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Mother, how are you?: Studies on self-rated health and childbirth experience
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health.ORCID iD: 0000-0003-1384-3181
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Description
Abstract [en]

Pregnancy and childbirth are characterised by emotional and physical changes, which can affect the mother’s mental health postpartum, as well as the infant. One step towards alleviating adverse consequences is to measure health status and childbirth experience. The aim of this thesis was to investigate women’s subjective health prior to pregnancy in relation to infant birth outcomes and childbirth experience, and to explore childbirth experience and its measurement from different perspectives.

The thesis consists of four papers, of which the first two were based on data from the Swedish Pregnancy Register 2013­-2018. In Paper I, self-rated health (SRH) prior to pregnancy was explored in relation to adverse birth outcomes, while Paper II investigated risk factors for negative childbirth experience. In Paper III, 112 written descriptions of negative childbirth experience were qualitatively explored in relation to events during labour and birth. In Paper IV, a single-item question about overall childbirth experience was compared to the validated four-dimensional Childbirth Experience Questionnaire 2, completed by 2,953 women.

Overall, the prevalence of poor SRH prior to pregnancy was 9.9%. Among primiparas, 8.5% reported poor SRH, and 8.4% negative childbirth experience. Poor SRH was independently associated with small for gestational age, preterm birth, and negative childbirth experience. It was also associated with stillbirth, but not after adjustment for other risk factors. The main contributing factors to negative childbirth experience were related to labour and birth, with operative birth modes being the most prominent. Poor SRH was the only pre-gestational factor independently associated with negative childbirth experience. Only small differences between type of negative childbirth experience, in terms of qualitative sub-themes, were found between birth modes and complications during labour. Fear-based emotions was the most common sub-theme. The single-item measurement of overall childbirth experience mainly captured experiences of perceived safety, to a lesser extent own capacity and participation, but not experiences related to professional support.

In conclusion, findings show the potential of using SRH assessments clinically to identify women in need of more extensive attention during pregnancy and childbirth. This thesis provides further proof of negative childbirth experience being multidimensional and subjective, and dominated by fear. When using single-item ratings of childbirth experience clinically, one must be aware that experiences of support are not well represented.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2023. , p. 78
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1896
Keywords [en]
Self-rated health, SRH, Small for Gestational Age, SGA, Preterm, Stillbirth, Pregnancy, Childbirth, Labour, Delivery, Childbirth Experience, Psychological Birth Trauma, Visual Analogue Scale, VAS, Numeric Rating Scale, NRS, Single-item, Childbirth Experience Questionnaire, CEQ 2, Midwifery
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-494918ISBN: 978-91-513-1689-5 (print)OAI: oai:DiVA.org:uu-494918DiVA, id: diva2:1729735
Public defence
2023-03-10, Sal IV, Universitetshuset, Biskopsgatan 3, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2023-02-17 Created: 2023-01-23 Last updated: 2023-02-17
List of papers
1. Self‐rated health before pregnancy and adverse birth outcomes in Sweden: A population‐based register study
Open this publication in new window or tab >>Self‐rated health before pregnancy and adverse birth outcomes in Sweden: A population‐based register study
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2021 (English)In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 48, no 4, p. 541-549Article in journal (Refereed) Published
Abstract [en]

Background Poor self-rated health (SRH) at time of childbirth has been associated with adverse birth outcomes. However, it is not known whether prepregnancy SRH contributes to these outcomes or whether SRH is a proxy for some other factors. Therefore, the purpose of this study was to explore the associations between poor SRH before pregnancy and adverse birth outcomes. In addition, maternal characteristics associated with SRH before pregnancy were explored.

Methods A population-based register study encompassing 261 731 deliveries in Sweden between January 2013 and July 2017 was conducted. The associations between poor SRH before pregnancy, rated at first antenatal visit, and the adverse birth outcomes of stillbirth, small for gestational age (SGA), and preterm birth were investigated with logistic regression analyses and presented as crude (OR) and adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Results Poor SRH before pregnancy was largely characterized by a history of psychiatric care and was associated with stillbirth (OR 1.37, 95% CI 1.04-1.79), SGA birth (OR 1.29, 95% CI 1.19-1.39), and preterm birth (OR 1.41, 95% CI 1.32-1.50). Adjusting for established risk factors for adverse birth outcomes, poor SRH remained associated with SGA birth (aOR 1.16, 95% CI 1.07-1.26) and preterm birth (aOR 1.25, 95% CI 1.17-1.33), but not with stillbirth (aOR 1.08, 95% CI 0.81-1.43).

Conclusions SRH assessments could be used in early pregnancy to identify women in need of more extensive follow-up, as SRH appears to capture something beyond currently known risk factors for adverse birth outcomes.

Place, publisher, year, edition, pages
John Wiley & SonsWiley, 2021
Keywords
antenatal care, premature birth, small for gestational age
National Category
Obstetrics, Gynecology and Reproductive Medicine Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Medical Science; Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-460806 (URN)10.1111/birt.12567 (DOI)000667535900001 ()34184771 (PubMedID)
Available from: 2021-12-08 Created: 2021-12-08 Last updated: 2024-01-15Bibliographically approved
2. Negative childbirth experience-what matters most?: a register-based study of risk factors in three time periods during pregnancy
Open this publication in new window or tab >>Negative childbirth experience-what matters most?: a register-based study of risk factors in three time periods during pregnancy
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2022 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 34, article id 100779Article in journal (Refereed) Published
Abstract [en]

Objective: To explore the impact of risk factors representing three different time periods during pregnancy on negative childbirth experience.

Methods: This was a register-based cohort study of 80 482 primiparas giving birth to singleton, term infants in Sweden 2013-2018, elective caesarean sections (CS) excluded. Hierarchical logistic regression was performed to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CIs) in three blocks, each representing risk factors from one of three time periods: I) before pregnancy, II) pregnancy, III) childbirth.

Results: Of the pre-gestational factors, only poor self-rated health (SRH) remained associated with negative childbirth experience after adjustment for pregnancy- and childbirth-related factors (aOR 1.20, 95% CI 1.08-1.34). Psychiatric care during pregnancy and fear of childbirth were both associated with negative birth experience (aOR 1.51, 95% CI 1.35-1.69; aOR 1.50, 95% CI 1.32-1.70), as were all childbirth-related factors included in the model. Women giving birth operatively vaginally or by unplanned CS under regional anaesthesia had three-fold higher ORs for rating their overall childbirth experience as negative (aOR 3.29, 95% CI 3.04-3.57; aOR 3.07, 95% CI 2.80-3.38). The highest OR, 5.44, was seen among women undergoing unplanned CS under general anaesthesia (95% CI 4.55-6.50).

Conclusion: The main contributing factors to negative childbirth experience are related to labour and birth, but poor SRH prior to pregnancy, together with psychiatric care during pregnancy and fear of childbirth, place the woman in a vulnerable position, and require extra attention.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Childbirth experience, Labour, Self -perceived health, Fear after birth, Birth satisfaction, Psychological birth trauma
National Category
Nursing Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-486699 (URN)10.1016/j.srhc.2022.100779 (DOI)000861182600003 ()36152452 (PubMedID)
Funder
Fredrik och Ingrid Thurings Stiftelse, 2019-00469
Available from: 2022-10-14 Created: 2022-10-14 Last updated: 2023-01-23Bibliographically approved
3. Negative childbirth experience in relation to mode of birth and events during labour: a mixed method study
Open this publication in new window or tab >>Negative childbirth experience in relation to mode of birth and events during labour: a mixed method study
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2023 (English)In: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 282, p. 146-154Article in journal (Refereed) Published
Abstract [en]

Objective: To explore descriptions of negative childbirth experience in relation to mode of birth and events during labour.

Design: A descriptive study using a convergent mixed methods design. Written responses to open-ended online questions regarding negative childbirth experience were explored using qualitative content analysis. Generated sub-themes were quantified, and stratified on mode of birth and events during labour.

Participants and setting: 112 women with low ratings of overall childbirth experience, participating in a randomised controlled trial evaluating internet-based cognitive behavioural therapy in Sweden. Qualitative data were collected before randomisation, three months postpartum.

Results: Four sub-themes emerged from the qualitative analysis: Experiencing fear-based emotions, Experiencing physical distress, Being affected by caregivers’ and partner’s behaviour and Being affected by bad facilities and poor organisation. Only small differences were found when stratifying sub-themes on mode of birth and events during labour. Regardless of mode of birth and events during labour, the childbirth experience was dominated by fear-based emotions.

Key conclusions and implications for practice: Mixed-methods analyses demonstrate the challenges in understanding negative childbirth experience in relation to mode of birth and specific events during labour, with results clearly showing the multifaceted nature of this concept. The central role of fear in relation to negative childbirth experience should be considered when designing support during and after labour, to prevent adverse effects of the childbirth experience.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Childbirth experience, Birth satisfaction, Labour, Psychological birth trauma, Women
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-494120 (URN)10.1016/j.ejogrb.2023.01.031 (DOI)000927796800001 ()
Note

Correction in: European Journal of Obstetrics & Gynecology and Reproductive Biology, vol. 283, page 141

doi: 10.1016/j.ejogrb.2023.03.001

Available from: 2023-01-23 Created: 2023-01-23 Last updated: 2023-04-14Bibliographically approved
4. Overall childbirth experience: what does it mean? A comparison between an overall childbirth experience rating and the Childbirth Experience Questionnaire 2
Open this publication in new window or tab >>Overall childbirth experience: what does it mean? A comparison between an overall childbirth experience rating and the Childbirth Experience Questionnaire 2
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2023 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 23, article id 176Article in journal (Refereed) Published
Abstract [en]

Background: In clinical settings and research studies, childbirth experience is often measured by the use of a single-item question about overall experience. Little is known about what women include in this rating, which complicates the design of adequate follow-up, as well as the interpretation of research findings based on ratings of overall childbirth experience. The aim of this study was to examine which known dimensions of childbirth experience women include in the rating on a single-item measure.

Methods: Ratings of overall childbirth experience on a 10-point numeric rating scale (NRS) from 2953 women with spontaneous or induced onset of labour at two Swedish hospitals were evaluated against the validated Childbirth Experience Questionnaire 2 (CEQ2), completed on one of the first days postpartum. The CEQ2 measures four childbirth experience domains: own capacity, perceived safety, professional support and participation. Internal consistency for CEQ2 was evaluated by calculating Cronbach’s alpha. NRS ratings were explored in relation to CEQ2 using empirical cumulative distribution function graphs, where childbirth experience was defined as negative (NRS ratings 1–4), mixed (NRS ratings 5–6) or positive (NRS ratings 7–10). A multiple linear regression analysis, presented as beta coefficients (B) and 95% confidence intervals (CI), was also performed to explore the relationship between the four domains of the CEQ2 and overall childbirth experience.

Results: The prevalence of negative childbirth experience was 6.3%. All CEQ2-subscales reached high or acceptable reliability (Cronbach’s alpha = 0.78; 0.81; 0.69 and 0.66, respectively). Regardless of overall childbirth experience, the majority of respondents scored high on the CEQ2 subscale representing professional support. Overall childbirth experience was mainly explained by perceived safety (B = 1.60, CI 1.48–1.73), followed by own capacity (B = 0.65, CI 0.53–0.77) and participation (B = 0.43, CI 0.29–0.56).

Conclusions: In conclusion, overall childbirth experience rated by a single-item measurement appears to mainly capture experiences of perceived safety, and to a lesser extent own capacity and participation, but appears not to reflect professional support. CEQ2 shows good psychometric properties for use shortly after childbirth, and among women with induced onset of labour, which increases the usability of the instrument.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Childbirth experience, Birth satisfaction, Labour, Psychological birth trauma, Women, CEQ2, Questionnaires, VAS, Visual Analogue Scale, Single item
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-494077 (URN)10.1186/s12884-023-05498-5 (DOI)000949335700001 ()36918812 (PubMedID)
Available from: 2023-01-23 Created: 2023-01-23 Last updated: 2023-04-12Bibliographically approved

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