Abstract
BackgroundNegative childbirth experience may affect mother wellbeing and health. However, it is rarely evaluated in studies comparing methods of induction of labor (IoL).AimTo compare women’s experience of IoL according to the method, considering the mediating role of interventions and complications of delivery.MethodsWe used data from the MEDIP prospective population-based cohort, including all women with IoL during one month in seven French perinatal networks. The experience of IoL, assessed at 2 months postpartum, was first compared between cervical ripening and oxytocin, and secondarily between different cervical ripening methods. Mediation analyses were used to measure the direct and indirect effects of cervical ripening on maternal experience, through delivery with interventions or complications.FindingsThe response rate was 47.8% (n = 1453/3042). Compared with oxytocin (n = 541), cervical ripening (n = 910) was associated less often with feelings that labor went ‘as expected’ (adjusted risk ratio for the direct effect 0.78, 95%CI [0.70–0.88]), length of labor was ‘acceptable’ (0.76[0.71–0.82]), ‘vaginal discomfort’ was absent (0.77[0.69–0.85]) and with lower global satisfaction (0.90[0.84–0.96]). Interventions and complications mediated between 6 and 35% of the total effect of cervical ripening on maternal experience. Compared to the dinoprostone insert, maternal experience was not significantly different with the other prostaglandins. The balloon catheter was associated with less pain.DiscussionCervical ripening was associated with a less positive experience of childbirth, whatever the method, only partly explained by interventions and complications of delivery.ConclusionCounselling and support of women requiring cervical ripening might be enhanced to improve the experience of IoL.
Highlights
Women’s experience and satisfaction with childbirth is an important element for judging the quality of care in a maternity ward [1]
The respondents included a higher proportion of women who were nulliparous, older than 35 years, born in Europe, living with a partner, who belonged to higher socio-professional categories and who did not receive intracervical balloon for induction of labor (IoL)
After taking the confounding and mediating factors into account, cervical ripening was significantly associated with a lower risk of experiencing that ‘labor went quite normally’ (RR adjusted for direct effect, aRR 0.86, 95% CI 0.81–0.93), that ‘labor and delivery went as expected’ and that the ‘length of labor was acceptable’
Summary
Women’s experience and satisfaction with childbirth is an important element for judging the quality of care in a maternity ward [1]. From 5 to 20% of women describe their experience of delivery as negative [2,3,4]. Women’s experience in childbirth is known to be worse when they have a cesarean delivery, especially when it is performed as an emergency [11, 12]. One of the most common interventions in obstetrics today is induction of labor (IoL). Intravenous oxytocin infusion and amniotomy are recommended when the cervix is favorable, otherwise cervical ripening is necessary to increase the likelihood of successful induction [16]. Negative childbirth experience may affect mother wellbeing and health. It is rarely evaluated in studies comparing methods of induction of labor (IoL)
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