Risk factors and racial disparities related to low maternal birth satisfaction with labor induction: a prospective, cohort study

Risk factors for a negative birth experience using the Birth Satisfaction Scale-Revised

OBJECTIVE

To evaluate the risk factors for a negative birth experience using the Birth Satisfaction Scale-Revised (BSS-R) questionnaire.

METHODS

A cross-sectional study including women who gave birth at a single tertiary hospital between February 2021 and January 1, 2022. Birth satisfaction was measured using the BSS-R questionnaire. Maternal, pregnancy, and delivery characteristics were collected. Negative birth experience was defined as a BSS-R score lower than the median. Multivariable regression analysis was used to examine the association between birth characteristics and negative birth experience.

RESULTS

A total of 1495 women answered the questionnaire and were included in the analysis; 779 women comprised the positive birth experience group and 716 women comprised the negative birth experience group. Prior deliveries, prior abortions, and smoking (adjusted odds ratio [aOR], 0.52 [95% confidence interval (CI), 0.41-0.66]; aOR, 0.78 [95% CI, 0.62-0.99]; aOR, 0.52 [95% CI, 0.27-0.99], respectively) were independently associated with lower risk of negative birth experience. Immigration, answering the questionnaires in person, and cesarean delivery were independently associated with increased negative birth experience risk (aOR, 1.39 [95% CI, 1.01-1.86]; aOR 1.37 [95% CI, 1.04-1.79]; aOR, 1.92 [95% CI, 1.52-2.41], respectively).

CONCLUSION

Parity, prior abortions, and smoking were associated with a lower risk of negative birth experience, while immigration, answering questionnaires in person, and cesarean delivery were associated with a higher risk of negative birth experience.

Standardized Cesarean Risk Counseling with Induction: Impact on Racial Disparities in Birth Satisfaction

OBJECTIVE

Our prior work demonstrated decreased birth satisfaction for Black women undergoing labor induction. We aimed to determine if implementation of standardized counseling around calculated cesarean risk during labor induction could reduce racial disparities in birth satisfaction.

STUDY DESIGN

We implemented use of a validated calculator that provides an individual cesarean risk score for women undergoing induction into routine care. This prospective cohort study compared satisfaction surveys for 6 months prior to implementation (preperiod: January 2018-June 2018) to 1 year after (postperiod: July 2018-June 2019). Women with full-term (≥37 weeks) singleton gestations with intact membranes and an unfavorable cervix undergoing induction were included. In the postperiod, providers counseled patients on individual cesarean risk at the beginning of induction using standardized scripts. This information was incorporated into care at patient-provider discretion. The validated 10-question Birth Satisfaction Scale-Revised (BSS-R) subdivided into three domains was administered throughout the study. Patients were determined to be "satisfied" or "unsatisfied" if total BSS-R score was above or below the median, respectively. In multivariable analysis, interaction terms evaluated the differential impact of the calculator on birth satisfaction by race (Black vs. non-Black women).

RESULTS

A total of 1,008 of 1,236 (81.6%) eligible women completed the BSS-R (preperiod: 330 [79.7%] versus postperiod: 678 [82.5%], p = 0.23), 63.8% of whom self-identified as Black. In the preperiod, Black women were 50% less likely to be satisfied than non-Black women, even when controlling for differences in parity (Black: 39.0% satisfied vs. non-Black: 53.9%, adjusted odds ratio [aOR] = 0.49, 95% confidence interval [CI]: 0.30-0.79). In the postperiod, there was no difference in satisfaction by race (Black: 43.7% satisfied vs. non-Black: 44.0%, aOR = 0.97. 95% CI: 0.71-1.33). Therefore, disparities in birth satisfaction were no longer present at postimplementation (interaction p = 0.03).

CONCLUSION

Implementation of standardized counseling with a validated calculator to predict cesarean risk after labor induction is associated with a decrease in racial disparities in birth satisfaction.

KEY POINTS

· Preintervention, Black women were less likely to have above-median birth satisfaction.. · We implemented standardized counseling around cesarean risk with labor induction.. · Implementation was associated with reduced racial disparities in birth satisfaction scores..

Six compared with 12 hours of Foley balloon placement for labor induction in nulliparous women with unripe cervices: a randomized controlled trial

BACKGROUND

Compared with a planned 12-hour placement of a double-balloon catheter, a planned 6-hour placement of a double-balloon catheter shortens the labor induction to delivery interval. The Foley catheter is low cost. Moreover, it has at least comparable effectiveness to the proprietary double-balloon labor induction devices. Of note, a 6-hour placement of a Foley balloon catheter in nulliparas has not been evaluated.

OBJECTIVE

This study aimed to evaluate 6- vs 12-hour Foley balloon placement for cervical ripening in the labor induction of nulliparas.

STUDY DESIGN

A randomized controlled trial was conducted at the Universiti Malaya Medical Centre from January 2022 to August 2022. Nulliparas aged ≥18 years, with a term, singleton pregnancy in cephalic presentation, with intact membranes, with reassuring fetal heart rate tracing, with an unripe cervix, and without any significant contractions, were recruited at admission for labor induction. Participants were randomized after successful Foley balloon insertion, for the balloon to be left passively in place for 6 or 12 hours and then removed to check for a ripened cervix. Amniotomy was performed once the cervix had ripened, followed by titrated oxytocin infusion to expedite labor and delivery. The primary outcome was the labor induction to delivery interval. The secondary outcomes were mostly from the core outcome set for trials on labor induction of labor trial reporting, such as change in the Bishop score after the intervention, use of an additional method for cervical ripening, time to delivery after double-balloon device removal, mode of delivery, indication for cesarean delivery, duration of oxytocin infusion, blood loss during delivery, presence of a third- or fourth-degree perineal tear, maternal infection, maternal satisfaction regional analgesia in labor, length of hospital stay, intensive care unit admission, cardiorespiratory arrest, need for hysterectomy. The neonatal outcomes were Apgar score at 1 and 5 minutes, neonatal intensive care unit admission, cord pH, neonatal sepsis, fetal birthweight, birth trauma, hypoxic-ischemic encephalopathy, or need for therapeutic hypothermia. Data were analyzed using the t test, Mann-Whitney U test, chi-square test, and Fisher exact test, as appropriate for the data type.

RESULTS

Overall, 240 women were randomized, 120 to each arm. The median labor induction to delivery intervals were 21.3 hours (interquartile range, 16.2-27.9) for the 6-hour balloon catheter placement and 26.0 hours (interquartile range, 21.5-30.9) for the 12-hour balloon catheter placement (P<.001). Of the secondary outcomes, for 6- vs 12-hour balloon catheter placement, the sequential use of additional cervical ripening agent (mostly Foley reinsertion) was 33 of 119 (27.5%) vs 17 of 120 (14.2%) (relative risk, 1.94; 95% confidence interval, 1.15-3.29; P=.011), Bishop score increase was 3 (interquartile range, 2.00-3.75) vs 3 (2.25-4.00) (P=.002), and the rate of recommendation to a friend was 83 of 118 (70.3%) vs 101 of 119 (84.9%) (relative risk, 0.83; 95% confidence interval; 0.72-0.95; P=.007), respectively. Cesarean delivery rates were 52 of 119 (43.7%) for the 6-hour balloon catheter placement and 64 of 120 (53.3%) for the 12-hour balloon catheter placement (relative risk, 0.82; 95% confidence interval, 0.63-0.07; P=.136), and maternal satisfaction scores (0-10 numerical rating scale) were 7 (interquartile range, 6-9) for the 6-hour balloon catheter placement and 7 (interquartile range, 7-9) for the 12-hour balloon catheter placement (P=.880).

CONCLUSION

Compared with a planned 12-hour Foley balloon catheter placement, a planned 6-hour Foley balloon placement shortens the time to birth, despite less cervical ripening at Foley balloon catheter removal and more additional cervical ripening agent use. However, the 6-hour balloon catheter placement was less likely to be recommended to a friend than the 12-hour balloon catheter placement.

Six vs 12 hours of Foley catheter balloon placement in the labor induction of multiparas with unfavorable cervixes: a randomized controlled trial

BACKGROUND

Planned 6- vs 12-hour placement of the double-balloon catheter for cervical ripening in labor induction hastens delivery. The Foley catheter is low-priced and typically performs at least as well as the proprietary double-balloon devices in labor induction. Maternal satisfaction with labor induction is usually inversely related to the speed of the process.

OBJECTIVE

This study aimed to compare Foley balloon placement for 6 vs 12 hours in the labor induction of multiparas with unfavorable cervixes.

STUDY DESIGN

A randomized controlled trial was conducted in a university hospital in Malaysia from January to October of 2022. Eligible multiparous women admitted for induction of labor for various indications were enrolled. Participant inclusion criteria were multiparity (at least 1 previous vaginal delivery of ≥24 weeks' gestation), age ≥18 years, term pregnancy >37 weeks' gestation, singleton pregnancy, cephalic presentation, intact membranes, normal fetal heart rate tracing, no significant contractions (< 2 in 10 minutes), and unfavorable cervix (Bishop score < 6). Participants were randomized after successful Foley balloon insertion for the balloon to be left in place for 6 or 12 hours of passive ripening before removal to check cervical suitability for amniotomy. The primary outcomes were the induction-to-delivery interval and maternal satisfaction with the allocated intervention assessed using a visual numerical rating scale (0-10). Secondary outcomes were derived in part from the core outcome set for trials on induction of labor (Core Outcomes in Women's and Newborn Health [CROWN]). Maternal outcomes were change in first Bishop score after intervention, use of additional method for cervical ripening, time to delivery after balloon removal, mode of delivery, indication for cesarean delivery, duration of oxytocin infusion, blood loss during delivery, presence of third- or fourth-degree perineal tear, maternal infection, use of regional analgesia in labor, length of hospital stay, intensive care unit (ICU) admission, cardiorespiratory arrest, and need for hysterectomy. The secondary neonatal outcomes were Apgar score at 1 and 5 minutes, neonatal intensive care unit (NICU) admission, cord blood pH, neonatal sepsis, birthweight, birth trauma, hypoxic-ischemic encephalopathy, or need for therapeutic hypothermia. Analyses were conducted with the t-test, Mann-Whitney U test, chi-square test, and Fisher exact test, as appropriate.

RESULTS

A total of 220 women were randomized (110 to each intervention). Regarding the 2 primary outcomes, the induction-to-delivery intervals were a median (interquartile range) of 15.9 (12.0-24.0) and 21.6 (17.3-26.0) hours (P<.001), and maternal satisfaction scores were 7 (6-8) and 7 (6-8) (P=.734) for 6- and 12-hour placement, respectively. The following rates were observed for 6- and 12-hour placement, respectively: sequential use of additional cervical ripening agent (Foley reinsertion)-29 per 110 (26.4%) and 13 per 110 (11.8%) (relative risk, 2.23; 95% confidence interval, 1.23-4.10; P=.006); spontaneous balloon expulsion-22 per 110 (20.0%) and 37 per 110 (33.6%) (relative risk, 0.60; 95% confidence interval, 0.38-0.94; P=.022); and recommendation of the allocated intervention to a friend-61 per 110 (73.6%) and 87 per 110 (79.1%) (relative risk, 0.90; 95% confidence interval, 0.80-1.08; P=.341). Other secondary outcomes, including cesarean delivery, were not significantly different.

CONCLUSION

Foley balloon placement for 6 hours for cervical ripening in parous women hastens birth but does not increase maternal satisfaction relative to 12-hour placement. Foley reinsertion for additional ripening was more frequent in the 6-hour group.

Predictors of maternal satisfaction with labor induction: A prospective observational cohort study

OBJECTIVE

To identify independent predictors of maternal satisfaction with labor induction.

METHOD

In this prospective observational cohort study, 769 women prior to their labor induction had sleep and psychological well-being assessed using Pittsburgh Sleep Quality Index and Depression, Anxiety and Stress Scales. Women were asked about the adequacy of labor induction information provided and their involvement and time pressure felt in the decision-making for their labor induction. Maternal characteristics, induction and intrapartum care measures, and labor and neonatal outcomes were also assessed. Prior to discharge, women rated their satisfaction with their birth experience.

RESULTS

A total of 34 variables were considered for bivariate analysis, with 15 found to have P < 0.05. Following adjusted analysis, 10 independent predictors of maternal satisfaction were identified: maternal education, previous cesarean delivery, maternal involvement, information provided, and decision-making time pressure regarding labor induction, amniotomy, induction to delivery interval, mode of delivery, postpartum hemorrhage, and neonatal admission. Maternal satisfaction was not associated with sleep, depression, anxiety, or stress.

CONCLUSION

The identification of independent predictors of maternal satisfaction allows for patient selection, targeting of specific preinduction and intrapartum care, and focus on induction methods that can reduce induction to delivery interval, cesarean birth, and delivery blood loss to maximize women's satisfaction with labor induction.

Induction of labor via Foley balloon catheter placement for 6 vs 12 hours in women with 1 previous cesarean delivery and unfavorable cervices: a randomized controlled trial

BACKGROUND

Induction of labor in women with 1 previous cesarean delivery and unripe cervices is a high-risk process, carrying an increased risk of uterine rupture and the need for cesarean delivery. Balloon ripening is often chosen as prostaglandin use is associated with an appreciable risk of uterine rupture in vaginal birth after cesarean delivery. A shorter duration of placement of the balloon typically expedites delivery; however, this has not been evaluated in induction of labor after 1 previous cesarean delivery.

OBJECTIVE

This study aimed to compare Foley balloon catheter placement for 6 vs 12 hours in induction of labor after 1 previous cesarean delivery.

STUDY DESIGN

A randomized controlled trial was conducted in a university hospital in Malaysia from January 2022 to February 2023. Eligible women with 1 previous cesarean delivery admitted for induction of labor were enrolled. Participants were randomized after balloon catheter insertion for 6 or 12 hours of passive ripening before balloon deflation and removal to check cervical status for amniotomy. The primary outcome was the induction of labor to delivery interval. The secondary outcomes were largely derived from the core outcome set for trials on induction of labor (Core Outcomes in Women's and Newborn Health [CROWN]). The Student t test, Mann-Whitney U test, chi-square test, and Fisher exact test were used as appropriate for the data.

RESULTS

Overall, 126 women were randomized, 63 to each intervention. The mean induction of labor to delivery intervals were 23.0 (standard deviation, ±8.9) in the 6-hour arm and 26.6 (standard deviation, ±7.1) in the 12-hour arm (mean difference, -3.5 hours; 95% confidence interval, -6.4 to -0.7; P=.02). The median induction of labor (Foley balloon catheter insertion) to Foley balloon catheter removal intervals were 6.0 hours (interquartile range, 6.0-6.3) in the 6-hour arm and 12.0 hours (interquartile range, 12.0-12.5) in the 12-hour arm (P<.001). The median induction of labor to amniotomy intervals were 14.1 hours (interquartile range, 9.3-21.8) in the 6-hour arm and 19.0 hours (interquartile range, 15.9-22.0) in the 12-hour arm (P=.02). The usage rates of epidural analgesia in labor were 46.0% (29/63) in the 6-hour arm and 65.1% (41/63) in the 12-hour arm (relative risk, 0.71; 95% confidence interval, 0.51-0.98; P=.03). Spontaneous balloon catheter expulsion rates were 22.2% (14/63) in the 6-hour arm and 17.5% (11/63) in the 12-hour arm (relative risk, 1.27; 95% confidence interval, 0.63-2.58; P=.50), and additional ripening use rates (Foley reinsertion) were 46.0% (29/63) in the 6-hour arm and 31.7% (20/63) in the 12-hour arm (relative risk, 1.45; 95% confidence interval, 0.92-2.27; P=.10). The results were not different. Moreover, maternal satisfaction scores (0-10 numerical rating scale) of 9 (range, 8-10) in the 6-hour arm and 9 (range, 8-10) in the 12-hour arm (P=.41) were not different. Other secondary maternal and neonatal outcomes were not significantly different either.

CONCLUSION

Foley balloon catheter placement for 6 hours hastened birth and reduced epidural analgesia use in labor without a change in maternal satisfaction.

Perinatal Education Participation: Description and Identification of Disparities

While perinatal education programs are designed to help nulliparous women prepare for childbirth and care of a newborn, many women in the United States do not attend such programs. This article presents partial data from a longitudinal study of 2,884 women aged 18-35 years who birthed their first child in Pennsylvania from 2009-2011. These partial data focused on women's participation in perinatal education and identify disparities in attendance. Overall, 79.1% reported attending one or more perinatal education programs. Women who were White, college educated, aged 30 years or older, and not in poverty were more likely to attend perinatal education programs. These results suggest a need for improved efforts to provide free or low-cost perinatal education to women across the socioeconomic spectrum in the U.S, especially in Pennsylvania.

Do Black birthing persons prefer a Black health care provider during birth? Race concordance in birth

BACKGROUND

For many years in the United States, there has been an active discussion about whether race concordance between care providers and patients contributes to better health outcomes. Although beneficial provider-patient communication effects have been associated with concordance, there is minimal evidence for concordance benefits to health outcomes.

METHODS

A cross-sectional survey was conducted including 200 Black mothers who had given birth within the last 2 years asking about the perceived racial identity of their birth health provider, whether they preferred to have Black women providers, and the intersection between race and gender concordance on birth outcomes. In addition to race and gender concordance, other variables were tested for their impact on birth satisfaction including respect, trust for the care provider, perceived competence, care provider empathy, and inclusive communication.

RESULTS

Forty-one percent of the mothers in this study were assisted in birth by a Black woman provider. Although patient-provider concordance did not result in measurable health outcomes, it is clear that compared to other studies of birth satisfaction among Black birthing persons, this study showed relatively higher levels of satisfaction, perceived trust, empathy, perceived provider competence, inclusive communication, and equal respect for both concordant and discordant care providers.

CONCLUSIONS

Although many participants showed a preference for race concordance, participants equally valued respect, competence, and trust with their care providers. Further community-based research needs to be conducted to examine whether race, gender, and cultural concordance results in other beneficial health outcomes.

Perceived Discrimination During Prenatal Care at a Community Health Center

Introduction

Discrimination in healthcare is associated with fetal growth restriction, preterm birth, and postpartum depression. A community-based participatory research study was designed to measure perceived discrimination and healthcare quality during prenatal care and delivery by a community health center, where the majority of patients served belong to historically marginalized ethnic and racial groups.

Methods

A 34-question phone survey was administered to women 18 years and older who received prenatal care at the study site during 2020–2021. The primary outcome was perceived discrimination during obstetric care, measured by the 7-question Discrimination in the Medical Setting (DMS) survey. Secondary outcomes included the association of race with perceived discrimination, quality of care, trust of healthcare providers, and perceived control over medical choices.

Results

Ninety-seven women completed the survey, 95 of whom were women of color. The sample was dichotomized into Black (n = 49) and non-Black (n = 46). Perceived discrimination for all participants was 21% (20/95), with 31% (15/49) of Black women reporting any discrimination during prenatal care and delivery. Compared to other women of color, Black women reported higher rates of perceived discrimination (31% vs 11%, aOR 3.9 [1.2–12.1], p < 0.05), lower control over health choices (84% vs 98%, aOR 0.1 [0.0–0.8], p < 0.05), and were more likely to perceive lack of respect (12% vs 2%, p = 0.045).

Conclusion

Although perceived discrimination at this community health center was low compared to prior studies, Black women experienced higher rates of discrimination than other women of color.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40615-022-01315-5.

Association of admission unit and birth satisfaction during induction of labor

OBJECTIVE

As induction of labor (IOL) becomes more common, hospitals must adjust to accommodate longer length of stays on labor and delivery. An alternative to reduce the length of time spent on labor and delivery during an IOL is to perform cervical ripening on an antepartum unit. However, this may affect patient satisfaction and knowledge about the birthing process. This study aimed to evaluate whether cervical ripening conducted in an antepartum unit, rather than on a labor and delivery unit, was associated with changes in patient satisfaction with birth experience and baseline knowledge about IOL. Additionally, the study aimed to understand how patients would prefer to receive education on the IOL process.

METHODS

This prospective observational study recruited English and Spanish-speaking patients at or after 39 weeks and 0 days gestation who were admitted for IOL. Consenting patients completed a preliminary survey containing sociodemographic and obstetric information as well as a previously validated survey on IOL knowledge on admission. Within 48 h of delivery, patients completed a follow-up survey including a validated birth satisfaction survey, the Birth Satisfaction Scale-Revised, and questions eliciting their preferred IOL education method. Data analyses compared patients who were admitted to antepartum for IOL to those admitted directly to labor and delivery. Multivariate analyses adjusted for sociodemographic and obstetric differences between the two groups. The primary outcomes were scores on the Birth Satisfaction Scale-Revised and on a test examining IOL knowledge. Secondary outcomes included preferred method of IOL education, obstetric outcomes, and neonatal outcomes.

RESULTS

A total of 277 eligible patients were approached from October 2020 to March 2021. Of the 216 (78%) that consented, 159 (74%) completed the follow-up survey and were subsequently included in this analysis. Individuals admitted directly to antepartum (n = 122) more commonly self-identified as Latina, Latin American, or Hispanic (27.9% vs. 8.1%, p = .01) and were nulliparous (68.0% vs. 21.6%, p < .001) compared to participants admitted to labor and delivery for IOL (n = 37). Patients admitted to labor and delivery were more likely to undergo elective induction (29.7% vs. 9.8%, p = .006). Admission unit was not associated with differences in birth satisfaction scores or obstetric or neonatal outcomes. However, after controlling for potential confounders, patients admitted to the antepartum unit correctly answered a greater percentage of questions assessing IOL knowledge compared to patients admitted to labor and delivery (73.9% vs. 62.3%, adjusted mean difference (aMD) 12.6 [95% CI 7.2, 18.0]). Patients in both groups indicated preference for reviewing an induction checklist with a provider during prenatal care (59.1%) or using a technology-based intervention (37.1%) over attending in-person classes (3.1%) to learn more about IOL.

CONCLUSION

Unit of admission for IOL is not associated with satisfaction with birth experience but is associated with patient knowledge of IOL. This suggests that IOL may be initiated in less acute units than labor and delivery without altering birth experience and may potentially allow for increased patient knowledge. Additionally, IOL checklists or technology-based education may help to further increase patient knowledge about IOL.

Validating machine learning models for the prediction of labour induction intervention using routine data: a registry-based retrospective cohort study at a tertiary hospital in northern Tanzania

OBJECTIVES

We aimed at identifying the important variables for labour induction intervention and assessing the predictive performance of machine learning algorithms.

SETTING

We analysed the birth registry data from a referral hospital in northern Tanzania. Since July 2000, every birth at this facility has been recorded in a specific database.

PARTICIPANTS

21 578 deliveries between 2000 and 2015 were included. Deliveries that lacked information regarding the labour induction status were excluded.

PRIMARY OUTCOME

Deliveries involving labour induction intervention.

RESULTS

Parity, maternal age, body mass index, gestational age and birth weight were all found to be important predictors of labour induction. Boosting method demonstrated the best discriminative performance (area under curve, AUC=0.75: 95% CI (0.73 to 0.76)) while logistic regression presented the least (AUC=0.71: 95% CI (0.70 to 0.73)). Random forest and boosting algorithms showed the highest net-benefits as per the decision curve analysis.

CONCLUSION

All of the machine learning algorithms performed well in predicting the likelihood of labour induction intervention. Further optimisation of these classifiers through hyperparameter tuning may result in an improved performance. Extensive research into the performance of other classifier algorithms is warranted.

The impacts of the COVID-19 pandemic on birth satisfaction in a prospective cohort of 2,341 U.S. women

PROBLEM

Birth satisfaction is an important health outcome that is related to postpartum mood, infant caretaking, and future pregnancy intention.

BACKGROUND

The COVID-19 pandemic profoundly affected antenatal care and intrapartum practices that may reduce birth satisfaction.

AIM

To investigate the extent to which pandemic-related factors predicted lower birth satisfaction.

METHODS

2341 women who were recruited prenatally in April-May 2020 and reported a live birth between April-October 2020 were included in the current analysis. Hierarchical linear regression to predict birth satisfaction from well-established predictors of birth satisfaction (step 1) and from pandemic-related factors (step 2) was conducted. Additionally, the indirect associations of pandemic-related stress with birth satisfaction were investigated.

FINDINGS

The first step of the regression explained 35% of variance in birth satisfaction. In the second step, pandemic-related factors explained an additional 3% of variance in birth satisfaction. Maternal stress about feeling unprepared for birth due to the pandemic and restrictions on companions during birth independently predicted lower birth satisfaction beyond the non-pandemic variables. Pandemic-related unpreparedness stress was associated with more medicalized birth and greater incongruence with birth preference, thus also indirectly influencing birth satisfaction through a mediation process.

DISCUSSION

Well-established contributors to birth satisfaction remained potent during the pandemic. In addition, maternal stress and restriction on accompaniment to birth were associated with a small but significant reduction in birth satisfaction.

CONCLUSION

Study findings suggest that helping women set flexible and reasonable expectations for birth and allowing at least one intrapartum support person can improve birth satisfaction.

Birth Satisfaction During the Early Months of the COVID-19 Pandemic in the United States

Purpose:

The purpose of this study was to describe birth satisfaction in women who gave birth in U.S. hospitals during the earliest months of the COVID-19 pandemic (March–July 2020).

Study Design and Methods:

A cross-sectional survey of 747 postpartum women who gave birth in the United States during the early COVID-19 pandemic was conducted. Participants in the United were recruited via social media. They completed a questionnaire that included demographic, health, and obstetric experience questions, and the Birth Satisfaction Scale-Revised. Descriptive statistics, t-tests, analysis of variance (ANOVA) models, and nonparametric correlations were performed.

Results:

Higher birth satisfaction scores were associated with higher income, marriage, white race, vaginal birth, having a birth partner present, and sufficient support during birth. Factors negatively associated with birth satisfaction were separation from infant, unplanned cesarean birth, neonatal intensive care unit admission, hypertension, preeclampsia, hemorrhage, depression, and anxiety.

Clinical Implications:

Presence of birth partners, sufficient birth support, and minimizing separation of mother and infant improve birth satisfaction. Obstetric complications, including unplanned cesarean birth, negatively affect birth satisfaction. There are racial disparities in birth satisfaction. It is critical to develop further interventions to end racism in maternal health care.

During the early months of the COVID-19 pandemic, there were many restrictive changes to childbirth practices in the inpatient setting geared toward reducing viral spread and keeping patients and health care workers safe. In this study 747 women who gave birth in the United States during the first several months of the pandemic offer their perspectives on how these changes affected their childbirth experience and overall satisfaction.

An educational video's impact on the induction of labor experience: a randomized controlled trial

BACKGROUND

Induction of labor is a common obstetrical intervention; much research focuses on medical indications, clinical outcomes, and induction agents. Little research has been conducted evaluating the patients' understanding of and satisfaction with induction of labor. Video-based educational tools have been validated as a practical and efficient counseling method by previous studies.

OBJECTIVE

This study aimed to evaluate whether an educational video enhances the patients' knowledge about induction of labor and improves satisfaction with the induction of labor process.

STUDY DESIGN

This was a single-center study in which women undergoing a scheduled induction of labor were randomized to either the control or intervention group. The control group was given a knowledge questionnaire about induction of labor before meeting their provider (midwife or obstetrician) on the day of scheduled induction of labor. The intervention group was shown a 3-minute educational video about induction of labor before administration of the knowledge questionnaire. Both groups, 24 to 48 hours after delivery, were asked to fill out a second questionnaire about satisfaction with the induction of labor process. Moreover, the video intervention group was asked to evaluate the video in the second questionnaire. Both knowledge and satisfaction questionnaires were compared between the control and intervention groups.

RESULTS

From October 2019 to February 2020, 145 women scheduled for induction of labor were eligible and approached for the study. Of the 145 participants, 129 consented and 119 completed the entire study. Moreover, 64 participants were randomized into the control group and 55 into the intervention group. Compared with patients in the control group, the patients who watched the educational video in the intervention group had significantly improved baseline knowledge about induction of labor (P<.001). Knowledge scores remained significantly higher in the intervention group when considering participants who had a previous induction of labor (parity, P<.001; nulliparity, P<.001; multiparity, P<.001). In addition, satisfaction with the induction of labor process among participants in the intervention group was significantly higher than those in the control group (P<.001). Moreover, this held true in those who had a cesarean delivery or had a history of a previous induction of labor (P<.003 and P<.001, respectively).

CONCLUSION

A brief educational video about induction of labor improved the patients' knowledge about the induction of labor process and their overall satisfaction with their delivery experience. Video-based education can play an innovative and important role in patient knowledge and satisfaction with the induction of labor process.

Course of pregnancy, labor, and women’s satisfaction with life in the early postpartum period

Background: The postpartum period, including hospitalization after a birth, requires the woman in puerperium to adjust to her new social role. The subject of satisfaction with life (SWL) in women in the early postpartum period has been rarely addressed in the literature and requires up-to-date, thorough research. Aim of the study: The present study aimed to evaluate the level of SWL among women after delivery according to selected characteristics concerning the course of pregnancy and labor. Material and methods: The study included 128 females who after delivery were hospitalized at maternity units in Lublin, Poland. The participants were administered the Satisfaction With Life Scale (SWLS) and a questionnaire to collect data on the course of pregnancy and labor. Results: It was found that 88 (68.75%) women had a high level of life satisfaction after childbirth, 27 (21.09%) had an average level, and 13 (10.16%) had a low level. Among the analyzed variables, a marginally significant increase in SWL was found for women in the early postpartum period that experienced skin-to-skin contact with the newborn immediately after delivery (p=0.054). The strength of the observed effect, as measured by Cohen’s d coefficient, was low (0.37). Conclusion: The current research contributes to the identification of factors occurring during pregnancy and labor that determine postpartum SWL. These results may enable the early elimination of variables that negatively affect postpartum SWL and place a focus on factors with a positive impact. The use of preventive measures designed to improve SWL are likely to aid in reducing the risk of mood disorders in the later postpartum period.

The Role of Labor Induction in Racial Disparities in Cesarean Delivery

We examined the interaction between race and labor induction in cesarean delivery in a cohort of 600,000 deliveries in the Cerner Health Facts database. Black women had higher likelihood cesarean (28.9 vs. 26.5%) and lower likelihood of induction of labor at delivery compared to white women (27.2 vs. 32.5%). Induction modified the association between race and cesarean-Black women (odds ratio=1.36, 95% confidence interval 1.30, 1.43) who were induced had significantly increased odds of cesarean delivery.

Rural residency as a risk factor for severe maternal morbidity

PURPOSE

The goal of this study was to evaluate how rural/urban status and other risk factors alter women's odds of severe maternal morbidity (SMM) at delivery.

METHODS

This study used 48,608 Kentucky resident delivery hospitalization records from 2017. We used multiple logistic regression with interaction terms to evaluate the moderating effect of rural/urban residence with other risk factors. We reported adjusted odds ratios (aORs) and 95% confidence intervals (CIs) as measures for association with the outcome of SMM at delivery.

FINDINGS

The percentage of delivery hospitalizations with SMM was higher for women with rural (2.4%) versus metro (1.1%) or metro-adjacent (1.5%) residence (p < .001). Rural status moderated the effect of anemia on SMM. The aOR for SMM for women with anemia versus those without was 8.56 (CI: 4.89-14.97) in rural areas, two times higher than in metro areas (aOR 3.87; CI: 3.09-4.86). Kentucky Appalachian region (aOR 1.90; CI: 1.46-2.47), Black race (aOR 1.30; CI: 1.02-1.66), history of cesarean section (aOR 1.28; CI: 1.07-1.52), hypertension (aOR 10.55; CI: 5.67-19.62), and opioid use (aOR 1.72; CI: 1.19-2.47) were significantly associated with SMM.

CONCLUSION

Rural women in Kentucky are at an increased risk for SMM. Quality and safety programming should specifically address the needs of isolated subpopulations. Women living in rural areas are more likely to experience SMM given an anemia diagnosis. The underlying cause and clinical management of anemia may differ between rural and urban areas.

Crisis, What Crisis? Replicability of the Key Measurement Characteristics of the Australian Version of the Birth Satisfaction Scale—Revised

BACKGROUND

Behavioral and medical science is currently in the grip of a “replication crisis,” circumscribed by the failure to replicate a large proportion of key studies and a consequential impact on confidence in the veracity of the scientific method. Given the contemporary nature of the debate it is surprising that the psychometric properties of commonly used outcome measures have not been evaluated in this context, despite the obvious potential for the measurement characteristics of the measures themselves to be a source of error within a study.

The current investigation sought to replicate the original validation study of the Australian version of the 10-item Birth Satisfaction Scale—Revised (A-BSS-R) with respect to key psychometric aspects and the issues of replicability.

METHODS

A replication study of all quantitative aspects of Jefford et al. (2018) with an increased sample size. Participants were a purposive sample of Australian postnatal women (n = 445).

RESULTS

Most key quantitative aspects of the original validation study were found to be replicable and consistent with Jefford et al. (2018), the A-BSS-R was found to have excellent psychometric properties fundamentally mirroring the measurement characteristics observed previously. However, a small number of instances of nonreplicability were found.

CONCLUSIONS

The A-BSS-R is a valid and reliable measure of birth satisfaction. Replicability, at least in part, is influenced by participant group characteristics, statistical power and sample size. More focus is required on the influence of self-report measures themselves on the germane aspects of successful study replication.