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      Mothers’ and fathers’ sense of security in the context of pregnancy, childbirth and the postnatal period: an integrative literature review

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          From the individual perspective, security, which is essential to life quality, is characterised as an elementary human need that requires fulfilment. During the transition to parenthood, mothers and fathers are confronted with changes in physical and psychosocial processes that are accompanied by uncertainty and insecurity. Feelings of insecurity may have consequences affecting their pregnancy and childbirth experiences as well as their adaption to the parental role in the first weeks following childbirth. In this context, it is important to understand how parents express and interpret their sense of security to effectively support their security needs. This integrative review aimed to provide a critical synthesis of existing research on parents’ experiences of their sense of security associated with pregnancy, childbirth and the postnatal period.


          A literature search of the PubMed, CINAHL, PsycINFO and GESIS Sowiport databases was performed. Peer-reviewed papers that were published in English or German between 1990 and 2017 focusing on mothers’ and fathers’ experiences of sense of security in the context of maternity care were included. A thematic analysis was performed to organise and describe the findings.


          Eleven research-based papers met the inclusion criteria. Four key themes among the data were analysed: the meaning and manifestation of sense of security, sense of security in relation to confidence and control, lack of feeling secure and coping strategies, and factors influencing sense of security.


          The findings revealed a complex profile of the perception of security associated with pregnancy, childbirth and the postnatal period. Sense of security can depend on multiple internal and external factors, which can differ between mothers and fathers. Research on the experiences and perceptions associated with fathers’ sense of security is lacking. Further research focused on the experiences of security from the parents’ perspective is necessary. Midwives and other involved health professionals should be aware of their role in creating a sense of security among parents. Based on a local specific understanding of security experiences, professional caregivers have the opportunity to support parents more effectively with regard to their specific security needs.

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          Most cited references 73

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          Towards an International Classification for Patient Safety: key concepts and terms

          Background Understanding the patient safety literature has been compromised by the inconsistent use of language. Objectives To identify key concepts of relevance to the International Patient Safety Classification (ICPS) proposed by the World Alliance For Patient Safety of the World Health Organization (WHO), and agree on definitions and preferred terms. Methods Six principles were agreed upon—that the concepts and terms should: be applicable across the full spectrum of healthcare; be consistent with concepts from other WHO Classifications; have meanings as close as possible to those in colloquial use; convey the appropriate meanings with respect to patient safety; be brief and clear, without unnecessary or redundant qualifiers; be fit-for-purpose for the ICPS. Results Definitions and preferred terms were agreed for 48 concepts of relevance to the ICPS; these were described and the relationships between them and the ICPS were outlined. Conclusions The consistent use of key concepts, definitions and preferred terms should pave the way for better understanding, for comparisons between facilities and jurisdictions, and for trends to be tracked over time. Changes and improvements, translation into other languages and alignment with other sets of patient safety definitions will be necessary. This work represents the start of an ongoing process of progressively improving a common international understanding of terms and concepts relevant to patient safety.
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            Experience of labor and birth in 1111 women.

            The association between women's overall experience of labor and birth and a range of possible explanatory variables were studied in a group of 1111 women who participated in a birth center trial. Data were collected by a questionnaire in early pregnancy (demographic background, parity, personality traits, and expectations), hospital records (pharmacological pain relief, induction, augmentation of labor, duration of labor, operative delivery, and infant outcome), and a follow-up questionnaire 2 months after the birth (the principal outcome "overall experience of labor and birth," pain, anxiety, freedom in expression, involvement, midwife, and partner support). Logistic regression was conducted by including all variables that were associated with the birth experience when analyzed one by one. In a second regression analysis, only explanatory variables measured independently of the principal outcome were included; that is, only data collected from the pregnancy questionnaire and the hospital records. The first regression analysis identified five explanatory variables: involvement in the birth process (perceived control) and midwife support were associated with a positive experience; anxiety, pain, and having a first baby with a negative experience. Parity remained a significant predictor in the second regression analysis, but the others were replaced by augmentation of labor, cesarean section, instrumental vaginal delivery, and nitrous oxide (Entonox), which were all associated with a negative birth experience.
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              Self-efficacy for labor and childbirth fears in nulliparous pregnant women.

               Jamie N Lowe (2000)
              In this secondary analysis, the relationship between self-efficacy for labor and childbirth fears in healthy nulliparous women was investigated during the third trimester of pregnancy. The sample consisted of 280 predominantly white, well-educated, middle-class nulliparae enrolled in childbirth classes. Consistent with Bandura's self-efficacy theory, outcome expectancies for childbirth were unrelated to childbirth fears while self-efficacy expectancies were significantly correlated with childbirth fears. When the sample was divided into a low-fear and a high-fear group, significant differences were found between groups on a number of psychological variables. The women in the high-fear group were characterized by significantly higher learned helplessness, chance health locus of control and powerful others health locus of control, and significantly lower self-esteem and generalized self-efficacy. The most common fears of the high-fear women were of losing control during delivery, of the birth itself, of something being wrong with the baby and of painful contractions.

                Author and article information

                BMC Pregnancy Childbirth
                BMC Pregnancy Childbirth
                BMC Pregnancy and Childbirth
                BioMed Central (London )
                4 December 2018
                4 December 2018
                : 18
                [1 ]ISNI 0000 0000 9024 6397, GRID grid.412581.b, Faculty of Health, Department of Nursing Science, , Witten/Herdecke University, ; Stockumer Strasse 12, 58453 Witten, Germany
                [2 ]Research Group `FamiLe – Family Health in Life Course`, Witten and Osnabrück, Germany
                [3 ]ISNI 0000 0001 1864 9826, GRID grid.434095.f, Faculty of Business Management and Social Sciences, Osnabrück, , Osnabrück University of Applied Sciences, ; Germany, P.O. Box: 1940, 49009 Osnabrück, Germany
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funded by: German Federal Ministry of Education and Research
                Award ID: FKZ: 01KX1113A and FKZ: 01KX1113B
                Award Recipient :
                Research Article
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                © The Author(s) 2018


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