The Impact of Primary Language on Knowledge of Labor Induction and Birth Satisfaction Prior to Implementation of Standardized Video Education

Background and Hypothesis: Induction of labor (IOL) is common, with as many as 1 in 4 labors being induced in the U.S. There is a lack of standardized patient education surrounding induction, however, which may contribute to patients’ expectations, feeling a lack of control, and lower birth satisfaction. We hypothesize that implementation of a video education tool prior to patients’ arrival for IOL may help manage patient expectations and improve birth satisfaction. Our objective was to ascertain knowledge, expectations, and satisfaction with IOL in a group of women before implementation of standardized pre-procedure education. Methods: Patients scheduled for induction were given a questionnaire after their delivery. The survey included knowledge and expectation questions about their induction, as well as the validated Birth Satisfaction Scale Revised (BSS-R). Birth and induction medication information were extracted from the medical record. Descriptive statistics were compiled, and knowledge and satisfaction scores were explored between English and Spanish surveys. Results: Our group consisted of 32 women, 19 English speaking and 13 Spanish speaking. The average BSS-R score was 26.87 ± 4.76. The average subcategory scores for stress experienced, personal attributes, and quality of care were 8.26 ± 3.15, 4.00 ± 2.03, and 14.81 ± 1.69, respectively. 65.7% of subjects correctly identified whether they received misoprostol during their induction. Correct identification for cervical ripening balloon (CRB), artificial rupture of membranes (AROM), and Pitocin use was 87.5%, 53.1%, and 56.3% respectively. There were few differences between English and Spanish speakers. Conclusions: While BSS-R scores for quality of care were high, overall stress experienced and personal attributes relating to anxiety could be improved. Additionally, just over half of the women correctly identified agents used in their induction. We anticipate that after standardized video education before induction, we will have improved knowledge, expectations, and satisfaction for women undergoing IOL.

Assessment of maternal birth satisfaction and intra-partum experiences among the women of rural areas of Tamil Nadu- a cross sectional study

Background: Childbirth, though a physiological process, has been associated with multiple risks and stress on the women, even before the time of conception till the post-partum. Every woman around the world has a right to receive respectful maternity care. Birth satisfaction and respectful maternal care has direct impact on percentage of institutional deliveries. There is paucity of studies conducted among the women of rural Tamil Nadu regarding birth satisfaction and intrapartum experiences.Methods: A cross-sectional study was conducted in primary health center area, red hills among the post-partum women attending the immunization OPD at 6, 10 and 14th week after delivery during the months of March to June 2018. By simple random sampling technique 195 subjects were included. A semi-structured questionnaire was administered to collect the data. Ethical clearance was obtained from our Institutional Ethics Committee. Data was entered in MS Excel and analysis was done using SPSS Software version 23.Results: The study shows the importance of maternal satisfaction and intrapartum experiences of women in rural areas. It concluded that the overall satisfaction was 85.5%. The transport facility available at the health care set up which satisfied the mothers was around 91.4%. The interaction of health care providers with mothers during delivery was around 64.5%. Cleanliness and comfort of the delivery area was around 64%. Equality of care provided at the health care set up was around 83%.Conclusions: Reasons for delivery visit, duration of labour, and mode of delivery are independent predictors of maternal satisfaction.

Standardized Cesarean Risk Counseling with Induction: Impact on Racial Disparities in Birth Satisfaction

Objective Our prior work demonstrated decreased birth satisfaction for Black women undergoing labor induction. We aimed to determine if implementation of standardized counseling around calculated cesarean risk during labor induction could reduce racial disparities in birth satisfaction. Study Design We implemented use of a validated calculator that provides an individual cesarean risk score for women undergoing induction into routine care. This prospective cohort study compared satisfaction surveys for 6 months prior to implementation (preperiod: January 2018–June 2018) to 1 year after (postperiod: July 2018–June 2019). Women with full-term (≥37 weeks) singleton gestations with intact membranes and an unfavorable cervix undergoing induction were included. In the postperiod, providers counseled patients on individual cesarean risk at the beginning of induction using standardized scripts. This information was incorporated into care at patient–provider discretion. The validated 10-question Birth Satisfaction Scale-Revised (BSS-R) subdivided into three domains was administered throughout the study. Patients were determined to be “satisfied” or “unsatisfied” if total BSS-R score was above or below the median, respectively. In multivariable analysis, interaction terms evaluated the differential impact of the calculator on birth satisfaction by race (Black vs. non-Black women). Results A total of 1,008 of 1,236 (81.6%) eligible women completed the BSS-R (preperiod: 330 [79.7%] versus postperiod: 678 [82.5%], p = 0.23), 63.8% of whom self-identified as Black. In the pre-period, Black women were 50% less likely to be satisfied than non-Black women, even when controlling for differences in parity (Black: 39.0% satisfied vs. non-Black: 53.9%, adjusted odds ratio [aOR] = 0.49, 95% confidence interval [CI]: 0.30–0.79). In the postperiod, there was no difference in satisfaction by race (Black: 43.7% satisfied vs. non-Black: 44.0%, aOR = 0.97. 95% CI: 0.71–1.33). Therefore, disparities in birth satisfaction were no longer present at postimplementation (interaction p = 0.03). Conclusion Implementation of standardized counseling with a validated calculator to predict cesarean risk after labor induction is associated with a decrease in racial disparities in birth satisfaction. Key Points

The Association between Birth Satisfaction and the Risk of Postpartum Depression

Negative experiences with childbirth might have a negative impact on a woman’s overall health, including a higher risk of postpartum depression. The aim of the study was to examine the association between birth satisfaction and the risk of postpartum depression (PPD). A 30-item version of the Birth Satisfaction Scale (BSS) and the Edinburgh Postnatal Depression Scale (EPDS) were used, as well as the Perceived Stress Scale (PSS). The study included 584 women (mean age 30.6 ± 4.9), 2 to 4 days postpartum. In the regression model, the negative effect of birth satisfaction on the risk of postpartum depression was shown: a lower level of satisfaction with childbirth was a significant predictor of a higher risk of PPD (β = −0.18, 95% CI = −0.08; −0.03). The regression model was controlled for the effect of the sociodemographic factors (such as education or marital status) and clinical variables (such as parity, type of delivery, psychiatric history, levels of prenatal stress). Levels of prenatal stress (β = 0.43, 95% CI = 0.27; 0.39), psychiatric history (β = 0.08, 95% CI = 0.01; 3.09), parity (β = −0.12, 95% CI = −1.82; −0.32) and type of delivery (β = 0.11, 95% CI = 0.20; 1.94) were also significantly associated with the levels of postnatal depression. The current study confirmed the association between the level of birth satisfaction and the risk of developing PPD, i.e., a lower satisfaction with childbirth may increase the risk of developing PPD.

Coping With the Unexpected in Childbirth: A Thematic Analysis

This article reports original research that describes new mothers' experiences of birth and maternity care. Qualitative data were collected through a survey on birth satisfaction, which included space for women to provide comments about their birth and experience of care. Thirty-nine women provided comments that were analyzed using the thematic analysis method. Two themes emerged from the women's experiences: “Unexpected birth processes: expectations and reality” and “Coping with birth: the role of health-care staff.” Participants described unexpected birthing processes, their experiences of care, and maternity care staff's contributions to coping with birth. Implications for practice for childbirth professionals include promotion of physiologic birth, respectful person-centered care during all phases of perinatal care, and the value of childbirth preparation.