The Effect of Shared Decision-Making in Choosing the Method of Labor Analgesic on Childbirth Experience: An experimental study

Abstract

Background: Childbirth pain is one of the most severe types of pain that a woman experiences during her life and during a normal birth. There are various pharmacological and non-pharmacological methods to reduce labor pain, but most women are unaware of their advantages and disadvantages and even their mechanism of action. Due to the lack of studies in this field, a study was designed and conducted to investigate the effect of shared decision-making in the selection of analgesia type on childbirth experience in nulliparous women. Materials and methods: The study was performed as an experimental study on 66 nulliparous women with a gestational age of 38 to 42 weeks who referred to the clinic of Taleghani Hospital in Tabriz for normal delivery. Participants were assigned to the intervention and control groups through simple random blocking with a ratio of 1: 1. Demographic questionnaire was completed before the intervention for both groups. Shared decision-making counseling was provided to the intervention group along with the decision help booklet regarding the advantages and disadvantages of using pharmacological and non-pharmacological labor analgesia. Pre-intervention questionnaire including demographic-obstetric and post-test questionnaires including birth experience, Mackey delivery satisfaction, childbirth support and control, decision regret and shared decision-making were completed questionniare during the first 24 hours after delivery. Data were analyzed by SPSS24 software using independent t-test and ANCOVA. Results: After the intervention, the mean score of delivery experience in the intervention group was significantly higher than the control group [mean difference of 6.77 with 95% confidence interval and (2.72 to 10.28), (P <0.001)]. The mean score of satisfaction with delivery after the intervention in the intervention group was significantly higher than the control group [difference between the mean of 19.06 with 95% confidence interval and (9.63 to 28.49), (P <0.00)] . After the intervention, the mean score of control and overall support in childbirth in the intervention group was significantly higher than the control group [mean difference of 17.21 with 95% confidence interval and (9.40 to 25.03), (P <0.001)] After the intervention, the mean score of decision regret in the intervention group was significantly lower than the control group [mean difference of -4.86 with 95% confidence interval and (-5.95 to -3/76), (P <0.001)]. After the intervention, the mean score of shared decision making in the intervention group was significantly higher than the control group [mean difference of 13.22 with 95% confidence interval and (10.33 to 16.12), (P <0.001)]. Conclusion: Counseling based on shared decision-making led to the improvement of experience and satisfaction with childbirth and the perception of control and support in childbirth. Therefore, considering the autonomy of the women and her right to decision on the delivery process, it is recommended that counseling based on shared decision-making in relation to pharmacological and non-pharmacological methods to reduce labor pain be included in pregnancy care programs.