Bossano Carla M, Townsend Kelly M, Walton Alexandra C, Blomquist Joan L, Handa Victoria L
Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Am J Obstet Gynecol. 2017 Sep;217(3):342.e1-342.e8. doi: 10.1016/j.ajog.2017.04.027. Epub 2017 Apr 25.
Maternal satisfaction with the birth experience is multidimensional and influenced by many factors, including mode of delivery. To date, few studies have investigated maternal satisfaction outside of the immediate postpartum period.
This study investigated whether differences in satisfaction based on mode of delivery are observed more than a decade after delivery.
This was a planned, supplementary analysis of data collected for the Mothers' Outcomes after Delivery study, a longitudinal cohort study of pelvic floor disorders in parous women and their association with mode of delivery. Obstetric and demographic data were obtained through patient surveys and obstetrical chart review. Maternal satisfaction with childbirth experience was assessed via the Salmon questionnaire, administered to Mothers' Outcomes after Delivery study participants >10 years from their first delivery. This validated questionnaire yields 3 scores: fulfillment, distress, and difficulty. These 3 scores were compared by mode of delivery (cesarean prior to labor, cesarean during labor, spontaneous vaginal delivery, and operative vaginal delivery). In addition, the impact of race, age, education level, parity, episiotomy, labor induction, and duration of second stage of labor on maternal satisfaction were examined.
Among 576 women, 10.1-17.5 years from delivery, significant differences in satisfaction scores were noted by delivery mode. Salmon scale scores differed between women delivering by cesarean and those delivering vaginally: women delivering vaginally reported greater fulfillment (0.40 [-0.37 to 0.92] vs 0.15 [-0.88 to 0.66], P < .001) and less distress (-0.34 [-0.88 to 0.38] vs 0.20 [-0.70 to 0.93], P < .001) than those who delivered by cesarean. Women who delivered by cesarean prior to labor reported the greatest median fulfillment scores and the lowest median difficulty scores. Median distress scores were lowest among those who delivered by spontaneous vaginal birth. Among women who underwent cesarean delivery, labor induction and prolonged second stage were associated with higher difficulty scores. These factors did not affect satisfaction scores among women who delivered vaginally. Among women who delivered vaginally, operative vaginal delivery was associated with less favorable scores across all 3 scores.
Maternal satisfaction with childbirth is influenced by mode of delivery. The birth experience leaves an impression on women more than a decade after delivery.
产妇对分娩经历的满意度是多维度的，受多种因素影响，包括分娩方式。迄今为止，很少有研究调查产后即时阶段以外的产妇满意度。
本研究调查了分娩十多年后，基于分娩方式的满意度差异是否依然存在。
这是一项针对“产后母亲结局”研究收集的数据进行的计划补充分析，该研究是一项关于经产妇盆底疾病及其与分娩方式关联的纵向队列研究。通过患者调查和产科病历审查获取产科和人口统计学数据。通过向首次分娩超过10年的“产后母亲结局”研究参与者发放的萨蒙问卷来评估产妇对分娩经历的满意度。这份经过验证的问卷得出三个分数：满足感、痛苦感和困难程度。按分娩方式（临产前剖宫产、产时剖宫产、自然阴道分娩和手术助产）比较这三个分数。此外，还研究了种族、年龄、教育水平、产次、会阴切开术、引产以及第二产程持续时间对产妇满意度的影响。
在分娩10.1至17.5年的576名女性中，发现满意度得分因分娩方式存在显著差异。剖宫产分娩的女性和阴道分娩的女性在萨蒙量表得分上存在差异：阴道分娩的女性报告的满足感更高（0.40 [-0.37至0.92] 对比0.15 [-0.88至0.66]，P <.001），痛苦感更低（-0.34 [-0.88至0.38] 对比0.20 [-0.70至0.93]，P <.001）。临产前剖宫产的女性报告的满足感中位数得分最高，困难程度中位数得分最低。自然阴道分娩的女性痛苦感中位数得分最低。在接受剖宫产的女性中，引产和第二产程延长与更高的困难程度得分相关。这些因素对阴道分娩的女性的满意度得分没有影响。在阴道分娩的女性中，手术助产在所有三个分数上的得分都不太理想。
产妇对分娩的满意度受分娩方式影响。分娩经历在产后十多年仍会给女性留下印象。
