Malin Bergström1, Helle Kieler, Ulla Waldenström. 1. Department of Women's and Children's Health, Karolinska Institutet, Retzius väg 13, Stockholm, Sweden. Malin.Bergstrom@ki.se
Abstract
OBJECTIVE: To study whether use of psychoprophylaxis during labor affects course of labor and experience of childbirth in nulliparous women. DESIGN: Cohort study. SETTING: Women were recruited from 15 antenatal clinics in Sweden between October 2005 and January 2007. SAMPLE: A total of 857 nulliparous women with a planned vaginal delivery. METHODS: Using data from a randomized controlled trial of antenatal education where the allocated groups were merged, we compared course of labor and experience of childbirth between women who used psychoprophylaxis during labor and those who did not. Data were collected by questionnaires in mid-pregnancy and three months after birth, and from the Swedish Medical Birth Register. Logistic regression was used to assess associations. MAIN OUTCOME MEASURES: Mode of delivery, augmentation of labor, length of labor, Apgar score, pain relief and experience of childbirth as measured by the Wijma Delivery Experience Questionnaire. RESULTS: Use of psychoprophylaxis during labor was associated with a lower risk of emergency cesarean section (adjusted odds ratio (OR) 0.57; 95% confidence interval (CI) 0.37-0.88), but an increased risk of augmentation of labor (adjusted OR 1.68; 95% CI 1.23-2.28). No statistical differences were found in length of labor (adjusted OR 1.32; 95% CI 0.95-1.83), Apgar score < 7 at five minutes (adjusted OR 0.82; 95% CI 0.33-2.01), epidural analgesia (adjusted OR 1.13; 95% CI 0.84-1.53) or fearful childbirth experience (adjusted OR 1.04; 95% CI 0.62-1.74). CONCLUSION: Psychoprophylaxis may reduce the rate of emergency cesarean section but may not affect the experience of childbirth.
OBJECTIVE: To study whether use of psychoprophylaxis during labor affects course of labor and experience of childbirth in nulliparous women. DESIGN: Cohort study. SETTING:Women were recruited from 15 antenatal clinics in Sweden between October 2005 and January 2007. SAMPLE: A total of 857 nulliparous women with a planned vaginal delivery. METHODS: Using data from a randomized controlled trial of antenatal education where the allocated groups were merged, we compared course of labor and experience of childbirth between women who used psychoprophylaxis during labor and those who did not. Data were collected by questionnaires in mid-pregnancy and three months after birth, and from the Swedish Medical Birth Register. Logistic regression was used to assess associations. MAIN OUTCOME MEASURES: Mode of delivery, augmentation of labor, length of labor, Apgar score, pain relief and experience of childbirth as measured by the Wijma Delivery Experience Questionnaire. RESULTS: Use of psychoprophylaxis during labor was associated with a lower risk of emergency cesarean section (adjusted odds ratio (OR) 0.57; 95% confidence interval (CI) 0.37-0.88), but an increased risk of augmentation of labor (adjusted OR 1.68; 95% CI 1.23-2.28). No statistical differences were found in length of labor (adjusted OR 1.32; 95% CI 0.95-1.83), Apgar score < 7 at five minutes (adjusted OR 0.82; 95% CI 0.33-2.01), epidural analgesia (adjusted OR 1.13; 95% CI 0.84-1.53) or fearful childbirth experience (adjusted OR 1.04; 95% CI 0.62-1.74). CONCLUSION: Psychoprophylaxis may reduce the rate of emergency cesarean section but may not affect the experience of childbirth.
Authors: Caroline A Smith; Kate M Levett; Carmel T Collins; Mike Armour; Hannah G Dahlen; Machiko Suganuma Journal: Cochrane Database Syst Rev Date: 2018-03-28