Maternal and Delivery Characteristics and Self-Reported Perceived Control During Labor
Authors: Mallett Gail , Hill Kim , Doherty Lindsay , Grobman William A. , Reddy Uma M. , Tita Alan T. N. , Silver Robert M. , Rice Madeline Murguia , El-Sayed Yasser Y. , Wapner Ronald J. , Rouse Dwight J. , Saade George R. , Thorp John M. , Chauhan Suneet P. , Costantine Maged M. , Chien Edward K. , Casey Brian M. , Srinivas Sindhu K. , Swamy Geeta K. , Simhan Hyagriv N. , Macones George A. ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network*
Published: June 2023

OBJECTIVE:
To evaluate the association between maternal and delivery characteristics and self-reported perceived control during childbirth.

METHODS:
A secondary analysis of a multicenter randomized trial was conducted to compare labor induction at 39 weeks of gestation with expectant management in low-risk nulliparous people. Six to 96 hours after delivery, participants who experienced labor completed the Labor Agentry Scale, a validated self-administered questionnaire to ascertain perceived control during childbirth. Scores range from 29 to 203, with higher scores indicating a sense of greater control. Multivariable linear regression was used to determine which maternal and delivery characteristics were associated with the Labor Agentry Scale score. Eligible characteristics included age, self-reported race and ethnicity, marital status, employment status, type of insurance, previous pregnancy loss before 20 weeks of gestation, body mass index (BMI), smoking, alcohol use, mode of delivery, labor pain (0–10 points), and a composite of perinatal death or severe neonatal complications. Significant variables (P<.05) were retained in the final multivariable model, and adjusted mean differences (95% CIs) between groups were estimated.

RESULTS:
Of 6,106 people enrolled in the trial, 6,038 experienced labor, of whom 5,750 (95.2%) completed the Labor Agentry Scale and were included in this analysis. Mean [95% CI] adjusted Labor Agentry Scale scores were significantly lower among those who identified as Asian (−6.4 [−10.5 to −2.3]) or Hispanic (−3.7 [−5.7 to −1.7]) compared with White, smoked compared with did not smoke (−2.8 [−5.5 to −0.1]), had BMIs of 35 or higher compared with less than 30 (−2.0 [−3.8 to −0.2]), were unemployed (−3.15 [−4.76 to −1.55]), did not have private health insurance (−2.61 [−4.47 to −0.76]), underwent operative vaginal (−5.1 [−7.7 to −2.6]) or cesarean (−14.4 [−16.1 to −12.6]) delivery compared with spontaneous vaginal delivery, and reported greater labor pain score of 8 or higher compared with less than 8 (−11.9 [−13.4 to −10.4]). Mean [95% CI] adjusted Labor Agentry Scale scores were significantly higher among people who were employed compared with unemployed (3.2 [1.6–4.8]) and had private compared with nonprivate insurance (2.6 [0.76–4.5]).

CONCLUSION:
In nulliparous people at low risk, unemployment, lack of private health insurance, Asian race, Hispanic ethnicity, smoking, operative delivery, and more labor pain were associated with lower perceived control during labor.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT01990612.