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Women's childbirth experiences in the Swedish Post-term Induction Study (SWEPIS): a multicentre, randomised, controlled trial
Institute of Health and Care Sciences, Sahlgrenska Akademy, University of Gothenbourg, Gothenbourg, Sweden.ORCID iD: 0000-0002-8562-3068
Institute of Health and Care Sciences, Sahlgrenska Akademy, University of Gothenbourg, Gothenbourg, Sweden; Department of Obstetrics, Sahlgrenska University Hospital, Gothenbourg, Sweden.
Institute of Health and Care Sciences, Sahlgrenska Akademy, University of Gothenbourg, Gothenbourg, Sweden.
Department of Obstetrics, Sahlgrenska University Hospital, Gothenbourg, Sweden; Centre of Perinatal Medicine & Health, Institute of Clinical Sciences, Salgrenska Akademy, Göteborgs Universitet, Gothenbourg, Sweden.
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2021 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 4, article id e042340Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To compare childbirth experiences in women randomly assigned to either induction of labour at 41 weeks or to expectant management until 42 weeks, in the Swedish Post-term Induction Study.

DESIGN: A register-based, multicentre, randomised, controlled, superiority trial.

SETTING: Women were recruited at 14 hospitals in Sweden, 2016-2018.

PARTICIPANTS: Women with an uncomplicated singleton pregnancy were recruited at 41 gestational weeks.

INTERVENTIONS: The women were randomly assigned to induction of labour at 41 weeks (induction group, n=1381) or expectant management until 42 weeks (expectant management group, n=1379).

OUTCOME MEASURES: As main outcome, women's childbirth experiences were measured using the Childbirth Experience Questionnaire version 2 (CEQ2), in 656 women, 3 months after the birth at three hospitals. As exploratory outcome, overall childbirth experience was measured in 1457 women using a Visual Analogue Scale (VAS 1-10) within 3 days after delivery at the remaining eleven hospitals.

RESULTS: The total response rate was 77% (2113/2760). There were no significant differences in childbirth experience measured with CEQ2 between the groups (induction group, n=354; expectant management group, n=302) in the subscales: own capacity (2.8 vs 2.7, p=0.09), perceived safety (3.3 vs 3.2, p=0.06) and professional support (3.6 vs 3.5, p=0.38) or in the total CEQ2 score (3.3 vs 3.2, p=0.07), respectively. Women in the induction group scored higher in the subscale participation (3.6 vs 3.4, p=0.02), although with a small effect size (0.19). No significant difference was observed in overall childbirth experience according to VAS (8.0 (n=735) vs 8.1 (n=735), p=0.22). 

CONCLUSIONS: There were no differences in childbirth experience, according to CEQ2 or overall childbirth experience assessed with VAS, between women randomly assigned to induction of labour at 41 weeks or expectant management until 42 weeks. Overall, women rated their childbirth experiences high.

TRIAL REGISTRATION NUMBER: ISRCTN26113652.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd , 2021. Vol. 11, no 4, article id e042340
Keywords [en]
Maternal medicine, obstetrics, reproductive medicine
National Category
Gynaecology, Obstetrics and Reproductive Medicine
Identifiers
URN: urn:nbn:se:hb:diva-29565DOI: 10.1136/bmjopen-2020-042340ISI: 000638218000011PubMedID: 33827832Scopus ID: 2-s2.0-85103978394OAI: oai:DiVA.org:hb-29565DiVA, id: diva2:1745648
Note

Funding Agencies:

Swedish government ALFGBG-440301 ALFGBG-718721 ALFGBG-70940 ALFGBG-426401

Health Technology Centre at Sahlgrenska University Hospital  

Foundation of the Health and Medical care committee of the region of Västra Götaland, Sweden VGFOUREG387351 VGFOUREG640891 VGFOUREG854081

Hjalmar Svensson Foundation  

Foundation Mary von Sydow  

Uppsala Örebro Regional Research Council RFR-556711 RFR-736891

Region Örebro County research committee OLL-715501

ALF agreement in Stockholm ALF-561222 ALF-562222 ALF-563222

Centre for Clinical Research Dalarna, Uppsala University, Sweden CKFUU-417011

Born Wijk donation fund 

Available from: 2021-04-14 Created: 2023-03-23 Last updated: 2025-09-24Bibliographically approved
In thesis
1. To give birth in late- and post-term pregnancy - women's experiences and perspectives
Open this publication in new window or tab >>To give birth in late- and post-term pregnancy - women's experiences and perspectives
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Childbirth is a lifechanging event, and women carry with them the experience throughout life. Around one in five pregnancies reach gestational week 41. When to recommend induction of labour for those extending 41 gestational weeks has been debated. Also, knowledge of women’s experiences and perspectives is limited. Therefore, the overall aim of this thesis was to obtain a deeper understanding of women’s experiences and perspectives of giving birth in late- and post-term pregnancy. Study I is a systematic review aiming to identify and present validated instruments measuring women’s childbirth experiences. In total, 36 instruments were identified representing different aspects of childbirth experiences with varying quality of psychometric properties. Study II compared childbirth experience between women randomised to either induction in gestational week 41+0 to 41+2 or to expectant management until gestational week 42. In total, 656 women responded to the Childbirth Experience Questionnaire version 2, three months after birth. As an exploratory outcome, 1457 women responded to the overall childbirth experience measured on a visual analogue scale within three days after birth. No significant difference was seen between the two randomised groups. Study III is a phenomenological study where twelve women were interviewed about their experience of induction of labour in late- and post-term pregnancy. The essence was described as the induction of labour becoming another journey than the intended one. In Study IV, ten women who wanted to await spontaneous onset in week 41 were interviewed about their experiences and perspectives regarding giving birth in late-term pregnancy. Through reflexive thematic analysis, three main themes were identified: well-being and trust in the own body’s process, not for me right now – if everything is good, and the embodied experience of giving birth. This thesis provides new insights into how induction of labour can be experienced in late- and post-term pregnancy as well as the experience of wanting to await spontaneous onset of labour. The included studies can aid maternity personnel in acquiring a deeper understanding and enable more individualised care in the lifechanging and existential period that giving birth and becoming a parent is.

Place, publisher, year, edition, pages
Göteborg: University of Gothenburg, 2022
Keywords
childbirth experience, late-term pregnancy, post-term pregnancy, induction of labour, systematic review, validated questionnaire, randomised controlled trial, phenomenology, thematic analysis
National Category
Nursing
Identifiers
urn:nbn:se:hb:diva-29567 (URN)978-91-8009-807-6 (ISBN)978-91-8009-808-3 (ISBN)
Public defence
2022-06-08, sal 2119, Arvid Wallgrens backe 1, Göteborg, 09:00
Available from: 2023-03-23 Created: 2023-03-23 Last updated: 2025-09-24Bibliographically approved

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