Labour experience and postpartum stress and depression: a quantitative and qualitative examination

The Effects of Accompaniment on Maternal Anxiety During Elective Cesarean Delivery: A Quasi-experimental Study

BACKGROUND

In Spain, allowing women to be accompanied by their partners during cesarean deliveries is a poorly consolidated practice. Going through this experience alone, not only deprives women from the opportunity of sharing the birth with their partners, but also, forces them to face, on their own, one of the most stressful experiences during pregnancy.

OBJECTIVE

To analyze whether significant differences exist in levels of anxiety of women who receive an elective cesarean delivery, according to whether they are allowed to be accompanied by their partners.

DESIGN

Quasi-experimental, longitudinal, prospective study, comparing a group of 31 women receiving elective cesarean deliveries, without the presence of their partners, with a group of 33 women with elective cesarean deliveries who were accompanied by their partners. Anxiety levels were assessed using the STAI-State/Trait scale. Participants were given a questionnaire to assess their level of satisfaction with the care received.

RESULTS

Anxiety measured via total scores on the STAI-S scale was significantly lower (p < 0.004) among the women who were accompanied by their partners during the elective cesarean delivery (median = 25), compared to the group who were not (median = 50). The differences were also significant (p < 0.003) considering the impact of accompaniment upon the group with high scores in the STAI-S (> 31) and continue to be significant when using the cut-off point of very high scores on the STAI-S (> 45).

CONCLUSIONS

Presence of partners during elective cesareans is a key factor for decreasing the anxiety caused by the surgery and for improving the overall experience of cesarean deliveries.

Women's views and experiences of augmentation of labour with synthetic oxytocin infusion: A qualitative evidence synthesis

OBJECTIVE

To explore and synthesise women's views and experiences of augmentation of labour with synthetic oxytocin infusion.

DESIGN

A qualitative evidence synthesis was conducted. The SPIDER acronym was used to develop the search terms and determine the inclusion criteria. Six bibliographic databases: MEDLINE, CINAHL, EMBASE, PsycINFO, Maternity and Infant Care and Web of Science Core Collection were searched in October 2021. Grey literature sources, EThOS, DART-Europe, and the World Health Organization's Clinical Trials Registry were searched, and reference lists of included studies were reviewed. Methodological quality of included studies was assessed using the Evidence for Policy and Practice Information and Co-ordinating (EPPI) Centre assessment tool. Data were synthesised thematically. The confidence of each review finding was assessed using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual). Research ethical approval was not required.

SETTING AND PARTICIPANTS

Women of any age, parity, and cultural background who underwent augmentation of labour with synthetic oxytocin infusion were included.

FINDINGS

A total of 9306 citations were retrieved. Twenty-five studies conducted across 14 countries met the inclusion criteria and contributed data. Three principal analytical themes emerged: feeling stuck; past and present shaping the future; and cause and effect of augmentation of labour. The decision to augment women's labour was often performed without their informed consent. Women's views and experiences of augmentation of labour were shaped according to their knowledge, beliefs and support received during labour. Irrespective of the context, women consistently associated augmentation of labour with pain.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Clinical guidelines on augmentation of labour need to be informed by research that includes women's views and experiences as a main outcome. Future research exploring the experience of augmentation of labour rather than the experience of labour dystocia would be beneficial. Increasing women's awareness and knowledge of augmentation of labour may help to ensure that their informed consent is obtained. Healthcare providers should discuss the effects, side effects and implications of augmentation of labour with women, ideally before labour.