Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
PLoS One. 2022 Oct 6;17(10):e0274949. doi: 10.1371/journal.pone.0274949. eCollection 2022.
First 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.
This 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.
The 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.
Nulliparous 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.
初次分娩和引产是负面分娩体验的危险因素。随着引产的增加，研究这一高风险群体的分娩体验变得尤为重要。我们旨在探讨初产妇或与引产、分娩和分娩相关的因素是否可以解释这种关联。
这是一项前瞻性研究，纳入了 2019 年 1 月 1 日至 2020 年 1 月 31 日期间在芬兰赫尔辛基大学医院接受引产的 711 名女性。参与者在分娩后回答了分娩体验问卷（CEQ）（应答率为 69.4%）。患者特征和分娩结局从患者记录中收集。我们对初产妇和经产妇进行了分析。
初产妇（n=408）的平均 CEQ 评分为 2.9（SD 0.5），经产妇（n=303）的平均 CEQ 评分为 3.2（SD 0.5），分值范围为 1-4；分数越高代表体验越积极。然而，7.3%的女性经历了负面的分娩体验（初产妇为 8.8%；经产妇为 5.3%，p=0.08）。负面体验与剖宫产（OR 6.7，95%CI 1.8-9.3，p<0.001）和阴道分娩中出血量≥1500ml（OR 2.8，95%CI 1.1-7.5，p=0.03）相关。在单独的 CEQ 领域分析中，初产妇在“自身能力”领域的负面体验与初产妇相关（OR 1.6，95%CI 1.0-2.4，p=0.03）。宫颈成熟、催产素使用和日间分娩与至少一个领域的负面体验相关，而硬膜外或脊髓镇痛在两个领域被认为是积极的，而在一个领域被认为是消极的。
接受引产的初产妇经历负面分娩体验的风险主要与分娩和分娩相关的因素有关，与经产妇相似。她们对分娩和分娩的能力和准备的认知应在产前得到增强。有效的引产方案可促进尽可能高的阴道分娩率，并为及时应对产后出血做好准备，这是避免负面分娩体验的关键。
