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Background Women’s childbirth experience can have immediate as well as long-term positive or negative effects on their life, well-being and health. When evaluating and drawing conclusions from research results, women’s experiences of childbirth should be one aspect to consider. Researchers and clinicians need help in finding and selecting the most suitable instrument for their purpose. The aim of this study was therefore to systematically identify and present validated instruments measuring women’s childbirth experience. Methods A systematic review was conducted in January 2016 with a comprehensive search in the bibliographic databases PubMed, CINAHL, Scopus, The Cochrane Library and PsycINFO. Included instruments measured women’s childbirth experiences. Papers were assessed independently by two reviewers for inclusion, and quality assessment of included instruments was made by two reviewers independently and in pairs using Terwee et al’s criteria for evaluation of psychometric properties. Results In total 5189 citations were screened, of which 5106 were excluded by title and abstract. Eighty-three full-text papers were reviewed, and 37 papers were excluded, resulting in 46 included papers representing 36 instruments. These instruments demonstrated a wide range in purpose and content as well as in the quality of psychometric properties. Conclusions This systematic review provides an overview of existing instruments measuring women’s childbirth experiences and can support researchers to identify appropriate instruments to be used, and maybe adapted, in their specific contexts and research purpose.

Introduction Women with polycystic ovary syndrome (PCOS) have more pregnancy complications like gestational diabetes, hypertension, and preterm labor than other women. Metformin has been used in an attempt to improve pregnancy outcomes. Our study aims to explore childbirth experiences in women with PCOS compared with a reference population. It also explores the potential influence of metformin, obesity, pregnancy complications, and the duration and mode of birth on childbirth experiences. Material and methods This study is a cohort study combining data from two randomized trials conducted in Norway, Sweden and Iceland. The PregMet2 study (ClinicalTrials.gov, NCT01587378) investigated the use of metformin vs. placebo in pregnant women with PCOS. The Labour Progression Study (ClinicalTrials.gov, NCT02221427) compared the WHO partograph to Zhang's guidelines for progression of labor and were used as the reference population. A total of 365 women with PCOS and 3604 reference women were included. Both studies used the Childbirth Experience Questionnaire (CEQ). Main outcome measures were total CEQ score and four domain scores. The CEQ scores were compared using Mann–Whitney U test for women in Robson group 1 with PCOS (n = 131) and reference women (n = 3604). CEQ scores were also compared between metformin‐treated (n = 180) and placebo‐treated (n = 185) women with PCOS, and for different subgroups of women with PCOS. Results There was no difference in total CEQ score between women with PCOS and reference women—Wilcoxon–Mann–Whitney (WMW)‐odds 0.96 (95% confidence interval [CI] 0.78–1.17). We detected no difference in CEQ scores between the metformin‐ and placebo‐treated women with PCOS (WMW‐odds 1.13, 95% CI 0.89–1.43). Complications in pregnancy did not affect CEQ (WMW‐odds 1, 95% CI 0.76–1.31). Higher body mass index (WMW‐odds 0.75, 95% CI 0.58–0.96), longer duration of labor (WMW‐odds 0.69, 95% CI 0.49–0.96), and cesarean section (WMW‐odds 0.29, 95% CI 0.2–0.42) were associated with lower CEQ scores in women with PCOS. Conclusions Women with PCOS experience childbirth similarly to the reference women. Metformin did not influence childbirth experience in women with PCOS, neither did pregnancy complications. Obesity, long duration of labor or cesarean section had a negative impact on childbirth experience. Women with polycystic ovary syndrome have similar childbirth experiences to other women, despite their increased risk of complications. Their childbirth experiences are negatively influenced by high BMI, long duration of labor, and operative delivery.

Introduction Sociodemographic and obstetric factors have been shown to impact childbirth experience, but results regarding the effect of certain factors have been heterogeneous. It is important to understand how individual risk factors affect childbirth experience to be able to identify women at risk for negative childbirth experience. The aim of this study was to determine individual associations between sociodemographic and obstetric factors and childbirth experience. Material and Methods The Labor Progression Study (LaPS‐NCT02221427) was a multicenter randomized trial examining clinical consequences of using Zhang's guideline vs the WHO partograph on intrapartum cesarean section rate. Four weeks after delivery, 5810 women received the Childbirth Experience Questionnaire (CEQ) online. The CEQ consists of 19 questions on four subscales (own capacity, professional support, perceived safety, and participation). The total CEQ score is the mean score of each of the subscale scores, ranging from 1 to 4, a higher score indicating a better childbirth experience. Sociodemographic (age, body mass index, education, civil status, and smoking) and obstetric (gestational age, prolonged labor, mode of delivery, and obstetric complications) characteristics of the women were recorded, and associations to total and subscale CEQ scores were examined with log‐linear regression. Results In all, 3604 women answered the questionnaire, a 62.9% response rate. The mean (SD) total CEQ score was of 3.24 (0.43). The subscale score was highest for professional support, mean 3.68 (0.49), and lowest for own capacity, mean 2.61 (0.54). The total CEQ score was not associated with any of the sociodemographic characteristics examined. Smoking in the first trimester was associated with lower scores on the professional support subscale 3.61 (3.55, 3.67) than nonsmokers, 3.69 (3.68, 3.71); p = 0.001. Of obstetric factors, only delivering in week 37 was significantly associated with a higher total CEQ score, 3.34 (3.28, 3.40), vs. 3.24 (3.22, 3.26) at 40 weeks, p = 0.002. Findings remained significant in adjusted analysis. Conclusions In our study, individual sociodemographic factors did not impact overall the childbirth experience. Smoking was associated with a lower score on the professional support subscale. Delivery in week 37 was associated with a better overall childbirth experience. No other obstetric factor influenced the childbirth experience. Individual sociodemographic and obstetric factors have little influence on childbirth experience in first‐time mothers when intrapartum and postpartum care is of a good standard.

Patient-provider language discordance is known to negatively affect patient experiences. This study describes the birth experience during COVID-19 among monolingual Spanish and bilingual Spanish/English speakers. Qualitative videoconference interviews with 15 monolingual Spanish and 15 bilingual Spanish/English patients that gave birth during the COVID-19 pandemic at a NYC tertiary-care hospital. 93% of participants had a positive birthing experience. Common themes were quality of care, birth outcome, and supportive staff. 80% of patients lacked a support person postpartum. 27% of Spanish-only speakers felt that an interpreter should have been provided but was not, and 47% felt the experience would have been different if they spoke English. The patient birth experience is tied to birth outcomes and quality of care and remained positive during the beginning of the COVID-19 pandemic. Restrictions on support people during the intra- or postpartum impacted the birthing experience more than provider language discordance.

Background Women’s experiences of labour and birth can have both short- and long-term effects on their physical and psychological health. The original Swedish version of the Childbirth Experience Questionnaire (CEQ) has shown to have good psychometric quality and ability to differentiate between groups known to differ in childbirth experience . Two subscales were revised in order to include new items with more relevant content about decision-making and aspects of midwifery support. The aim of the study was to develop new items in two subscales and to test construct validity and reliability of the revised version of CEQ, called CEQ2. Method A total of 11 new items ( Professional Support and Participation ) and 14 original items from the first CEQ ( Own capacity and Perceived safety ), were answered by 682 women with spontaneous onset of labour. Confirmatory factor analysis was used to analyse model fit. Results The hypothesised four-factor model showed good fit (CMIN = 2.79; RMR = 0.33; GFI = 0.94; CFI = 0.94; TLI = 0.93; RMSEA = 0.054 and PCLOSE = 0.12) Cronbach’s alpha was good for all subscales (0.82, 0.83, 0.76 and 0.73) and for the total scale (0.91). Conclusions CEQ2, like the first CEQ, yields four important aspects of experience during labour and birth showing good psychometric performance, including decision-making and aspects of midwifery support, in both primiparous and multiparous women.

Background Assessing women’s childbirth experiences is a crucial indicator in maternity services because negative childbirth experiences are associated with maternal mortalities and morbidities. Due to the high caesarean birth rate in Iran, measuring childbirth experience is a top priority, however, there is no standard tool to measure this key indicator in Iran. The aim of present study is to adapt the “Childbirth Experience Questionnaire 2.0” to the Iranian context and determine its psychometric characteristics. Methods Childbirth Experience Questionnaire 2.0 was translated into Farsi. A total of 500 primiparous women, at 4 to 16 weeks postpartum, were randomly selected from 54 healthcare centres in Tabriz. Internal consistency and reliability was calculated using the Cronbach’s Coefficient alpha and Intraclass Correlation Coefficient, respectively. Construct validity was assessed using exploratory and confirmatory factor analysis and discriminant validity using the known-group method and the Mann-Whitney U-test. Results The internal consistency and reliability for the total tool were high (Cronbach’s alpha = 0.93; Intraclass Correlation Coefficient = 0.97). Explanatory factor analysis demonstrated the adequacy of the sampling (Kaiser-Meyer-Olkin = 0.923) and significant factorable sphericity ( p  < 0.001). Confirmation factor analysis demonstrated acceptable values of fitness (RMSEA = 0.07, SRMSEA = 0.06, TLI = 0.97, CFI > 0.91, x 2 / df = 4.23). Discriminatory validity of the tool was confirmed where the CEQ score and its subdomains were significantly higher in women who reported having control over their childbirth than women who did not. Conclusion The Farsi version of the Childbirth Experience Questionnaire 2.0 tool is a valid and reliable tool and can be used to measure the childbirth experience in Iranian women.

Background The objective of this paper was to test the psychometric properties of the questionnaire for assessing the childbirth experience (QACE) among Chinese postpartum women. Methods Research instruments included the demographic characteristics form, the QACE, the Edinburgh Postnatal Depression Scale (EPDS), and the Generalized Anxiety Disorder-7 (GAD-7). The item analysis, confirmatory factor analysis (CFA), known-groups discriminant validity, divergent validity, and internal consistency reliability were assessed for the psychometric properties of QACE. Results A total of 235 postpartum women were recruited in this study. Item analysis showed that the critical ratios of all items were greater than 3, and all item-total correlation coefficients were greater than 0.4. The fit indices showed that the original correlated four-factor model of QACE was adequate. In terms of the divergent validity, the QACE subscale and total score were in a significant positive correlation with the EPDS and GAD-7. Regarding reliability, the Cronbach’s alpha of the QACE was 0.812, ranging from 0.611 to 0.844 for total scale and sub-scales, respectively. Conclusions The QACE is a valid and reliable tool for measuring childbirth experience among Chinese women sample of postpartum women.

We examined the birth experience of immigrant and minority women and how CenteringPregnancy (Centering), a model of group prenatal care and childbirth education, influenced that experience. In-depth interviews and surveys were conducted with a sample of racially diverse Centering participants about their birth experiences. Interview transcripts were analyzed thematically. Study participants (n = 34) were primarily low-income, Spanish-speaking immigrants with an average age of 29.7. On a scale from 1 (not satisfied) to 10 (very satisfied), women reported high satisfaction with birth (9.0) and care (9.3). In interviews, they expressed appreciation for the choice to labor with minimal medical intervention. Difficulties with communication arose from fragmented labor and delivery care by multiple providers. Centering provided women with pain coping skills, a familiar birth attendant, and knowledge to advocate for themselves. High reported satisfaction may obscure challenges to providing high quality childbirth care for marginalized women. Further study should examine the potential of Centering to positively impact underserved women’s birth experiences.

There is evidence that 3.17% of women report post-traumatic stress disorder (PTSD) after childbirth. This meta-analysis synthesizes research on vulnerability and risk factors for birth-related PTSD and refines a diathesis–stress model of its aetiology. Systematic searches were carried out on PsycINFO, PubMed, Scopus and Web of Science using PTSD terms crossed with childbirth terms. Studies were included if they reported primary research that examined factors associated with birth-related PTSD measured at least 1 month after birth. In all, 50 studies (n = 21 429) from 15 countries fulfilled inclusion criteria. Pre-birth vulnerability factors most strongly associated with PTSD were depression in pregnancy (r = 0.51), fear of childbirth (r = 0.41), poor health or complications in pregnancy (r = 0.38), and a history of PTSD (r = 0.39) and counselling for pregnancy or birth (r = 0.32). Risk factors in birth most strongly associated with PTSD were negative subjective birth experiences (r = 0.59), having an operative birth (assisted vaginal or caesarean, r = 0.48), lack of support (r = −0.38) and dissociation (r = 0.32). After birth, PTSD was associated with poor coping and stress (r = 0.30), and was highly co-morbid with depression (r = 0.60). Moderator analyses showed that the effect of poor health or complications in pregnancy was more apparent in high-risk samples. The results of this meta-analysis are used to update a diathesis–stress model of the aetiology of postpartum PTSD and can be used to inform screening, prevention and intervention in maternity care.

Background Pregnancy and childbirth are significant events in women’s lives and most women have expectations or plans for how they hope their labour and birth will go. It is possible that strong expectations about labour and birth lead to dissatisfaction or other negative outcomes if these expectations are not met, but it is not clear if this is the case. The aim was therefore to synthesise prospective studies in order to understand whether unmet birth expectations are associated with adverse outcomes for women, their partners and their infants. Method Searches were carried out in Academic Search Complete; CINAHL; Medline; PsycINFO, PsychArticles, PubMed, SCOPUS and Web of Science. Forward and backward searches were also completed. Studies were included if they reported prospective empirical research that examined the association between a mismatch in birth expectations/experience and postnatal outcomes in women, their children and/or their partners. Data were synthesised qualitatively using a narrative approach where study characteristics, context and methodological quality were extracted and summarised and then the differences and similarities among studies were used to draw conclusions. Results Eleven quantitative studies were identified for inclusion from nine countries. A mismatch between birth expectations and experiences was associated with reduced birth satisfaction. Three studies found a link between a mismatch and the development of postnatal post-traumatic stress disorder (PTSD). The evidence was inconsistent for postnatal depression, and fear of childbirth. Only one study looked at physical outcomes in the form of health-related quality of life. Conclusions A mismatch between birth expectations and experiences is associated with birth satisfaction and it may increase the risk of developing postnatal PTSD. However, it is not clear whether a mismatch is associated with other postnatal mental health conditions. Further prospective research is needed to examine gaps in knowledge and provide standardised methods of measuring childbirth expectations-experiences mismatch. To ensure women’s expectations are met, and therefore experience a satisfying birth experience, maternity providers should provide sensitive care, which acknowledges women’s needs and preferences, is based on open and clear communication, is delivered as early in pregnancy as possible, and enables women to make their own decisions about care. Trial registration Protocol registration: PROSPERO CRD42020191081 .