初产妇和经产妇在阴道分娩第一和第二产程中的分娩经历及对疼痛管理的满意度——一项前瞻性队列研究。

Primiparous and multiparous women's birthing experiences and satisfaction with pain management in the first and second stages of vaginal delivery-A prospective cohort study.

作者信息

Mäkelä Katja, Palomäki Outi, Helminen Mika, Uotila Jukka

机构信息

Department of Obstetrics and Gynecology, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland.

Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.

出版信息

Acta Obstet Gynecol Scand. 2025 Jun;104(6):1143-1152. doi: 10.1111/aogs.15083. Epub 2025 Apr 28.

Abstract

INTRODUCTION

Most women are satisfied with their delivery experience but the effects of pain relief and different pain relief methods on the birthing experience remain inconsistent. We wanted to evaluate the impact of pain relief on the birthing experience during the first and second stages of labor among primiparous and multiparous women.

MATERIAL AND METHODS

A total of 2042 parturients (953 primiparous and 1089 multiparous women) completed a questionnaire on the second day after vaginal delivery and, using visual analogue scale (VAS), assessed their experience and satisfaction with their pain management during the first and second stages of labor. The experiences of primiparous and multiparous women were compared, and the factors associated with positive and negative birthing experiences were ascertained.

RESULTS

Overall birthing experience was better among multiparous than among primiparous women (VAS 8.6 vs. 8.0; p < 0.001). Reported satisfaction with pain management revealed no significant differences between multiparous and primiparous women during the first stage of labor (VAS 8.2 vs. 8.1) or the second stage of labor (VAS 7.8 vs. 7.7). Some variation was reported in satisfaction with the various pain management methods, epidural and spinal block having the highest ratings during both stages of labor. However, despite differences in satisfaction with pain management, in overall birthing experience, no difference according to pain relief administered was reported among multiparous and only minor differences in primiparous women in the second stage of labor. Those parturients reporting negative birthing experiences (VAS ≤5) reported relatively high satisfaction with pain management during the first stage of labor (medians 8 and 8 in multiparous and primiparous women respectively) while satisfaction with second-stage pain management was clearly lower (respective medians 2 and 5). In a regression model satisfaction with pain management during the second stage of labor varied significantly with birthing experience.

CONCLUSIONS

The childbirth experience was slightly better among multiparous than among primiparous women, although there were no significant differences regarding satisfaction with pain management according to parity during the first or second stage of labor. Satisfaction with pain relief during the second stage of labor was significantly associated with overall birthing experience.

摘要

引言

大多数女性对她们的分娩经历感到满意,但疼痛缓解措施及不同的疼痛缓解方法对分娩体验的影响仍不一致。我们想要评估疼痛缓解措施对初产妇和经产妇第一产程及第二产程分娩体验的影响。

材料与方法

总共2042名产妇(953名初产妇和1089名经产妇)在阴道分娩后第二天完成了一份问卷,并使用视觉模拟评分法(VAS)评估她们在第一产程和第二产程期间对疼痛管理的体验和满意度。比较了初产妇和经产妇的体验,并确定了与积极和消极分娩体验相关的因素。

结果

经产妇的总体分娩体验优于初产妇(VAS评分8.6对8.0;p<0.001)。报告的对疼痛管理的满意度显示,经产妇和初产妇在第一产程(VAS评分8.2对8.1)或第二产程(VAS评分7.8对7.7)期间没有显著差异。对各种疼痛管理方法的满意度存在一些差异,硬膜外阻滞和脊髓阻滞在两个产程阶段的评分最高。然而,尽管对疼痛管理的满意度存在差异,但在总体分娩体验方面,经产妇中根据所采用的疼痛缓解措施未报告有差异,而初产妇在第二产程仅有微小差异。那些报告有消极分娩体验(VAS评分≤5)的产妇在第一产程期间对疼痛管理的满意度相对较高(经产妇和初产妇的中位数分别为8和8),而对第二产程疼痛管理的满意度明显较低(各自的中位数为2和5)。在一个回归模型中,第二产程期间对疼痛管理的满意度随分娩体验有显著变化。

结论

经产妇的分娩体验略优于初产妇,尽管在第一产程或第二产程期间按产次划分对疼痛管理的满意度没有显著差异。第二产程期间对疼痛缓解的满意度与总体分娩体验显著相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6b88/12087509/a063a0958b2f/AOGS-104-1143-g001.jpg

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