Departments of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, University of Utah Health Sciences Center, Salt Lake City, Utah, University of Alabama at Birmingham, Birmingham, Alabama, Stanford University, Stanford, California, Columbia University, New York, New York, Brown University, Providence, Rhode Island, University of Texas Medical Branch, Galveston, Texas, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas The Ohio State University, Columbus, Ohio, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio, University of Texas Southwestern Medical Center, Dallas, Texas University of Pennsylvania, Philadelphia, Pennsylvania; Duke University, Durham, North Carolina, University of Pittsburgh, Pittsburgh, Pennsylvania, and Washington University in St. Louis, St. Louis, Missouri; the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
Obstet Gynecol. 2023 Jul 1;142(1):117-124. doi: 10.1097/AOG.0000000000005230.
To evaluate the association between maternal and delivery characteristics and self-reported perceived control during childbirth.
A secondary analysis of a multicenter randomized trial was conducted to compare labor induction at 39 weeks of gestation with expectant management in low-risk nulliparous people. Six to 96 hours after delivery, participants who experienced labor completed the Labor Agentry Scale, a validated self-administered questionnaire to ascertain perceived control during childbirth. Scores range from 29 to 203, with higher scores indicating a sense of greater control. Multivariable linear regression was used to determine which maternal and delivery characteristics were associated with the Labor Agentry Scale score. Eligible characteristics included age, self-reported race and ethnicity, marital status, employment status, type of insurance, previous pregnancy loss before 20 weeks of gestation, body mass index (BMI), smoking, alcohol use, mode of delivery, labor pain (0-10 points), and a composite of perinatal death or severe neonatal complications. Significant variables ( P <.05) were retained in the final multivariable model, and adjusted mean differences (95% CIs) between groups were estimated.
Of 6,106 people enrolled in the trial, 6,038 experienced labor, of whom 5,750 (95.2%) completed the Labor Agentry Scale and were included in this analysis. Mean [95% CI] adjusted Labor Agentry Scale scores were significantly lower among those who identified as Asian (-6.4 [-10.5 to -2.3]) or Hispanic (-3.7 [-5.7 to -1.7]) compared with White, smoked compared with did not smoke (-2.8 [-5.5 to -0.1]), had BMIs of 35 or higher compared with less than 30 (-2.0 [-3.8 to -0.2]), were unemployed (-3.15 [-4.76 to -1.55]), did not have private health insurance (-2.61 [-4.47 to -0.76]), underwent operative vaginal (-5.1 [-7.7 to -2.6]) or cesarean (-14.4 [-16.1 to -12.6]) delivery compared with spontaneous vaginal delivery, and reported greater labor pain score of 8 or higher compared with less than 8 (-11.9 [-13.4 to -10.4]). Mean [95% CI] adjusted Labor Agentry Scale scores were significantly higher among people who were employed compared with unemployed (3.2 [1.6-4.8]) and had private compared with nonprivate insurance (2.6 [0.76-4.5]).
In nulliparous people at low risk, unemployment, lack of private health insurance, Asian race, Hispanic ethnicity, smoking, operative delivery, and more labor pain were associated with lower perceived control during labor.
ClinicalTrials.gov , NCT01990612.
评估产妇和分娩特征与分娩时自我报告的控制感之间的关系。
对一项多中心随机试验进行二次分析，比较了低危初产妇在 39 孕周时引产与期待管理的效果。分娩后 6 至 96 小时，经历过分娩的参与者完成了劳动代理量表，这是一种经过验证的自我管理问卷，用于确定分娩时的控制感。分数范围为 29 至 203，分数越高表示控制感越强。多变量线性回归用于确定哪些产妇和分娩特征与劳动代理量表评分相关。合格特征包括年龄、自我报告的种族和民族、婚姻状况、就业状况、保险类型、20 周前妊娠丢失、体重指数（BMI）、吸烟、饮酒、分娩方式、分娩疼痛（0-10 分），以及围产期死亡或严重新生儿并发症的综合情况。有显著意义的变量（P＜0.05）被保留在最终的多变量模型中，并估计了组间的调整后平均差异（95%CI）。
在参加试验的 6106 人中，有 6038 人经历了分娩，其中 5750 人（95.2%）完成了劳动代理量表，被纳入本分析。与白人相比，自我报告为亚洲人（-6.4[10.5 至-2.3]）或西班牙裔（-3.7[5.7 至-1.7]）的参与者的调整后劳动代理量表评分明显较低；与不吸烟相比，吸烟的参与者评分较低（-2.8[5.5 至-0.1]）；BMI 为 35 或更高的参与者评分较低（-2.0[3.8 至-0.2]）；与就业相比，失业的参与者评分较低（-3.15[4.76 至-1.55]）；与有私人医疗保险相比，没有私人医疗保险的参与者评分较低（-2.61[4.47 至-0.76]）；与自然分娩相比，接受阴道手术分娩（-5.1[7.7 至-2.6]）或剖宫产（-14.4[16.1 至-12.6]）的参与者评分较低；与疼痛评分低于 8 相比，疼痛评分 8 或更高的参与者评分较低（-11.9[13.4 至-10.4]）。与失业相比，就业的参与者评分较高（3.2[1.6-4.8]）；与非私人医疗保险相比，私人医疗保险的参与者评分较高（2.6[0.76-4.5]）。
在低危初产妇中，失业、缺乏私人医疗保险、亚裔、西班牙裔、吸烟、手术分娩和更多的分娩疼痛与分娩时的低控制感相关。
ClinicalTrials.gov，NCT01990612。
