Satisfaction of adolescent mothers with childbirth care at a public maternity hospital

Birth-related posttraumatic stress disorder and negative childbirth experience related to maternal functioning among adolescent mothers: a cross-sectional study

BACKGROUND

Adolescent pregnancy is an important issue in terms of reproductive health. Adolescent mothers have to overcome two crises at the same time: motherhood and maturity. Childbirth experience and posttraumatic stress disorder may influence the mother's perception of her infant and postpartum care behaviors.

METHODS

This cross-sectional study was conducted on 202 adolescent mothers referring to health centers in Tabriz and its suburbs between May and December, 2022. Data were collected by PTSD Symptom Scale, Childbirth Experience Questionnaire 2.0, and Barkin Index of Maternal Functioning. The association between childbirth experience, posttraumatic stress disorder and maternal functioning was assessed by multivariate analysis.

RESULTS

After adjusting the effect of socio-demographic and obstetric characteristics, the score of maternal functioning among mothers without posttraumatic stress disorder was statistically significantly higher than mothers with posttraumatic stress disorder diagnosis [β (95% CI) = 2.30 (0.39 to 4.20); p = 0.031]. The score of maternal functioning increased with the increase in the childbirth experience score [β (95% CI) = 7.34 (3.87 to 10.81); p < 0.001]. The score of maternal functioning among mothers with wanted sex of baby was statistically significantly higher than unwanted sex of baby [β (95% CI) = 2.70 (0.37 to 5.02); p = 0.023].

CONCLUSION

Healthcare professionals should pay special attention to improving maternal functioning among adolescent mothers. One of the important actions can be to create a positive experience of childbirth for avoiding of posttraumatic stress disorder following birth and counseling with mothers who stated sex of fetus is undesired.

How to Improve Adolescent Mothers' Satisfaction with Childbirth?

STUDY OBJECTIVE

This study aimed to analyze factors related to adolescent mothers' satisfaction with childbirth.

DESIGN

Prospective and cross-sectional study PARTICIPANTS: Fifty adolescent mothers with maternal age from 14 to 19 years and delivery of a single and live newborn at term SETTING: Low-risk maternity hospital INTERVENTION: The participants were invited to answer a questionnaire (North Bristol modified version of the Mackey Childbirth Satisfaction Rating Scale [mMCSRS]) with 18 items measuring childbirth satisfaction. Each item was to be rated on a 5-point Likert scale (very dissatisfied to very satisfied).

MAIN OUTCOME MEASURE

The main outcome measure was the total score on the questionnaire.

RESULTS

The median maternal age was 18 years (95% CI, 11-25), and the median maternal satisfaction score of adolescent mothers was 88 (95% CI, 83-90). There was a significant difference in the total scores on the mMCSRS regarding the following factors: "oral fluid and food intake during labor" (yes = 84.0 vs no = 78.0, P = 0.044); "professional who attended the birth" (physician = 78.0 vs midwife = 86.0, P = 0.022); "skin-to-skin contact" (yes = 83.0 vs no = 71.0, P = 0.004); and "breastfeeding at the first hour" (yes = 84.5 vs no = 75.5, P = 0.008). Multiple regression with a stepwise procedure identified the following independent factors: "gestational age" (coefficient = 2.14, P = 0.03), "oral fluid and food intake during labor" (coefficient = 5.30, P = 0.013), and "skin-to-skin contact" (coefficient = 11.2, P < 0.001).

CONCLUSION

Satisfaction with childbirth in adolescent mothers is associated with measures that can be easily implemented in the health care system. They are chiefly the provision of oral fluid and food during labor and skin-to-skin contact. Specific strategies are thus needed to increase adolescents' satisfaction with childbirth.

Unmet Birth Expectations and Birth Trauma among Adolescents

PURPOSE

To assess and compare birth expectations of younger and older age adolescents and explore if unmet expectations predict psychological birth trauma (PBT).

STUDY DESIGN AND METHODS

This secondary analysis expands findings of a previous study (N = 303) which classified adolescents' perceptions of birth into four main themes. The previous study used a mixed-methods approach providing data related to birth expectations. For the current study, expectations were determined by themes as met or unmet by three reviewers. Of 116 useable written narrations, responses of younger (ages 13-17) versus older (ages 18-19) adolescents were compared and explored for impact on PBT.

RESULTS

Birth expectations for both age groups were more often unmet than met. Despite a smaller cohort, younger adolescents provided more remarks than older adolescents. There were no differences between groups on unmet birth expectations (p = .16). Unmet expectations most often related to pain with older adolescents more inclined to state poor pain management. Younger adolescents more often feared dying. Unmet expectations did not predict PBT.

CLINICAL IMPLICATIONS

Comprehensive prenatal care can allow for early, open conversations to assess labor knowledge and misconceptions, fear of birth, existing supports, and overall birth expectations, with a premier focus on expected labor pain and pain management. Multiparous adolescents should receive prenatal assessments of posttraumatic stress (PTS) symptoms (a recognized predictor of posttraumatic stress syndrome) potentially originating from a previous traumatic birth. Following birth, symptoms of acute stress and PTS should be assessed of all adolescents, especially if experienced numerous unmet labor expectations.

Birth Stories, Support, and Perinatal Emotional Health among Minority Adolescent Mothers: A Mixed Methods Study

STUDY OBJECTIVE

To explore minority, adolescent birth and perinatal experiences to inform and improve quality of care for this unique group.

DESIGN

Mixed quantitative and qualitative study guided by Bourdieu's Social Fields framework.

SETTING

Clinic dedicated to parenting adolescents, and a local charter school founded to serve pregnant and parenting young adults.

PARTICIPANTS

Sample size for quantitative data: n = 27; qualitative data: n = 14. Average age was 16.39 years (SD = 1.29); most self-identified as Latina/Hispanic or African American/Black/Afro-Caribbean/African.

INTERVENTIONS AND MAIN OUTCOME MEASURES

We used 2 validated surveys: Birth Satisfaction Scale-Revised (BSS-R), and the Postpartum Worry Scale-Revised (PWS-R). The BSS-R has 10 items, and quantifies labor and delivery experiences. The PWS-R has 20 items, and quantifies maternal, infant, and social-emotional worries. The qualitative, semistructured 30-minute interviews with a subset of survey respondents further explored perinatal mental health, labor experiences, and support networks.

RESULTS

BSS-R data resulted in an average score of 25.14 (SD = 5.35), which correlated to moderate satisfaction with birth experience (range, 0-40 with 0 = most negative). The PWS-R average score of 55.79 (SD = 21.06) indicated elevated postpartum worry (range, 20-100 with 20 = most worry). Qualitative interviewees worried about relationships and newborn well-being; support networks fluctuated; distinct events, pain, and fear during labor dominated birth stories. Advice for peers included: tending to social support, stress, and self-care. Nonjudgmental communication, empathy, and emotional connection were desired attributes of their health care team. Participants had anxiety related to social networks and newborn care. Although birth experiences were moderately positive, they were also described as stressful. However, participants were resourceful, insightful, and took advantage of social supports.

CONCLUSION

Birth experiences, patterns of stress, and support networks are uniquely identified and utilized by adolescent mothers. Being heard and feeling connected to providers empowered this group of young, minority adolescents. Participant advice could inform future educational courses, programs, and hospital innovations for perinatal adolescents.

Adolescents' Perceptions of Childbirth

PURPOSE

The purpose of this study was to describe adolescents' perception of birth within the first 72 hours postpartum.

STUDY DESIGN & METHODS

A thematic analysis using qualitative data captured via one overarching question about labor expectations as part of a larger, parent quantitative study exploring psychological birth trauma.

RESULTS

Forty-two percent (n = 128) of adolescents ages 13 to 19 in the original study responded in writing to one overarching question concerning birth expectations. Four major themes were identified including pain, support, personal control, and fear, with three subthemes. Pain was expressed as a primary theme for all age adolescents and had an impact on all other themes. Expressed fear was general and specific including a fear of dying that emerged as a subtheme along with labor information and emotions.

CLINICAL IMPLICATIONS

Lacking a positive birth experience has been linked with poor mental health outcomes (depression and posttraumatic stress) postpartum. Findings offer a guide for nurses and other healthcare providers to promote a positive birth experience for adolescents. Pain management is foremost to adolescents and requires healthcare providers' continued attention. Working together with adolescents to identify and monitor level of pain; assess support needs, feelings of loss of personal control, and signs or verbal expressions of fear; and offer ongoing information about labor progress and necessary procedures can help strengthen bonds between teens and their healthcare provider and create a positive birth experience.