J Ad Nu s. 2024;80:2363–2378.
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2363wileyonlinelib a y.com/jou nal/jan
Recei ed: 8 Augus 2023
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Re ised: 9 No embe 2023
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Accep ed: 13 No embe 2023
DOI: 10.1111/jan.15989
EMPIRICAL RESEARCH QUANTITATIVE
Explo ing home bi hs in Ca alonia (Spain): A c oss-sec ional
s udy o women's expe iences and in luencing ac o s
Lucia Alca az-Vidal1,2,3 | Fa ima Leon-La ios4 | Gemma Robleda5,6 |
Ra ael Vila- Candel7,8
This is an open access a icle unde he e ms o he C ea i e Commons A ibu ion License, which pe mi s use, dis ibu ion and ep oduc ion in any medium,
p o ided he o iginal wo k is p ope ly ci ed.
© 2023 The Au ho s. Jou nal o Ad anced Nu sing published by John Wiley & Sons L d.
1Depa men o Obs e ics and
Gynecology, Uni e si y Hospi al Ge mans
T ias i Pujol, Badalona, Spain
2Resea ch G oup on Sexual and
Rep oduc i e Heal hca e (GRASSIR)
(2021-SGR-01489), Ba celona, Spain
3Ca alan Associa ion o Home Bi h
Midwi es, Ba celona, Spain
4Nu sing Depa men . Facul y o Nu sing,
Physio he apy and Podia y, Uni e si y o
Se ille, Se illa, Spain
5Campus Docen Fundació P i ada
San Joan de Déu, School o Nu sing,
Uni e si y o Ba celona, Ba celona, Spain
6Cen o Coch ane Ibe oame icano,
Ba celona, Spain
7Facul y o Heal h Sciences, In e na ional
Uni e si y o Valencia –VIU, Valencia,
Spain
8Depa men o P ima y Heal h,
Founda ion o P omo ing o Heal h and
Biomedical Resea ch in he Valencian
Region (FISABIO-SP), Valencia, Spain
Co espondence
Fa ima Leon-La ios, Facul y o Nu sing,
Physio he apy and Podia y, Uni e si y o
Se ille, Calle A enzoa 6, 41009-Se illa,
Spain.
Email: a imale[email p o ec ed]
Funding in o ma ion
Fundación pa a el Fomen o de la
In es igación Sani a ia y Biomédica de
la Comuni a Valenciana, G an /Awa d
Numbe : II Call o Nu sing R&D&I G an s.
2020; UGP-20-245
Abs ac
Aim: The s udy explo es he expe iences o women wi h low- isk p egnancies and no
complica ions who planned a home bi h.
Design: A c oss-sec ional s udy was conduc ed using an online ques ionnai e.
Me hods: The ques ionnai e included socio-demog aphic, obs e ic and pe ina al a -
iables. Bi h sa is ac ion was e alua ed ia he Spanish e sion o he childbi h expe-
ience ques ionnai e. The s udy g oup comp ised home-bi hing women in Ca alonia,
Spain. Da a we e collec ed om 1 Janua y 2019 o 31 Decembe 2021. S a is ical
analysis was pe o med using SPSS.
Resul s: A o al o 236 women esponded. They epo ed gene ally posi i e expe i-
ences, wi h p o essional suppo and in ol emen being he mos highly a ed dimen-
sions. Be e childbi h expe iences we e associa ed wi h labou las ing less han 12 h,
no pe ineal inju ies, no in apa um ans e s o hospi al, eu hocic deli e y and he
p esence o a midwi e.
Conclusions: Women's posi i e home bi h expe iences we e linked o ac i e pa -
icipa ion and midwi e suppo . Mul ipa ous women el sa e . Medical in e en ions,
especially ans e s o hospi als, educed sa is ac ion, highligh ing he need o im-
p o ed ca e du ing home bi hs.
Implica ions o he P o ession and Pa ien Ca e: Home bi hs should be included
among he bi hplace op ions o e ed by public heal h se ices, gi en he ex emely
posi i e eedback epo ed by women who ga e bi h a home.
Impac : Home bi h is no an op ion o e ed unde Ca alonia's public heal h sys em
only as a p i a e se ice. The expe ience o home-bi hing women is unknown. This
s udy shows a e y posi i e bi h expe ience due o g ea e pa icipa ion and midwi e
suppo . The esul s help s akeholde s assess home bi h's public heal h inclusion and
unde s and alued ac o s, suppo ing home-bi hing women.
Repo ing Me hod: The s udy ollowed he STROBE checklis guidelines o c oss-
sec ional s udies.
Public Con ibu ion: Women who planned a home bi h pa icipa ed in he pilo es o
alida e he ins umen , and hei con ibu ions we e collec ed by he lead esea che .
2364
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ALCARAZ-VIDAL e al.
1 | INTRODUCTION
High-quali y, p o essionally p o ided heal hca e se ices a e c u-
cial o women. I is essen ial o e alua e hese se ices so hey
can be imp o ed and ailo ed o mee women's needs (O'B ien
e al., 2021; Olza e al., 2018). Childbi h s ands ou as one o
he mos signi ican e en s in a woman's li e wi h bo h sho - and
long- e m implica ions o he heal h. A c ucial ac o a ec ing
he childbi h expe ience is he planned bi h se ing (Win e
e al., 2022). In coun ies whe e home bi hs a e in eg a ed in o
he na ional heal h se ice, such as Scandina ian coun ies and he
Ne he lands, women who op o gi e bi h a home epo posi i e
expe iences ela ed o he eedom o choose hei companions,
he in imacy and anquilli y, and he us hey ha e in hemsel es
and hei accompanying midwi es (Hollande e al., 2019; Sjöblom
e al., 2014).
In Spain, hospi al is he p edominan se ing o childbi h; home
bi hs a e no in eg a ed in o he public heal h sys em (O ega
Ba eda e al., 2017). To ou knowledge, he e a e no quan i a i e
s udies compa ing women's expe iences based on he bi hing en i-
onmen in he Spanish con ex . Consequen ly, i is c ucial o e al-
ua e wha aspec s con ibu e o a sa is ying bi h expe ience o
women, ega dless o whe e hey gi e bi h.
2 | BACKGROUND
Di e en au ho s ha e iden i ied a ious elemen s ela ed o child-
bi h expe iences, such as he mo he 's indi idual ac o s (pa i y, ex-
pe iences o emale suppo du ing childbi h, cul u al backg ound
and expec a ions o childbi h); in e pe sonal ac o s ela ed o
companions and heal hca e p o essionals a ending he bi h,
and ac o s ela ed o he sense o con ol and pe cei ed sa e y,
bo h physically and emo ionally (Chabbe e al., 2021; Leinwebe
e al., 2022; Vedele e al., 2022).
Posi i e bi h expe iences a e linked wi h he pe cep ion o
con ol o e he p ocess, he p esence o chosen companions
du ing labou , pain elie and he ca e p o ided by heal hca e p o-
essionals, wi h special conside a ion gi en o con inuous suppo
om midwi es (Chabbe e al., 2021; Downe e al., 2018; Pe dok
e al., 2018).
Con e sely, nega i e bi h expe iences a e linked wi h la-
bou induc ion (Place e al., 2022), medical o neona al complica-
ions (Chabbe e al., 2021; Hosseini Tabaghdehi e al., 2019) and
he unnecessa y medicaliza ion o childbi h, which unde mines
a woman's con idence in he own bi hing abili y (Wo ld Heal h
O ganisa ion, 2018). A nega i e bi h expe ience is associa ed wi h
an inc eased likelihood o de eloping ea o anxie y du ing subse-
quen childbi h (Vii man e al., 2023), pos - auma ic s ess diso -
de (McKel in e al., 2021), pos pa um dep ession and di icul ies
in bonding wi h he newbo n (a achmen di icul ies) (G unds öm
e al., 2022; Yildiz e al., 2017). Mo eo e , a nega i e expe ience
migh in luence a woman's choices ega ding u u e p egnancies,
bi h op ions and e en he iming o u he p egnancies (McKel in
e al., 2021; Sho ey e al., 2018).
The planned bi h se ing also impac s he bi h expe ience.
Se e al s udies ha e obse ed ha women who planned a home
bi h had be e expe iences han women who chose o deli e
in hospi al. The home-bi hing women's be e expe iences we e
linked o he ac o s al eady men ioned: a g ea e sense o con ol
o e he en i onmen , he abili y o make hei own decisions abou
he p ocess, con inuous suppo om midwi es, and a lowe isk o
unnecessa y in e en ions o dis up ions (Gee s e al., 2017; Gillen
e al., 2023b; Hauck e al., 2020; Zielinski e al., 2015).
Among he elemen s ha in luence he expe ience o planned
home bi h, no able ac o s include inc eased accessibili y o mid-
wi es, he abili y o in ol e amily membe s and comp ehensi e
pos pa um ca e (Janssen e al., 2009). Ano he aspec is he sense
o secu i y ela ed o knowing he midwi e o midwi e y eam be-
o ehand and ha ing con idence in hei compe ence and pe sonal-
ized ca e (Qua occhi, 2022; Sandall e al., 2016).
Acco ding o ecen da a, home bi hs accoun o 1%–4% o
all bi hs in Eu ope, bu he p e alence al e s signi ican ly om
one coun y o ano he . Fo example, he Ne he lands has a ela-
i ely high a e o home bi hs a 16.3%, while Denma k, Ge many
and Belgium ha e lowe a es (1.4%, 1.3% and 1.1% espec i ely)
(Galko á e al., 2022). The p e alence a ies based on di e en
heal hca e sys ems, policies and cul u al p e e ences in each
coun y.
In Spain, planned home bi hs a e gene ally o e ed as a p i-
a e se ice, p o ided by midwi es (O ega Ba eda e al., 2017).
Expec an mo he s con ac midwi es specializing in home bi hs and
es ablish a con ac ual, ca e-based ela ionship, in ol ing con inu-
ous suppo and assis ance h oughou p egnancy o pos pa um,
ollowing a model o ca e con inui y.
The Ca alan Associa ion o Home Bi h Midwi es (CAHMB) i
is a scien i ic associa ion, one o whose objec i es is o conduc
esea ch on home bi h, examining bo h ma e nal and neona al
The ques ionnai e ga he ed he pa icipan s' email add esses, and a commi men was
made o dissemina e he s udy's esul s h ough his means.
KEYWORDS
bi h expe ience, bi hplace, childbea ing, home bi h, midwi e y, place o bi h, women's
heal h
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ALCARAZ-VIDAL e al.
clinical ou comes, as well as women's expe iences. CAHMB has
63 a ilia ed midwi es, who p o ide ca e o bo h home bi hs
and bi hs a he Migjo n Bi hing Cen e, a p i a e acili y in
Ba celona, Spain. The Migjo n Bi hing Cen e is designed o p o-
ide he ypical condi ions and cha ac e is ics necessa y o a
home bi h when a woman's usual esidence does no mee he e-
qui ed c i e ia o a bi h se ing. Midwi es a ilia ed wi h CAHMB
ollow a common se o guidelines endo sed by scien i ic socie -
ies, and hei s a u es manda e eco ding bi h da a in a sha ed
da abase (Alca az-Vidal e al., 2021). The es ablishmen o such
guidelines and da a- eco ding p ocedu es ensu es ha he ca e
p o ided by CAHMB midwi es adhe es o s anda d p ac ices and
allows he collec ion o aluable in o ma ion o esea ch and con-
inuous imp o emen in he ield o home bi hs and ca e o he
bi h cen e (Alca az-Vidal e al., 2018).
Acco ding o Spain's Na ional Ins i u e o S a is ics, he e we e
815 home bi hs a ended by heal hca e pe sonnel in Spain in
2019, comp ising 0.22% o all bi hs ha yea (Ins i u o Nacional
de Es adís ica, 2023). O hese, 37.4% (305 o 815) we e e-
co ded in Ca alonia; o he Ca alan home bi hs, 80.9% (247 o
305) we e a ended by CAHMB midwi es (Ins i u o Nacional de
Es adís ica, 2023).
Howe e , da a on whe he o no hese home bi hs we e
planned in ad ance a e no a ailable, as he INE does no collec
in o ma ion on in ended bi h se ings. Simila ly, i is no known how
many in ended home bi hs e en ually deli e ed in hospi al (Alca az-
Vidal e al., 2021).
The lack o speci ic da a on planned and ac ual bi h se ings
highligh s he need o mo e comp ehensi e and s anda dized da a
collec ion in he ield o home bi hs o be e unde s and and assess
he esul s and expe iences o women who choose his bi h op ion
in Spain.
3 | THE STUDY
3.1 | Aim
The s udy's main objec i e was o explo e he bi h expe iences o
women wi h low- isk obs e ic p egnancies and no associa ed com-
plica ions who planned a home bi h in Ca alonia.
4 | METHODS
4.1 | Design
This c oss-sec ional s udy sampled women who planned a home
bi h om 1 Janua y 2019 o 31 Decembe 2021. Pa icipan s com-
ple ed he Spanish e sion o he childbi h expe ience ques ion-
nai e (CEQ-E) e ospec i ely, be ween 1 and 3 mon hs a e gi ing
bi h.
4.2 | S udy se ing and sampling
The popula ion was de ined as women who wan ed a planned home
bi h and we e accep ed a e an ini ial e alua ion, conduc ed by he
midwi es who would moni o he p egnancy and a end he bi h.
Du ing he i s home pos pa um appoin men , signed in o med
consen o ms and pe sonal con ac in o ma ion o u he ollow-
up appoin men s we e ob ained om candida es who we e willing
o pa icipa e. The signed in o med consen o ms, along wi h he
women's da a, we e sen by he midwi es o he s udy's p incipal
in es iga o .
A sample size o 214 pa icipan s was de e mined using he
EPIDAT 3.1 s a is ical p og amme o es ima e a p opo ion wi h
he ollowing assump ions: a o al o 700 bi hs in he 2 yea s o
ollow-up, an 80% a endance a e, a 95% con idence le el, 5% p e-
cision and an expec ed p opo ion o losses o 15% d opou a e.
4.3 | Inclusion c i e ia
Con enience sampling was used, wi h he ollowing inclusion c i-
e ia: (i) expec an mo he s who could speak ei he Spanish and/o
English, (ii) low- isk obs e ic, (iii) single on p egnancy and (i ) in he
cephalic p esen a ion.
4.4 | Validi y, eliabili y and igou
The s udy collec ed he ollowing da a: he pa icipan s' socio-de-
mog aphic in o ma ion (age, le el o educa ion, coun y o o igin,
e hnici y and pa i y); a iables ela ed o childbi h (ges a ional age,
ype o bi h, in apa um ans e s, pain a ing using a nume ical
scale, use o non-pha macological analgesia measu es and du a ion
o labou ); ma e nal mo bidi y a iables (pe ineal ea , episio omy
and admission o he in ensi e ca e uni ) and neona al a iables
(Apga sco e, baby's weigh , ype o eeding in he i s mon h and
admission o he neona al in ensi e ca e uni [NICU]).
The du a ion o labou was de ined as he ime, in hou s, ha
elapsed om he ac i e phase o labou o he hi d s age o labou .
The ype o eeding in he i s mon h was classi ied as (i) ex-
clusi e b eas eeding (including exp essed milk and/o milk om a
dono ) (Vila-Candel e al., 2021; Wink is e al., 2015), (ii) exclusi e
o mula eeding o (iii) mixed i he bay's die combined b eas milk
and o mula. The b eas eeding s a us was eco ded a he same
ime he women comple ed he ques ionnai e (be ween he i s and
hi d mon h pos pa um).
4.5 | Nume ical pain scale
Pain was assessed using a nume ical pain in ensi y scale anging
om 0 o 10 (Nugen e al., 2021), whe e 0 ep esen s no pain and
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ALCARAZ-VIDAL e al.
10 ep esen s he wo s pain imaginable. This i em co esponds o
I em 20 on he CEQ-E.
4.6 | Deg ees o pe ineal inju y
Pe ineal ea s we e classi ied as ollows: i s -deg ee ea s in ol e
inju y o he skin only. Second-deg ee ea s in ol e inju y o he skin
and pe ineal muscles bu no he anal sphinc e . Thi d-deg ee ea s
in ol e inju y o he skin, pe ineal muscles and anal sphinc e (sub-
ypes A, B and C depend on he deg ee o in ol emen o he ex e -
nal and in e nal anal sphinc e s). Finally, ou h-deg ee ea s in ol e
pe ineal lesions ha a ec bo h he sphinc e s and he anal mucosa
(Sul an e al., 2008).
4.7 | Childbi h expe ience ques ionnai e—
Spanish e sion
The e a e a ious alida ed ins umen s o assessing childbi h ex-
pe iences ac oss di e en dimensions. O hese, he CEQ has dem-
ons a ed highe alidi y han o he ools (Nil é e al., 2017). The
Spanish e sion o he CEQ, known as he CEQ-E, was alida ed by
So iano-Vidal e al. (2016). While he e is no speci ic ins umen ha
add esses home bi hing speci ically, in p e ious s udies conduc ed
in o he coun ies, esea che s ha e used his ques ionnai e o meas-
u e sa is ac ion wi h planned home bi hs (Handelzal s e al., 2016).
The CEQ-E sc eening ool was sel -adminis e ed and ypically
ook app oxima ely 5–10 min o comple e. The ques ionnai e com-
p ises 22 i ems ela ed o he bi h expe ience, ca ego ized in o ou
domains: sel -capaci y, pe cei ed sa e y, p o essional suppo and
pa icipa ion. The i s 19 i ems a e a ed on a 4-poin Like scale,
enabling he assessmen o each i em based on he woman's le el o
ag eemen , anging om s ongly ag ee o s ongly disag ee.
The las h ee i ems measu e he emembe ed sense o pain,
con ol and sa e y du ing he bi h and a e cap u ed using a 4-poin
isual scale, which is hen con e ed in o ca ego ical alues anging
om 0 o 100.
The inal sco e anges be ween one and ou and is calcula ed
ollowing he ini ial e sion o he CEQ's guidelines. The CEQ-E
demons a ed high eliabili y, wi h a C onbach's alpha o 0.88.
4.8 | Da a collec ion
Pa icipan s comple ed he online ques ionnai e. A pilo es was
conduc ed be o ehand wi h 10 women o assess he easibili y o
adminis e ing he ques ionnai e in a non-clinical en i onmen ; he e
we e no doub s abou i s applicabili y. Pa icipan s we e ec ui ed by
he CAHMB midwi es using con enience sampling. All he women
who we e in o med abou he s udy chose o pa icipa e and p o-
ided hei consen by signing he consen o m. The ques ionnai e
link was sen o hem by email 30 days a e hey ga e bi h.
Da a we e colla ed in an anonymized da abase ha was pe iodi-
cally e iewed. The a ending midwi es con ac ed he esea ch mid-
wi e each ime a woman ag eed o pa icipa e in he s udy, and he
esea ch midwi e was esponsible o sending he ques ionnai e link,
e iewing he CEQ-E's comple ion, cleaning he da a and ensu ing
anonymi y.
4.9 | S a is ical analysis
The da a analysis in ol ed employing basic desc ip i e me hods o
calcula e means and s anda d de ia ion (SD) o con inuous a i-
ables, o medians and in e qua ile anges (IQRs) o non-no mally
dis ibu ed a iables. Ca ego ical a iables we e summa ized using
absolu e and ela i e equencies. The no mali y assump ion o he
dependen quan i a i e a iable, bi h expe ience (CEQ-E), was as-
sessed using he Kolmogo o –Smi no goodness-o - i es .
Due o he non-no mal dis ibu ion o he CEQ-E a iable, he
Mann–Whi ney U es was u ilized o compa e he medians be-
ween his a iable and he ca ego ical a iables in wo independen
g oups. We analysed he obs e ic a iables be ween women in a-
pa um ans e ed o hospi al ia 2 × 2 ables and he chi-squa ed
es (χ2) o quali a i e a iables. Fo ca ego ical a iables wi h mo e
han wo g oups, he K uskal–Wallis es was applied.
The sco es o each i em in he CEQ-E we e added o sub ac ed
acco ding o he au ho s' ins uc ions o ob ain a o al sco e. A
highe sco e indica es a be e expe ience.
Da a analysis was pe o med using he SPSS .28.1 s a is i-
cal package (IBM Co p. Released 2018. IBM SPSS S a is ics o
Windows, A monk, NY, USA). S a is ical signi icance was conside ed
when p < .05.
4.10 | E hical conside a ions
The s udy adhe ed o he Decla a ion o Helsinki's ecommenda-
ions and was app o ed on 10 Oc obe 2018 by he clinical esea ch
e hics e iew boa d o E hics Commi ee o D ug Resea ch, Pa c de
Salu Ma (s udy egis a ion numbe #2018/8120/l).
All he pa icipan s we e ully in o med abou he s udy, i s
olun a y na u e and con iden iali y. The esea ch eam ec ui ed
women a home in pe son and w i en in o med consen was ob-
ained in all cases. Anonymi y and con iden iali y we e gua an eed.
5 | RESULTS
5.1 | Sample cha ac e is ics
A o al o 223 su eys we e comple ed du ing he 2-yea s udy pe-
iod, esul ing in an o e all su ey esponse a e o 100%.
Table 1 shows he socio-demog aphic, obs e ic and neona al
cha ac e is ics o he pa icipan s. Mos o he women a e Caucasian,
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2367
ALCARAZ-VIDAL e al.
o Spanish o igin, mul ipa ous, li e wi h a pa ne and ha e a uni e -
si y educa ion. App oxima ely 75% o he pa icipan s we e aged be-
ween 30 and 39 yea s, wi h a mean age o 34.6 yea s (4.0).
Rega ding bi h plans, 92% o women in ended o gi e bi h a
home. Mos o he bi hs we e ull e m; he 2.3% o bi hs we e
be ween 36 and 37 weeks. The du a ion o labou a ied widely, bu
app oxima ely 73% o he women's labou s las ed less han 12 h. The
sample's sel - epo ed pain le els anged om ze o o 10, wi h a me-
dian o nine.
Du ing labou , 59% o women we e imme sed in wa e . The
majo i y op ed o non-pha macological pain elie , wi h only 0.9%
choosing ni ous oxide and 9.9% op ing o epidu al analgesia.
TABLE 1 Demog aphic, obs e ical and neona al cha ac e is ics
(N = 223).
Demog aphic N%
Ma e nal age
18–29 23 10.3
30–39 167 74.9
>40 33 14.8
Coun y o o igin
Spain 198 88.8
Fo eign 25 11.2
Educa ional le el
Non-uni e si y 36 16.1
Uni e si y 187 83.9
Li es in couple
Yes 220 98.7
No 31.3
E hnici y
Caucasic 215 96.4
O he 83.5
Pa i y
Nullipa ous 87 39.0
Mul ipa ous 136 61.0
Obs e ical
Planned place o bi h
Home bi h 206 92.4
Bi h cen e 17 7.6
Ges a ional age a bi h*
<37 52.3
37–42 211 95.0
>42 62.7
Du a ion o labou (h)
<12 h 162 72.6
>12 h 61 27.4
Wa e imme sion
Yes 132 59.2
No 91 40.8
Ni ous oxide use
Yes 20.9
No 221 99.1
Epidu al
Yes 22 9.9
No 201 90.1
Non-pha macological measu es
Yes 174 82.1
No 38 17.9
In apa um oxy ocin use
Yes 19 9.0
No 193 91.0
(Con inues)
Demog aphic N%
Pos pa um oxy ocin use
Yes 33 15.9
No 175 84.1
Pe ineal inju y
Yes 120 53.8
No 103 46.2
Type o pe ineal inju y
In ac 103 46.2
I deg ee 63 28.3
II deg ee 44 19.7
III deg ee 31.3
IV deg ee 20.9
Episio omy 83.6
End o labou
Eu hocic 208 93.3
Ins umen al 83.6
C-sec ion 73.1
In apa um ans e o hospi al
Yes 27 12.1
No 196 87.9
Neona al
Bi h weigh (g)
<2500 20.9
2500–4000 205 91.9
>4000 16 7.2
Apga <7 a 5 min
Yes 16 8.2
No 178 91.8
Type o b eas eeding a 1 mon h
Exclusi e b eas eeding 202 95.7
Mixed b eas eeding 9 4.3
NICU admission
Yes 20.9
No 221 99.1
*One missing alue (N = 222).
TABLE 1 (Con inued)
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2368
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ALCARAZ-VIDAL e al.
Mos o he esponden s' bi hs we e simple and no oxy ocin no
o he medica ions we e used du ing labou o pos pa um. Pe ineal
inju y occu ed in mo e han hal o he bi hs, wi h sligh ly mo e
han 2% expe iencing second- o ou h-deg ee ea s, and 3.6% un-
de going episio omies. A o al o 12% (27 o 223) we e ans e ed
o hospi al du ing labou .
Rega ding neona al cha ac e is ics, mos o he newbo ns
weighed be ween 2500 and 4000 g (median: 3459 g) and had an
Apga sco e g ea e han se en a 5 min a e bi h. Fu he mo e,
no newbo ns equi ed admission o he NICU, and 95.7% we e ex-
clusi ely b eas ed.
Quan i a i e analysis o he a iables ela ed o bi h expe i-
ence was pe o med. In gene al, he esponden s a ed hei bi h
expe iences posi i ely, wi h a mean sco e o 3.5 (0.3). O he di-
mensions assessed, p o essional suppo ecei ed he highes
a ing, wi h a mean sco e o 3.9 (0.3), ollowed closely by pa ici-
pa ion, wi h a mean sco e o 3.7 (0.5) (see Table 2). Con as ingly,
own capaci y ecei ed a low a ing, wi h a mean sco e o 3.0 (0.4).
TABLE 2 O e all CEQ-E sco e (N = 223).
NMinimum Maximum Mean SD
Own capaci y 223 1.50 3.88 3.0 0.4
P o essional suppo 223 2.00 4.00 3.9 0.3
Pe cei ed sa e y 223 1.67 4.00 3.3 0.3
Pa icipa ion 223 1.33 4.00 3.7 0.5
To al CEQ 223 1.72 3.91 3.5 0.3
I em numbe NMinimum Maximum Mean SD
Own capaci y
Labou and bi h wen as I had expec ed 1 223 143.4 0.8
I el s ong du ing labou and bi h 2223 143.6 0.6
I el capable du ing labou and bi h 4223 141.8 1.0
I was i ed du ing labou and bi h 5223 142.7 1.0
I el happy du ing labou and bi h 6223 143.5 0.7
I el ha I handled he si ua ion well 19 223 2 4 3.7 0.5
As a whole how pain ul did you eel you childbi h was?
( isual pain scale, VPS)
20 223 142.3 1.1
As a whole how much con ol did you eel you had du ing
childbi h? (VPS)
21 223 143.2 1.1
P o essional suppo
My midwi e de o ed enough ime o me 13 223 2 4 3.9 0.2
My midwi e de o ed enough ime o my pa ne 14 223 143.8 0.4
My midwi e kep me in o med abou wha was happening
du ing labou and bi h
15 223 143.8 0.5
My midwi e unde s ood my needs 16 223 2 4 3.9 0.3
I el e y well ca ed o by my midwi e 17 223 2 4 3.9 0.3
My imp ession o he eam's medical skills made me eel
secu e
18 223 2 4 3.9 0.3
Pe cei ed sa e y
I el sca ed du ing labou and bi h 3223 141.6 0.8
I ha e many posi i e memo ies om childbi h 7223 143.7 0.6
I ha e many nega i e memo ies om childbi h 8223 143.7 0.6
Some o my memo ies om childbi h make me eel
dep essed
9223 143.6 0.8
As a whole how secu e did you eel du ing childbi h? (VAS) 22 223 143.6 0.9
Pa icipa ion
I el I could ha e a say whe he I could be up and abou o
lie down
10 223 143.9 0.4
I el I could ha e a say in deciding my bi hing posi ion 11 223 143.7 0.8
I el I could ha e a say in he choice o pain elie 12 223 143.7 0.7
13652648, 2024, 6, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1111/jan.15989 by Readcube (Lab i a Inc.), Wiley Online Lib a y on [09/12/2024]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License
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2369
ALCARAZ-VIDAL e al.
Pe cei ed sa e y was he lowes - a ed dimension, wi h a mean
sco e o 3.3 (0.0).
The Mann–Whi ney U es e ealed signi ican di e ences
be ween he women who ans e ed o hospi al du ing labou
and hose who did no ; he women who expe ienced in apa um
ans e ga e lowe sco es ac oss all he dimensions. These indings
e ince ha in apa um ans e is associa ed wi h no able di e -
ences in he a iables e alua ed, as summa ized in Table 3.
Table 4 p esen s a compa ison o he obs e ic a iables o he
women who expe ienced in apa um ans e and hose who ga e
bi h a home. The analysis e eals se e al s a is ically signi ican
a iables associa ed wi h in apa um ans e . Namely, labou du a-
ion exceeding 12 h, he use o ni ous oxide o epidu al anaes hesia,
in apa um adminis a ion o oxy ocin, dys ocic bi h, pos pa um
use o oxy ocin, pe ineal inju y and he absence o a midwi e's as-
sis ance we e all signi ican ly ela ed o highe a es o in apa um
ans e .
On he o he hand, a iables, such as imme sion in wa e du ing
labou , an Apga sco e below 75 min a e bi h, NICU admission and
he ype o eeding in he i s mon h did no show signi ican as-
socia ions wi h in apa um ans e . These indings shed ligh on
he ac o s ha play a c ucial ole in de e mining he likelihood o
in apa um ans e du ing childbi h.
5.2 | Obs e ic a iables ela ed o he CEQ-E
Ou objec i e was o pe o m a bi a ia e analysis o in es iga e he
associa ion be ween bi h expe ience (conside ed he dependen
a iable) and o he ca ego ical a iables o clinical in e es collec ed
in he s udy. The indings a e p esen ed in Table 5, which speci ically
ocuses on he CEQ-E.
The esul s e ealed signi ican di e ences, indica ing mo e
posi i e bi h expe iences in ce ain scena ios. Speci ically, be e
bi h expe iences a e associa ed wi h labou las ing less han 12 h
(p < .001), he absence o pe ineal inju ies (p = .018), no in apa um
ans e o hospi al (p < .001), eu hocic labou and deli e y (p < .001)
and he p esence o a midwi e du ing he bi h (p < .001).
Howe e , no s a is ically signi ican di e ences we e ound be-
ween he bi h expe ience and imme sion in wa e du ing labou
(p = .556), he use o non-pha macological pain elie measu es (p = .765),
pos pa um oxy ocin adminis a ion (p = .150), neona al Apga sco es
<7 a 5 min a e bi h (p = .887) and he ype o eeding (p = .606).
Rega ding pe ineal inju y, which anges om in ac pe ineum,
i s - o ou h-deg ee ea s and episio omy, s a is ically signi i-
can di e ences we e obse ed conce ning he ype o inju y
(p < .001). Upon compa ison o he g oups, i was ound ha
women wi h an in ac pe ineum had a signi ican ly be e bi h
expe ience compa ed o hose who unde wen an episio omy
(p < .001). Mo eo e , women who expe ienced ea s du ing child-
bi h epo ed a mo e a ou able expe ience han hose who had
an episio omy (p = .006).
5.3 | CEQ-E and pa i y
Table 6 p o ides he i em desc ip ions and s a is ical esul s o he
CEQ-E o bo h nullipa ous and mul ipa ous women. The i ems a e
g ouped in o ou domains: own capaci y, p o essional suppo , pe -
cei ed sa e y and pa icipa ion.
TABLE 3 Compa ison o childbi h expe ience (CEQ-E) be ween in apa um- ans e ed women and home bi h (N = 223).
NMean SD SE
CI 95%
Lowe
limi Uppe limi A e age ank Sum o anks p- alue
Own Capaci y Yes 27 2.5 0.5 0.09 2.3 2.7 48.2 1301.5 <.001
No 196 3.1 0.4 0.03 33.1 120.79 23674.5
To al 223 30.4 0.03 2.9 3.1
P o essional suppo Yes 27 3.6 0.6 0.11 3.4 3.8 91.13 2460.5 .014
No 196 3.9 0.2 0.01 3.8 3.9 114.88 22515.5
To al 223 3.9 0.3 0.02 3.8 3.9
Pe cei ed sa e y Yes 27 2.9 0.5 0.09 2.7 339.74 1073 <.001
No 196 3.4 0.3 0.02 3.4 3.4 121.95 23903
To al 223 3.3 0.3 0.02 3.3 3.4
Pa icipa ion Yes 27 30.8 0.15 2.7 3.3 50.63 1367 <.001
No 196 3.8 0.3 0.02 3.8 3.9 120.45 23609
To al 223 3.7 0.5 0.03 3.7 3.8
To al CEQ-E Yes 27 30.4 0.08 2.8 3.2 30.15 814 <.001
No 196 3.6 0.2 0.01 3.5 3.6 123.28 24162
To al 223 3.5 0.3 0.02 3.5 3.5
Abb e ia ions: CI 95%, con idence in e al 95%; SD, s anda d de ia ion; SE, s anda d e o .
13652648, 2024, 6, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1111/jan.15989 by Readcube (Lab i a Inc.), Wiley Online Lib a y on [09/12/2024]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License
2370
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ALCARAZ-VIDAL e al.
In e ms o hei own capaci y, bo h nullipa ous and mul ipa-
ous women exp essed sa is ac ion wi h hei abili ies du ing labou
and bi h. Nullipa ous women epo ed highe le els o i edness
(p < .001), while mul ipa ous women el happie (p = .013) and mo e
con iden in handling he bi h (p = .034). Simila ly, mul ipa ous
women pe cei ed childbi h o be less pain ul compa ed o nullipa-
ous women (p = .043).
Rega ding p o essional suppo , bo h g oups epo ed high
le els o sa is ac ion wi h he suppo p o ided by hei midwi es.
Mul ipa ous women pe cei ed g ea e ca e (p = .042) and suppo
(p = .019). Addi ionally, hey el ha hei midwi es dedica ed mo e
ime o hei pa ne s (p = .045).
Conce ning he pe cei ed sa e y, bo h nullipa ous and mul ipa-
ous women epo ed simila le els o ea du ing labou and bi h.
Howe e , mul ipa ous women had mo e posi i e memo ies (p = .031)
o childbi h and ewe nega i e memo ies (p = .04). Bo h g oups e-
po ed low le els o eeling dep essed due o memo ies o childbi h,
wi h mean sco es o 3.4 and 3.7 espec i ely (p = .019).
Las ly, ega ding pa icipa ion, mul ipa ous women el mo e
empowe ed o make decisions abou hei bi hing posi ion and
TABLE 4 Compa ison o obs e ic a iables be ween in apa um ans e ed (N = 223).
In apa um ans e o hospi al
p- alue*
Yes No
n%n%
Du a ion o Labou (h) <12 h 622.2 156 79.6 .001
>12 h 21 77.8 40 20.4
Wa e imme sion Yes 19 70.4 113 57.7 .207
No 829.6 83 42.3
Ni ous oxide use Yes 27.4 00.0 .001
No 25 92.6 196 100.0
Epidu al use Yes 22 81.5 00.0 .001
No 518.5 196 100.0
Non-pha macological measu es Yes 24 88.9 150 81.1 .323
No 311.1 35 18.9
In apa um oxy ocin use Yes 19 70.4 00.0 <.001
No 829.6 185 100.0
End o labou Eu hocic 12 44.4 196 100.0 <.001
Dys ocic 15 55.6 00.0
Pos pa um oxy ocin use Yes 939.1 24 13.0 .001
No 14 60.9 161 87.0
Pe ineal inju y Yes 19 70.4 101 51.5 .066
No 829.6 95 48.5
Type o pe ineal inju y In ac 829.6 95 48.5 <.001
I deg ee 6 22.2 57 29.1
II deg ee 725.9 37 18.9
III deg ee 00.0 31.5
IV deg ee 00.0 21.0
Episio omy 622.2 21.0
Midwi e assis s bi h Yes 14 51.9 196 100.0 <.001
No 13 48.1 00.0
Apga <7 a 5 min Yes 00.0 16 9.3 .135
No 22 100.0 156 90.7
NICU admission Yes 13.7 10.5 .099
No 26 96.3 195 99.5
Type o b eas eeding a 1 mon h EBF 26 96.3 176 95.7 .877
Mixed BF 1 3.7 84.3
Abb e ia ions: BF, B eas eeding; EBF, exclusi e b eas eeding; NICU, neona al in ensi e ca e uni .
*Chi-squa ed es (χ2).
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2371
ALCARAZ-VIDAL e al.
mobili y du ing labou han nullipa ous women (p = .011 and p = .011
espec i ely). Bo h g oups epo ed a sense o pa icipa ion in he
choice o pain elie me hods, wi h no s a is ically signi ican di e -
ence obse ed.
The analysis o pe cei ed sa e y indica es ha pa icipan s, e-
ga dless o pa i y, el gene ally sa e du ing labou and bi h. They
epo ed low le els o ea , posi i e and nega i e memo ies, and
eelings o dep ession associa ed wi h childbi h. The indings sug-
ges ha he esponden s pe cei ed childbi h as a ela i ely sa e
and secu e e en .
The analysis o domain sco es in Table 7 e eals signi ican di -
e ences be ween nullipa ous and mul ipa ous women. In he own
TABLE 5 CEQ-E sco e ela ed o obs e ical and neona al a iables (N = 223).
N n Mean SD
A e age
ank
Mann
Whi ney U
K uskal–
Wallis p- alue d
Du a ion o labou (h) 223 <.001 —
<12 h 162 3.56 0.19 123.32 3.107.00
>12 h 61 3.33 0.41 81.93
Wa e imme sion 223 .556 —
Yes 132 3.49 0.27 109.89 6.284.50
No 91 3.51 0.31 115.06
Non-pha macological
measu es
212 .765 —
Yes 174 3.49 0.31 107.09 3.203.50
No 38 3.5 0.22 103.8
Pos pa um oxy ocin use 208 .150 —
Yes 33 3.43 0.33 90.68 3.343.50
No 175 3.53 0.22 107.11
Pe ineal inju y 223 .018 —
Yes 120 3.47 0.29 102.57 7.312.00
No 103 3.53 0.28 122.89
Type o pe ineal inju y 223 <.001 2
In ac 103 3.54 0.28 125.18 17.461
Episio omy 83.13 0.30 32.94
Inju y 112 3.49 0.28 105.52
In apa um ans e 223 <.001 —
Yes 27 3.01 0.44 30.15 4.856.00
No 196 3.56 0.18 123.28
End o labou 223 <.001 —
Eu hocic 208 3.54 0.24 118.43 222
Dys ocic 15 2.95 0.37 22.8
Bi h weigh 223 .272 —
<3400 97 3.52 0.25 117.40 5587.0
> = 3400 126 3.48 0.32 107.84
Apga <7 a 5 min 194 .887 —
Yes 16 3.52 0.22 99.41 15.395
No 178 3.5 0.30 97.33
Type o b eas eeding 211 .606 —
Mixed BF 9 3.51 0.18 95.72 816.5
EBF 202 3.49 0.30 106.46
Midwi e assis s bi h 223 <.001 —
Yes 210 3.53 0.24 117.69 170.5
No 13 2.94 0.38 20.12
Abb e ia ions: BF, B eas eeding; d , deg ees o eedom; EBF, exclusi e b eas eeding; SD, s anda d de ia ion.
13652648, 2024, 6, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1111/jan.15989 by Readcube (Lab i a Inc.), Wiley Online Lib a y on [09/12/2024]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License
2378
|
ALCARAZ-VIDAL e al.
Win e , C., Junge-Ho meis e , J., Bi ne , A., Ge s ne , I., & Weidne , K.
(2022). Planned Place o bi h—Impac o psychopa hological isk
ac o s on he choice o bi hplace and i s pos pa um e ec on
psychological adap ion: An explo a o y s udy. Jou nal o Clinical
Medicine, 11(2), 292. h p s : / / d o i . o g / 1 0 . 3 3 9 0 / j c m 1 1 0 2 0 2 9 2
Wo ld Heal h O ganisa ion. (2018). WHO ecommenda ions: In apa um
ca e o a posi i e childbi h expe ience. Wo ld Heal h O ganiza ion.
h p : / / a p p s . w h o . i n / i i s / b i s e a m / h a n d l e / 1 0 6 6 5 / 2 6 0 1 7 8 / 9 7 8 9 2
4 1 5 5 0 2 1 5 - e n g . p d ; j s e s s i o n i d = B 7 4 2 3 0 C F 9 B 1 B C 0 B E C D F 2 5 F F 3 6
4 C D 5 9 1 7 ? s e q u e n c e = 1
Yildiz, P. D., Aye s, S., & Phillips, L. (2017). The p e alence o pos au-
ma ic s ess diso de in p egnancy and a e bi h: A sys ema ic
e iew and me a-analysis. Jou nal o A ec i e Diso de s, 208, 634–
645. h p s : / / d o i . o g / 1 0 . 1 0 1 6 / j . j a d . 2 0 1 6 . 1 0 . 0 0 9
Zhu, X., Wang, Y., Zhou, H., Qiu, L., & Pang, R. (2019). Adap a ion o he
childbi h expe ience ques ionnai e (CEQ) in China: A mul isi e
c oss-sec ional s udy. PLoS One, 14(4), 1–16. h p s : / / d o i . o g / 1 0 .
1 3 7 1 / j o u n a l . p o n e . 0 2 1 5 3 7 3
Zielinski, R., Acke son, K., & Low, L. K. (2015). Planned home bi h:
Bene i s, isks, and oppo uni ies. In In e na ional jou nal o Women's
heal h (Vol. 7, pp. 361–377). Do e Medical P ess L d. h p s : / / d o i .
o g / 1 0 . 2 1 4 7 / I J W H . S 5 5 5 6 1
How o ci e his a icle: Alca az-Vidal, L., Leon-La ios, F.,
Robleda, G., & Vila- Candel, R. (2024). Explo ing home bi hs
in Ca alonia (Spain): A c oss-sec ional s udy o women's
expe iences and in luencing ac o s. Jou nal o Ad anced
Nu sing, 80, 2363–2378. h ps://doi.o g/10.1111/jan.15989
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