RCOG World Congress 2023

Women’s labour and birth expectations and birth experiences- a national survey

Congruence between labour expectations and actual birth experiences is associated with psychological wellbeing after childbirth. An expectations-outcomes mismatch has been associated with post-traumatic stress disorder (PTSD) and reduced satisfaction, with consequent family impact¹.

Aims

We aimed to explore postnatal women’s expectations of childbirth, the extent to which they were met, and perceived factors influencing their congruence in a group of postnatal women.

Methods

Online cross-sectional survey of postnatal women in the UK.

Sample

We recruited primiparous and multiparous postnatal women (age>16 years) who had given birth in the last 5 years.

Recruitment

Social media advertising and snowballing between June 2019 and July 2020.

Survey

Women completed an online questionnaire using iteratively developed and piloted multiple-choice questions, which explored:

oWhether their birth was as expected

oPerceived preparedness for birth

Open-ended questions explored reasons for expectation-outcome congruence/incongruence

Analysis

Data from multiple choice questions were analysed in STATA and summarised using descriptive statistics.

Qualitative responses were thematically analysed by >2 researchers to support validity of coding.

Results

819 women completed the survey (46% primiparous)

Ethnicity: 93.5% White British, 87.8% born in the UK

Education: 75.9% Degree level education or above

Birth mode:

•Vaginal 56.8%, VBAC 21.0%,

•Instrumental 13.4%,

•Unplanned caesarean 13.4%,

•Planned caesarean 11.8%%,

•Other 0.6%

Antenatal classes attended for most recent pregnancy:

•50.4% NHS +/- private, 25.6% private only, 23.9% did not attend any

Birth expectations:

•738 women indicated their birth was not as expected (49% primiparous, 51% multiparous), of which 56% found it more difficult and 44% easier or as expected (see figure 1).

Conclusions and recommendations

•A substantial number of both primiparous and multiparous women report birth is more difficult than anticipated.

•Difficulties largely relate to unanticipated complications and intervention.

•There is a need to improve understanding of likelihood and nature of birth complications to prepare women and support psychological wellbeing.

Clinical interactions and antenatal education should address this important barrier to women’s wellbeing.

RCOG World Congress 2023

Women’s labour and birth expectations and birth experiences- a national survey

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