Dlivery and Labor Room, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Rd, Tianhe District, Guangzhou 510623, China.
Statistician, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Int J Nurs Stud. 2020 May;105:103549. doi: 10.1016/j.ijnurstu.2020.103549. Epub 2020 Feb 28.
Pain assessment is crucial for in-labour pain management. Even though women's self-rated pain intensity is the standard for pain relief or analgesic administration, multiparas appear to receive worse in-labour pain management than primiparas do. The discrepancy in pain perception between primiparas and multiparas remains unclear. Healthcare providers tend to think that multiparas endure the pain and report less pain because they have experienced childbirth.
To retrospectively analyse the intensity of in-labour pain during first and second vaginal childbirth within the same group of women and explore whether parity may be an influential factor in labour pain intensity.
Retrospective cohort study.
Labour and delivery in a large academic specialized hospital in Guangzhou, China.
Women were included if they had two consecutive vaginal childbirths with singleton cephalic presentations and cervical dilation ≤ 3 cm for the first childbirth and ≤ 2 cm for the second childbirth. The final study sample consisted of 417 women.
All childbirth case records between January 2015 and August 2018 were scanned using a structured electronic medical system. Maternal and neonatal demographics as well as obstetric and neonatal outcomes were extracted. The in-labour pain for each childbirth was compared between first and second births. Paired t-tests, McNemar's chi-square tests and mixed-effects modelling were applied to compare the differences in labour pain intensity between the two vaginal childbirths and explore the factors that influenced maximum labour pain scores during the second childbirth.
Four hundred seventeen women were included, with an average birth interval of 1.7 years. The average maximum labour pain score during the latent phase was 6 (5,6) for the first childbirth and 5 (4,6) for the second childbirth (paired t =-6.13, P <0.001). Pain scores decreased in 28.1% (117/417) of women and increased in 13.7% (57/417) of women from the first to the second childbirth. More than half of the women in our study experienced the same maximum labour pain score during the first and second labour. Mixed-effects modelling revealed that parity, education and pregnancy complications were independently associated with maximum labour pain scores.
From a clinical point of view, in-labour pain is not clinically different for women when comparing their first and second labours. Health care professionals may underestimate in-labour pain in primiparas when comparing them with nulliparas. More studies are warranted to explore options for achieving better pain management for women with more childbirths.
疼痛评估对于分娩过程中的疼痛管理至关重要。尽管女性的自我评估疼痛强度是缓解疼痛或给予镇痛药物的标准，但多产妇在分娩过程中的疼痛管理似乎不如初产妇。初产妇和多产妇之间的疼痛感知差异仍不清楚。医疗保健提供者往往认为多产妇能够忍受疼痛，并报告较少的疼痛，因为她们已经经历过分娩。
回顾性分析同一组女性首次和第二次阴道分娩时的分娩疼痛强度，并探讨产次是否是分娩疼痛强度的影响因素。
回顾性队列研究。
中国广州一家大型学术专业医院的产房和分娩室。
纳入标准为连续两次阴道分娩，且两次分娩均为单胎头位，第一次分娩时宫颈扩张≤3cm，第二次分娩时宫颈扩张≤2cm。最终研究样本包括 417 名女性。
使用结构化电子病历系统扫描 2015 年 1 月至 2018 年 8 月期间的所有分娩病例记录。提取产妇和新生儿人口统计学数据以及产科和新生儿结局数据。比较两次阴道分娩时的分娩疼痛。采用配对 t 检验、McNemar 卡方检验和混合效应模型比较两次阴道分娩时的劳动疼痛强度差异，并探讨影响第二次分娩时最大劳动疼痛评分的因素。
417 名女性被纳入研究，平均分娩间隔为 1.7 年。第一次分娩潜伏期的平均最大疼痛评分为 6（5，6），第二次分娩潜伏期的平均最大疼痛评分为 5（4，6）（配对 t=-6.13，P<0.001）。与第一次分娩相比，28.1%（117/417）的女性疼痛评分下降，13.7%（57/417）的女性疼痛评分升高。我们研究中的大多数女性在第一次和第二次分娩时经历了相同的最大分娩疼痛评分。混合效应模型显示，产次、教育和妊娠并发症与最大分娩疼痛评分独立相关。
从临床角度来看，比较女性的第一次和第二次分娩时，分娩疼痛在临床上没有差异。当比较初产妇和经产妇时，医疗保健专业人员可能会低估初产妇的分娩疼痛。需要进一步研究，以探索为分娩次数较多的女性提供更好疼痛管理的选择。
