434 17 2266 2 7909 document 2266 BORDaR RETHINK Study raw data anonymised.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet 957741a6916d1dd6cea21db9fab3e313 MD5 705324 2025-01-31 11:43:43 https://bordar.bournemouth.ac.uk/434/1/BORDaR%20RETHINK%20Study%20raw%20data%20anonymised.xlsx 434 1 1 application/vnd.openxmlformats-officedocument.spreadsheetml.sheet spreadsheet en public cc_by_nd_4

BORDaR RETHINK Study raw data anonymised.xlsx

full_archive archive 5363 disk0/00/00/04/34 2025-02-10 14:14:53 2025-11-04 16:12:21 2025-02-10 14:14:53 data_collection show Bartholomew Vanessa vbartholomew@bournemouth.ac.uk pub ihcs Early, latent, labour, pain, catastrophising, hospital, admission Background: Women experiencing an uncomplicated pregnancy are at increased risk of interventions if admitted to hospital during the latent phase of labour. Women expecting their first child (nulliparous) are more likely to be admitted during the latent phase than women who have had one (primiparous) or more babies (multiparous). Pain and fear are cited as significant factors in early hospital admissions. Some women may have exaggerated, negative cognitions for their pain experience, which have been referred to as pain catastrophising. To date there have been no studies that have sought to use a screening tool to identify pain catastrophising in pregnancy and to understand if a positive screening result influences when nulliparous women seek hospital admission in labour. Study aim: The primary aim of this study was to determine the prevalence of pain catastrophising in a population of nulliparous women who were experiencing an uncomplicated pregnancy, and to determine whether pain catastrophising had an impact on their timing of admission to hospital when they were in labour. Method: This was a longitudinal cohort study. Nulliparous women, experiencing an uncomplicated pregnancy in England, were recruited between 25-33 weeks gestation. Participants completed two online questionnaires, (1) on recruitment, (2) at three weeks postnatal. The antenatal questionnaire included the Pain Catastrophizing Scale (PCS) and the Wijma Delivery Expectancy Questionnaire (WDEQ-A) to detect fear of childbirth (FOC). Results: A total of 389 eligible participants entered the study. Pain catastrophising scores of ≥20 and ≥30 were considered. There were 28.1% of women who indicated PCS scores ≥20 and 7.6% who were in the group with PCS scores ≥30. There was no significant association between pain catastrophising and the timing of hospital admission. The percentage of women reporting FOC (WDEQ-A score ≥85) was 10.6%. FOC (WDEQ-A score ≥85) was highly associated with PCS scores (p<.001) at both the lower (≥20) and higher (≥30) thresholds. Other significant associations were found between pain catastrophising and the variables of ethnicity, age, antenatal pain, and postnatal mental health issues. Discussion: Although there was no significant association found between pain catastrophising and the timing of hospital admission, there was a tendency identified for women who pain catastrophise to present to hospital for admission during the latent phase of labour. Since FOC is known to be associated with latent phase admission, the highly significant association between PCS and WDEQ-A scores has implications for the identification of these women. The findings suggest that the PCS can be used as a screening tool to identify those women who have exaggerated, negative cognitions around pain and who may also go on to develop clinically relevant FOC. Further studies are needed to confirm the acceptability of the PCS as a screening tool with women, and to confirm the tendency that women who pain catastrophise are more likely to present to hospital for admission during the latent phase of labour. 2025-02-10 published Bournemouth University 10.18746/bmth.data.00000434 Mixed Vanessa Bartholomew bordar@bournemouth.ac.uk Chief Investigator Bartholomew Vanessa vbartholomew@bournemouth.ac.uk pub https://doi.org/10.1016/j.srhc.2023.100941. DOI https://www.sciencedirect.com/science/article/pii/S1877575623001313?via%3Dihub pub Sexual & Reproductive Healthcare Original scores collected for the Fear of Childbirth have been included in the dataset as have the adjusted scores, as per the designers of this questionnaire (Wijma et al 1998) instructions. These adjusted scores were used in the analyses. (Wijma, K., Wjma, B. and Zar, M., 1998. Psychometric aspects of the W-DEQ; a new questionnaire for the measurement of fear of childbirth. Journal of Psychosomatic Obstetrics and Gynaecology, 19 (2), 84-97). Wessex Integrated Clinical Academic Training Programme Dorset County Hospital NHS Foundation Trust "Study Design This was a longitudinal cohort study. Over an 18 month period data were collected via two online questionnaires, one antenatal and one postpartum, and by retrieving participants’ routinely collected birth data from participating sites’ digitally held records. Setting All National Health Service (NHS) Hospitals in England with an obstetric maternity unit, or alongside midwife-led units, or stand-alone midwife-led units were eligible to participate. A total of 24 primary care NHS Hospitals (sites) across England chose to be included. Participant recruitment took place concurrently at multiple independent sites. The study opened to participant recruitment and data collection at the first participating site on 31st December 2020. This was following a delay caused by research measures imposed in the United Kingdom (UK) to help tackle the novel coronavirus pandemic. Data collection closed 30th June 2022. Study Population Eligibility Criteria This study aimed to recruit healthy nulliparous women between 18 and ≤40 years of age, experiencing an uncomplicated pregnancy, and planning a hospital birth. Participants were required to understand and read English, be between 25 and 33 weeks and 6 days gestation and have internet access and an email address for study correspondence. The age range was chosen to reflect the study focus on uncomplicated pregnancies. Women outside this age range are more likely to require medical assessment, intervention or, at the lower age range require additional support. Women who chose to take up the invitation to be included accessed the study online either by themselves or with the assistance of the midwife researcher. Exclusion Criteria Women who were under ongoing care from an obstetrician, aged 41 or over, with current or pre-existing mental health condition requiring current medication or specialised care, or already participating in a study providing pain management or labour support interventions were excluded. Sampling Method, Sample Size The sampling technique was nonprobability, convenience sampling. The sample size was determined by considering previous studies that used the PCS as an assessment tool [12,16,17]. Studies have used various cut-off scores of between ≥20 [12,16] and ≥30 [12,17] for diagnosis of pain catastrophising. Considering a 47.5% prevalence of pain catastrophising found in a non-pregnant population using the cut-off point of ≥20 [12], a cut-off point also used with a pregnant population [16], a power calculation determined the sample size of 384 participants which would give us 90% power to determine association with hospital admission. This study aimed to recruit 768 women to allow for potential loss to follow-up or changes in risk status from low to high during the antenatal period. The Measures Demographics The demographic profile of participants helped provide context which aided understanding about the findings from this study. Demographic details, included: • Relationship/Marital status • Ethnicity • Employment status • Highest level of education achieved Supplement contextual questions included: • If they had ever been pregnant before but unfortunately suffered a miscarriage or termination of pregnancy before 24 weeks pregnant • Their current gestation • A brief pain experience history, including antenatal pain level using an 11 point Numerical Rating Scale (NRS) for intensity ratings from 0 (no pain) to 10 (very severe pain). The NRS was chosen for its reliability and because it is easy to administer and score [18] The Pain Catastrophising Scale (PCS) The PCS is one of the most widely used psychometric measures of catastrophic thinking linked to pain [8,17,19]. The PCS is a self-report measure developed for both clinical and non-clinical use. It is composed of 13 items based on catastrophising definitions described in the literature, and previous experimental and clinical research on catastrophic thinking in connection to pain experience [17]. PCS scores have been found to correlate with other health measures, including pain intensity, pain-related disability, and psychosocial distress [20]. The 13 items are divided into three dimensions (subscales): helplessness, magnification and rumination. The correlational relationship between these dimensions has been replicated in several investigations demonstrating internal consistency and validity of the three subscales with total PCS Cronbach’s coefficient alphas = 0.87, rumination = 0.87, magnification = 0.66, and helplessness = 0.78 [21] and it has a high test-retest correlation of r=0.75 across 6 weeks [17]. For each of the 13 items participants are required to reflect on past painful experiences and score their thoughts or feelings on a 5-point Likert scale between “not at all” (score 0), and “all the time” (score 4). The highest possible total score is 52. The higher the score the greater the catastrophic thinking. Although pain catastrophising scores have been shown to be normally distributed, the PCS developers have predominantly taken a score of 30 or more to determine pain catastrophising as clinically relevant [17] with other studies finding lower cut-off scores are clinically relevant [16]. The Wijma Delivery Expectancy Questionnaire WDEQ-A The Wijma Delivery Expectancy Questionnaire Part A (WDEQ-A) [22] asks women about their cognitive and emotional beliefs about childbirth. It is a self-report measure with 33 items, each item rated on a 6-point Likert scale ranging from ‘‘not at all’’ to ‘‘extremely’’. The minimum total score is 0 and the maximum is 165. The higher the score the greater the fear with a cut-off point of 85 or above indicating clinically relevant FOC [10,23]. The internal consistency of the WDEQ-A has been found to be strong with a Cronbach’s coefficient alpha of 0.87 [22] and 0.94 [10]. Although the WDEQ-A has been criticised for its multidimensionality [24] and its phraseology for use with UK women [25], the WDEQ-A was chosen in the absence of a more fitting measure of FOC. It is perceived by women as a thorough tool which captures most of women’s fears [25] and has demonstrated good reliability and validity [26]. It is one of the most widely used tools worldwide in assessing FOC [26,27] and has also shown to correlate well with other FOC measures in identifying high childbirth fear in first time mothers, previous emergency caesarean and women with self-reported anxiety and/or depression [10]. Postnatal Questionnaire (PNQ) Participants were asked to complete a second online survey at approximately 3 weeks postpartum, or 3 weeks after their expected due date if they had their baby early. The majority of woman completed the PNQ between 21-28 days. Prior to its use the postnatal questionnaire was pretested with four pregnant women, two birthing partners, two non-pregnant multiparous women of childbearing age, four maternity support workers and nine clinical maternity experts. For this study participants were asked to provide data on their latent phase (which is not routinely collected in the NHS), including cervical dilatation on admission. Recruitment A pragmatic approach was taken for participant recruitment allowing sites to use various methods such as posters, social media, or direct invitation by relevant staff, or a combination of methods." V Bartholomew, V Hundley, C.J Clark, B.A Parris, The RETHINK Study: Could pain catastrophising explain why some women are more likely to attend hospital during the latent phase of labour, Sexual & Reproductive Healthcare, Volume 39, 2024, 100941, ISSN 1877-5756, https://doi.org/10.1016/j.srhc.2023.100941. The risk of disclosing participants' identities was mitigated by removing references to real names and other identifying information. 2020-12-31 2022-06-30