Mode of delivery preferences: the role of childbirth fear among nulliparous women

Factors influencing the choice of lumbar epidural analgesia and its association with postpartum depression risk

BACKGROUND

The use of lumbar epidural analgesia (LEA) during childbirth varies significantly among women. Factors influencing a woman's choice of LEA and its possible effects on postpartum depression (PPD) remain underexplored.

OBJECTIVES

To investigate factors influencing the choice of LEA among women with intended vaginal deliveries. A secondary objective was to explore the association between LEA use and PPD.

STUDY DESIGN

A longitudinal cohort study.

SETTING

Uppsala University Hospital, Sweden, 2010 to 2019.

POPULATION

Women with an intended vaginal delivery.

EXCLUSIONS

Twins, elective caesarean section, induction of labour.

METHODS

Data were collected by web-based self-completed questionnaires at gestational weeks 17, 32 and at 6 weeks and 6 months postpartum. The exposures were sociodemographic, resilience-related, medical and obstetric characteristics of all participants from the BASIC (Biology, Affect, Stress, Imaging and Cognition) study. Information on the use of LEA was retrieved from medical records. PPD was assessed using either the Edinburgh Postnatal Depression Scale, or the Depression Self-Rating Scale, and/or the Mini-International Neuropsychiatric Interview at 6 to 8 weeks and 6 months postpartum. Bayesian models were applied to investigate the associations of multivariate factors with the choice for LEA, and the association between the use of LEA and PPD.

RESULTS

Among 4436 participants, 38% opted for LEA, while 62% did not. LEA users were younger, primiparous, reported higher rates of intimate partner violence (IPV) and had lower resilience. The adjusted model revealed primiparity, previous caesarean section, IPV, pregnancy length at least 280 days and fear of childbirth as independent predictors of LEA use. While LEA use was associated with higher odds of PPD in the crude regression model, it was no longer statistically significant after adjusting for possible confounders and mediators.

CONCLUSION

Social and psychological vulnerabilities influence a woman's decision to opt for LEA during childbirth. LEA was not associated with PPD in adjusted models.

TRIAL REGISTRATION

This is a longitudinal study which was not registered back in 2010.

Multi-level factors influencing caesarean section preferences among women in low- and middle- income countries: A systematic review

BACKGROUND

Women's preferences regarding caesarean section (CS) are a significant contributing factor to the increasing and widely varying rates of this procedure across countries and regions. This trend is particularly pronounced in low- and middle-income countries (LMICs), where both overuse and underuse of CS can pose significant health risks. Understanding the multi-level factors influencing CS preferences is essential for promoting the appropriate use of this procedure and ensuring optimal maternal and neonatal health outcomes.

AIM

To systematically review literature examining multi-level factors influencing CS preferences among women in LMICs through ecological systems and exploring the prevalence of CS preferences.

METHODS

A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Six electronic databases were searched: Academic Search Ultimate (EBSCO), MEDLINE (EBSCO), Nursing & Allied Health Premium (ProQuest), PubMed, ScienceDirect, and Scopus. The search included studies published from January 2014 to August 2024. The quality of each article was assessed using the Joanna Briggs Institute's critical appraisal tool.

FINDINGS

A total of 17 studies were included in this review. The proportion of CS preferences varied significantly, ranging from 8.8 % to 58 % in LMICs. The multi-level factors influencing CS preferences were summarized across four levels, based on ecological systems: microsystem level (sociodemographic factors, reproductive factors, psychological factors, and literacy-related factors), mesosystem level (healthcare influence, family and relative influence), exosystem level (healthcare environment and social media influence), and macrosystem level (socio-cultural factors).

CONCLUSION

Factors within the microsystem, mesosystem, and macrosystem levels displayed the substantial influence aligned with ecological systems. To reduce unnecessary CS, future research should comprehensively explore multi-level factors. Policymakers should implement prominent factors across the system.

Effect of antenatal education on pregnant women`s knowledge, attitude and preferences of delivery mode

BACKGROUND

Childbirth is considered as the happiest action that occurs in any parent's life. Although childbirth is a natural process, the choice of delivery mode is one of the concerns of pregnant women. Consequently, the objective of this study to assess the effect of antenatal education on pregnant women`s knowledge, attitude, and preferences of delivery mode.

METHODS

A quasi-experimental research design was utilized to achieve the study utilizing 140 purposive sample of pregnant women selected from antenatal outpatient clinics at the New Obstetrics and Gynecology Hospital in Mansoura, Egypt.

RESULTS

The study findings reported that there was a significant improvement in total scores of the intervention group`s knowledge and attitude toward the modes of delivery, with a highly statistically significant difference (p < 0.001) at post-intervention compared to the control group.

CONCLUSION

Prenatal education sessions were linked to a significantly improved maternal outcome in terms of knowledge, attitude, and preferences for delivery mode (p < 0.001).

TRIAL REGISTRATION

ClinicalTrials.gov, NCT06561984, registered on August 19, 2024, retrospectively registered.

Determinants of Prenatal Childbirth Fear during the Third Trimester among Low-Risk Expectant Mothers: A Cross-Sectional Study

BACKGROUND

Fear of Childbirth (FOC) can significantly impact women's physical and psychological health; therefore, healthcare providers must provide proactive care, which means they have to intervene before FOC becomes tokophobia. This study's purpose is to evaluate the determinants of prenatal childbirth fear during the third trimester among low-risk expectant mothers.

METHODS

A cross-sectional comparative study was conducted at the Maternal and Children Hospital's outpatient clinics in Najran City, Saudi Arabia, from April to July 2023. The study involved 377 nulliparous and multiparous women, using a systemic random sampling technique. The data were collected using an interview schedule composed of questions related to demographic and obstetrics characteristics, the FOC questionnaire, and a multidimensional scale of perceived social support. Significant FOC predictors were examined using a binary logistic regression model.

RESULTS

There was a statistically significant difference between nulliparous and multiparous participants concerning FOC; 80.0% of nulliparous participants had significant FOC compared to 67.8% of multiparous participants (p = 0.011). A binary logistic regression clarified that regular antenatal care and family and spousal support were significantly negatively correlated with significant FOC among multiparous and nulliparous women (p < 0.05). For multiparas, FOC was associated with pregnancy planning and previous labor-related complications. In addition, friends' support was an important predictor of significantly lower FOC among nulliparous women (p < 0.05).

CONCLUSIONS

Significant FOC was higher in nulliparous women when compared to multiparous women. Numerous obstetric variables and different types of social support play important roles in significant FOC. Special attention and support should be provided to high-risk women for proper FOC management during prenatal classes to improve their childbirth experiences.