Wednesday, 23 April 2014

The Birth Satisfaction Scale (BSS)

Prof Caroline J. Hollins Martin PhD MPhil BSc PGCE PGCC ADM RM RGN
To obtain the BSS and marking grid email:

Measuring women’s experiences of childbirth can be achieved using a valid and reliable instrument. For this purpose a psychometric scale called the 10-item-Birth-Satisfaction-Scale-Revised (10-item-BSS-R) has been developed. Two versions of the scale are now available for use in projects intended to evaluate childbearing women’s experiences of childbirth:

(1)   The psychometrically robust, valid and reliable 10-item-BSS-R from which scores can be correlated with other validated measures (e.g., pain, depression, self-efficacy scales).

(2)   The qualitative 30-item-Birth-Satisfaction-Scale-Long-Form (30-item-BSS-LF) designed to assess individual women’s experiences for purpose of debriefing, before counselling or prior to in-depth qualitative work.

What is birth satisfaction?
Every woman constructs expectations of childbirth with variation in appreciating the concept. Literature supports that birth satisfaction includes:
          having one’s comfort considered
          being listened too
          receiving the type of pain relief requested
          coping well during labour
          feeling in control
          being well-prepared
          receiving minimal obstetric injuries
          achieving the desired style of delivery
Within the confines of safety, birth satisfaction is about attempting to provide women with what they want during labour. Three overarching themes identified in the literature are important when measuring birth satisfaction:
(1)   Quality of care provision
(2)   Personal attributes
(3)   Stress experienced during labour
These 3 themes are divided into sub-themes that underpin the questions asked on the 30-item-BSS-LF 

Scale development paper:
Hollins Martin, C.J., Fleming, V. (2011). The Birth Satisfaction Scale (BSS). International Journal of Health Care Quality Assurance. 24(2):124-135.

Qualitative validation of the themes and sub-themes that underpin the 30-item-BSS-LF was carried out using a research method called concurrent analysis.

Qualitative validation reference
Hollins Martin, C.J., Snowden, A., Martin, C.R. (2012). Concurrent analysis: validation of the domains within the Birth Satisfaction Scale. Journal of Reproductive and Infant Psychology. 30(3):247-260. 

Evaluation of key psychometric properties of the 30-item-BSS-LF
For the purpose of psychometric testing of statements on the 30-item-BSS-LF, a quantitative survey was carried out at Ayrshire Maternity Unit (AMU) in Kilmarnock (West of Scotland, UK). Participants included a convenience sample of women (n=228) <10 days post-delivery. Key psychometric properties of the 30-item-BSS-LF were evaluated using Exploratory Factor Analysis (EFA) and Structural Equation Modelling techniques (SEM).
Post psychometric analysis of the items on the 30-item-BSS-LF, the scale was reconfigured into the 10-item-BSS-R, which comprises 3 sub-scales that measure distinct but correlated domains of: (1) quality of care provision (4-items), (2) women’s personal attributes (2-items), and (3) stress experienced during labour (4-items)

Psychometric report paper
Hollins-Martin, C.J., Martin, C. (2014). Development and psychometric properties of the Birth Satisfaction Scale-Revised (BSS-R). Midwifery.

The validated 10-item-BSS-R is a robust questionnaire that can be used to measure birth satisfaction post birth. The BSS can be used to collect data both nationally and internationally, with results potentially correlated with other validated measures. In contrast, the 30-item-BSS-LF may be used to assess individual women’s views of their birth experience prior to counselling or in-depth qualitative work. If you would like to use either scale please contact: The first author would be interested in working with researchers who are willing to translate the scale into other languages to make it available for wider use. 

Friday, 24 January 2014

Diet and nutrition in the menstrual cycle, periconception and fertility



Hollins-Martin,C.J., van den Akker, O.B.A., Martin, C.R., Preedy, V.R. (Eds.). (2014). Handbook of diet and nutrition in the menstrual cycle, periconception and fertility. Human Health Handbooks no.7. Wageningen Academic Publishers, The Netherlands. ISBN: 978-90-8686-212-2

Published: 15th January 2014 by Human Health Handbooks - 566 pages

The reproductive cycle in women is complex and can be considered to begin with epigenetic programming and ending with menopause. Intervening steps involve a variety of processes, including the cellular development of the sex organs, menarche, episodic endocrine cycles, menstruation, ovulation and conception. These processes can be influenced by diet and nutrition and vice versa. Body composition has an impact on the menstrual cycle and periconception and these factors in turn also influence body composition. Similarly, either food deprivation, dietary excess or obesity can result in marked changes in the menstrual cycle with a concomitant effect on fertility. This handbook is the first scientific source that provides a comprehensive overview of the relationship of diet and nutrition with puberty, menarche and menstrual cycle, conception and fertility and infertility. The handbook of diet and nutrition in the menstrual cycle, conception and fertility will benefit dieticians, nutritionists, gynaecologists, endocrinologists, obstetricians, paediatricians and those concerned with women's health in general.

Thursday, 14 November 2013

Nutrition and diet in menopause

Hollins Martin, C.J., Watson, R.R., Preedy, V.R. (Eds.). (2013) Nutrition and diet in menopause. Humana Press, London (UK).
Published: 20th June 2013 by Humana Press - 469 pages

Nutrition and Diet in Menopause is a single comprehensive source that will provide readers with an understanding of menopause. Holistic in its approach, this volume is divided into five sections covering psychological, endocrine and lifestyle factors, metabolism and physiology, bone and nutrition, cancer and nutrition, cardiovascular factors and dietary supplements in menopause. In-depth chapters review the potential long term consequences of menopause on the overall health of women, not only at the physical level including hot flushes (flashes), alterations to the genitourinary system, skin changes, decreased cardiovascular functions, hypertension, headache, back pain, and constipation. Written by international leaders and trendsetters, Nutrition and Diet in Menopause is essential reading for endocrinologists, cardiologists, nutritionists and all health care professionals who are interested in women’s health. 
 About my co-editors:

Professor Ron Watson, PhD works in the Department of Health Promotion Sciences, at the University of Arizona's Mel and Enid Zuckerman College of Public Health. He has edited 88 biomedical books, particularly in nutrition and food sciences. He published 450 papers, and presently directs several NIH funded biomedical grants relating to bioactive disease particularly immune function and cardiovascular effects including studying complementary and alternative medicines. Professor Ronald Ross Watson was Director of a National Institutes of Health funded Alcohol Research Center for 5 years. The main goal of the Center was to understand the role of ethanol-induced immunosuppression on immune function and disease resistance in animals. He is an internationally recognized alcohol-researcher, nutritionist and immunologist. He also initiated and directed other NIH-associated work at The University of Arizona, College of Medicine. Dr. Watson has funding from companies and non-profit foundations to study bioactive foods' components in health promotion. Professor Watson attended the University of Idaho, but graduated from Brigham Young University in Provo, Utah, with a degree in Chemistry in 1966. He completed his Ph.D. degree in 1971 in Biochemistry from Michigan State University. His postdoctoral schooling was completed at the Harvard School of Public Health in Nutrition and Microbiology, including a two-year postdoctoral research experience in immunology. Professor Watson is a distinguished member of several national and international nutrition, immunology, and cancer societies. He has been doing studies of dietary supplements in treatment of diabetes and related cardiovascular disease including heart failure.

Professor Victor R. Preedy BSc, PhD, DSc, FSB, FRCPath, FRSPH, FRSC is a senior member of King's College London (Professor of Nutritional Biochemistry) and King's College Hospital (Professor of Clinical Biochemistry).  He is attached to both the Diabetes and Nutritional Sciences Division and the Department of Nutrition and Dietetics.  He is also Director of the Genomics Centre and a member of the School of Medicine.  Professor Preedy graduated in 1974 with an Honours Degree in Biology and Physiology with Pharmacology.  He gained his University of London PhD in 1981.  In 1992, he received his Membership of the Royal College of Pathologists and in 1993 he gained his second doctoral degree, for his outstanding contribution to protein metabolism in health and disease. Professor Preedy was elected as a Fellow to the Institute of Biology in 1995 and to the Royal College of Pathologists in 2000.  Since then he has been elected as a Fellow to the Royal Society for the Promotion of Health (2004) and The Royal Institute of Public Health (2004).  In 2009, Professor Preedy became a Fellow of the Royal Society for Public Health and in 2012 a Fellow of the Royal Society of Chemistry.  In his career Professor Preedy has carried out research at the National Heart Hospital (part of Imperial College London) and the MRC Centre at Northwick Park Hospital. He has collaborated with research groups in Finland, Japan, Australia, USA and Germany.  He is a leading expert on the science of health.  He has lectured nationally and internationally.  To his credit, Professor Preedy has published over 570 articles, which includes 165 peer-reviewed manuscripts based on original research, 100 reviews and over 50 books and volumes.   

Friday, 4 October 2013

Views about a fathers’ role during childbirth

We see a great deal of news about celebrities who during host shows talk about their children, but rarely their experiences of childbirth. Two particular favorites of mine are Antonio Banderas and Brad Pitt. This leads me to believe that such discussions are considered ‘taboo’ or ‘not cool’, along with pictures and discussions of women in labour and breastfeeding. However, almost all people will produce offspring.
For midwives, attending to the father must be considered part of providing family care. Delivering quality support to families embraces the 6 C’s advocated by the Department of Health (2012), which includes compassion, courage, competency, commitment, care and good communication. These integrally include family members.
In the West there is a contemporary expectation that ‘fathers’ should be present at the birth, with many unclear of their job description. In addition to painting the spare room he is also expected to provide his partner with support during her birth experience. A former RCM survey established that 98% of UK fathers want to participate at the birth, with the majority holding positive attitudes towards the impending event. Some fathers judged themselves as being on the periphery of events during labour and were unsure of their role. It would seem quite natural for a father to be nervous about his role, especially if it is his first time. He may lose sleep worrying over whether or not he will cope, in accord with the axiom ‘I have many worries and most of them never happen’.
The question I am asking is whether midwives do enough to allay fathers’ anxiety and to prepare him for his impending role. It is usual for a childbearing woman to discuss her ‘birth plan’ with her midwife, partner and friends and expectantly conversations should incorporate preparing the father for his impending role.
It is important for all parties to acknowledge each others wants and attitudes towards this life altering experience. If the quoted 98% of fathers want to be present at the birth, the remaining 2-3% don’t. What happens when this is voiced? How do we respond?
There is a dearth of evidence about the expressed requirements and fears of men in relation to birth, although research has shown that men’s fears are comparable to women’s. For example, risk of their partner or baby suffering and/or losing control. Advantages and disadvantages of the father being present at the birth is an under researched area. For example, one stated benefit is the potential for enhanced bonding with both mother and baby and the potential for developing sexual difficulties post birth, both of which are under researched areas.

What can midwives do to help?
In 2008, I developed a tool called the Birth Participation Scale (BPS), which midwives can use to prepare fathers for the birth. If you want to utilize this instrument then please contact me ( The BPS ascertains whether the father genuinely wants to attend the birth and if so gives the midwife indicators of how to help him plan his journey.

Wednesday, 12 June 2013

Shaping Bereavement Care in Midwifery Practice

Today Cristina Vasilica has kindly given some of her time to teach me how to blog. So here I am creating my first blog. To introduce myself. I am a Professor in Midwifery in the School of Nursing, Midwifery and Social Work (College of Health and Social Care) at the University of Salford (Greater Manchester). The picture below is of me holding baby Jamie McKay who is the son of a good friend of mine. He is alive, thriving and well.

I have several areas of academic interest, but today I will introduce just one - bereavement. Maternity health and social care professionals are often called upon to care for parents who have experienced a pregnancy loss or the death of an infant. In such circumstances, they are expected to interact with bereaved parents and their families in a supportive manner. Consequently, it is important that staff feel adequately prepared with strategies to deliver effective bereavement care. The Stillbirth and Neonatal Death Society (SANDS) recommends that all community health practitioners who support bereaved parents should have access to basic, post basic and in-service training to equip them to offer adequate care to such families. This has recently been endorsed by the Scottish Government’s guidance “Shaping Bereavement Care”, which called for improved training and support for all NHS staff working in this field. For many bereaved parents, the care that maternity health and social care professionals provide has a crucial effect on their response to a loss or death. Providing care to grieving parents can be demanding, difficult and stressful, with some professionals feeling ill equipped to provide appropriate help. In 2009, the National Maternity Support Foundation (NMSF) survey reported that the level of bereavement care delivered in a number of maternity units in the UK was inadequate. In response to the results of the NMSF (2009), I collaborated with a midwifery lecturer from Glasgow Caledonian University to write a book called “Bereavement Care for Childbearing Women and their Families”. This workbook has been designed to facilitate midwives, neonatal nurses and allied health and social care professionals with developing structured skills to deliver effective bereavement care. On completion of this workbook, the reader should be equipped with fundamental skills to support childbearing women, partners and families who have experienced childbirth related bereavement. At a national and international level, there is valuable information for a wide range of interested parties.

This book is now a course reader for a module to be delivered on line at Masters level in the University of Salford (School of Nursing, Midwifery and Social Work). In fact, there is a whole masters degree in midwifery/women's health available from the University of Salford that you can access from the comfort of your own home. This MSc is available at a national and international level. 

Earth Mother

The beautiful painting ‘Earth Mother’ on the front cover of this book was painted by Becca Marsh who has a BA(Hons) in Fine Art and was a Student Midwife at the University of Salford who qualified in September 2012. The painting was completed as part of the ‘The Art of Midwifery Project’, which is carried out in the third year of the midwifery degree program. The art project involves students creating positive images of pregnancy and birth. Thank you Becca. Details of the book follow:


Reference: Hollins Martin, C.J., Forrest, E. (2013) Bereavement care for
                   childbearing women and their families: an interactive workbook.  
                   Routledge, Abingdon, Oxon (UK).

Published: 12th July 2013 by Routledge – 168 pages

For many bereaved parents, the care provided by health professionals at birth – from midwives to antenatal teachers – has a crucial effect on their response to a loss or death. This interactive workbook is clearly applied to practice and has been designed to help practitioners deliver effective bereavement care. Providing care to grieving parents can be demanding, difficult and stressful, with many feeling ill equipped to provide appropriate help. Equipping the reader with fundamental skills to support childbearing women, partners and families who have experienced childbirth-related bereavement, this book outlines:

(1)   What bereavement is and the ways in which it can be experienced
in relation to pregnancy and birth
(2)   Sensitive and supportive ways of delivering bad news to childbearing
women, partners and families
(3)   Models of grieving
(4)   How to identify when a bereaved parent may require additional
support from mental health experts
(5)   Ongoing support available for bereaved women, their partners
and families
(6)   The impact on practitioners and the support they may require
(7)   How to assess and tailor care to accommodate a range of spiritual
and religious beliefs about death.

Written by two highly educated, experienced midwifery lecturers, this practical and evidence-based workbook is a valuable resource for all midwives, neonatal nurses and support workers who work with women in the perinatal period.