Article Text

Original research
Women’s childbirth experiences in the Swedish Post-term Induction Study (SWEPIS): a multicentre, randomised, controlled trial
  1. Helena Nilvér1,
  2. Anna Wessberg1,2,
  3. Anna Dencker1,
  4. Henrik Hagberg2,3,
  5. Ulla-Britt Wennerholm2,3,
  6. Helena Fadl4,
  7. Jan Wesström5,
  8. Verena Sengpiel2,3,
  9. Ingela Lundgren1,2,
  10. Christina Bergh6,
  11. Anna-Karin Wikström7,
  12. Sissel Saltvedt8,9,
  13. Helen Elden1,2
  1. 1Institute of Health and Care Sciences, Sahlgrenska Akademy, University of Gothenbourg, Gothenbourg, Sweden
  2. 2Department of Obstetrics, Sahlgrenska University Hospital, Gothenbourg, Sweden
  3. 3Centre of Perinatal Medicine & Health, Institute of Clinical Sciences, Salgrenska Akademy, Göteborgs Universitet, Gothenbourg, Sweden
  4. 4Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
  5. 5Centre for Clinical Research, Department of Women’s Health, Dalarna County Council, Falun, Sweden
  6. 6Department of Reproductive Medicine, Sahlgrenska University Hospital, Gothenbourg, Sweden
  7. 7Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
  8. 8Department of Obstetrics and Gynaecology, Karolinska University Hospital, Stockholm, Sweden
  9. 9Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Helena Nilvér; helena.nilver{at}gu.se

Abstract

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.

  • obstetrics
  • maternal medicine
  • reproductive medicine

Data availability statement

Data are available on reasonable request. Data will be made available, from the corresponding author, on reasonable request.

https://creativecommons.org/licenses/by/4.0/

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Data availability statement

Data are available on reasonable request. Data will be made available, from the corresponding author, on reasonable request.

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Footnotes

  • Twitter @HelenaFadl

  • Contributors AW, AD, HH, U-BW, VS and HE conceived and designed the study. HN, AW, HH, U-BW, HF, JW, A-KW and SS oversaw recruitment of study participants and collection of Childbirth Experience Questionnaire data at the local centres. U-BW and HN did the data cleaning together with statisticians Mattias Molin and Per Ekman. HN compiled and analysed the Childbirth Experience Questionnaire version 2 data. Per Ekman did the analysis regarding Visual Analogue Scale. HN wrote the first draft of the manuscript, which was then critically reviewed and revised by all coauthors (HN, AW, AD, HH, U-BW, HF, JW, VS, IL, CB, A-KW, SS and HE). All authors have approved the final version of the manuscript for submission. All authors have full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. HE is the guarantor.

  • Funding This study was supported by the Swedish state under the agreement between the Swedish government and the county councils, the ALF agreement (ALFGBG-440301, ALFGBG-718721, ALFGBG-70940 and ALFGBG-426401); the Health Technology Centre at Sahlgrenska University Hospital; the Foundation of the Health and Medical care committee of the region of Västra Götaland, Sweden (VGFOUREG387351, VGFOUREG640891 and VGFOUREG854081); Hjalmar Svensson Foundation; the foundation Mary von Sydow; born Wijk donation fund; Uppsala-Örebro Regional Research Council (RFR-556711 and RFR-736891); Region Örebro County research committee (OLL-715501); the ALF agreement in Stockholm (ALF-561222,ALF-562222 and ALF-563222); and Centre for Clinical Research Dalarna, Uppsala University, Sweden (CKFUU-417011).

  • Disclaimer The funders had no role in the study design, data collection, data analysis, data interpretation or writing of the report. The researchers were independent of the funders.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.

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