A comparison of maternal fear of childbirth,labor pain intensity and intrapartum analgesic consumption between primiparas and multiparas:A cross-sectional study

Objectives:To describe and compare fear of childbirth and in-labor pain intensity between primiparas and multiparas and explore the association between the amount of actual pain relief and fear of childbirth.Methods:A convenience sampling method was used.A total of 260 women undergoing spontaneous or induced labor,including 97 primiparas and 163 multiparas,were recruited in a large academic specialized hospital in Guangzhou,China,from February 2018 to August 2019.The clinical data of maternal and neonatal were extracted from a structured electronic medical record system.Other demographic information,such as employment and family monthly income,was collected by a questionnaire.The Numeric Rating Scale(NRS)and the Chinese version of the Childbirth Attitude Questionnaire(C-CAQ)were applied to assess maternal in-labor pain intensity and fear of childbirth.The analgesic consumption and the frequency of manual boluses as rescue analgesia were stored and collected from the analgesia pump.Results:Eighty-two(84.5%)primiparas and ninety-nine(60.7%)multiparas received epidural analgesia(P<0.001).In the epidural subgroup,the primiparous average fear of childbirth(36.46±10.93)was higher than that of the multiparas(32.06±10.23)(P¼0.007).However,multiparas reported more intense in-labor pain[8.0(8.0,9.0)vs.8.0(7.0,8.0)],had more successful manual boluses per hour[2.68(1.65,3.85)vs.1.77(0.90,2.47)],more hourly analgesic consumption[23.00(16.00,28.25)vs.17.24(11.52,21.36)mL]and more average analgesic consumption[0.35(0.24,0.45)vs.0.26(0.19,0.35)mL/(h$kg)]than the primiparas(P<0.05).Spearman’s correlation analysis showed that the maximum in-labor pain was weakly positively correlated with fear of childbirth(r¼0.09)(P<0.05),hourly analgesic consumption(r¼0.16)(P<0.01)and average analgesic consumption(r¼0.17)(P<0.05).No statistically significant association was uncovered between analgesic consumption and maternal fear of childbirth.Conclusions:Fear of childbirth is a potential predictor of labor pain intensity.Further study is needed to explore its role and value in pain management during delivery.Parity is not a determinant of pain relief use and should not be a preconceived preference of obstetric care team members to determine the distribution of epidural analgesia,especially when analgesia resources are insufficient.

Neonatal Death Rates: Lack of Equal Access to Hospital Obstetric Service and Intensive Therapy

Aim: To identify the association between access to obstetric and neonatal hospital service and neonatal death rates. Method: Quantitative and retrospective research retrieved from Declaration of Live Newly-born Children;Declaration of Death;Investigation Chart on Municipal Child Mortality, between 2000 and 2009, at the Nucleus of Information on Mortality Rates. The population studied comprised 537 neonatal deaths and mothers with residence in the municipality, and investigated by the work team of the Committee for the Investigation of Mother-Child Deaths. Data were analyzed in Epi Info 2002? computer program and the Statistical Package for the Social Sciences? was used. Chi-square Test and Fischer’s Exact Test were applied at p < 0.05. Results: 63.7% of 537 neonates were born in hospitals with maternities and neonatal intensive therapy unit;60.7% weighed ≤1.500 grams;76.7% had a pregnancy age of ≤36 weeks;73% died of asphyxia in the 1st minute and 73.5% died during the perinatal period. Throughout the ten years of analysis, access to hospital obstetric service without NITU reduced death rate from 25% in 2000 to 6.8% in 2009. There was a significant statistical association between place of delivery and maternal socio-demographic variables (maternal age bracket p = 0.028;schooling p = 0.000;family income p = 0.000);occupation p = 0.000) and neonatal variables (race/skin color p = 0.007;type of delivery p = 0.000;weight at birth p = 0.000;pregnancy age p = 0.000 and Apgar Score 1st minute p = 0.000 and Apgar Score 5th minute p = 0.007). Conclusion: Although the municipal government provides obstetric services and specialized neonatal care, this right is not extensive to all;gaps at different levels in mother-child care should be identified to reduce neonatal deaths.

Parity 3 or More at Haiphong Hospital of Obstetrics and Gynecology in 2016

Background： Although increasing parity increased the risk of pregnancy complications and despite of Vietnam’s family planning policy of two-child, the percent of women having three or more children has tended for five years. Objectives： （1） Find out the prevalence of parity ≥ 3 and their reasons at Haiphong Hospital of Obstetrics and Gynecology in 2016; （2） Describe the methods of labor and its adverse outcomes. Materials and methods： A cross-sectional in 485 women had delivered three or more infants at Haiphong Hospital of Obstetrics and Gynecology from June to August, 2016. Results： The prevalence of parity ≥ 3 is 11.9%, no relation to geopraphy, education and career. The main reasons are unplanned pregnancy and desire to have a baby boy. The sex ratio at birth is 162. The proportion of cesarean delivery is 53.4%, in which is due to an old C-section. Conclusion： serious gender is imbalance among women having three or more baby （162 baby boys per hundred baby girls）.