Ci a ion: Rúge -Na a e e, A.;
Vázquez-La a, J.M.;
An únez-Cal en e, I.;
Rod íguez-Díaz, L.; Riesco-González,
F.J.; Palomo-Gómez, R.;
Gómez-Salgado, J.;
Fe nández-Ca asco, F.J. An ena al
Fea o Childbi h as a Risk Fac o o
a Bad Childbi h Expe ience.
Heal hca e 2023,11, 297. h ps://
doi.o g/10.3390/heal hca e11030297
Academic Edi o : Abdel-La i
Mohamed
Recei ed: 18 Decembe 2022
Re ised: 12 Janua y 2023
Accep ed: 16 Janua y 2023
Published: 18 Janua y 2023
Copy igh : © 2023 by he au ho s.
Licensee MDPI, Basel, Swi ze land.
This a icle is an open access a icle
dis ibu ed unde he e ms and
condi ions o he C ea i e Commons
A ibu ion (CC BY) license (h ps://
c ea i ecommons.o g/licenses/by/
4.0/).
heal hca e
A icle
An ena al Fea o Childbi h as a Risk Fac o o a Bad
Childbi h Expe ience
Azaha a Rúge -Na a e e 1, Juana Ma ía Vázquez-La a 2,*, I ene An únez-Cal en e 3, Luciano Rod íguez-Díaz 2,
F ancisco Ja ie Riesco-González 3, Rocío Palomo-Gómez 4, Juan Gómez-Salgado 5,6,*
and F ancisco Ja ie Fe nández-Ca asco 3,7
1Depa men o Su ge y, Hospi en Es epona, 29689 Es epona, Spain
2Nu sing Depa men , Facul y o Heal h Sciences o Ceu a, Uni e si y o G anada, 51001 Ceu a, Spain
3Depa men o Obs e ics, Hospi al Uni e si a io Pun a de Eu opa, 11207 Algeci as, Spain
4Depa men o Obs e ics, La Linea de la Concepción Hospi al, 11300 La Línea de la Concepción, Spain
5Depa men o Sociology, Social Wo k and Public Heal h, Facul y o Labou Sciences, Uni e si y o Huel a,
21007 Huel a, Spain
6Sa e y and Heal h Pos g adua e P og amme, Uni e si y o Espí i u San o, Guayaquil 092301, Ecuado
7Depa men o Nu sing and Physio he apy, Facul y o Nu sing, Uni e si y o Cádiz, 11207 Algeci as, Spain
*Co espondence: [email p o ec ed] (J.M.V.-L.); [email p o ec ed] (J.G.-S.);
Tel.: +34-956526116 (J.M.V.-L.); +34-959219703 (J.G.-S.)
Abs ac :
Gi ing bi h is one o he mos imp essi e expe iences in li e. Howe e , many p egnan
women su e om ea o childbi h (FOC) and expe ience labou in e y di e en ways, depending
on hei pe sonali y, p e ious li e expe iences, p egnancy, and bi h ci cums ances. The aim o his
s udy was o analyse how ea o childbi h a ec s he childbi h expe ience and o assess he ela ed
consequences. Fo his, a desc ip i e c oss-sec ional s udy was ca ied ou in a sample o 414 women
be ween 1 July 2021 and 30 June 2022. The Bi h An icipa ion Scale (BAS) was used o measu e
ea o childbi h and he Childbi h Expe ience Ques ionnai e (CEQ-E) was applied o measu e
sa is ac ion wi h he childbi h expe ience. Fea o childbi h nega i ely and signi ican ly p edic ed
he childbi h expe ience. In addi ion, women who we e mo e ea ul o childbi h we e ound o ha e
wo se obs e ic ou comes and a highe likelihood o ha ing a caesa ean deli e y
(p= 0.008 C. I 95%
).
Fea beha ed as a isk ac o o he bi h expe ience, so he g ea e he ea , he highe he isk o
ha ing a wo se bi h expe ience (OR 1.1). Encou aging ac i e lis ening and suppo s a egies may
inc ease p egnan women’s con idence, hus dec easing hei ea o he p ocess and imp o ing hei
childbi h expe ience.
Keywo ds: ea o childbi h; childbi h expe ience; obs e ics; p egnancy; childbi h
1. In oduc ion
Childbi h is a decisi e, meaning ul, and li e-changing expe ience. In his sense, a
joy ul and posi i e expe ience is expec ed, bu ea ela ed o childbi h (o some kind o
ea ) canno be uled ou as i is di icul o p edic how he p ocess will un old. Thus, ea
o childbi h (FOC) can luc ua e du ing p egnancy, wi h up o 80% o women expe iencing
some o m o childbi h- ela ed ea a some poin , which becomes mo e in ense in he las
weeks o p egnancy [1,2].
FOC is a p oblem ha occu s among nullipa ous, p imipa ous, and mul ipa ous
women, and ha has heal h consequences and implica ions o labou and he pue -
pe ium [
1
,
2
]. O’Connell e al. ound ha mo e han 40% o new mo he s and mo e
han 30% o mul ipa ous women had a high le el o ea o childbi h [1].
FOC exis s on a spec um om low o high. I s ex eme exp ession is phobic ea ,
which in ol es a oidance beha iou s ha ypi y a phobic condi ion. Women wi h an
ex eme ea o childbi h may be sc upulous abou con acep ion o eso o olun a y
Heal hca e 2023,11, 297. h ps://doi.o g/10.3390/heal hca e11030297 h ps://www.mdpi.com/jou nal/heal hca e
Heal hca e 2023,11, 297 2 o 13
e mina ion o p egnancy o a oid ha ing o ace childbi h a all cos s. This phobic ea is
known as okophobia, a se e e ea o p egnancy and childbi h [
3
,
4
]. Howe e , e en when
FOC is no a phobic diso de , i can encompass a wide ange o emo ions du ing p egnancy,
such as anxie y and s ess, which also e lec a spec um o ma e nal dis ess [
5
,
6
]. In
addi ion, FOC can cause signi ican p oblems du ing labou which may ansla e in o
inc eased pain and a p olonga ion o he i s and second s ages o labou , oge he wi h
a s ong sense o dissa is ac ion [
7
–
9
]. Fu he mo e, ea has a s onge associa ion wi h
pain and du a ion o labou han s ess [
4
]. Epidu al anaes hesia ini ially educes pain, bu
in e es ingly, women who eques i a e mo e ea ul [
10
]. This p oblem is also ound in
7–22% o elec i e caesa ean sec ions chosen by he mo he wi hou a medical jus i ica ion,
which inc eases he caesa ean sec ion a e [
11
]. Ryding e al. also ound ha se e e ea can
cause labou o esul in an eme gency caesa ean sec ion [12].
Possible causes o FOC a e ela ed o se e al ac o s, such as women’s pe sonal,
in e nal, and ex e nal condi ions, i.e., men al heal h p oblems (such as anxie y diso de s)
and p e ious expe iences o auma and abuse. Addi ionally, social ci cums ances, such
as poo social suppo , unemploymen , and economic p oblems, ha e an e ec on he
likelihood o de eloping FOC [
13
,
14
]. To his, cul u al belie s abou childbi h as a isky
medical e en a e added, as hey may also in luence he de elopmen o FOC [15,16].
Women’s expe iences o p egnancy, labou , and childbi h a e mul idimensional [
17
]
and can include e e y hing om joy and sa is ac ion o anxie y and ho o . Some p egnan
women a e g ipped by nega i e eelings and may de elop a ea o childbi h, which can
ha e consequences o hei wellbeing and heal h [18].
Fea o childbi h expe iences in women appea o be ela ed o hei emo ional
wellbeing, s ess symp oms, impac s on daily li e, and desi e o a caesa ean sec ion a hei
nex bi h [
13
]. Women who ea childbi h may eel a lack o con idence in childbi h, be
in luenced by nega i e s o ies abou childbi h, ea labou pain o loss o con ol, and ea
physical inju y du ing childbi h. Women who gi e bi h a e a p e ious nega i e bi h
expe ience o en ea ano he bad bi h expe ience [19].
The emo ional and psychological wellbeing o women signi ican ly con ibu es o hei
pe cep ions and expe iences o p egnancy and childbi h. Poo emo ional heal h is associ-
a ed wi h inc eased ea o childbi h and isk o dep ession [
20
], bi h auma
[21–24]
, in-
abili y o in e ac posi i ely wi h he baby and mee he child’s de elopmen al needs
[25,26]
,
and can also ac as a s esso o he couple’s ela ionship [26,27].
The aim o his esea ch was o analyse how ea o childbi h (FOC) a ec s he childbi h
expe ience and o assess how i in luences he o he obs e ic and socio-demog aphic a iables.
2. Ma e ials and Me hods
2.1. S udy Design
A desc ip i e c oss-sec ional s udy was designed using ques ionnai es.
The s udy a iables we e ‘ ea o childbi h’ (FOC) using he Bi h An icipa e Scale
(BAS) sco e [
28
] and ‘childbi h expe ience’ using he Childbi h Expe ience Ques ionnai e
in i s alida ed Spanish e sion (CEQ-E) [29].
In addi ion, sociodemog aphic a iables we e aken in o accoun : age, ma i al s a us,
educa ional le el, and income. Fu he mo e, obs e ic a iables we e included, such as
ha ing a ended an ena al classes, mode o onse o labou , analgesia ecei ed du ing
deli e y, ype o deli e y, and ecei ing s i ches a e deli e y [30].
2.2. Popula ion and Sample
The s udy popula ion consis ed o a o al o 3269 p egnan women unde ollow-up
and who ga e bi h in wo public hospi als o Andalusia: Hospi al Pun a de Eu opa in
Algeci as (Cadiz) and Hospi al Cos a del Sol in Ma bella (Malaga), be ween July 2021 and
June 2022.
Heal hca e 2023,11, 297 3 o 13
Es ablishing a con idence le el o 95% and wi h a maximum e o o 5%, he op imal
sample should consis o a leas 344 subjec s. Finally, a o al o 414 subjec s we e ec ui ed
o allow o possible losses, es ima ed a a ound 20%.
The sample selec ion p ocess was ca ied ou sys ema ically, andomly selec ing
women who isi ed any o he hospi als o a ollow-up o hei p egnancy, who me he
inclusion c i e ia and wished o olun a ily pa icipa e in he s udy.
The inclusion c i e ia we e women who a ended he p egnancy ollow-up consul a ion
in he 35 h week o ameno hoea and who subsequen ly ga e bi h in any o he wo s udy
hospi als by eu ocic, dys ocic, and/o caesa ean deli e y wi hou pe ipa um pa hologies,
such as placen al ab up ion, p olapsed co d, o acu e oe al dis ess. In addi ion, he
newbo ns mus ha e been bo n heal hy and wi hou any neona al pa hology and should
ha e no equi ed mo e ime han usual in hospi al.
The exclusion c i e ion was he exis ence o a language ba ie (pa ien could no
w i e, ead, o e en speak in Spanish). In many cases, he companion o di ec ela i e did
unde s and Spanish, bu e en so, his equi emen was main ained as an exclusion c i e ion.
2.3. Ins umen s
Two alida ed ques ionnai es we e used o da a collec ion: he Bi h An icipa ion
Scale (BAS) [
28
] and he Childbi h Expe ience Ques ionnai e in i s alida ed Spanish
e sion (CEQ-E) [
29
]. In addi ion o hese wo ools, sociodemog aphic da a we e collec ed
om he pa ien s.
The BAS includes a six-i em scale o measu e ea o bi h. Pa icipan s exp ess whe he
hey eel ne ous, wo ied, ea ul, elaxed, e i ied, o calm ega ding he bi h o he baby,
using ‘ex emely’, ‘qui e a lo ’, ‘mode a ely’, ‘a li le’, and ‘no a all’ as esponse op ions.
The o al sco e is he sum o he esponses; he highe he sco e, he mo e ea ul he woman
is o he upcoming bi h. The o al sco e can ange om 6 (no ea ) o 30 (ex eme ea ) and
he o e all C onbach’s Alpha ob ained o his scale was 0.82. Sco es a e classi ied in o
h ee ca ego ies: be ween 6 and 13—‘low ea ’; be ween 14 and 20—‘in e media e ea ’;
and be ween 21 and 30—‘high ea ’ [28].
Gi en ha his ques ionnai e was alida ed in he Uni ed S a es by El ande e al. [
28
],
in o de o use i in he p esen s udy en i onmen and speci ic popula ion, he co espond-
ing c oss-cul u al adap a ion was ca ied ou . The eliabili y analysis using C onbach’s
alpha o his esul ing e sion was sligh ly highe han ha o he o iginal es , wi h a
alue o 0.87.
The CEQ-E includes 22 i ems e e ing o he childbi h expe ience. Responses o
he i s 19 i ems a e sco ed on a 4-poin Like scale (1. s ongly ag ee; 2. mainly ag ee;
3. mainly disag ee; 4. s ongly disag ee) and he las h ee i ems a e assessed using a isual
analogue scale, i.e., pain memo y, pe cei ed sa e y, and con ol.
The CEQ-E ques ionnai e consis s o 4 domains: ‘own capaci y’ (8 i ems ela ed o
sense o con ol, pe sonal eelings, and labou pain); ‘p o essional suppo ’ (5 i ems abou
p o essional ca e); ‘pe cei ed sa e y’ (6 i ems ega ding sense o secu i y and memo ies
om he childbi h); and ‘pa icipa ion’ (3 i ems ela ed o own possibili ies o in luence
posi ion, mo emen s, and pain elie du ing labou and bi h). The in e nal consis ency
eliabili y o he CEQ-E was good o he o e all scale (0.88) and o all he subscales
(0.80, 0.90, 0.76, 0.68 o ‘own capaci y’, ‘p o essional suppo ’, ‘pe cei ed sa e y’, and
‘pa icipa ion’, espec i ely), simila alues o he ones in he o iginal e sion [18].
2.4. Da a Collec ion
Da a we e collec ed om 1 July 2021 o 30 June 2022. Da a we e ob ained om he e -
ospec i e pa ien managemen da abase o he Andalusian Public Heal h Sys em (Spain).
Once he pa ien was selec ed, a membe o he esea ch eam con ac ed he by ele-
phone o in o m he o he cha ac e is ics o he s udy and in i e he o pa icipa e. When
he pa ien ga e he consen , she was sen a Google o ms link ia Wha sApp so ha she
could access he i ual ques ionnai e con enien ly and secu ely om he own phone.
Heal hca e 2023,11, 297 4 o 13
2.5. Da a Analysis
The desc ip i e analysis o quan i a i e a iables was pe o med using measu es o
cen al endency and dispe sion. Ca ego ical a iables we e desc ibed in absolu e numbe s
and pe cen ages. In he bi a ia e s a is ical analysis, o compa e quan i a i e a iables and
a e pe o ming he Kolmogo o –Smi no no mali y es , non-pa ame ic es s we e used:
Mann–Whi ney U es and K uskal–Wallis es . Finally, a mul i a ia e bina y logis ic e-
g ession model was de eloped o es ablish associa ions be ween he di e en independen
a iables and he dependen a iable (childbi h expe ience). Con idence in e als (CI)
we e ob ained a 95% and a signi icance le el o p< 0.05. The s a is ical s udy was ca ied
ou using he IBM SPSS S a is ics e sion 26.
Fo he alida ion o he BAS ques ionnai e, he o iginal ques ionnai e was ansla ed
in o Spanish by wo na i e ansla o s. I was hen e alua ed by a g oup o expe s o
check whe he he i ems we e adap ed o he a ge con ex . The ques ionnai e was hen
pilo - es ed wi h a g oup o 30 women o con i m he co ec unde s anding o he ques ions.
The nex s ep was o adminis e he ques ionnai e o he s udy sample and o ca y ou a
subsequen ac o analysis o all i s componen s. Finally, his ac o analysis was alida ed
using he AMOS p og amme, con i ming he cons uc alidi y.
2.6. E hical Aspec s
The gene al p inciples o he Decla a ion o Helsinki, upda ed in 2013 in Fo aleza
(B azil), we e conside ed h oughou his s udy by he en i e esea ch eam. In addi ion,
he p o isions o cu en Spanish legisla ion on biomedical esea ch (Law 14/2007, o 3
July, on Biomedical Resea ch) and Law 41/2002, o 14 No embe , on pa ien au onomy and
igh s and obliga ions ega ding clinical in o ma ion and documen a ion we e ollowed.
All pe sonal da a we e p o ec ed in acco dance wi h O ganic Law 15/1999, o 13 Decembe ,
on he P o ec ion o Pe sonal Da a. Pe mission o conduc his s udy was ob ained om he
Andalusian Biomedical Resea ch E hics Commi ee (code 47-N-20).
3. Resul s
3.1. Valida ion o he BAS Ques ionnai e
A ac o analysis was ca ied ou o he alida ion o he BAS ques ionnai e.
The esul s o he alida ion we e as ollows: The Kaise –Meye –Olkin measu e o
sampling adequacy was 0.84 and Ba le ’s es o sphe ici y had a signi icance o 0.001. As
in he o iginal ques ionnai e, only a single domain was ob ained which explained 62% o
he a iance. When applying he es – e es eliabili y analysis using C ombach’s alpha, a
alue o 0.87 was ob ained. This alue was somewha highe han ha o he o iginal scale.
3.2. Desc ip i e Analysis
The mean age o he women was 32 yea s, wi h a minimum age o 16 yea s and a
maximum age o 44 yea s. The median alue o he Bi h An icipa ion Scale (BAS) was 16,
wi h a SD o 4.84; he median alue o he Childbi h Expe ience Scale (CEQ-E) was 64,
wi h a SD o 11.27.
The desc ip i e analysis o he quali a i e a iables is shown in Table 1.
Table 1. Desc ip i e analysis o quali a i e a iables.
Va iable Values F equency Pe cen age
Ma i al s a us
Single 230 55.6
Ma ied 172 41.5
Di o ced 12 2.8
To al 414 100
Heal hca e 2023,11, 297 5 o 13
Table 1. Con .
Va iable Values F equency Pe cen age
Le el o s udies
No s udies 7 1.8
P ima y s udies 112 27.1
Highe seconda y s udies o oca ional aining 168 40.5
Uni e si y o pos g adua e 127 30.6
To al 414 100
Employmen si ua ion
Unemployed 111 26.8
Wo king 232 56
Household ca e 71 17.3
To al 414 100
Economic le el (income)
EUR <1000 73 17.6
Be ween EUR 1000 and 2000 188 45.4
Be ween EUR 2000 and 3000 115 27.8
EUR >3000 38 9.2
To al 414 100
P e ious misca iages
Yes 128 31
No 286 69
To al 414 100
A endance o an ena al
classes
Yes 179 43.3
No 235 56.7
To al 414 100
Mode o onse o labou
Spon aneous 248 59.9
Induced 133 32
Planned caesa ean 33 8.1
To al 414 100
Analgesia used du ing labou
No analgesia 103 25
Epidu al 277 66.9
Opioids 34 8.1
To al 414 100
Accompanied du ing dila ion
and/o deli e y
Yes 356 85.9
No 58 14.1
To al 414 100
Type o deli e y
Eu ocic 255 61.6
Ins umen al 56 13.4
Caesa ean 103 25
To al 414 100
S i ches a e deli e y
No s i ches 89 21.5
Episio omy 74 18
Tea ing 147 35.6
Caesa ean- ela ed 104 25
To al 414 100
Fea o Childbi h
Low 106 25.7
In e media e 229 55.3
Ex eme 79 2
To al 414 100
3.3. Co ela ional Analysis
Age was posi i ely co ela ed wi h numbe o child en (p= 0.001), and nega i ely
wi h childbi h expe ience (p= 0.001). Numbe o child en was posi i ely and signi ican ly
co ela ed wi h childbi h expe ience, so he highe he numbe o child en, he be e he
expe ience (p= 0.008).

Heal hca e 2023,11, 297 6 o 13
Fea o childbi h was nega i ely co ela ed wi h he childbi h expe ience, so he mo e
ea ul he woman was, he wo se he expe ience (p= 0.001). Al hough he co ela ions
we e signi ican on some occasions, hey we e gene ally e y low, i.e., below 0.6 (Table 2).
Table 2. Co ela ion be ween he di e en quan i a i e a iables.
Numbe o Child en To al BAS To al CEQ-E
Age Co ela ion coe icien 0.2 ** −0.31 −0.169 **
Sig (bila e al) 0.001 0.46 0.001
Numbe o child en Co ela ion coe icien −0.6 0.112 *
Sig (bila e al) 0.156 0.008
To al BAS Co ela ion coe icien −0.267 **
Sig (bila e al) 0.001
* The co ela ion is signi ican a 0.05 le el (bila e al); ** The co ela ion is signi ican a 0.001 le el (bila e al)
(Spea man’s Rho co ela ion coe icien ).
3.4. Compa isons o Medians (—) and Bi a ia e Analysis
3.4.1. Fea o Childbi h (BAS) and Childbi h Expe ience (CEQ-E) Rela ed o he Di e en
Sociodemog aphic Va iables
S a is ically signi ican di e ences we e ound be ween he di e en g oups when
ela ing ea o childbi h o le el o educa ion (p= 0.005) and income (p= 0.002). Simila ly,
hese di e ences we e also ound when ela ing childbi h expe ience o ma i al s a us
(p= 0.04)
and income (p= 0.001). Howe e , no s a is ically signi ican di e ences we e
ound ega ding he o he associa ions (Table 3).
Table 3.
Compa ison o medians o ea o childbi h (BAS) and childbi h expe ience (CEQ-E) wi h
sociodemog aphic a iables.
BAS Tes CEQ-E Tes
NMedian Range pValue * Median Range pValue *
Le el o
s udies
No s udies 7 19 14.22–23.78
0.005
62 48.89–75.11
0.23
P ima y s udies 112 16 11.07–20.93 67 56.74–77.26
Highe seconda y
s udies o
oca ional aining 168 16 11.09–20.91 65 52.92–77.18
Uni e si y o
pos g adua e 127 14 9.47–18.53 67 56.36–77.64
Ma i al s a us
Single 230 16 11.32–20.68
0.13
65 53.46–76.54
0.04
Ma ied 172 15 10.01–19.99 67 56.25–77.75
Di o ced 12 19 13.87–24.13 63 51.25–74.75
Economic le el
(income)
EUR <1000 73 16 10.88–21.12
0.002
61 48.46–73.54
0.001
Be ween EUR 1000
and 2000 188 16 11.19–20.81 66 55.43–76.57
Be ween EUR 2000
and 3000 115 16 11.44–20.56 65 53.47–76.53
EUR >3000 38 14 9.28–18.72 69 60.33–68.67
* K uskal–Wallis es .
3.4.2. Fea o Childbi h (BAS) and Childbi h Expe ience (CEQ-E) Rela ed o
Obs e ic Fac o s
S a is ically signi ican di e ences we e ound when ela ing childbi h expe ience
(CEQ-E) o ha ing had p e ious misca iages. Thus, women who had had misca iages had
a be e expe ience (p= 0.001). No such di e ences we e ound when ela ing his a iable
o ea o childbi h (BAS) (Table 4). Rele an di e ences we e also ound when ela ing
he a iable ‘a endance o an ena al classes’ o ea o childbi h (BAS), so women who
Heal hca e 2023,11, 297 7 o 13
a ended hese cou ses we e less ea ul o childbi h (p= 0.02). Howe e , no di e ences
we e ound when ela ing his a iable o childbi h expe ience (CEQ-E). When analysing
he in luence ha being accompanied du ing dila ion and/o deli e y may ha e on he
ou comes, s a is ically signi ican di e ences we e obse ed in ela ion o ea o childbi h
(BAS) (p= 0.001) and childbi h expe ience (CEQ-E). Thus, accompanied women had a
be e childbi h expe ience (p= 0.001) (Table 4).
Table 4.
Compa ison o medians o ea o childbi h (BAS) and childbi h expe ience (CEQ-E) wi h
dicho omous obs e ic a iables.
BAS Tes CEQ-E Tes
N Median Range pValue * Median Range pValue *
P e ious misca iages Yes 128 15 10.46–19.54 0.15 67 56.6–77.4 0.001
No 286 16 11.03–20.97 65 53.43–76.57
A endance o an ena al
classes
Yes 179 15 10.16–19.84 0.02 65 54.54–75.56 0.21
No 235 16 11.19–20.81 63 51.16- 74.84
Accompanied du ing
dila ion and/o deli e y
Yes 356 16
11.11– 20.89
0.001 67 56.88–77.12 0.001
No 58 17 12.44–21.56 51 40.5–61.5
* Mann–Whi ney U es .
No s a is ically signi ican di e ences we e ound when ela ing he mode o onse
o labou o he ‘ ea o childbi h’ a iable (BAS). Howe e , signi ican di e ences we e
ound when ela ing his a iable o childbi h expe ience (CEQ-E), wi h women who
s a ed labou spon aneously ha ing a be e expe ience (p= 0.001) (Table 5).
Table 5.
Compa ison o medians o ea o childbi h (BAS) and childbi h expe ience (CEQ-E) wi h
poly omous obs e ic a iables.
BAS Tes CEQ-E Tes
NMedian Range pValue * Median Range pValue *
Mode o onse
o labou
Spon aneous 248 15 10.08–19.92
0.09
67 56.65–77.35
0.001
Induced 133 16 11.54–20.46 64 53.33–74.67
Elec i e
caesa ean 33 17 11.42–22.58 53 39.78–66.22
Analgesia used
du ing labou
No analgesia 103 15 10.03–19.97
0.001
71 60.17–81.83
0.001
Opioids 277 17 12.37–21.63 61 49.92–72.08
Epidu al 34 16 11.24–20.76 65 53.87–76.13
Type o
deli e y
Eu ocic 255 15 10.23–19.77
0.08
70 60.4–79.6
0.001
Ins umen al 56 16 11.22–20.78 63 51.56–74.44
Caesa ean 103 16 11–21 59 47.75–70.25
S i ches a e
deli e y
No s i ches 89 14 8.8–19.2
0.19
70 60.87–79.13
0.001
Episio omy 74 16 11.21–20.79 66 55.83–76.17
Tea ing 147 16 11.36–20.64 67 56.31–77.69
Caesa ean-
ela ed 104 16 11.24–20.76 59 47.73–70.27
* K uskal–Wallis es .
The pos hoc es showed s a is ically signi ican di e ences be ween he g oup in
which labou had begun spon aneously and he g oup ha had a planned caesa ean sec ion
(p= 0.001).
S a is ically signi ican di e ences we e also ound when ela ing he ype o analgesia
used du ing labou o ea o childbi h (BAS). Women who did no eques any ype o
Heal hca e 2023,11, 297 8 o 13
analgesia had he lowes le els o ea o childbi h (p= 0.001) (Table 5). The pos hoc es
o he ‘ ea o childbi h’ a iable (BAS) did no es ablish s a is ically signi ican di e ences
be ween he di e en g oups. Rega ding he childbi h expe ience acco ding o he ype o
analgesia chosen o alle ia e labou pain, i could be obse ed ha women who did no
choose any ype o analgesia we e hose who had a be e childbi h expe ience
(CEQ-E)
.
On he o he hand, he pos hoc es o he ‘childbi h expe ience’ a iable (CEQ-E)
es ablished ha signi ican di e ences we e ound be ween he g oup o women who did
no use any analgesia and he g oup o women who used opioids as a me hod o pain elie
in labou (p= 0.001); be ween he g oup o women who chose opioids o labou pain elie
and he g oup o women who chose epidu al analgesia (p= 0.02); and be ween he g oup
o women who did no use any analgesia o labou pain and he g oup o women who
chose epidu al analgesia (p= 0.001).
When ela ing he ype o deli e y o he ‘ ea o childbi h’ scale (BAS), s a is ically
signi ican di e ences we e ound. Women who had a eu ocic bi h we e he leas ea -
ul (Table 5). Ye , he pos hoc es o he ‘ ea o childbi h’ a iable did no es ablish
s a is ically signi ican di e ences be ween he di e en g oups.
S a is ically signi ican di e ences we e also obse ed o he associa ion be ween
he expe ience o childbi h and he ype o deli e y, so women who had a eu ocic bi h
we e he ones who ob ained sco es indica ing a be e childbi h expe ience. The pos hoc
es es ablished ha s a is ically signi ican di e ences we e ound be ween he g oup o
women who had a eu ocic bi h and he g oup o women who had a caesa ean (p= 0.001);
and be ween he g oup o women who had a eu ocic bi h and he g oup who had an
ins umen al bi h (p= 0.001).
No s a is ically signi ican di e ences we e ound when ela ing he ‘s i ches ecei ed
a deli e y’ a iable o he ea o childbi h scale (BAS). Howe e , s a is ically signi ican
di e ences we e ound be ween he di e en g oups when ela ing he childbi h expe ience
o he ‘s i ches ecei ed a deli e y’ a iable, wi h women who had had no s i ches a bi h
ha ing he bes childbi h expe ience. The pos hoc es also showed s a is ically signi ican
di e ences be ween he ollowing g oups: be ween he g oup o women who ended labou
wi h no s i ches and he g oup o women who ended labou wi h an episio omy
(p= 0.001)
;
be ween he g oup o women who ended labou wi hou s i ches and he g oup o women
who had a caesa ean sec ion (p= 0.001); be ween he g oup o women who ended he bi h
wi h s i ches and he g oup o women who had a caesa ean sec ion (p= 0.001); and be ween
he g oup o women who ended he bi h wi h an episio omy and he g oup o women
who had a caesa ean sec ion (p= 0.001).
3.5. Mul i a ia e Analysis (—) and Bina y Logis ic Reg ession Analysis
The mul i a ia e analysis was pe o med wi h he ‘childbi h expe ience’ ecoded
a iable (CEQ-E es sco e), wi h alues o 1 ( alues abo e he mean) and 0 ( alues below
he mean). The independen a iables included we e age, numbe o child en, ea o
childbi h (BAS es sco e), as well as hose ca ego ical a iables ha we e s a is ically
signi ican in he bi a ia e analysis: ma i al s a us, economic income, p e ious misca iages,
mode o onse o labou , analgesia used in labou , accompanimen du ing dila ion and/o
deli e y, ype o deli e y, and s i ches ecei ed a e labou (Hosme and Lemeshow
Chi-squa e Tes 16. 12 (p= 0.04); Nagelke ke’s R2 (0.47)) (Table 6).
Rega ding age, i beha ed as a isk ac o o he ‘childbi h expe ience’ a iable in
such a way ha he olde he woman, he wo se he childbi h expe ience.
Women wi h he highes income (o e EUR 3000 pe mon h) we e 3.53 imes mo e
likely o ha e a be e expe ience han hose wi h he lowes income (less han EUR 1000 pe
mon h). Simila ly, middle-income women (income be ween EUR 1000 and 2000 pe mon h)
we e 2.4 imes mo e likely o ha e a be e childbi h expe ience han hose wi h lowe
incomes (Table 6). Addi ionally, women who had had p e ious misca iages we e 1.59 imes
mo e likely o ha e a be e childbi h expe ience han hose who had had no p e ious
misca iages. Finally, women who we e accompanied du ing dila ion and/o deli e y
Heal hca e 2023,11, 297 9 o 13
we e 3.68 imes mo e likely o ha e a be e childbi h expe ience han hose who we e
unaccompanied (Table 6).
Table 6. Bina y logis ic eg ession model.
Independen Va iables Sig. OR 95% C.I. o EXP (B)
Lowe Uppe
Age 0.001 0.91 0.88 0.95
Income (<1000 eu os/mon h) 0.004 Re .
Income (1000–2000
eu os/mon h) 0.002 2.4 1.37 4.23
Income (2000–3000
eu os/mon h) 0.001 2.83 1.52 5.27
Income (>3000 eu os/mon h) 0.002 3.53 1.58 7.89
Misca iages 0.03 1.58 1.05 2.4
Accompanimen 0.001 3.68 1.91 7.11
Type o deli e y (eu ocic) 0.001 Re .
Type o deli e y (ins umen al) 0.001 0.41 0.25 0.68
Type o deli e y (caesa ean) 0.016 0.51 0.3 0.88
Fea o childbi h (FBS sco e) 0.001 0.9 0.87 0.94
Dependen a iable: childbi h expe ience (0/1); independen a iables: numbe o
child en, ma i al s a us, income, p e ious misca iages, mode o onse o labou , analgesia,
accompanimen du ing dila ion and/o deli e y, ype o deli e y, s i ches ecei ed, ea o
childbi h (FBS es sco e).
4. Discussion
Many p egnan women su e om se e e ea o childbi h (FOC) and expe ience
his in e y di e en ways, depending on hei pe sonali y, p e ious li e and bi h expe i-
ences, p egnancy, and bi h ci cums ances [
1
,
9
]. This a iabili y highligh s he in e es in
app oaching his expe ience om di e en poin s o iew, so ha di e en pe spec i es
can be p o ided. In his sense, he p esen s udy may o e ele an in o ma ion o be
conside ed in he p ocess.
Among he main indings o he p esen s udy, women who we e mo e ea ul o child-
bi h we e ound o ha e a wo se childbi h expe ience. I has been consis en ly published
in he scien i ic li e a u e ha a highe FOC has been associa ed wi h un a ou able bi h
ou comes and wo se subjec i e childbi h expe iences [9].
Olde women we e mo e ea ul o childbi h han younge women and, hough his
seems logical, he esul can be su p ising. I can be due o he ac ha , as a gene al ule, age
is a isk ac o o complica ions du ing p egnancy [
31
,
32
]. In addi ion, olde women a e
mo e likely o ha e had p e ious p egnancies, and he e o e o ha e expe ienced childbi h
be o e. I his p e ious expe ience was no he bes , i can be expec ed ha hey will be
mo e ea ul o he new upcoming bi h [33,34].
Women who a ended an ena al classes had lowe le els o FOC and, as a consequence,
a be e childbi h expe ience, mos likely due o he in o ma ion ecei ed in hese cou ses.
These indings a e consis en wi h o he ecen ly published s udies [
30
–
36
]. Howe e , he
ac ha women who a ended an ena al classes had a be e expe ience o childbi h has
no been s a is ically p o en as, al hough hey ob ained highe childbi h expe ience sco es
(CEQ-E), he di e ences iden i ied we e no s a is ically signi ican .
The way in which labou was ini ia ed was also a de e minan as ega ds he le el
o ea o childbi h. Thus, women who had a planned caesa ean sec ion we e he mos
ea ul. This was p obably due o he ac ha aginal bi h is unde s ood as a mo e na u al
p ocess, whe eas deli e y by caesa ean sec ion implies a su gical in e en ion, wi h he
isks ha his may en ail. In ac , women who we e scheduled o induc ion o labou we e
also mo e ea ul han hose who had a no mal deli e y. These esul s a e consis en wi h
o he s udies, such as he one by Sydsjö e al. [37].