcl.ac.uk. Background. Increasing emphasis on control in childbirth in UK maternity policy

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The Labor Agentry Scale Control in Childbirth

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  1. The Labor Agentry ScaleControl in Childbirth European Perinatal Epidemiology Network Measuring the outcome of pregnancy in Europe 3rd October 2003, Oxford Jane Sandall Jane.sandall@kcl.ac.uk

  2. Background • Increasing emphasis on control in childbirth in UK maternity policy • Control used as a measure of ‘quality’ • Need to assess psycho-social childbirth outcomes in addition to morbidity and mortality in research • Seen as desirable in both natural and technocratic birth settings Davis-Floyd 1994, SocSciMed 38,8:1125 Viisainen 2000, SocSciMed, 52:1109

  3. Psychological theories Locus of control (Wallston & Wallston 1978) Self-efficacy theory (Bandura 1977) Sociological theories Sense of coherence (Antonovsky 1987) How Has Control Been Defined?

  4. What Does It Mean? • Differing views about value of control in childbirth and what this means • Objective and subjective component • Mastery • Control of self, of others, to let go of control? • Is control a good thing?

  5. Why Is Control Important? • Short term effects • Long term effects • Key component of satisfaction with birth and assessment of the quality of care women receive

  6. Labor Agentry Scale Hodnett ED, Simmons-Tropea DA (1987) The Labour Agentry Scale: Psychometric Properties of An Instrument Measuring Control During Childbirth. Research in Nursing and Health 10:301-310

  7. Labor Agentry Scale • 29 item scale, single underlying factor relating to mastery and sense of control, high internal reliability • 10-item inventory including six positive and four negative descriptions of the perceived degree of control experienced during childbirth. • Women ranked the items on a 7-point scale from (1) ‘almost all of the time’ to (7) ‘never, or almost never’. • High score = high control • High internal consistency in previous studies of 29 item LAS (alpha = 0.91-0.98).

  8. Review of Studies: Labour Agentry Scale

  9. Validity & Reliability of LAS in the UK • Not been used in the UK previously • Factor analysis used to assess whether the LAS had the intended factor structure in relation to UK sample. • An initial two-factor model emerged, reflecting the negative and positively worded questions respectively. • The 10 item LAS had a Cronbach’s Alpha reliability of 0.84.

  10. Factors Related to Control • Expectations • Social support • Place of birth • Low levels of obstetric intervention

  11. What Is It Measuring? • Underlying concept? • Underlying assumptions? • Discriminating ability?

  12. Conclusions • Control in childbirth is important to women • Associated with high levels of satisfaction and positive appraisal of quality of care • Underlying assumption that control associated with ‘natural’ birth? • Discriminant ability? • Prediction of longer term outcomes? • Validity and reliability in other cultures?

  13. Further Questions • Causal relationship? • Confounding factors? • Does perceived high control in childbirth have a halo effect? • Do women who want and get technocratic birth have high levels control? • What is relationship with postnatal well being and longer term outcomes • Validity in non-white groups and different social classes

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