Exploring Priority Intrapartum Services Associated with Childbirth Experience During Vaginal Birth: A Multicenter Cross-Sectional Study.

Background

A woman's childbirth experience is important to her health and family well-being. Evidence-based intrapartum care may support a positive experience. When resources are constrained, identifying services that are most strongly associated with childbirth experience may help inform quality-improvement priorities. This study aimed to explore priority intrapartum services associated with women's experience following vaginal birth.

Methods

A multicenter cross-sectional study was conducted in mainland China. A total of 498 postpartum women from ten tertiary facilities were involved. Data were collected through retrospective review of medical records and self-administered questionnaires completed by postpartum women. A self-designed questionnaire was used to collect general information and information on intrapartum services, and the Childbirth Experience Questionnaire was used to assess childbirth experiences. Random forest and Bayesian network analysis were used to examine associations and identify potentially high-priority services.

Results

Childbirth experience scores ranged from 27 to 76, with a mean of 61.29. In bootstrap analyses of the random forest model, coefficient of variation for variable-importance estimates ranged from 5.1% to 32.3%. The Bayesian network contained seven structurally compact communities, five of which were closely associated with childbirth-experience outcomes; hospital type was an important connecting node between intrapartum services and childbirth experience. Among the top ten factors associated with the overall childbirth experience, several intrapartum services stood out. These included the type, initiation time, and duration of skin-to-skin contact; the number of evidence-based services received during the first and second stages of labour; and the use of pain-relief methods.

Conclusions

Receiving a broader range of evidence-based intrapartum services, longer uninterrupted skin-to-skin contact and access to pain-relief options were associated with more positive childbirth experience scores.