Conceptual analysis and empirical test of multi-dimensional perceptions of control in childbirth

Abstract

Background: Perceptions of control play a major role in many health psychology theories. Their definitions and methods of assessment greatly vary. Our aim was to test a multidimensional conceptualization of perceived control, adapted to the context of childbirth. We developed a model and an instrument based on Walker's (2001) unifying theory of control (including self and medical staff control), combined with anticipated and desired control of each type. Methods: Pregnant women (N=850) filled in questionnaires including: Perceptions of self- control over the process of childbirth and over the staff and the surroundings and perceptions of staff control over childbirth (each set repeated twice, for anticipated and desired control); their intentions regarding a variety of natural choices during childbirth; and fear of birth. We conducted factor analyses and regression models (using PROCESS for interactions). Findings: Greater desired and anticipated staff control, less desired and anticipated self-control of the birth surroundings, were significantly related to more fear of birth and fewer natural birth choices; anticipated self-control of the birth process showed opposite associations. Desired and anticipated staff control significantly interacted: Only when desired staff control was low, higher anticipated staff control was related to more natural birth choices. Incongruent desired/anticipated perceptions of staff control were related to fear of childbirth. Discussion: The findings illustrate the importance of attending to the full complexity of control perceptions when attempting to understand women's perspectives on childbirth. The multi-dimensional conceptualization of control developed here could help understand individuals' views of other health events and medical procedures.