title: Traumatic experience with vacuum extraction--influence of personal preparation, physiology, and treatment during labor.
abstract: OBJECTIVE
  To assess pre-labor attitudes and post-labor experiences of the use of vacuum extraction during delivery. To seek associations between traumatic labor experience and personal preparation, physiology of labor and treatment during labor.
  
  
  METHODS
  A total of 205 women filled in a questionnaire within five days of vacuum extraction delivery. The questionnaire was designed to distinguish the group of women having experienced their labor as traumatic from those not having such an experience. The association between explanatory variables grouped as background factors, physiological factors of labor and treatment-related factors in relation to traumatic experience status was studied by bivariate analysis by the chi-square test or Student's t-test. Logistic regression analysis was carried out to examine simultaneous effects of factors. In the first phase, each of the previously chosen groups was analyzed separately, and in the second, all risk factors thus emerging as significant were entered into the final model.
  
  
  RESULTS
  Forty-two women (20%) regarded their childbirth experience as traumatic. Of the background factors, insufficient pre-labor training and a pre-labor desire for extra strong pain relief during the coming labor were significantly more common in the traumatic birth group. Of the physiological factors of labor, unsatisfactory pain relief and a difficult third stage of labor were associated with a traumatic birth experience. The treatment-related factors showed mutual correlation and were strongly associated with birth experience. After logistic regression analysis only four independent risk factors emerged as significant: insufficient support immediately after delivery, the experience of being poorly listened to during labor, insufficient doctor's support during the first stage of labor, and pre-labor training classes considered insufficient.
  
  
  CONCLUSIONS
  Treatment-related factors were the most powerful predictors of an adverse birth experience after vacuum extraction delivery, exceeding those related to labor physiology. Thus, the role of treatment and care before, during and after vacuum extraction is emphasized.
authors.affiliation: Department of Obstetrics and Gynecology, Tampere University Hospítal, Finland. jukka.uotila@uta.fi
authors.forename: Jukka Tapio
authors.initials: JT
authors.lastname: Uotila
authors.forename: Kirsi
authors.initials: K
authors.lastname: Taurio
authors.forename: Raili
authors.initials: R
authors.lastname: Salmelin
authors.forename: Pertti
authors.initials: P
authors.lastname: Kirkinen
mesh_terms: D000328:Adult; D016362:Analgesia, Obstetrical; D005113:Extraction, Obstetrical / Q000379:methods* / Q000523:psychology*; D005260:Female; D005387:Finland; D006801:Humans; D007744:Obstetric Labor Complications / Q000503:physiopathology / Q000523:psychology*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011247:Pregnancy; D011295:Prenatal Care; D011795:Surveys and Questionnaires