Childbirth Experience Questionnaire Research Articles

Childbirth experience in induced labor: A prospective study using a validated childbirth experience questionnaire (CEQ) with a focus on the first birth.

ObjectiveFirst birth and labor induction are risk factors for negative childbirth experiences. As labor inductions are increasing, research into this high-risk group’s childbirth experiences is important. We aimed to investigate whether nulliparity or factors related to labor induction, labor, and delivery explain the association.MethodsThis was a prospective study of 711 women undergoing labor induction at Helsinki University Hospital, Finland, between January 1, 2019, and January 31, 2020. The participants answered the Childbirth Experience Questionnaire (CEQ) after delivery (response rate 69.4%). The patient characteristics and delivery outcomes were collected from patient records. We analyzed the results for nulliparous and parous women.ResultsThe mean CEQ scores were 2.9 (SD 0.5) for nulliparous women (n = 408) and 3.2 (SD 0.5) for parous women (n = 303), on a scale of 1–4; higher scores represent more positive experiences. However, 7.3% of the women had negative childbirth experiences (8.8% nulliparous; 5.3% parous, p = 0.08). Negative experiences were associated with a cesarean section (OR 6.7, 95% CI 1.8–9.3, p < 0.001) and a hemorrhage ≥ 1500 ml in vaginal delivery (OR 2.8, 95% CI 1.1–7.5, p = 0.03). In the separate CEQ domains analyses, nulliparity was associated with negative experiences in the “Own Capacity” domain (OR 1.6, 95% CI 1.0–2.4, p = 0.03). Cervical ripening, oxytocin use, and daytime delivery were associated with negative experiences in at least one domain, whereas epidural or spinal analgesia was regarded positively in two domains and negatively in one.ConclusionsNulliparous women undergoing labor induction risk negative childbirth experiences mainly due to labor and delivery-related factors, similar to parous women. Their perceptions of their capacity and preparedness for labor and delivery should be enhanced antenatally. An effective labor induction protocol promoting as high a rate of vaginal delivery as possible and preparedness to promptly respond to postpartum hemorrhage are key for avoiding negative childbirth experiences.

Correlations Between Primiparous Women’s Perceived Internal Control, External Control, Support and Their Birth Experience

BACKGROUNDPerceived control and support can contribute to a positive childbirth experience. However, most studies have not differentiated between perceived internal and external control.OBJECTIVEThe present study aimed to assess primiparous women’s perceived internal control, external control, and support, including family and professional support and their association with the childbirth experience.METHODSA cross-sectional study was carried out on 800 primiparous mothers recruited from health centers across Tabriz, Iran, through cluster sampling. The childbirth experience questionnaire (2.0) and the support and control in birth scale were used to measure women’s childbirth experience and their perceived internal and external control and support. Data were collected through an interview during early postpartum and analyzed by independent t-test, one-way ANOVA, Pearson correlation and general linear model.RESULTSThe results demonstrated a significant correlation between perceived internal control (r = 0.80, p &lt; .001), external control (r = 0.79, p &lt; .001) and professional support (r = 0.83, p &lt; .001) with childbirth experience. By controlling confounders such as socio-demographic and reproductive variables, internal control [β (95% CI): 0.28 (0.25 to 0.31); p &lt; .001], external control [0.10 (0.06 to 0.14); p &lt; .001], professional support [0.27 (0.23 to 0.30); p &lt; .001], were independent predictors of positive childbirth experience.CONCLUSIONThese findings point to the importance of perceived internal, external control and professional support and the relationship between healthcare providers, especially midwives, with the women in improving childbirth experience. It is suggested that healthcare providers give support to women and utilize methods that enhance women’s control during labor and childbirth.

Twin birth: The maternal experience

ObjectiveTwin birth is a special setting for women giving birth, and the experience of childbirth can be different from singleton birth. The objective of this study was to evaluate and compare the childbirth experiences of twin mothers and singleton mothers. We also aimed to identify the risk factors of a negative childbirth experience in the whole study population. MethodsAll live diamniotic twin deliveries in the study hospital of at least 35+0 weeks of gestation with a plan of vaginal birth were included in this matched groups study from August 2015 to August 2019. For every twin birth, two singleton birth controls were selected and matched with parity, the actual mode of birth, and gestational weeks at birth. Six weeks after birth, a Childbirth Experience Questionnaire (CEQ) was sent to mothers, and 72 twin mothers and 126 singleton mothers returned the questionnaire. ResultsThe twin mothers’ overall childbirth experience was positive. They reported a significantly lower opportunity to choose the birthing position (p < 0.001). Otherwise, there were no differences in the CEQ mean total scores between the study groups. Intrapartum cesarean section raised the risk of a negative childbirth experience and there was a high level of satisfaction with midwifery care among the whole study population. ConclusionThe overall maternal experience in planned vaginal twin birth was positive. Twin mothers felt less often able to choose their birthing position, otherwise the childbirth experience did not differ from that of singleton mothers.

Comparison of primiparous women's childbirth experience in labor induction with cervical ripening by balloon catheter or oral misoprostol - a prospective study using a validated childbirth experience questionnaire (CEQ) and visual analogue scale (VAS).

Primiparity and labor induction, especially when cervical ripening is required, are risk factors for a negative childbirth experience. Our aim was to compare childbirth experience in primiparous women with cervical ripening by balloon catheter or oral misoprostol using the validated Childbirth Experience Questionnaire (CEQ). We also wanted to compare assessment of a negative childbirth experience by visual analogue scale (VAS) and CEQ. This is a prospective study of 362 primiparous women undergoing cervical ripening and labor induction by balloon catheter (67.4%) or oral misoprostol (32.6%) at Helsinki University Hospital, Finland, between January 1, 2019 and January 31, 2020. After delivery, the women assessed their childbirth experience using the CEQ, and patient records provided the patient characteristics, delivery outcomes and VAS ratings. We analyzed the results using IBM SPSS Statistics. Overall, the women experienced their labor and delivery rather positively, with a mean CEQ score of 2.9 (SD 0.6) (scale 1-4), and no differences were detectable when comparing women with cervical ripening by balloon catheter or misoprostol. However, women with balloon catheter were more often satisfied with the method chosen for them and would choose the same method in a future pregnancy. Compared with CEQ, VAS seems mainly to reflect the women's perception of their own capacity to give birth and the safety of the hospital setting, not the level of professional support or participation in decision-making. According to our results, CEQ and VAS are comparable, but the usability of the CEQ is limited by its inability to distinguish the most negative and the most positive experiences, and the VAS is limited by its simplicity. Women with cervical ripening by balloon catheter or oral misoprostol experienced their childbirth rather positively, results being similar in both groups. However, women with cervical ripening by balloon catheter were more content with their labor induction. The CEQ and VAS can both be used to assess the childbirth experience of primiparous women undergoing labor induction, but both methods have limitations.

Do women's perceptions of their childbirth experiences change over time? A six-week follow-up study in a Danish population

ObjectiveTo evaluate how women's perception of the childbirth experience developed during the postpartum period. The secondary aim was to explore how selected birth interventions were subjectively perceived as part of the birth experience. DesignA prospective cohort study comparing childbirth experience, assessed at one and six weeks postpartum, using the Childbirth Experience Questionnaire (CEQ). SettingA regional hospital in the northern part of Denmark, with 1,400 childbirths annually. ParticipantsA total of 201 women with low-risk births who gave birth at North Denmark Regional Hospital were included in this study. We included both nulliparous and multiparous women. Measurements and findingsMore than 50% of the women changed their perceptions about their childbirth experience after six weeks. After six weeks the overall CEQ score and the domains ‘Participation’ and ‘Professional support’ had a lower CEQ score compared to scores obtained one week postpartum, although differences were small. Induction of labor, augmentation of labor, emergency caesarean section, epidural analgesia, and use of nitrous oxide were associated with a lower CEQ score. Key conclusionsWomen assessed their overall birth experience more negatively at six weeks postpartum compared to one week postpartum. Some interventions in the labor process influenced the women's assessment of their experiences negatively. Implications for practicePaying attention to preventive initiatives to ensure the women a spontaneous birth, if possible, may be essential to create positive perceptions of the childbirth experience.

METHODS OF LABOR ANALGESIA BY DETERMING THE LEVEL OF CHILDBIRTH SATISFACTION

Introduction. Woman’s satisfaction with childbirth is associated with adequate labor analgesia [1]. Negative labor experience could increase the risk of poor mother-child connection, breastfeeding problems [2], and decreased desire for elective caesarian section [3]. Effective management of labor pain and positive childbirth experience improve the quality of maternity care [4]. Aim. Explore correlation between different pharmacological/non-pharmacological methods of labor analgesia at ‘’home’’/hospital environment with positive childbirth experience. Methods and materials: There are 321 women who completed questionnaire of childbirth experience. Survey consists of 4 parts: ‘’own capacity’’, ‘’professional support’’, ‘’perceived safety’’, ‘’participation’’. In postpartum period, women were divided into 4 groups with: patient-control epidural analgesia (PCEA) (n=217), nitrous oxide (50:50) (n=18), alternative methods of labor analgesia in ‘’home’’ environment (n=46) and hospital birth without pharmacological analgesia (n=40). Logistic regression was used to analyze the risks. Results. The study shown the risk of unsatisfactory assessment of Childbirth Experience Questionnaire in the sections “perceived safety” (p=0,034, OR=2,03 (95% CІ 1,06–3,86)), ‘’professional support’’ (p=0,006, (OR=2,58 (95% CІ 1,31–5,07)), increased for patients with severe pain (VAS 7 points), compared with patients for VAS &lt;7 points. PCEA is considered to be standard of labor analgesia and is not associated with the risk of unsatisfactory assessment in sections “perceived safety” and ‘’own capacity’’ (p&gt;0,05). Nitrous oxide and alternative methods of analgesia shown higher rates of childbirth satisfaction in the sections ’’participation’’ (p=0,029, OR=0,48 (95% CІ 0,25–0,93), ‘’own capacity’’(р=0,040), and low rates in ‘’professional support’’ (p=0,029, OR=1,91 (95% CІ 1,07–3,41). Conclusions. An effective strategy to increase level of childbirth satisfaction is to provide positive communication with women and to inform about risk of using pharmacological/ non-pharmacological labor analgesia

Psychometric Evaluation of the Malay Version of the Childbirth Experience Questionnaire (CEQ-My).

Negative childbirth experience may cause adverse psychological effects in postpartum mothers. The Childbirth Experience Questionnaire (CEQ) is a multidimensional tool designed to assess women’s perceptions of labour and birth. We aim to validate the Malay version of the CEQ (CEQ-My) and evaluate its psychometric properties. The previously published Malay-translated CEQ was reviewed by a panel of experts and underwent minor changes. The original visual analogue scoring (VAS) was changed to a numerical scale. The reliability and construct validity of CEQ-My was assessed using Cronbach’s alpha and exploratory analysis, respectively. Known-groups validation was conducted using the Mann–Whitney U test, whilst the inter-item correlations between CEQ-My and its subdomains were evaluated through Spearman’s correlation. The final analysis involved 246 women. The questionnaire was easy to understand and all women preferred numeric scoring to the VAS. Based on the principal component factor analysis, we deleted one item and rearranged the domain for four items. The twenty-one items CEQ-My demonstrated good reliability with Cronbach’s alpha of 0.77. Women who had spontaneous vaginal delivery demonstrated significantly greater CEQ-My scores than those who underwent operative delivery (p = 0.002). The domain of professional support was positively correlated to that of own capacity and participation (p-value of < 0.001 and 0.002, respectively). The CEQ-My is a valid and reliable instrument to assess Malaysian women’s childbirth experiences. The easy-to-use electronic version of CEQ-My will improve future research and ease data collection.

Two are better than one? The impact of lay birth companions on childbirth experiences and PTSD.

Although continuous support during childbirth is recommended by the World Health Organization (WHO) and has well-established benefits, the practice is still not routinely implemented in all maternity settings. We studied the possible effect of an additional lay companion (other than the partner) on childbirth experience and postpartum post-traumatic stress disorder (PTSD). Two hundred and forty-six women, who gave birth in maternity wards of a large tertiary health center in Israel, responded to questionnaires in person at 1–4 days (Demographic questions and the childbirth experience questionnaire) and on-line at 8–10 weeks postpartum (City Birth Trauma Scale). Obstetric data were taken from the medical files. Women who were accompanied by their partners and an additional companion were lower in birth-related PTSD symptoms (M = 1.17, SD = 2.61) than women accompanied by only their partner (M = 1.53, SD = 2.79) (F(2, 240) = 4.0, p < 0.05). Women who had a single companion (M = 1.44, SD = 2.61) showed more birth-related PTSD symptoms than women who had two or more companions (M = 1.17, SD = 2.52) (F(1, 241) = 6.4, p < 0.05). In addition, women who had a single companion were higher in general PTSD symptoms (M = 3.91, SD = 4.73) than women who had two or more companions (M = 2.31, SD = 4.29) (F(1, 241) = 4.2, p < 0.05). No differences were found in childbirth experiences of women with single or multiple companions. Allowing more than one lay companion (other than the partner) may be a simple cost-effective way of providing beneficial support in all birth settings, promoting respectful maternity care and reducing childbirth-related PTSD levels and by that future psychopathology sequela.

Epidural analgesia associations with depression, PTSD, and bonding at 2 months postpartum

The research aim was to study the possible effect of epidural analgesia, as well as other possible demographic/obstetric variables and subjective birth experience on postpartum depression, PTSD, and impaired bonding. This was a longitudinal study of 254 women who gave birth at the maternity wards of a large tertiary health center and responded to questionnaires at T1 (Childbirth Experience Questionnaire and level of fatigue question; in person, 1–4 days postpartum) and at T2 (Postnatal Depression Scale, Postpartum Bonding Questionnaire, and the City Birth Trauma Scale; online-two months postpartum). Obstetric and demographic data were taken from medical files. Having a previous psychiatric diagnosis and higher levels of fatigue significantly predicted worse outcomes in all measures (level of fatigue was not associated with the City Birth Trauma birth-related symptoms factor). Having higher education, being primiparous, worse birth experience, and longer second stage of birth predicted worse outcomes in some measures. Although epidural administration had no effect on any of the outcome variables, special attention should be devoted to women who had long second-stage births and/or suffering from postpartum fatigue to prevent postpartum psychopathology. In addition, demographic variables, such as primiparity, education, and prior psychopathology diagnosis should be considered to treat women and prevent postpartum psychopathology.

An informative video before planned cesarean delivery and maternal anxiety—a multicenter randomized controlled trial

Cesarean delivery is one of the most common procedures performed in obstetrics, and although cesarean delivery is a blissful occasion, it is commonly associated with fear and anxiety for the new mother. We aimed to study the impact of watching a detailed, informative video on maternal anxiety levels, childbirth experience, and patient satisfaction in patients undergoing a primary cesarean delivery. We performed a multicenter randomized control trial. Women scheduled to undergo a primary nonemergent cesarean delivery were recruited. All participants in the intervention group watched an informative video on recruitment. This 4-minute video described in detail the expected cesarean delivery process: preparations before entering the operation room, regional anesthesia administration, sterile covering, the surgical procedure itself, and recovery (including mobilization and lactation). Situation-specific anxiety was measured at recruitment, before exposure to the video (S1), at the day of the operation (S2), and at postpartum day 1 (S3) using the State-Trait Anxiety Inventory score. In addition, participants answered a 10-item Childbirth Experience Questionnaire. A sample size of 63 per group was planned to achieve 80% power to detect a difference of 5 points in the primary outcome (State-Trait Anxiety Inventory score on the day of the operation). Overall, 154 participants from 4 medical centers were randomized, and 132 participants were analyzed after completing all questionnaires, 64 participants in the video group and 68 participants in the control group. The groups did not differ in demographics and delivery characteristics and had similar baseline anxiety levels (S1). On operation day (S2, the primary outcome), significantly lower anxiety levels were reported in the video group than in the control group (State-Trait Anxiety Inventory scores, 41.3±9.5 vs 49.3±10.3; P<.001). Moreover, anxiety levels in postpartum day 1 (S3) remained significantly lower in the video group (P<.001). No difference between the groups in childbirth experience score or patient satisfaction was demonstrated. A detailed informative video shown to patients before primary cesarean delivery decreased maternal anxiety levels before and after the procedure.

Assessing Dutch women\u2019s experiences of labour and birth: adaptations and psychometric evaluations of the measures Mothers on Autonomy in Decision Making Scale, Mothers on Respect Index, and Childbirth Experience Questionnaire 2.0

BackgroundThe Mothers Autonomy in Decision Making Scale (MADM) assesses women’s autonomy and role in decision making. The Mothers on Respect Index (MORi) asseses women’s experiences of respect when interacting with their healthcare providers. The Childbirth Experience Questionnaire 2.0 assesses the overall experience of childbirth (CEQ2.0). There are no validated Dutch measures of the quality of women’s experiences in the intrapartum period. Therefore, the aim of this study was to evaluate the psychometric properties of these measures in their Dutch translations.MethodsThe available Dutch versions of the MADM and MORi were adapted to assess experiences in the intrapartum period. The CEQ2.0 was translated by using forward-backward procedures. The three measures were included in an online survey including items on individual characteristics (i.e. maternal, birth, birth interventions). Reliability was assessed by calculating Cronbach’s alphas. Mann-Whitney, Kruskal Wallis or Student T-tests were applied where appropriate, to assess discrimination between women who differed on individual characteristics (known group validity). We hypothesized that women who experienced pregnancy complications and birth interventions would have statistically lower scores on the MADM, MORi and CEQ2.0, compared with women who had healthy pregnancies and physiological births. Convergent validity was assessed using Spearman Rank correlations between the MADM, MORi and/or CEQ2.0. We hypothesized moderate to strong correlations between these measures. Women’s uptake of and feedback on the measures were tracked to assess acceptability and clarity.ResultsIn total 621 women were included in the cross sectional study. The calculated Cronbach’s alphas for the MADM, MORi and CEQ, were ≥ 0.77. Knowngroup validity was confirmed through significant differences on all relevant individual characteristics, except for vaginal laceration repair. Spearman Rank correlations ranged from 0.46-0.80. In total 98% of the included women out of the eligible population completed the MADM and MORi for each healthcare professional they encountered during childbirth. The proportions of MADM and MORi-items which were difficult to complete ranged from 0.0-10.8%, 0.6-2.7%, respectively.ConclusionsThe results of our study showed that the Dutch version of the MADM, MORi and CEQ2.0 in Dutch are valid instruments that can be used to assess women’s experiences in the intrapartum period.

Validating the use of the revised childbirth experience questionnaire in Hong Kong

ObjectiveTo evaluate the psychometric properties of the traditional Chinese version of the Childbirth Experience Questionnaire (CEQ 2.0) and assess the childbirth experiences of Chinese women.MethodsA cross-sectional survey was conducted in Hong Kong from July 2020 to February 2021. In total, 975 mothers, who could read traditional Chinese and gave birth in 2020 or 2021, were included in the analysis. Data were fitted into the model proposed by the original developers using the confirmatory factor analysis. The data were then randomly split into training and validation sets for exploratory and confirmatory factor analyses. Childbirth experiences were assessed. Factor structure, internal construct validity, internal consistency, and known-group validity were assessed.ResultsThe originally proposed CEQ2.0 model showed a poor fit. An exploratory factor analysis identified a revised four-factor model (CEQ2.0-R) on a randomly split sample, which showed a satisfactory fit (CFI=0.912; TLI=0.884; SRMR=.053; RMSEA=0.072) on the other split sample. The revised scale comprised 13 items and four domains: (1)“Own capacity” (6 items), (2) “General support” (3 items), (3) “Perceived safety” (2 items), and (4) “Professional support” (2 items). CEQ2.0-R showed high internal construct validity and reliability. It can differentiate between participants with different characteristics, including parity, oxytocin augmentation, and companionship during labour. The childbirth experiences of the participants were merely positive, and participants reported that more support from midwives is needed.ConclusionsCEQ2.0-R can adequately describe the childbirth experiences of women in Hong Kong. The questionnaire is easy to be administer and can be used to assess several domains of the childbirth experiences. It may be useful to evaluate the aspects of support needed during childbirth.

The relationship between women’s childbirth experiences and their maternal attachment and the risk of postpartum depression

Introduction and aim. This descriptive study was conducted to examine the effects of the childbirth experiences of mothers on their maternal attachment and postnatal depression. Material and methods. The study was conducted with 315 mothers who agreed to participate in the study in Obstetrics and Gynecology Hospital between 2 September 2019 and 25 February 2020. A “Personal Information Form”, “Childbirth Expectation and Experience Questionnaire (CEEQ)”, “Maternal Attachment Inventory (MAI)”, and “Edinburgh Postnatal Depression Scale (EPDS)” were used to collect data. The data were analyzed with the IBM SPSS v23 program. Independent-samples t test, oneway analysis of variance (ANOVA), and Pearson’s correlation test were used in the analyses. Results. The mean postpartum depression mean score of the participants was 4.3±5.9, and 23% of them were at risk of depression. The mean maternal attachment score of participants was determined as 85.2±4.6, and their mean birth experience score was 3.0±3.1. A positive and significant relationship was found between more than half of the items of Childbirth Expectation and Experience Questionnaire and general satisfaction (p≤0.05). The childbirth experience scores of the participants were not significantly related to their maternal attachment and postpartum depression scores (p&gt;0.05). Conclusion. In this study, no significant relationship was found between the childbirth experiences of women and their maternal attachment or postpartum depression levels.

Childbirth Experience Questionnaire: Cross-cultural validation and psychometric evaluation for European Portuguese.

Background:Self-reported measures are relevant both for the clinic and for health evaluation because they provide an interpretation of quality parameters. Women who experience labour can express themselves through these measures, identifying indicators that need improvement.Objective:The objective of this study is to adapt the Childbirth Experience Questionnaire to the Portuguese context and to determine its psychometric properties.Method:A methodological study carried out with a convenience sample where the participants were 161 female users of a hospital in southern Portugal. They were aged between 20 and 43 years (M = 31.05, SD = 4.87) and answered a questionnaire approximately 48 h postpartum, preserving the ethical principles. The original instrument, with 22 items, underwent the linguistic and cultural adequacy process.Results:Factor analysis with Varimax rotation was performed, revealing a set of 19 items with factor weights above .400. The set of items remained four-dimensional as the original, explaining 62.517% of the variance. In the retest, the reliability results showed that similar characteristics to the original study are maintained in the two subscales that express ‘Participation’ (three items) and ‘Professional Support’ (four items), with internal consistency values of .807 and .782. The ‘Own Performance’ and ‘Own Threshold’ subscales were elaborated from the results of the Varimax rotation, presenting Cronbach’s alpha coefficients of .840 and 714, respectively. The total scale showed alpha values of .873 and .823 in the test and retest, respectively. Time stability showed a positive association, with r = .659 (p < .001). Accuracy through the split-half method reached an alpha value of .880 with Spearman–Brown correction. The floor effect was high in the ‘Participation’ subscale, both in the test and in the retest. Convergent validity between the instrument and the ‘Index of Strategies for Pain Relief in Labour’ discrete variable showed a Spearman’s rho value of .209 (p = .011) in the total scale. In discriminating validity, the Mann–Whitney test reveals that the women who recognize interactions with the midwife have more favourable scores in Childbirth Experience Questionnaire (U = 2748.000; Z = 2.905; p = .004).Conclusion:The current version in European Portuguese suggests that it is a valid and reliable measure. This study may facilitate other validation processes in Lusophony countries.

Satisfaction of women with childbirth

Aim: The study aimed to determine childbirth experience and the overall satisfaction of women with childbirth and its related socio-demographic and obstetric factors. Design: A cross-sectional study. Methods: We used the Childbirth Experience Questionnaire (CEQ) on a sample of 161 primiparous women. Results: Total mean CEQ score was 49.78 (SD = 6.02). The best-rated domain was the Perceived safety domain at 2.66 (&#177; 1.90). The worst-rated domain was the Professional support domain at 1.66 (&#177; 1.30). Regarding childbirth satisfaction, the mode of delivery proved to be a related factor, with the highest level of childbirth satisfaction in women after surgical delivery. Conclusion: Providing quality care and creating a positive experience that can contribute to overall birth satisfaction should be a common target of healthcare professionals in caring for parturient women. In order to create a positive childbirth experience, it is necessary to pay increased attention to the management of labor pain relief, to improving the professional support provided by midwives (i.e., through a more sensitive approach to mothers), to promoting the active participation of the mother during childbirth, and to supporting spontaneous vaginal delivery.

The effect of Zhang's guideline vs the WHO partograph on childbirth experience measured by the Childbirth Experience Questionnaire in the Labor Progression Study (LaPS): A cluster randomized trial.

Childbirth experience is an increasingly recognized and important measure of quality of obstetric care. Previous research has shown that it can be affected by intrapartum care and how labor is followed. A partograph is recommended to follow labor progression by recording cervical dilation over time. There are currently different guidelines in use worldwide to follow labor progression. The two main ones are the partograph recommended by the World Health Organization (WHO) based on the work of Friedman and Philpott and a guideline based on Zhang's research. In our study we assessed the effect of adhering to Zhang's guideline or the WHO partograph on childbirth experience. Zhang's guideline describes expected normal labor progression based on data from contemporary obstetric populations, resulting in an exponential progression curve, compared with the linear WHO partograph. The choice of labor curve affects the intrapartum follow-up of women and this could potentially affect childbirth experience. The Labor Progression Study (LaPS) study was a prospective, cluster randomized controlled trial conducted at 14 birth centers in Norway. Birth centers were randomized to either follow Zhang's guideline or the WHO partograph. Nulliparous women in active labor, with one fetus in cephalic presentation at term and spontaneous labor onset were included. At 4 weeks postpartum, included women received an online login to complete the Childbirth Experience Questionnaire (CEQ). Total score on the CEQ, the four domain scores on the CEQ, and scores on the individual items on the CEQ were compared between the two groups. There were 1855 women in the Zhang group and 1749 women in the WHO partograph group. There was no difference in the total or domain CEQ scores between the two groups. We found statistically significant differences for two individual items; women in the Zhang group scored lower on positive memories and feeling of control. Based on our findings on childbirth experience there is no reason to prefer Zhang's guideline over the WHO partograph.

The Impact of First Childbirth Experience on Women’s Attitude Towards Having Another Child and Subsequent Vaginal Birth

Background: Some women may consider childbirth an unpleasant event, which can influence their decisions on subsequent pregnancies and type of birth. Objective: The aim of this study was to determine the proportion of negative childbirth experience and its relationship with women’s attitudes towards subsequent pregnancy and vaginal birth. Methods: The study design was a cross-sectional. A cluster sampling was used to recruit 800 primiparous women from health centers in Tabriz, Iran. The Persian version of the Childbirth Experience Questionnaire was used to assess women’s childbirth experiences. Univariate and multivariate logistic regression was used to assess the impact of childbirth experiences on women’s attitudes towards subsequent pregnancy and vaginal birth. Results: Thirty-seven percent of women reported a negative childbirth experience. There was a statistically significant relationship between childbirth experience and the attitude of women towards subsequent pregnancy (p&lt;0.001) and vaginal birth (p&lt;0.001). By controlling the effects of potential confounding variables such as socio demographic characteristics, negative childbirth experience was found to be an independent predictive factor for women’s reluctance towards subsequent pregnancies [OR= 0.42 (CI 95%: 0.57 to 0.31), p&lt;0.001] and vaginal birth [OR= 0.08 (CI 95%: 0.14 to 0.04); p&lt;0.001]. Conclusion: Negative childbirth experience is associated with a reduced willingness for women to get pregnant again and have vaginal birth. It is recommended that key stakeholders pay attention to strategies to improve childbirth experiences among primiparous women in Iran.

Negative Childbirth Experience and Post-traumatic Stress Disorder - A Study Among Postpartum Women in South India.

Purpose: Negative childbirth experience has been associated with post-traumatic stress disorder (PTSD) and depression in the postpartum period with a significant impact on the mother as well as the infant.Methods: The current study aimed at studying the association of negative child birth experience with PTSD and depressive symptoms among primiparous mothers within 6 weeks of child birth. The Childbirth Experience Questionnaire (CEQ), PTSD checklist (PCL), and Edinburgh Postnatal Depression scale (EPDS) were used to assess negative childbirth experience, symptoms of PTSD, and depression respectively.Results: Of the 95 women in the study, fifty women (52.6%) had a score below the median of CEQ score (score of 72) indicating a negative childbirth experience. Lower Scores on CEQ indicating negative childbirth experience correlated with PTSD scores on the PCL (r = −0.560, p = 0.001) and depression scores on the EPDS (r = −0.536, p = 0.001). Of the sample of 95 women, 7.36% (N = 7) met the criteria for probable PTSD and 3.16% (N = 3) met criteria for partial PTSD. Twelve women (12.6%) had EPDS scores above 13 indicating probable clinical depression. Median CEQ scores were lower among the women who had PTSD or partial PTSD (N = 10) and among the women who had probable depression (N = 12) than those who did not. Childbirth experience emerged as the only predictor of PTSD on logistic regression (p = 0.03) (95% CI 1.17–79.61).Conclusions: Negative childbirth experiences are common and appear to be associated with depressive and PTSD symptoms. These findings emphasize the need to provide good intrapartum care including respectful maternity care for a positive childbirth experience.

Recommendations for improving primiparous women\u2019s childbirth experience: results from a multiphase study in Iran

BackgroundWomen's satisfaction with childbirth experience is considered as one of the quality indicators of the maternity services across the world. However, there is no guideline for improving the experience of childbirth in Iran that is suitable for women with different cultural, economic, and social statuses. The aim of this study is to make recommendations for practice and propose a clinical guideline for improving the experience of women with vaginal births.Methods/designThe study design was a mixed method study with a sequential explanatory approach consisting of three phases. The first phase of the study was a cross-sectional study to identify the predictors of traumatic vaginal childbirth experience among 800 primiparous women from Tabriz health centers who had vaginal birth. Data collection tools in this phase were Childbirth Experience Questionnaire (CEQ) and Support and Control in Birth (SCIB). Both tools were validated for Farsi language. The second phase was a qualitative study with 17 in-depth individual interviews among women who took part in the first phase to better understand their reasons that influenced their childbirth experience either positively or negatively. The third phase of the study was to develop recommendations for a proposed clinical guideline through a Delphi study where maternal health experts were selected and invited to take part in the panel. They first rated the proposed recommendations individually and provided written responses on their own agreement or disagreement with each statement in terms of its impact on childbirth experience, feasibility, acceptability, and cost-effectiveness. After three confirmation rounds, the final conscience was reached by the panel members.ResultsThe results of the quantitative phase showed that the probability of negative experience of childbirth was increased when physical exercise was not implemented during pregnancy, lacking pain relief options, having fear of childbirth, lacking skin to skin contact with the newborn and being unable to initiate breastfeeding in the first hour after birth (P < 0.05). The analysis of qualitative data revealed 13 major theme categories which were related to women’s sense of internal control, external control and support. In the third phase of the study, culturally appropriate recommendations were made and an evidence-based clinical guideline was proposed. The proposed guideline was based on the combination of the quantitative and qualitative phases, a review of the literature, and the opinions of Iranian experts using the Delphi technique.ConclusionGiven the high prevalence of negative childbirth experience among Iranian primiparous women, the present study may be of great interest for managers, leaders, policymakers, and care providers to improve the quality of the maternity services. However, further studies are required to translate the recommendations into practice and identify enablers and barriers during the implementation of the proposed guideline. To adopt the recommendations at national level, there is a need to further studies to assess the effectiveness of the proposed guideline within different communities across the region and the country.

The effects of perineal trauma on immediate self-reported birth experience in first-time mothers

Introduction Childbirth can sometimes be stressful or traumatic, and previous research has considered how birth complications and interventions may contribute to a negative birth experience. One of the most frequent complications during birth is trauma to the perineum. The aim of this study was to investigate whether different levels of perineal trauma were associated with differences in women’s evaluation of their birth experience. Materials and methods As part of a longitudinal cohort study, the self-reported birth experiences of 202 primiparous women were compared based on the degree of perineal trauma they had experienced. Women who had given birth for the first time, vaginally and within the last 48 h in a large tertiary maternity unit in England were invited to take part. Data were collected from their hospital records with their consent and using the Childbirth Experience Questionnaire (CEQ), Experience of Birth Scale (EBS) and a perineal pain Visual Analogue Scale (VAS). Results Women with an obstetric anal sphincter injury (OASI) or episiotomy reported a more negative overall birth experience and perceived themselves as having less ability to give birth compared to those with a 1st/2nd degree sutured tear. Those with an episiotomy also reported feeling less involved in decision making processes during their birth. Significant differences remained between the OASI and 1st/2nd degree tear groups when controlling for factors known to affect birth experience, highlighting severe perineal trauma as a potential contributor to more negative birth experience. Conclusions Perineal trauma may affect a woman’s birth experience. Experiencing an episiotomy should not be overlooked as a potential contributor, especially during instrumental birth and in the absence of involved decision making. Further research is needed to disentangle the effects of episiotomy on birth experience, to explore the care needs of women with different degrees of perineal trauma and to explore how a negative birth experience may contribute to poor psychological health in the longer term.