The Labor Agentry Scale Control in Childbirth

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The Labor Agentry Scale Control in Childbirth
European Perinatal Epidemiology Network Measuring
the outcome of pregnancy in Europe 3rd October
2003, Oxford

• Jane Sandall
• Jane.sandall_at_kcl.ac.uk

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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 38,81125 Viisainen
2000, SocSciMed, 521109
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How Has Control Been Defined?

• Psychological theories
• Locus of control (Wallston Wallston 1978)
• Self-efficacy theory (Bandura 1977)

• Sociological theories
• Sense of coherence
• (Antonovsky 1987)

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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?

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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

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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 10301-310
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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).

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Review of Studies Labour Agentry Scale
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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 Cronbachs Alpha
  reliability of 0.84.

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Factors Related to Control

• Expectations
• Social support
• Place of birth
• Low levels of obstetric intervention

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What Is It Measuring?

• Underlying concept?
• Underlying assumptions?
• Discriminating ability?

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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?

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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