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Husby AE, Simpson MR, Dalbye R, Larsen M, Vanky E, Løvvik TS. Childbirth experiences in women with polycystic ovary syndrome: A cohort study. Acta Obstet Gynecol Scand 2024; 103:1092-1100. [PMID: 38366810 PMCID: PMC11103144 DOI: 10.1111/aogs.14800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/11/2024] [Accepted: 01/24/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Women with polycystic ovary syndrome (PCOS) have more pregnancy complications like gestational diabetes, hypertension, and preterm labor than other women. Metformin has been used in an attempt to improve pregnancy outcomes. Our study aims to explore childbirth experiences in women with PCOS compared with a reference population. It also explores the potential influence of metformin, obesity, pregnancy complications, and the duration and mode of birth on childbirth experiences. MATERIAL AND METHODS This study is a cohort study combining data from two randomized trials conducted in Norway, Sweden and Iceland. The PregMet2 study (ClinicalTrials.gov, NCT01587378) investigated the use of metformin vs. placebo in pregnant women with PCOS. The Labour Progression Study (ClinicalTrials.gov, NCT02221427) compared the WHO partograph to Zhang's guidelines for progression of labor and were used as the reference population. A total of 365 women with PCOS and 3604 reference women were included. Both studies used the Childbirth Experience Questionnaire (CEQ). Main outcome measures were total CEQ score and four domain scores. The CEQ scores were compared using Mann-Whitney U test for women in Robson group 1 with PCOS (n = 131) and reference women (n = 3604). CEQ scores were also compared between metformin-treated (n = 180) and placebo-treated (n = 185) women with PCOS, and for different subgroups of women with PCOS. RESULTS There was no difference in total CEQ score between women with PCOS and reference women-Wilcoxon-Mann-Whitney (WMW)-odds 0.96 (95% confidence interval [CI] 0.78-1.17). We detected no difference in CEQ scores between the metformin- and placebo-treated women with PCOS (WMW-odds 1.13, 95% CI 0.89-1.43). Complications in pregnancy did not affect CEQ (WMW-odds 1, 95% CI 0.76-1.31). Higher body mass index (WMW-odds 0.75, 95% CI 0.58-0.96), longer duration of labor (WMW-odds 0.69, 95% CI 0.49-0.96), and cesarean section (WMW-odds 0.29, 95% CI 0.2-0.42) were associated with lower CEQ scores in women with PCOS. CONCLUSIONS Women with PCOS experience childbirth similarly to the reference women. Metformin did not influence childbirth experience in women with PCOS, neither did pregnancy complications. Obesity, long duration of labor or cesarean section had a negative impact on childbirth experience.
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Affiliation(s)
- Anne Engtrø Husby
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Department of Obstetrics and GynecologySt Olav's University HospitalTrondheimNorway
| | - Melanie Rae Simpson
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Rebecka Dalbye
- Department of Obstetrics and GynecologyØstfold Hospital TrustGrålumNorway
- Department of Nursing and Health Promotion, Faculty of Health SciencesOslo Metropolitan UniversityOsloNorway
| | - Marit Larsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Department of Obstetrics and GynecologySt Olav's University HospitalTrondheimNorway
| | - Eszter Vanky
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Department of Obstetrics and GynecologySt Olav's University HospitalTrondheimNorway
| | - Tone Shetelig Løvvik
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Department of Obstetrics and GynecologySt Olav's University HospitalTrondheimNorway
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Huang Y, Zhong Y, Chen Q, Zhou J, Fu B, Deng Y, Tu X, Wu Y. A comparison of childbirth self-efficacy, fear of childbirth, and labor pain intensity between primiparas and multiparas during the latent phase of labor: a cross-sectional study. BMC Pregnancy Childbirth 2024; 24:400. [PMID: 38822235 PMCID: PMC11143632 DOI: 10.1186/s12884-024-06571-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/09/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Childbirth is a long-lasting physiological stress. As one of the main stressors, labor pain exists throughout the whole process. Childbirth self-efficacy is the confidence, or belief that they can manage pain during childbirth. This sense of self-efficacy determines how pregnant women deal with labor pain and enables them to regulate their behavior and actively deal with childbirth. However, the difference in pain sensitivity between single births (primiparas) and multiple births (multiparas) has rarely been investigated. OBJECTIVES This study is aimed at investigating self-efficacy, fear of childbirth, labor pain of primiparas and multiparas and exploring factors related to the perceived labor pain intensity of pregnant women. DESIGN Prospective cross-sectional study. SETTING(S) Labour and delivery in a large academic specialized hospital in Guangzhou, China. PARTICIPANTS A total of 347 women, (182 primiparas and 165 multiparas) were enrolled in the data analysis. Pain was assessed before cervical dilatation (cervical dilatation ≤ 3 cm for the first delivery and ≤ 2 cm for the second delivery). METHOD The general information of participants was obtained by questionnaire and obstetrical records of the subjects were obtained from the electronic medical records extracted from the electronic medical record system (EMRS). Childbirth self-efficacy, fear of childbirth (FOC) and labor pain were compared between primiparas and multiparas. Paired t-test, chi-square test, Mann-Whitney test, univariate and multivariate regression analysis were used to analyze labor pain between the two groups and investigate factors related perceived labor pain intensity. RESULTS The total scores related to fear of childbirth, fetal health, self-control, and labor pain injury of multiparas were notably reduced compared with primiparas (all P < 0.05). The perceived labor pain intensity and duration of the first stage of labor was reduced in the multipara group compared with the primipara group. The childbirth control sense of the multipara was better than that of the primipara. The perceived labor pain intensity was negatively correlated with advanced age (age ≥ 35 years), self-efficacy score, family support, and education (all P < 0.05). In contrast, the perceived labor pain intensity was positively correlated with tension, severe fear of childbirth, and anxiety (P < 0.05). Self-efficacy, gravidity, delivery cognition, and fear of childbirth were independent risk factors for the perceived labor pain intensity in the latent period (all P < 0.05). CONCLUSIONS Fear of childbirth is a predictor of perceived labor pain intensity. The extent of labor pain (minimum and maximum) can be predicted by the level of fear the expectant mother has. During the latent phase of labor, self-efficacy, fear of childbirth and labor pain are different between primiparas and multiparas.
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Affiliation(s)
- Yue Huang
- Department of Obstetrics, Guangzhou Women and Children Medical Center, Guangzhou Medical University, No.9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
| | - Yuehua Zhong
- Department of Obstetrics, Guangzhou Women and Children Medical Center, Guangzhou Medical University, No.9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
| | - Qiaozhu Chen
- Department of Obstetrics, Guangzhou Women and Children Medical Center, Guangzhou Medical University, No.9 Jinsui Road, Tianhe District, Guangzhou, 510623, China.
| | - Jun Zhou
- Department of Obstetrics, Guangzhou Women and Children Medical Center, Guangzhou Medical University, No.9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
| | - Bailing Fu
- Department of Obstetrics, Guangzhou Women and Children Medical Center, Guangzhou Medical University, No.9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
| | - Yongfang Deng
- Department of Obstetrics, Guangzhou Women and Children Medical Center, Guangzhou Medical University, No.9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
| | - Xianfang Tu
- Department of Obstetrics, Guangzhou Women and Children Medical Center, Guangzhou Medical University, No.9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
| | - Yingfang Wu
- Department of Obstetrics, Guangzhou Women and Children Medical Center, Guangzhou Medical University, No.9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
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Bjelke M, Oscarsson M, Thurn L, Palmér L. Nulliparous women's lived experiences of the prolonged passive stage of labour: A thematic analysis based on descriptive phenomenology. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 41:100985. [PMID: 38823161 DOI: 10.1016/j.srhc.2024.100985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/10/2024] [Accepted: 05/24/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Prolonged progress can occur in the first and second stages of labour and may contribute to a negative birth experience. However, previous studies have mainly focused on quantitative aspects or overall birth experience, and little is known about women's experiences of a prolonged passive second stage. OBJECTIVE To describe the lived experiences of a prolonged passive second stage of labour in nulliparous women. METHODS A qualitative study was conducted with 15 nulliparous women with a passive second stage lasting three hours or more. Data were analysed using thematic analysis based on descriptive phenomenology. RESULTS The analysis resulted in four themes: "An unknown phase" that entailed remaining in a phase that the women lacked an awareness of. "Trust and mistrust in the body's ability" represents the mindset for vaginal birth as well as feelings of powerlessness and self-guilt. The theme "Loss of control" included experiences of frustration, fatigue, and having to deny bodily instincts. "Support through presence and involvement" signifies support through the midwife's presence in the birthing room, although there were also descriptions of emotional or physical absence. CONCLUSIONS The findings contribute to the understanding of prolonged labour based on women's lived experiences and add to the body of knowledge about the prolonged passive second stage. This study highlights that women need support through information, presence, and encouragement to remain in control. It can be beneficial during birth preparation to include knowledge about the passive second stage together with unexpected or complicated situations during birth, such as prolonged labour.
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Affiliation(s)
- Maria Bjelke
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
| | - Marie Oscarsson
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Lars Thurn
- Department of Obstetrics and Gynaecology, Lund University, Lund, Sweden
| | - Lina Palmér
- Department of Caring Science, University of Boras, Boras, Sweden
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Brüggemann C, Carlhäll S, Grundström H, Ramö Isgren A, Blomberg M. Cumulative oxytocin dose in spontaneous labour - Adverse postpartum outcomes, childbirth experience, and breastfeeding. Eur J Obstet Gynecol Reprod Biol 2024; 295:98-103. [PMID: 38350309 DOI: 10.1016/j.ejogrb.2024.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/11/2024] [Accepted: 01/31/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVES This study aimed to determine the association between the total cumulative oxytocin dose during labour and adverse postpartum outcomes, childbirth experience and breastfeeding in term primiparous women with spontaneous onset of labour. STUDY DESIGN A prospective observational multicentre study, including 1395 women with spontaneous labour, in seven hospitals in Southeast Sweden. Multivariable logistic regression (Crude Odds Ratios (OR) and adjusted OR (aOR) for relevant confounders) was used to analyze the association between oxytocin dose and postpartum outcomes. The exposure was the cumulative oxytocin dose during labour, classified in percentiles (<25th, 25-75th, >75th). The outcomes were occurrence of obstetric anal sphincter injury, postpartum haemorrhage (blood loss > 1000 ml), Apgar score < 7 at five minutes, umbilical cord arterial pH, postpartum bladder overdistension, exclusive breastfeeding at one week and three months, and the woman's perceived birth experience. RESULTS Women receiving high amounts (>75th percentile, >4370 mU) of oxytocin infusion during labour had an increased risk of postpartum haemorrhage (OR 2.73 (1.78-4.19)), an overdistended bladder (OR 2.19 (1.11-4.31)), an infant with an Apgar score < 7 at five minutes (OR 2.89 (1.27-6.57)), a negative birth experience (OR 1.83 (1.25-2.69)), and a decreased chance of exclusive breastfeeding at one week (OR 0.63 (0.41-0.96)). After adjusting for confounders, all outcomes remained statistically significant except risk of low Apgar score and chance of exclusive breastfeeding. CONCLUSION In women with high cumulative oxytocin dose during labour prompt, and prophylactic administration of uterotonics after delivery of the placenta should be considered to reduce the risk of postpartum haemorrhage. The risk for bladder overdistension can be reduced by implementing routines for observation for signs of bladder filling in the early postpartum period, as well as routine use of bladder scans post micturition to assess for successful bladder emptying. As women's birth experience have a major impact on their future mental health, should be routinely assessed postpartum, and support should be offered to women with negative experiences.
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Affiliation(s)
- Cecilia Brüggemann
- Department of Obstetrics and Gynaecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, S-58185 Linköping, Sweden.
| | - Sara Carlhäll
- Department of Obstetrics and Gynaecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, S-58185 Linköping, Sweden.
| | - Hanna Grundström
- Department of Obstetrics and Gynaecology in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, S-58185 Linköping, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, S-58185 Linköping, Sweden.
| | - Anna Ramö Isgren
- Department of Obstetrics and Gynaecology in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, S-58185 Linköping, Sweden.
| | - Marie Blomberg
- Department of Obstetrics and Gynaecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, S-58185 Linköping, Sweden.
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Machín-Martín E, González-de la Torre H, Bordón-Reyes H, Jeppesen-Gutiérrez J, Martín-Martínez A. Cultural adaptation, validation and evaluation of the psychometric properties of Childbirth Experience Questionnaire version 2.0 in the Spanish context. BMC Pregnancy Childbirth 2024; 24:207. [PMID: 38504191 PMCID: PMC10949694 DOI: 10.1186/s12884-024-06400-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/08/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Several instruments have been designed to assess the childbirth experience. The Childbirth Experience Questionnaire (CEQ) is one of the most widely used tools. There is an improved version of this instrument, the Childbirth Experience Questionnaire (CEQ 2.0), which has not been adapted or validated for use in Spain. The aim of present study is to adapt the CEQ 2.0 to the Spanish context and evaluate its psychometric properties. METHODS This research was carried out in 2 stages. In the first stage, a methodological study was carried out in which the instrument was translated and back-translated, content validity was assessed by 10 experts (by calculating Aiken's V coefficient) and face validity was assessed in a sample of 30 postpartum women. In the second stage, a cross-sectional study was carried out to evaluate construct validity by using confirmatory factor analysis, reliability evaluation (internal consistency and temporal stability) and validation by known groups. RESULTS In Stage 1, a Spanish version of the CEQ 2.0 (CEQ-E 2.0) was obtained with adequate face and content validity, with Aiken V scores greater than 0.70 for all items. A final sample of 500 women participated in Stage 2 of the study. The fit values for the obtained four-domain model were RMSEA = 0.038 [95% CI: 0.038-0.042], CFI = 0.989 [95% CI: 0.984-0.991], and GFI = 0.990 [95% CI: 0.982-0.991]. The overall Omega and Cronbach's Alpha coefficients were 0.872 [95% CI: 0.850-0.891] and 0.870 [95% CI: 0.849-0.890] respectively. A coefficient of intraclass correlation of 0.824 [95% CI: 0.314-0.936] (p ≤ 0.001) and a concordance coefficient of 0.694 [95% CI: 0.523-0.811] were obtained. CONCLUSIONS The Spanish version of CEQ 2.0 (CEQ-E 2.0), has adequate psychometric properties and is a valid, useful, and reliable instrument for assessing the childbirth experience in Spanish women.
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Affiliation(s)
- Elisabet Machín-Martín
- University of Las Palmas de Gran Canaria, Edificio Ciencias de La Salud, C/Blas Cabrera Felipe S/N, 35016, Las Palmas de Gran Canaria, CP, Spain
- Department of Obstetrics and Gynaecology, Insular Maternal and Child University Hospital Complex of Gran Canaria-Canary Health Service, Avda Marítima del Sur S/N, 35016, Las Palmas de Gran Canaria, CP, Spain
| | - Héctor González-de la Torre
- Research Support Unit of Insular Maternal and Child University Hospital Complex of Gran Canaria, Canary Health Service, Avda Marítima del Sur S/N, 35016, Las Palmas de Gran Canaria, CP, Spain.
- Department of Nursing, University of Las Palmas de Gran Canaria, Edificio Ciencias de La Salud, C/Blas Cabrera Felipe S/N, Las Palmas de Gran Canaria, CP, 35016, Spain.
| | - Haridian Bordón-Reyes
- Department of Obstetrics and Gynaecology, Insular Maternal and Child University Hospital Complex of Gran Canaria-Canary Health Service, Avda Marítima del Sur S/N, 35016, Las Palmas de Gran Canaria, CP, Spain
| | - Julia Jeppesen-Gutiérrez
- Multiprofessional Teaching Unit of Obstetrics and Gynaecology of the University Hospital Complex Insular Materno-Infantil of Gran Canaria, Canary Health Service, Avda Marítima del Sur S/N. CP:35016, Las Palmas de Gran Canaria-Canary Islands, Spain
| | - Alicia Martín-Martínez
- University of Las Palmas de Gran Canaria, Edificio Ciencias de La Salud, C/Blas Cabrera Felipe S/N, 35016, Las Palmas de Gran Canaria, CP, Spain
- Department of Obstetrics and Gynaecology, Insular Maternal and Child University Hospital Complex of Gran Canaria-Canary Health Service, Avda Marítima del Sur S/N, 35016, Las Palmas de Gran Canaria, CP, Spain
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Overall childbirth experience: what does it mean? A comparison between an overall childbirth experience rating and the Childbirth Experience Questionnaire 2. BMC Pregnancy Childbirth 2023; 23:176. [PMID: 36918812 PMCID: PMC10012290 DOI: 10.1186/s12884-023-05498-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND In clinical settings and research studies, childbirth experience is often measured using a single-item question about overall experience. Little is known about what women include in this rating, which complicates the design of adequate follow-up, as well as the interpretation of research findings based on ratings of overall childbirth experience. The aim of this study was to examine which known dimensions of childbirth experience women include in the rating on a single-item measure. METHODS Ratings of overall childbirth experience on a 10-point numeric rating scale (NRS) from 2953 women with spontaneous or induced onset of labour at two Swedish hospitals were evaluated against the validated Childbirth Experience Questionnaire 2 (CEQ2), completed on one of the first days postpartum. The CEQ2 measures four childbirth experience domains: own capacity, perceived safety, professional support and participation. Internal consistency for CEQ2 was evaluated by calculating Cronbach's alpha. NRS ratings were explored in relation to CEQ2 using empirical cumulative distribution function graphs, where childbirth experience was defined as negative (NRS ratings 1-4), mixed (NRS ratings 5-6) or positive (NRS ratings 7-10). A multiple linear regression analysis, presented as beta coefficients (B) and 95% confidence intervals (CI), was also performed to explore the relationship between the four domains of the CEQ2 and overall childbirth experience. RESULTS The prevalence of negative childbirth experience was 6.3%. All CEQ2-subscales reached high or acceptable reliability (Cronbach's alpha = 0.78; 0.81; 0.69 and 0.66, respectively). Regardless of overall childbirth experience, the majority of respondents scored high on the CEQ2 subscale representing professional support. Overall childbirth experience was mainly explained by perceived safety (B = 1.60, CI 1.48-1.73), followed by own capacity (B = 0.65, CI 0.53-0.77) and participation (B = 0.43, CI 0.29-0.56). CONCLUSIONS In conclusion, overall childbirth experience rated by a single-item measurement appears to mainly capture experiences of perceived safety, and to a lesser extent own capacity and participation, but appears not to reflect professional support. CEQ2 shows good psychometric properties for use shortly after childbirth, and among women with induced onset of labour, which increases the usability of the instrument.
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