95: Maternal characteristics, delivery outcomes and self-reported perceived control during childbirth in low-risk nulliparous women

Abstract

Objective: To evaluate the association between maternal characteristics, delivery outcomes and self-reported perceived control during childbirth. This is a secondary analysis of a multicenter randomized trial comparing induction of labor at 39 weeks with expectant management in low-risk nulliparous women. Six to 96 hours after delivery, women who had spontaneous or induced labor completed the Labor Agentry Scale (LAS), a validated self-administered questionnaire consisting of 29 questions to ascertain perceived control during childbirth. Scores on the LAS range from 29 to 203, with higher scores indicating a sense of greater control. The maternal characteristics evaluated included maternal age, race/ethnicity, marital status, employment status, type of insurance, previous pregnancy loss before 20 weeks, body mass index, smoking and alcohol. Delivery outcomes evaluated included mode of delivery, post-delivery pain score (0-10 Likert scale with higher scores indicating greater pain), and a composite of perinatal death or severe neonatal complications (Table). The LAS score was evaluated as a continuous outcome using a multivariable linear regression model that included significant variables (p<0.05). Of 6,106 women enrolled in the primary trial, 6038 had spontaneous or induced labor, and of these 5,750 completed the LAS questionnaire and were included in this analysis. LAS scores were significantly higher (greater perceived control) among non-Hispanic whites, employed participants, those with private insurance, nonsmokers, and those with lower body mass index (Table). LAS scores were lower among women who were delivered by cesarean and who reported greater labor pain. In an unadjusted analysis, LAS scores were lower among single women and women whose neonate experienced the perinatal composite. However, these differences were no longer significant in the multivariable analysis. No association was observed with maternal age, previous pregnancy loss, or alcohol use. Results remained unchanged after adjusting for treatment group. In this cohort of low-risk nulliparous women, perception of control during labor was associated with maternal demographics and lifestyle characteristics as well as mode of delivery and labor pain.