Maternal childbirth experience and time of delivery: a retrospective 7-year cohort study of 105 847 parturients in Finland

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Abstract

Objectives

To explore how the time of delivery influences childbirth experience.

Design

A retrospective cohort study.

Setting

Childbirth in the four Helsinki and Uusimaa Hospital District hospitals, Finland, from 2012 to 2018.

Participants

105 847 childbirths with a singleton live fetus.

Main outcome measures

Childbirth experience measured by Visual Analogue Scale (VAS).

Results

The major difference in average childbirth experience measured by VAS was between primiparas (8.03; 95% CI 8.01 to 8.04) and multiparas (8.47; 95% CI 8.45 to 8.48). Risk ratio (RR) of the low VAS (≤5) was 2.3 when primiparas were compared with multiparas. Differences in VAS between distinct periods were found in two stages: annual and time of day. The decrease in VAS from 2012–2016 to 2017–2018 in primiparas was from 7.97 (95% CI 7.95 to 7.99) to 7.80 (95% CI 7.77 to 7.83) and from 2014–2016 to 2017–2018 in multiparas from 8.60 (95% CI 8.58 to 8.61) to 8.49 (95% CI 8.47 to 8.52). Corresponding RRs of low VAS were 1.3 for primiparas and 1.2 for multiparas. Hourly differences in VAS were detected in primiparas between office hours 08:00–15:59 (7.97; 95% CI 7.94 to 7.99) and other times (night 00:00–07:59; 7.91; 95% CI 7.88 to 7.94; and evening 16:00–23:59; 7.90; 95% CI 7.87 to 7.92). In multiparas differences in VAS were detected between evening (8.52; 95% CI 8.50 to 8.54) and other periods (night; 8.56; 95% CI 8.54 to 9.58; and office hours; 8.57; 95% CI 8.55 to 8.59).

Conclusion

The maternal childbirth experience depended on the time of delivery. Giving birth during the evening led to impaired childbirth experience in both primiparas and multiparas, compared with delivery at other times. The impact of labour induction on childbirth experience should be further examined. The reorganisation of delivery services and the reduction of birth preparations might affect annual VAS. VAS is a simple method of measuring the complex entity of childbirth experience, and our results indicate its ability to capture temporal variation.

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Most cited references 44

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Pain and women's satisfaction with the experience of childbirth: a systematic review.

Ellen Hodnett (2002)

To summarize what is known about satisfaction with childbirth, with particular attention to the roles of pain and pain relief. A systematic review of 137 reports of factors influencing women's evaluations of their childbirth experiences. The reports included descriptive studies, randomized controlled trials, and systematic reviews of intrapartum interventions. Results were summarized qualitatively. Four factors-personal expectations, the amount of support from caregivers, the quality of the caregiver-patient relationship, and involvement in decision making-appear to be so important that they override the influences of age, socioeconomic status, ethnicity, childbirth preparation, the physical birth environment, pain, immobility, medical interventions, and continuity of care, when women evaluate their childbirth experiences. The influences of pain, pain relief, and intrapartum medical interventions on subsequent satisfaction are neither as obvious, as direct, nor as powerful as the influences of the attitudes and behaviors of the caregivers.

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Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group

Marian Knight, William Callaghan, Cynthia Berg … (2009)

Background Postpartum hemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. Several recent publications have noted an increasing trend in incidence over time. The international PPH collaboration was convened to explore the observed trends and to set out actions to address the factors identified. Methods We reviewed available data sources on the incidence of PPH over time in Australia, Belgium, Canada, France, the United Kingdom and the USA. Where information was available, the incidence of PPH was stratified by cause. Results We observed an increasing trend in PPH, using heterogeneous definitions, in Australia, Canada, the UK and the USA. The observed increase in PPH in Australia, Canada and the USA was limited solely to immediate/atonic PPH. We noted increasing rates of severe adverse outcomes due to hemorrhage in Australia, Canada, the UK and the USA. Conclusion Key Recommendations 1. Future revisions of the International Classification of Diseases should include separate codes for atonic PPH and PPH immediately following childbirth that is due to other causes. Also, additional codes are required for placenta accreta/percreta/increta. 2. Definitions of PPH should be unified; further research is required to investigate how definitions are applied in practice to the coding of data. 3. Additional improvement in the collection of data concerning PPH is required, specifically including a measure of severity. 4. Further research is required to determine whether an increased rate of reported PPH is also observed in other countries, and to further investigate potential risk factors including increased duration of labor, obesity and changes in second and third stage management practice. 5. Training should be provided to all staff involved in maternity care concerning assessment of blood loss and the monitoring of women after childbirth. This is key to reducing the severity of PPH and preventing any adverse outcomes. 6. Clinicians should be more vigilant given the possibility that the frequency and severity of PPH has in fact increased. This applies particularly to small hospitals with relatively few deliveries where management protocols may not be defined adequately and drugs or equipment may not be on hand to deal with unexpected severe PPH.

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Incidence, risk factors, and temporal trends in severe postpartum hemorrhage.

Azar Mehrabadi, Suresh K. Joseph, Mourad Dahhou … (2013)

Because the diagnosis of postpartum hemorrhage (PPH) depends on the accoucheur's subjective estimate of blood loss and varies according to mode of delivery, we examined temporal trends in severe PPH, defined as PPH plus receipt of a blood transfusion, hysterectomy, and/or surgical repair of the uterus. We analyzed 8.5 million hospital deliveries in the US Nationwide Inpatient Sample from 1999 to 2008 for temporal trends in, and risk factors for, severe PPH, based on International Classification of Diseases, 9th revision, clinical modification diagnosis and procedure codes. Sequential logistic regression models that account for the stratified random sampling design were used to assess the extent to which changes in risk factors explain the trend in severe PPH. Of the total 8,571,209 deliveries, 25,906 (3.0 per 1000) were complicated by severe PPH. The rate rose from 1.9 to 4.2 per 1000 from 1999 to 2008 (P for yearly trend < .0001), with increases in severe atonic and nonatonic PPH, due especially to PPH with transfusion, but also PPH with hysterectomy. Significant risk factors included maternal age ≥35 years (adjusted odds ratio [aOR], 1.5; 95% confidence interval [CI], 1.5-1.6), multiple pregnancy (aOR, 2.8; 95% CI, 2.6-3.0), fibroids (aOR, 2.0; 95% CI, 1.8-2.2), preeclampsia (aOR, 3.1; 95% CI, 2.9-3.3), amnionitis (aOR, 2.9; 95% CI, 2.5-3.4), placenta previa or abruption (aOR, 7.0; 95% CI, 6.6-7.3), cervical laceration (aOR, 94.0; 95% CI, 87.3-101.2), uterine rupture (aOR, 11.6; 95% CI, 9.7-13.8), instrumental vaginal delivery (aOR, 1.5; 95% CI, 1.4-1.6), and cesarean delivery (aOR, 1.4; 95% CI, 1.3-1.5). Changes in risk factors, however, accounted for only 5.6% of the increase in severe PPH. A doubling in incidence of severe PPH over 10 years was not explained by contemporaneous changes in studied risk factors. Copyright © 2013 Mosby, Inc. All rights reserved.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2021

Publication date (Electronic): 16 June 2021

Volume: 11

Issue: 6

Electronic Location Identifier: e046433

Affiliations

[1 ] departmentFaculty of Management and Business , Tampere University , Tampere, Finland

[2 ] departmentDepartment of Obstetrics and Gynaecology , Helsinki University Hospital , Helsinki, Finland

[3 ] departmentFaculty of Medicine , University of Helsinki , Helsinki, Finland

[4 ] departmentInformation , Finnish Institute of Health and Welfare , Helsinki, Finland

[5 ] departmentDivision of Family Medicine , Karolinska Institute Department of Neurobiology, Care Sciences and Society , Huddinge, Sweden

[6 ] departmentFolkhälsän Research Center , Biomedicum , Helsinki, Finland

Author notes

[Correspondence to ] Mrs Johanna Joensuu; johanna.joensuu@ 123456hus.fi

Author information

Johanna Joensuu http://orcid.org/0000-0002-6349-7419

Article

Publisher ID: bmjopen-2020-046433

DOI: 10.1136/bmjopen-2020-046433

PMC ID: 8211041

PubMed ID: 34135044

SO-VID: 8f9c58f9-d511-425c-8584-f23be3dcabd2

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 02 November 2020

Date accepted : 28 May 2021

Funding

Funded by: Helsinki University Hospital Research Grant;

Award ID: TYH2019302

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ScienceOpen disciplines: Medicine

Keywords: obstetrics,epidemiology,health services administration & management

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ScienceOpen disciplines: Medicine

Keywords: obstetrics, epidemiology, health services administration & management

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Maternal childbirth experience and time of delivery: a retrospective 7-year cohort study of 105 847 parturients in Finland

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Abstract

Objectives

Design

Setting

Participants

Main outcome measures

Results

Conclusion

Related collections

Advocacy for Maternal and Women’s Health

Most cited references 44

Pain and women's satisfaction with the experience of childbirth: a systematic review.

Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group

Incidence, risk factors, and temporal trends in severe postpartum hemorrhage.

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Cited by 7

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