Pain and women's satisfaction with the experience of childbirth: A systematic review☆,☆☆

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Abstract

Objective: To summarize what is known about satisfaction with childbirth, with particular attention to the roles of pain and pain relief. Study Design: A systematic review of 137 reports of factors influencing women's evaluations of their childbirth experiences. The reports included descriptive studies, randomized controlled trials, and systematic reviews of intrapartum interventions. Results were summarized qualitatively. Results: Four factors—personal expectations, the amount of support from caregivers, the quality of the caregiver-patient relationship, and involvement in decision making—appear to be so important that they override the influences of age, socioeconomic status, ethnicity, childbirth preparation, the physical birth environment, pain, immobility, medical interventions, and continuity of care, when women evaluate their childbirth experiences. Conclusion: The influences of pain, pain relief, and intrapartum medical interventions on subsequent satisfaction are neither as obvious, as direct, nor as powerful as the influences of the attitudes and behaviors of the caregivers. (Am J Obstet Gynecol 2002;186:S160-72.)

Section snippets

Methods

Studies were considered for inclusion if they involved women in labor or women who had experienced labor, and outcomes included one or more of the following: measures of satisfaction (with the childbirth experience, with care, or with pain relief); measures of pain; and women's views of and evaluations of their childbirth experiences. Studies of pharmacologic and nonpharmacologic measures to alleviate intrapartum pain were included only if they incorporated a measure of satisfaction.

The types

Results

One hundred thirty-seven reports were retrieved in the literature search. Sixty-eight reports were excluded for the following reasons. In 37, the purpose was not relevant. Nine reports provided no data on satisfaction with pain relief nor satisfaction with any aspect of the birth experience, 1 systematic review reported satisfaction with pain relief, but the experimental intervention was not a pain relief method, 18 had one or more serious methodological problems, and 3 were literature reviews

Comment

Descriptive studies of the impact of intrapartum medical interventions on satisfaction with care consistently show inverse relationships: the more interventions, the more likely it is that some dissatisfaction will be reported. However, interpretations of most of the observational studies are complicated by the problem of inferring causality from relationships. Ordinarily, the best method of ascertaining cause and effect would be the randomized controlled trial. The trials of medical

References (87)

  • RJ Fontenot et al.

    Double-blind evaluation of patient-controlled epidural analgsia during labor

    Int J Obstet Anesth

    (1993)
  • CR Bailey et al.

    Diamorphine-bupivacaine mixture compared with plain bupivacaine for analgesia

    Br J Anaesth

    (1994)
  • KS James et al.

    Comparison of epidural bolus administration of 0.25% bupivacaine and 0.1% bupivacaine with 0.0002% fentanyl for analgesia during labour

    Br J Anaesth

    (1998)
  • M Porter et al.

    What is, must be best: a research note on conservative or deferential responses to antenatal care provision

    Soc Sci Med

    (1984)
  • E. Hodnett

    Personal control and the birth environment: comparisons between home and hospital settings

    J Environ Psychol

    (1989)
  • R. Melzack

    The short-form McGill pain questionnaire

    Pain

    (1987)
  • S Brown et al.

    The 1993 survey of recent mothers: issues in survey design, analysis and influencing policy

    Int J Qual Health Care

    (1997)
  • S Brown et al.

    Changing childbirth: lessons from an Australian survey of 1336 women

    Br J Obstet Gynaecol

    (1998)
  • R. Fitzpatrick

    Surveys of patient satisfaction: I. Important general considerations

    Br Med J

    (1991)
  • A. Ross

    Maternal satisfaction with labour analgesia

    Baillieres Clin Obstet Gynaecol

    (1998)
  • IJ Bramadat et al.

    Satisfaction with childbirth: theories and methods of measurement

    Birth

    (1993)

  • Cochrane Library

    (2000)
  • C Forchuk et al.

    “How to critique qualitative research articles.”

    Can J Nurs Res

    (1993)
  • Hodnett E. Pain and women's satisfaction with the experience of childbirth: a systematic review. Available at...
  • CR Climie et al.

    Consumer satisfaction in the labour ward

    Med J Aust

    (1973)
  • D. Shields

    Nursing care in labor and patient satisfaction: a descriptive study

    J Adv Nurs

    (1978)
  • A. Cartright

    The dignity of labour? A study of childbearing and induction

    (1979)
  • P Butani et al.

    Mothers' perceptions of their labor experiences

    Matern Child Nurs J

    (1980)
  • PN. Kirke

    Mothers' views of obstetric care

    Br J Obstet Gynaecol

    (1980)
  • PN. Kirke

    Mothers'views of care in labour

    Br J Obstet Gynaecol

    (1980)
  • BM Morgan et al.

    Analgesia and satisfaction in childbirth (The Queen Charlotte's 1000 Mother Survey)

    Lancet

    (1982)
  • DA Sullivan et al.

    Satisfaction with maternity care: a matter of communication and choice

    Med Care

    (1982)
  • MK. Nelson

    Working-class women, middle-class women, and models of childbirth

    Social Problems

    (1983)
  • S Brown et al.

    Satisfaction with care in labor and birth: a survey of 790 Australian women

    Birth

    (1989)
  • NC Drew et al.

    Mothers', midwives' and obstetricians' views on the features of obstetric care which influence satisfaction with childbirth

    Br J Obstet Gynaecol

    (1989)
  • L Séguin et al.

    The components of women's satisfaction with maternity care

    Birth

    (1989)
  • JM Green et al.

    Expectations, experiences, and psychological outcomes of childbirth: a prospective study of 825 women

    Birth

    (1990)
  • JM. Green

    Expectations and experiences of pain in labor: findings from a large prospective study

    Birth

    (1993)
  • R Salmon et al.

    Women's anticipation and experience of childbirth: the independence of fulfilment, unpleasantness and pain

    Br J Med Psychol

    (1990)
  • P. Simkin

    Just another day in a woman's life? Women's long-term perceptions of their first birth experience. Part I

    Birth

    (1991)
  • P. Simkin

    Just another day in a woman's life? Part II: Nature and consistency of women's long-term memories of their first birth experiences

    Birth

    (1992)
  • P Slade et al.

    Expectations, experiences and satisfaction with labour

    J Clin Psychol

    (1993)
  • P Ranta et al.

    Maternal expectations and experiences of labour pain: opinions of 1091 Finnish parturients

    Acta Anaesthesiol Scand

    (1995)

    • Cited by (0)

    ☆

    Supported by the University of Toronto.

    ☆☆

    Reprint requests: Professor Ellen Hodnett, RN, PhD, Maternal-Child Nursing Research Unit, 790 Bay St, Suite 950, Toronto, Ontario M5G 1N8, Canada.

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