Psychological aspects of communication, anxiety and satisfaction in obstetrics
Communication, anxiety and satisfaction during pregnancy was examined. Ley (1977) presents a cognitive model to explain satisfaction and its links with understanding. Janis (1958, 1971) notes a curvilinear relationship between anxiety and post-operative coping and postulates that information, anxiety and cognitive preparation are the variables accounting for this. Kumar and Robson note that obstetric anxiety is related to concerns for maternal and infant well being rather than irrational anxiety. This study examined the experience of women, stressors, communication satisfaction, knowledge and information and looked at the extent to which these three theories could interrelate to provide a fuller explanation of the psychological experience of women. Five studies were undertaken. Initially a pilot study revealed many negative statements about communication when transcripts were analysed. Communication factors and anxiety laden instances were correlated. The next study was set up to examine knowledge levels as Ley predicts that these, together with misunderstandings could contribute to dissatisfaction. Desire for knowledge was high. Knowledge varied according to social class but not parity. Doctors felt parity would be a factor. Women had difficulty approaching their doctor for information yet still desired doctors as their primary information source. Doctors delegated much information imparting to classes. Study three examined anxiety, communications and satisfaction in labour with pain management (a noted stressor in study 1). Patients receiving Pethidine were dissatisfied. Their pain experience did not differ markedly,but their psychological preparation did. In study 4 anxiety and outcome was monitored, together with information gathering strategies. Linear, rather than curvilinear relationships were found (unlike those predicted by Janis). The course of anxiety was a useful measure and the impact of anxiety on caregivers in the cycle of communications and recovery were explored. The final study looked at the impact of intervention on anxiety and satisfaction in ante-natal care. Women were randomly allocated to groups receiving no intervention, information and information plus feedback. The latter group had significantly lower post-consultation anxiety and higher satisfaction than the other two. The role of knowledge and accuracy in relation to satisfaction was explored. Kumar and Robsons propositions about anxiety were supported in these studies. Ley's cognitive model contributed much to the understanding but limitations in this model are explored, especially in relation to process and interaction factors and the routes to understanding. Janis' curvilinear relationship was not upheld, but his theoretical explanations involving the use of information and worry needs further testing.