In this two-year tertiary hospital cohort study of 18,396 women, a total of 4.5% of women had a low childbirth experience VAS score. Poor childbirth experience was associated with primiparity, labor induction, operative delivery, and maternal labor complications, such as PPH and infections. As the maternal childbirth experience may play an important role in family planning and subsequent pregnancies, assessing the factors influencing childbirth experiences is important. These results highlight the specific patient groups and aspects of care for which patient experiences could be improved by additional support and counselling.
In this study, primiparity was a significant risk factor for a low childbirth experience score. This was also observed in a previous survey study on more than 5,000 women in which multiparous women were more likely to have a positive experience than primiparous women .
Consistent with our results, IOL and labor interventions are associated with more negative childbirth experiences compared to spontaneous onset of labor [7, 8]. In a mixed-methods study on 5,333 women, delay in labor induction, delay in transfer to delivery ward, and delay in receiving pain relief were mentioned as the key themes for poor childbirth experiences [8, 18]. This may explain why some women with successful IOL and vaginal delivery in our study were not satisfied with their childbirth experiences. In addition, a lack of information and choice as well as feelings of disappointment, anxiety, and neglect have been discussed in previous studies . These negative feelings are more likely to occur in cases of failed induction, prolonged labor, and other labor complications , which was also observed in our study in which labor complications, operative delivery, maternal infections, and PPH were associated with poor childbirth experiences. Furthermore, post-partum problems and length of post-partum hospital stay have been previously associated with negative childbirth experiences , which was also reflected in the current study.
In our study, women who had CS or operative vaginal delivery were less likely to have a positive childbirth experience compared to women with spontaneous vaginal delivery, which is in line with previous studies [8, 19]. Failed induction and prolonged labor have previously been reported as significant factors of a negative childbirth experience [9, 10]. This may explain some of our findings because failed induction and labor dystocia were common indications for CS in our study.
Neonatal care admission was not found to be a significant factor in childbirth experiences in some studies [10, 20, 21], while in others, it was found to be salient . In our study, admission to NICU was not associated with a low childbirth experience score; however, maternal post-partum complications were associated with poor childbirth experiences in our study, which may partly be explained by maternal health issues, perhaps preventing an active role in the postnatal care of the infant and breastfeeding. Furthermore, the length of postnatal hospital stay and delay in recovery may have influenced interactions between the mother and the infant .
The major weaknesses of our study are the retrospective design and the childbirth experience VAS score being a subjective rating that may have been influenced by a variety of factors, such as individual variation of midwives discussing the birth and obstetric interventions and presenting the VAS scale. Furthermore, non-native speakers were involved in the study, so there may have been a lack of clarity involved in some cases. The VAS score is a narrow measurement for overall birth experience, and it may be influenced by several factors, such as delivery expectations, social status, support, labor analgesia, communication with medical staff, involvement in decision making, and the opportunity to discuss the labor after delivery. However, Larsson and colleagues have shown VAS to be suitable for evaluating the negative childbirth experience, and VAS has been validated for assessing birth experiences by comparing VAS with the Wijma Delivery Expectancy/Experience Questionnaire with a significant correlation between the two measurements [14, 16] According to the hospital protocol, the VAS assessment was performed 1–3 days after delivery, just before discharging the patient from the postpartum ward. The optimal time for evaluating a birth experience may be questioned, and the VAS score in our study may have been influenced by the short time interval from delivery and the initial positive feelings towards having a baby . However, this is a large two-year cohort with more than nine of 10 women who delivered in a large tertiary care hospital having given the childbirth experience score, which adds to the value of the study. The authors acknowledge that investigating structured reasons and women’s perceptions of labor rather than relying on population characteristics and labor outcome data would improve these findings. We also regret not having the data on duration of labor. In addition, because the childbirth experience is influenced by a variety of health, social, and care factors, including data on long-term mental health, family planning, and social issues would be ideal.