Childbirth Self Efficacy Inventory

Archived User

Childbirth Self Efficacy Inventory
Nancy Lowe developed a self-efficacy tool for identifying women who may need additional childbirth education as a way to improve their self-efficacy about birth. This is especially interesting to me since I believe that factual information is required but insufficient to change our birth culture. The following citation refers to a study which showed that women who chose repeat cesarean section scored lower than those who chose VBAC. Dilks FM, Beal. Role of self-efficacy in birth choice. J Perinat Neonatal Nurs. 1997 Jun;11(1):1-9 I would like to know if this same tool could identify women who would prefer home, birth center, or hospital births, or women who believe in the importance of technology or physicians versus her own body. Does anyone know of any other applications of this tool published anywhere? Or have ideas of how to go about studying this? It would be great to be able to predict whether a mother is really truly going to be happy afterwards with a hospital or home birth. Or target women with additional resources who may then change their plans for birth environment or birth attendant. Tienchin Ho

Henci Goer

RE: Childbirth Self Efficacy Inventory
(in response to Archived User)

I think this is an interesting idea, and I agree that information is not enough. In fact, one of my talks is on the many factors that may impede a woman from making optimal choices for herself and her baby from the context of her own value system. However, there is a problem with any tool that tries to connect women's preferences with the degree to which the women are inner or outer directed: Regardless of whether a woman is normally self-actualizing or tends to look to others, pregnancy puts her in the position of needing to rely on those she assumes to be experts on issues where the stakes are high for the choices she makes. This makes it particularly difficult to override what the culture and those experts tell her even if she would ordinarily be inclined to trust her instincts.

The study you cite illustrates this problem. It assumed that women were choosing VBAC or repeat cesarean based on their own predilections. I have several studies of women's choice around VBAC carried out during the first wave of VBAC activism in the 1980s. Some women chose VBAC and most chose repeat cesareans, but no woman chose VBAC if her physician opposed it, some women who wanted a VBAC were talked out of it, and the reasons women chose repeat cesarean surgery were mostly based on misinformation about about the comparative risks of VBAC vs. repeat surgery.  

-- Henci

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