Nulliparous Women's Experience in the Immediate Postpartum Period After Cervical Ripening According to the Method: A Prospective Observational Study

Abstract

Background/Objectives: Women's experience plays an important role in the evaluation of different methods in obstetric practice with a patient-centered approach, especially for induction of labor (IOL). For IOL, cervical ripening seemed to be associated with a less positive experience of childbirth. More specific data regarding the different cervical ripening methods might help the obstetrician to better counsel and support women requiring cervical ripening to improve their experience of IOL. The aim of this study was therefore to assess whether the method is associated with altered experiences of cervical ripening and childbirth among nulliparous women. Methods: A prospective observational study included 340 nulliparous women with a singleton fetus in cephalic presentation and cervical ripening at term (≥37 weeks) for maternal and/or fetal disease using a cervical ripening balloon (CRB, 33.8%), dinoprostone vaginal insert (PG, 32.7%), oral misoprostol (M, 3.8%), or repeated methods (R, 29.7%). The cervical ripening method was left to the free discretion of the obstetrician responsible for the women. A self-developed questionnaire assessed women's feelings and experience of cervical ripening and childbirth using Likert scales from 0 to 10 (very satisfied) according to the method in the immediate postpartum period. We compared the women's experiences and feelings according to the cervical ripening method (CRB, PG, M, or R) and specifically studied the association (assessed by multivariate logistic regression analyses) between women's experience in the immediate postpartum period and the cervical ripening method. Results: The overall vaginal rate was 79.1% and was similar between groups (CRB 77.4%, PG 87.4%, M 69.2%, and R 73.3%; p = 0.15). The experience of ripening was significantly better with CRB, M, or PG compared to R (CRB: 6.7 ± 2.5, PG: 7.2 ± 2.6, M: 6.8 ± 3.6, and R: 5.2 ± 2.8; p < 0.001). The maximum pain during ripening was significantly higher in PG (7.9 ± 2.5 vs. CRB 7.2 ± 2.4, M 7.0 ± 3.9, and R 7.8 ± 2.4; p = 0.02). The experience of childbirth was more negative in the R group (6.1 ± 2.7 vs. CRB 6.9 ± 2.6, PG 7.2 ± 2.4, and M 7.4 ± 3.1; p = 0.02). After multivariate analysis with adjustment for confounders (method for cervical ripening, pain during IOL, mode of birth, maternal morbidity, and neonatal morbidity), repeated methods were significantly associated with worse overall experiences of cervical ripening (aOR = -1.4, 95%CI -2.1--0.67; p < 0.001) and childbirth (aOR = -0.75, 95% CI -1.6--0.05; p = 0.03), compared to PG, CRB, or M used alone. After adjustment, maternal experience and childbirth were similar between methods used alone for cervical ripening. Conclusions: Nulliparous women who required repeated methods for cervical ripening at term had significantly worse experiences of ripening and childbirth in the immediate postpartum period compared to PG, CRB, or M used alone, regardless of the mode of delivery and maternal and neonatal morbidity.

Keywords: cervical ripening; childbirth; induction of labor; women’s experience.

Figure 1

Flow chart.