The Effect of a Labor Podcast Intervention on Patient Satisfaction and Postpartum Depression in Nulliparous Women
Phase: NA
Conditions: Labor Onset and Length Abnormalities, Pregnancy Related
Sponsor: University of Pennsylvania

Study Summary  
 
Title 
A Randomized Trial Assessing the Impact of 
Educational Podcasts on Personal Control and 
Satisfaction During Childbirth  
Short Title 
LaPPS 
NCT 
NCT04933708 
Date of Document 
7/16/2021 
Methodology 
Randomized Clinical Trial 
Study duration 
1 year  
Study Center (s) 
Single-center 
Objective 
To assess the effect of listening to physician-created 
podcasts of common labor topics on patient 
satisfaction and perception of their birth experience   
Number of Subjects 
63 subjects per arm  
Diagnosis and Main Inclusion Criteria 
Age between 16-50; singleton gestation 
Study Procedures 
Enrolled at 19w0d-28w0d. Randomized at 28w0d to 
one of two arms:  
• 
Labor podcasts – Six labor podcasts that can 
be downloaded for any podcast app  
• 
Usual care  
Primary Outcome 
Patient satisfaction as measured by LAS + 2 
satisfaction questions  
Statistical methodology 
Intention to treat analysis 
Non-parametric tests for LAS-10 scores, birth 
satisfaction surveys, and EDPS scores 
Logistic regression for multivariate analysis  
 
 
 

Study Coordinator/Principle Investigator: Fei Cai, MD; Fellow, Division of Maternal Fetal Medicine, Department of 
Obstetrics and Gynecology 
 
Faculty Advisor/Principle Investigator: Sindhu Srinivas, MD; Professor of Obstetrics and Gynecology, Division of 
Maternal Fetal Medicine, Department of Obstetrics and Gynecology 
 
Abstract:  
Objective:  
To assess the effect of listening to physician-created podcasts of common labor topics on patient satisfaction and 
perception of their birth experience   
 
Methods:  
This is a randomized-controlled trial to assess the effect of listening to podcasts vs. usual patient education on 
patient birth experience satisfaction. Patients who will be eligible for the study will be nulliparous, low-risk women 
who have reached at least 36 weeks of gestation. Women will be recruited through the Hospital of the University 
of Pennsylvania, though Penn Ob/Gyn Associates, Maternal Fetal Medicine, and the Helen O. Dickens Clinic. At 
time of enrollment, redcap will be used to randomize women to either receive access to the Labor Podcast 
Application on their smartphones or usual teaching methods by their respective clinics. Method of contact by text 
or email will also be collected. Patients can use the application as much or as little as they desire. Demographics, 
labor, and birth data from each patient enrolled will be included. After delivery, the patients will receive surveys 
assessing use of podcast, labor agentry, labor satisfaction, and the Edinburgh Depression Scale.  
 
Expected Results:  
We hypothesize that patients randomized to receiving the labor podcast will score higher on surveys assessing 
labor agentry, satisfaction, and lower on the Edinburgh Depression Scale.  
 
Implications:  
This study may help Ob/Gyn providers to better care for their patients through technology and spend more time 
during clinic hours discussing other portions of care. Also, by receiving the same message via podcast, patients are 
more likely to receive equitable care. Finally, by answering common questions, the podcast may increase patient’s 
health access and understanding, allowing for better care.  
 
 
 
 

1 
Background and Rational  
Recently, podcasts have been used for both undergraduate and graduate medical education, with studies showing 
that they are feasible, acceptable, and effective (1-6). Learners appear to enjoy podcast learning because they 
increased efficiency by allowing listeners to multitask, made listeners keep up to date with medical literature, and 
increased overall knowledge (4). However, podcast learning has not been as widespread for patient education. 
There have been some studies that showed that podcast patient education is feasible, and one small study showed 
increased knowledge scores after listening to podcasts (7,8).  
 
To our knowledge, podcast learning has never been studied in the obstetric population. Labor and delivery is 
usually a time that is fraught with questions from first time mothers, and more education may increase these 
women’s perception of control and satisfaction overall with birth and the postpartum period. The Labor Agentry 
Scale (LAS)-10 is a validated instrument measuring expectancies and experiences of personal control during 
childbirth (9). The Edinburgh Postnatal Depression Scale (EPDS) is also a validated scale that measures levels of 
postpartum depression that is commonly used at our institution both immediately postpartum and at the 
postpartum visit 4-6 weeks after delivery (10).  
 
2 
Study Aims  
2.1 Aim:  
The aim of our study is to assess the effect of listening to physician-created podcasts of common labor topics on 
patient satisfaction and perception of their birth experience though the LAS-10 and a birth satisfaction survey 
created by HUP, as well as how this affects postpartum depression as assessed by the EDPS.  
 
2.2 Endpoints 
Primary Endpoint  
Score on the LAS-10 and HUP based birth satisfaction survey  
 
Secondary Endpoint  
Score on EDPS  
 
3 Patient Eligibility  
Subjects must meet all of the inclusion and exclusion criteria to be enrolled to the study. Study treatment may not 
begin until a subject is consented and randomized. 
 
 
3.1 Inclusion criteria  
• 
Nulliparous  
• 
Singleton pregnancy  
• 
English-speaking  
• 
Age 18-50  
• 
Own a smart phone or device capable of downloading podcasts   
• 
Reached at least 36w0d of gestation  
• 
Willing and able to sign consent form  
3.2 Exclusion criteria  
• 
Planned cesarean delivery  
• 
Complication in pregnancy including:  
o 
Placenta accrete spectrum  
o 
Vasa previa  
o 
Intrauterine fetal demise  

o 
Known major fetal anomaly  
• 
 Delivery planned at location other than HUP and PAH  
Women included in the analysis included those that met the inclusion criteria and had a liveborn singleton fetus 
between 36w0d and 42w0d either by vaginal delivery or cesarean section.  
 
3.3 Vulnerable patient population  
Pregnant women are considered a vulnerable population. As the condition of interest is a pregnancy-related 
and specific condition, it is unavoidable to exclude pregnant women from this research study. As the research study 
involves listening to podcasts and no other clinical intervention, we anticipate no increased risks from that 
experienced in routine clinical care. 
 
3.4 Ensuring Necessary Medical Interventions 
 
Enrollment in this study will not alter postpartum women’s access to needed medical services. All 
women will have the opportunity to ask their obstetricians regarding labor expectations and usual labor 
and delivery care.  
 
 
3.5 Potential Benefit to Participants 
 
Women randomized to the labor podcast group may have increased satisfaction toward their labor 
experience.  
 
4 Study Arms  
 
4.1 Study Arms  
• 
Labor Podcast Group – Women randomized to this arm will receive access to a link to download six HUP 
physician created labor podcasts in addition to usual care during labor, delivery, and postpartum  
o 
Podcast topics:  
§ 
Labor Anesthesia. Induction of Labor, Second Stage of Labor, Reasons for Cesarean 
Section, Postpartum Recovery, Complications of Labor and Birth  
o 
LAS-10 and Birth Satisfaction survey – Women will be sent these surveys on postpartum day 2 via 
method they indicated they desire (either email or text message)  
o 
EDPS – Women will receive this survey on postpartum day 7 via method they desire  
• 
Usual care – Women randomized to this arm will receive usual care during labor, delivery, and 
postpartum with the following exceptions:  
o 
LAS-10 and Birth Satisfaction survey – Women will be sent these surveys on postpartum day 2 via 
method they indicated they desire (either email or text message)  
o 
EDPS – Women will receive this survey on postpartum day 7 via method they desire  
 
4.2 Duration of Therapy  
Women will be followed from time of consent until 7 days postpartum  
 
4.3 Duration of Follow Up  
Women will be followed from time of consent until 7 days postpartum. No information will be collected 
on women in either group after that time.  
 
4.4 Blinding  
Due to the nature of the treatment arm, neither providers nor participants will be blinded to their 
treatment arm.  
 

5 Procedures  
 
5.1 Screening for Recruitment and Recruitment Process  
 
Women meeting the criteria listed in section 3.1 will be invited to participate in the study. Consent via 
Redcap, with signature (see HIPPA form), will be obtained from those who choose to participate. Invitation to 
participate will be done during inpatient visits after 19 week gestation either at prenatal visits or at ultrasound 
appointments.  
 
Patients that decline enrollment will be asked to participate in a de-identified demographics survey for 
further comparison with enrolled group. Written or digital consent will also be done via Redcap.  
 
 
 
5.2 Enrollment Period  
Upon enrollment, patients will provide a method of contact, either email or text, which will be stored on 
an encrypted drive that is only associated with their study number. A survey regarding demographics data will be 
sent upon enrollment.  
 
 
5.3 Randomization  
 
Subjects who agree to enrollment will be immediately randomized by Redcap to receive the intervention 
(an application that they can download on their smartphones with the podcasts available) or usual care (standard 
patient education regarding labor by their physicians). 
 
 
 
5.4 Procedures During Treatment  
 
After randomization, women will be given a link or a QR code pending preference to the podcast. Patients 
can download the podcasts and listen to them as many times as they desire. After delivery, on schedule reviewed 
in 4.1, women will receive above surveys on the above schedule via text or email, depending on their preference 
collected during enrollment.  
 
 
5.5 Protection Against Physical Risk  
 
There is minimal physical risk incurred by participants as part of this study.  
 
 
5.6 Protection against Loss of Privacy/Breach of Confidentiality  
 
All information collected from subjects will be protected in the following manner. Patients will only be 
approached in a private setting. Upon recruitment and randomization, all subjects will be identified by a number 
key, which will be kept on a password protected Redcap account. This will hold information as to whether the 
subject was randomized to podcast intervention or usual care (ie. Subject 1: Randomized to usual care), 
demographics information, and birth outcomes.  
A separate spreadsheet will be used to track subject medical record number and contact information by 
key (ie. Subject 1: MRN, Email, phone number) and whether the subject desires to be contacted via email or text. 
This list will be kept behind the hospital firewall in a password-protected file. This list will also be used to follow-up 
with the LAS-10, birth satisfaction survey, and EPDS and track if these emails or texts have been sent and if the 
subject has completed them.  
 
No PHI will be shared with anyone outside the institution.  
 
6 Study Design/Study Endpoints  
 
This will be a prospective, randomized, single-center study on the utility of labor podcasts support on 
patient labor satisfaction compared to usual care.  
 
6.1 Sample size  

 
Based on previous studies using the LAS-10, average score ranged between 45-53/70, with standard 
deviations ranging from 6-12. Therefore, we would estimate that the LAS score in the usual care group to be 
approximately 50. To be able to detect an effect size of 4, with a standard deviation of 9, and to achieve a power of 
0.8 and alpha of 0.05, we would need a sample size of approximately 79 subjects per group. Calculating for a 20% 
loss to follow-up rate, we would anticipate recruiting 95 subjects per group.  
 
Our city has an average of 16% preterm birth rate. Our hospital averages 1400 nulliparous deliveries/year. 
We would conservatively estimate approaching 50% of these women in the prenatal period for enrollment. If we 
assume a 75% consent rate for the RCT, which is standard for our center, we anticipate enrolling 30-36 women per 
month in our study. We would therefore anticipate it taking 6 months before we reach our target sample size.  
 
 
6.2 Data analysis plan  
Demographics data and birth outcomes will be described. Comparison between groups will be performed using 
appropriate non-parametric tests for LAS-10 scores, birth satisfaction surveys, and EDPS scores. P values of <.05 
will be considered statistically significant. Secondary analysis will be performed looking at the effect of podcast use 
(how many episodes listened to and time spent listening to podcasts) with regards to LAS-10 score, birth 
satisfaction scores, and EPDS. Logistic regressions will be calculated to see if there relationship between time spent 
with the podcast and overall LAS-10 score as well as number of podcasts used and overall LAS-10 score. 
 
Intention-to-treat analyses will be conducted such that all patients with available follow-up measures be 
included in the analysis.  
 
7 Additional Information  
Podcast creation and distribution   
 
A small group of nulliparous women were asked about their labor experience and asked to provide areas 
of improvement in their labor experiences. All patients were asked while postpartum or postoperative day 1-4 
while in the hospital. Questions asked included:  
1) Tell me about your experience with labor and birth  
2) What are some things that you wished you had known prior to coming in for delivery?  
3) What were some things that were different from your expectations regarding your birth experience?  
4) How could we have better prepared you for labor and delivery?  
5) During pregnancy, would you have been open/willing to listen to podcasts with more information about 
the labor process?   
 
From these questions, answers aggregated from these nulliparous women were used to create the following 
podcast topics:  
1) Labor Anesthesia  
2) Induction of Labor  
3) Second Stage of Labor  
4) Reasons for Cesarean Section  
5) Postpartum Recovery  
6) Complications of Labor and Birth  
7) Normal Labor  
 
Podcast topics were then given to two focus groups composed of 8 antepartum and 8 postpartum women 
for review. Once the topics were discussed and refined with the focus groups, the podcasts were created by 
obstetrics providers at HUP, including maternal fetal medicine and general obstetrics and gynecologic faculty. The 
conversations were led by one of the study personnel, FC.  

 
References  
1. Lee SC, Huang H, Minard CG et al. The use of podcast videos for airway skills. Clin Teach. 2019 Dec; 
16(6):585-588.  
2. Cai F, Burns RN, Kelly B et al. CREOGs Over Coffee: feasibility of an Ob-Gyn medical education podcast by 
residents. J Grad Med Educ. 2020 Jun;12(3):340-343.  
3. Young BK, Pouw A, Redfern A et al. Eyes for Ears--a medical education podcast feasibility study. J. Surg 
Educ. 2020 Jul 21;S1931-7204(20)30234-8.  
4. Malecki SL, Quin KL, Zilbert N. Understanding the use and perceived impact of a medical podcast: 
qualitative study. JMIR Med Educ 2019 Sep 19;5(2):e12901.  
5. Chin A, Helman A, Chan TM. Podcast use in undergraduate medical education. Cureus. 2017 
Dec9;9(12):e1930.  
6. Alikhan A, Kaur RR, Feldman SR. Podcasting in dermatology education. J Dermatolog Treat. 2010 
Mar;21(2):73-9.  
7. Abreu DV, Tamura TK, Sipp JA et al. Podcast: contemporary patient education. Ear Nose Throat J. 2008 
Apr;87(4):208, 210-1.  
8. Johnson J, Ross L, Iwanenko W, et al. Are podcasts effective at educating African American men about 
diabetes? Am J Mens Health. 2012 Sep;6(5):365-7.  
9. Hodnet ED, Simmons-Tropea DA. The Labor Agentry Scale: psychometric properties of an instrument 
measuring control during childbirth. Res Nurs health. 1987 Oct;10(5):301-10.  
10. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh 
Postnatal Depression Scale. British Journal of Psych. 1987; 150:782-786.  
11. Yuenyong S, O’Brien B, Jiraapeet V. Effects of Labor Support from Close Female Relative on Labor and 
Maternal Satisfaction in a Thai Setting. JOGNN. 2012; 41: 45-56 
12. Hodnett ED, Low NK, Hannah ME. Effectiveness of Nurses as Providers of Birth Labor Support in North 
American Hospitals. JAMA. 2002;288(11):1373-1381.  
13. Kabakian T, Bashour H, El-Nerrner A et al. Women’s satisfaction and perception of control in childbirth in 
three Arab countries. Reprod Health Matters  2017 Nov; 25(1): 16-26.  
 
 

Shell Tables 
Table 1: Demographics  
Characteristic 
Podcast Intervention 
Usual Care 
Maternal age, years 
 
 
BMI, kg/m^2 
 
 
Race 
 
 
Non-Hispanic White 
 
 
Hispanic White  
 
 
Non-Hispanic Black  
 
 
Asian/Pacific Islander 
 
 
Native American  
 
 
Other  
 
 
Private Insurance 
 
 
Gestational Age at 
Delivery (weeks) 
 
 
Received Antenatal 
Steroids  
 
 
Diabetes  
 
 
Gestational 
 
 
Pregestational 
 
 
Hypertensive Disease of 
Pregnancy  
 
 
Gestational 
Hypertension/ 
Preeclampsia w/o SF 
 
 
PEC w/ SF  
 
 
HELLP/Eclampsia 
 
 
Fetal growth restriction 
 
 
Childbirth Classes 
 
 
 
 
 

 
 
 
Table 2: Labor and Delivery Outcomes  
Outcome 
Podcast Intervention 
Usual Care 
Method of Delivery 
 
 
Vaginal  
 
 
Unscheduled cesarean 
delivery  
 
 
Operative vaginal 
delivery  
 
 
Induction of Labor  
 
 
Augmentation of Labor  
 
 
Time to Delivery 
 
 
Admission to Delivery 
 
 
Second Stage to Delivery 
(vaginal delivery only) 
 
 
Regional Anesthesia  
 
 
Perineal Laceration 
 
 
First  
 
 
Second 
 
 
Third  
 
 
Fourth  
 
 
Complications during 
postpartum stay  
 
 
NICU stay 
 
 
Composite neonatal 
complications (ARRIVE) 
 
 
Chorioamnionitis 
/endometritis 
 
 
Hemorrhage >1 L 
(collapse with 
transfusion and OR 
 
 

Takeback)  
Transfusion  
 
 
OR Takeback  
 
 
Postpartum LOS 
 
 
Consider doing 
“Prolonged LOS” - >2 
days for VD,  >4 d for CS  
 
 
 
 
Table 3: LAS, Birth Satisfaction, and EPDS  
Outcome 
Podcast Intervention 
Usual Care 
P-Value 
LAS-10 
 
 
 
HUP Birth Satisfaction 
Survey 
 
 
 
EPDS >/=9 
 
 
 
Overall EPDS 
 
 
 
Self-harm question +  
 
 
 
 
Table 4: Analysis of Podcast Use in Podcast Intervention Group  
Outcome  
Percent of Podcast Intervention  
# of podcasts used 
 
0  
 
1-2 
 
3-4 
 
5-6  
 
Time spent listening to 
podcast  
 
0 - 10 min  
 
11 - 20 min 
 
21 - 30 min  
 
31 min - 60 min 
 

>1 hr  
 
How many times each 
podcast was listened to 
 
Labor Anesthesia 
 
Induction of Labor  
 
Second Stage of Labor  
 
Reason for Cesarean Section 
 
Postpartum Recovery 
 
Complications of Labor and 
Birth 
 
Normal Labor 
 
Rating of Podcast Material (1-
10)  
 
Would you recommend to 
your friends and family?  
 
 
 
Subanalysis of people who actually listened vs. intention to treat (primary analysis)  
 
Things to put into multivariable analysis:  
Age, race, insurance type, method of delivery, maternal complication (composite), neonatal complications 
(composite), childbirth classes? (but may be a lot of people)  
 
Consider: amount of time listening to podcast?  
Vs which podcasts were listened to most?