Comfort in Labor: "Like Being Able to Exhale"

Development and Testing of a Survey Measure of Organizational Perinatal Patient‐Centered Care Culture

OBJECTIVE

To develop and test a measure of patient-centered care (PCC) culture in hospital-based perinatal care.

DATA SOURCES

Data were obtained from US perinatal hospitals: one provided survey development data and 14 contributed data for survey testing.

STUDY DESIGN

We used qualitative and quantitative methods to develop the mother-infant centered care (MICC) culture survey. Qualitative methods included observation, focus group, interviews, and expert consultations to adapt items from other settings and create new items capturing dimensions of PCC articulated by The Commonwealth Fund. We quantitatively assessed survey psychometric properties using reliability (Cronbach's α and Pearson correlation coefficients) and validity (exploratory and confirmatory factor analysis [CFA]) statistics, and refined the survey. After confirming aggregation suitability (ICCs), we calculated "MICC culture scores" at the individual, unit, and hospital level and assessed associations between scores and survey-collected, staff-reported outcomes to evaluate concurrent validity.

DATA COLLECTION

Survey development included 12 site-visit observations, one semi-structured focus group (five participants), two semi-structured interviews, five cognitive interviews, and three expert consultations. Survey testing used online surveys administered to obstetric and neonatal unit staff (N = 316).

PRINCIPAL FINDINGS

Using responses from 10 hospitals with ≥4 responses from both units (n = 240), the 20-item MICC culture survey demonstrated reliability (Cronbach's α = 0.95) while capturing all PCC dimensions (subscale Cronbach's α = 0.72-0.87). CFA showed validity through goodness-of-fit (overall chi-square = 214 [p-value = 0.012], SRMR = 0.056, RMSEA = 0.041, CFI = 0.97, and TLI = 0.96). Aggregation statistics (ICCs < 0.05) justify unit- and hospital-level aggregation. Demonstrating preliminary validity, individual-, unit-, and hospital-level MICC culture scores were associated with all outcomes (satisfaction with care provided, within-unit team effectiveness, and relational coordination [RC] between units) (p-values < 0.05), except for neonatal unit scores and RC (p-value = 0.11).

CONCLUSIONS

The MICC culture survey is a psychometrically sound measure of PCC culture for hospital-based perinatal care. Survey scores are associated with staff-reported outcomes. Future studies with patient outcomes will aid identification of improvement opportunities in perinatal care.

Comfort and Satisfaction Among Women Who Used Different Options for Analgesia During Labor and Birth

OBJECTIVE

To determine if comfort and satisfaction with the birth experience differed among women who used nitrous oxide (N₂O), epidural analgesia, or no analgesia during labor and birth.

DESIGN

Nonexperimental, cross-sectional, between-subjects.

SETTING

Maternity care units in three U.S. Midwest hospitals from June to October 2019.

PARTICIPANTS

A total of 84 women with spontaneous vaginal birth at term gestation (≥37 weeks).

METHODS

Women were grouped according to self-selected pain management method: N₂O and oxygen (50%/50% mixture) only (n = 28), epidural analgesia (may have been in combination with other analgesia options; n = 28), or no analgesia (n = 28). We collected data within 6 hours after childbirth using the Birth Satisfaction Scale-Revised and the researcher-modified Childbirth Comfort Questionnaire. We analyzed data for differences in comfort and satisfaction scores among the three groups of women using analysis of variance.

RESULTS

We found no statistically significant differences related to comfort during labor and birth among women who used N₂O only, epidural analgesia, or no analgesia during labor and birth, F(2, 81) = 1.11, p = .34. We also found no statistically significant differences related to satisfaction with the birth experience among women who used N₂O only, epidural analgesia, or no analgesia during labor and birth, F(2, 81) = .084, p = .92.

CONCLUSION

Our finding of no statistically significant differences in comfort and satisfaction with the birth experience across groups highlights the need to present comprehensive pain management options to women for labor and birth, such as N₂O.

The Effect of Labor Dance on Traumatic Childbirth Perception and Comfort: A Randomized Controlled Study

This study aims to evaluate the effect of labor dance on traumatic childbirth perception and comfort. This is a randomized controlled experimental study. The study was conducted with 120 primiparous pregnant women (60 in experiment group, 60 in control group). The pregnant women in the experiment group performed labor dance with the researcher midwife during the active phase of labor. The researcher implemented the Childbirth Comfort Questionnaire (CCQ) when the cervical dilation was 8 cm. The Postpartum Comfort Scale (PCS) and Traumatic Childbirth Perception Scale (TCPS) were implemented almost 2 hours after giving birth. The scores of the women in the experiment group in TCPS were significantly lower than those in the control group while their mean scores in CCQ and PCS were significantly higher. Labor dance contributed to the women's more positive childbirth experiences, perceptions of childbirth as less traumatic, and increased their comfort levels.