How Long Is a Normal Labor? Contemporary Patterns of Labor and Birth in a Low‐Risk Sample of 1,612 Women from Four Nordic Countries

Hildingsson, Ingegerd; Blix, Ellen; Hegaard, Hanne Kristine; Huitfeldt, Anette Schaumburg; Ingversen, Karen; Ólafsdóttir, Ólöf Ásta; Lindgren, Helena

doi:10.1111/birt.12191

Cited by 15 publications

(28 citation statements)

References 29 publications

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“…Education was at a higher level in 59%. Mean duration of delivery was 6.8 hours (nulliparous 8.0h, multipara 5.1h), which is comparable to previous national data [29]. Epidural analgesia was offered to 26% at mean cervical dilatation 6.5 cm (Table 1).…”

Section: Participantssupporting

confidence: 79%

Are labor pain and birth experience associated with persistent pain and postpartum depression? A longitudinal cohort study

Rosseland

Rème

Simonsen

et al. 2019

Preprint

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Background: Managing labor pain and early postpartum pain has been linked to a reduced risk for postpartum depression and pain. However, the role of labor pain and the overall birth experience in the development of postpartum depression and persistent pain still remains unclear. Methods: The study sample (n=2217) was drawn from the Akershus Birth Cohort, which targeted all pregnant women scheduled to give birth at Akershus University Hospital in Norway between 2008-2010. Data from the hospital’s birth record as well as questionnaire data from gestational week 17 of pregnancy and eight weeks postpartum were used. An additional questionnaire about labor pain and birth experience was answered by 1 244 women within 48 hours after delivery. The Edinburgh Postnatal Depression Scale was used to measure postpartum depression, a single question was used to measure persistent pain eight weeks postpartum, while pain and birth experience were measured by numeric rating scales within 48 hours after delivery. Results: The results showed that neither labor pain nor birth experience were associated with persistent pain eight weeks postpartum, whereas pain before pregnancy (OR 3.70; 95% CI 2.71-5.04) and a history of depression (OR 2.31; 95% CI 1.85-2.88) were statistically significant predictors of persistent pain. A negative birth experience was significantly (OR 1.16; 95% CI 1.04-1.29) associated with postpartum depression, whereas labor pain intensity was not. Again, a history of depression (OR 3.95; 95% CI 2.92-5.34) and pre-pregnancy pain (OR 2.03; 95% CI 1.37-3.01) were important predictors of postpartum depression eight weeks after delivery. Discussion: Whilst the relationship between labor pain intensity and postpartum pain and depression remain unclear, our results do imply the need to screen for previous depression and chronic pain conditions in pregnant women, as well as consider preventive measures in those who screen positive.

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Section: Participantssupporting

confidence: 79%

Are labor pain and birth experience associated with persistent pain and postpartum depression? A longitudinal cohort study

Rosseland

Rème

Simonsen

et al. 2019

Preprint

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“…Women with shorter labour duration, indicating quicker labour progress, were more likely to give birth vaginally in our study. In contrast, other studies found that labour lasted longer in settings with low c-section rates (X3; Hildingsson et al, 2015). This might indicate that women with longer labour durations have a reduced chance of birthing vaginally if they do not receive enough time.…”

Section: Accepted Manuscriptmentioning

confidence: 84%

“…Previous studies have also found differences in VBAC rates, the use of interventions and labour duration between and within countries and have suggested that variations in labour and birth management might be the cause (Gross et al, 2015;Mikolajczyk et al, 2013;Hildingsson et al, 2015). However, it remains unclear, why intervention rates in Italy were much lower compared to Ireland and Germany, because the Italian guideline addressing VBAC does not provide any recommendations about intrapartum intervention (Ministry of Health Italy, 2016).…”

Section: Discussionmentioning

confidence: 99%

Labour characteristics of women achieving successful vaginal birth after caesarean section in three European countries

et al. 2019

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Objective: Knowledge about labour characteristics of women achieving successful vaginal birth after caesarean section (VBAC) might be used to improve labour and birth management. This study examined sociodemographic and labour process-related factors regarding a) differences between countries, b) the comparison of successful VBAC with unplanned caesarean section, and c) predictors for the success of planned VBAC in three European countries. Design: We analysed observational data collected within the OptiBIRTH trial, a clusterrandomised controlled trial. Setting: Fifteen study sites in Ireland, Italy and Germany, five in each country. Participants: 790 participants going into labour for planned VBAC. Measurements: Descriptive statistics and random-effects logistic regression models were applied. Findings: The pooled successful VBAC-rate was 74.6%. Italy had the highest proportion of women receiving none of the four intrapartum interventions amniotomy (ARM), oxytocin, epidural or opioids (42.5% vs Ireland: 26.8% and Germany: 25.3%, p<0.001). Earlier performance of ARM was associated with successful VBAC (3.50 hrs vs 6.08 hrs, p=0.004). A positive predictor for successful vaginal birth was a previous vaginal birth (OR=3.73, 95% CI [2.17, 6.44], p<0.001). The effect of ARM increased with longer labour duration (OR for interaction term=1.06, 95% CI [1.004, 1.12], p=0.035). Higher infant birthweight (OR per kg=0.34, 95% CI [0.23, 0.50], p<0.001), ARM (reference spontaneous rupture of membranes (SROM), OR=0.20, 95% CI [0.11, 0.37], p<0.001) and a longer labour duration (OR per hour=0.93, 95% CI [0.90, 0.97], p<0.001) decreased the odds of a vaginal birth. Key conclusion: Women with a previous vaginal birth, an infant with a lower birth weight, SROM and a shorter labour duration were most likely to have a successful vaginal birth. If SROM did not occur, an earlier ARM increased the odds of a vaginal birth. Implication for practice: Labour progress should be accelerated by fostering endogenous uterine contractions. With slow labour progress and intact membranes, ARM might increase the chance of a vaginal birth.

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“…(19,20) Another explanation may be that most pregnant women are primiparous, whose labor is usually longer. (21) This finding points to the need to expand studies to better evaluate this association, as well as to inform women about this possibility when using pharmacological analgesia. The presence of a companion with almost all the women studied is positive, and indicates that the "Companion Law" is respected in the institution, which can contribute to reduced instrumental vaginal delivery, by offering women continuous support.…”

Section: Discussionmentioning

confidence: 99%

O uso de analgesia farmacológica influencia no desfecho de parto?

et al. 2017

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Objective: To investigate the association between pharmacological analgesia and childbirth outcomes. Methods: A cross-sectional study using a representative sample of childbirth performed in 2013, at a maternity hospital in Belo Horizonte, Minas Gerais. Data from 978 childbirths were included, excluding elective cesareans. The main exposure was the use of pharmacological analgesia during labor, with the outcome classified as vaginal, instrumental vaginal, or cesarean delivery. The association between analgesia and childbirth outcomes was assessed using multinomial logistic regression to obtain Odds Ratio (OR) estimates with their respective 95% confidence intervals. The final model was adjusted for the woman's age, number of previous births, presence of companion or doula, and cervical dilatation at the time of analgesia. Results: Among the total number of births, 87.1% were vaginal and 12.9% were cesarean. The prevalence of the use of pharmacological analgesia was 34.2%, and delivery with instrumentation was 8.4%. About 70% of the women had a normal risk pregnancy. Even after adjusting for confounding variables, the use of analgesia increased the chance of delivery with instrumentation by 3.5 times (p<0.0001); for women with high-risk pregnancies, this increase was even higher (OR=4.62; p<0.0001). There was no association between analgesia and cesarean section (p=0.320). Conclusion: The use of pharmacological analgesia modifies the outcome of childbirth, increasing the chances of delivery with instrumentation, especially in women with high-risk pregnancies. In this context, it is important to guide women about the potential risks and benefits of analgesia so they may make a safe choice. ResumoObjetivo: Investigar associação entre analgesia farmacológica e desfechos do parto. Métodos: Estudo transversal que utilizou amostra representativa dos partos realizados em 2013, em uma maternidade de Belo Horizonte, Minas Gerais. Foram incluídos dados de 978 partos, excluindo-se as cesarianas eletivas. A exposição principal foi o uso de analgesia farmacológica durante o trabalho de parto e o desfecho classificado como parto vaginal, vaginal instrumentalizado e cesariana. Verificou-se a associação entre analgesia e os desfechos do parto por meio de regressão logística multinominal para obter as estimativas de Odds Ratio (OR) com seus respectivos intervalos de 95% de confiança, e o modelo final foi ajustado por idade da mulher, número de partos anteriores, presença de acompanhante ou doula e dilatação cervical no momento da analgesia. Resultados: Do total de nascimentos, 87,1% foram vaginais e 12,9% cesariana. A prevalência do uso de analgesia farmacológica foi 34,2% e do parto instrumentalizado de 8,4%. Cerca de 70% das mulheres tiveram gestação de risco habitual. Mesmo após ajuste por confundidores, o uso da analgesia aumentou em 3,5 vezes a chance de parto instrumentalizado (p<0,0001) e para as mulheres com gestação de alto risco esse aumento foi ainda superior (OR=4,62; p<0,0001). Não houve associação do uso da ...

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How Long Is a Normal Labor? Contemporary Patterns of Labor and Birth in a Low‐Risk Sample of 1,612 Women from Four Nordic Countries

Cited by 15 publications

References 29 publications

Are labor pain and birth experience associated with persistent pain and postpartum depression? A longitudinal cohort study

Are labor pain and birth experience associated with persistent pain and postpartum depression? A longitudinal cohort study

Labour characteristics of women achieving successful vaginal birth after caesarean section in three European countries

O uso de analgesia farmacológica influencia no desfecho de parto?

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