title: Indications for Emergency Intervention, Mode of Delivery, and the Childbirth Experience.
abstract: BACKGROUND
  Although the impact of emergency procedures on the childbirth experience has been studied extensively, a possible association of childbirth experience with indications for emergency interventions has not been reported.
  
  
  OBJECTIVE
  To compare the impacts on childbirth experience of 'planned' delivery (elective cesarean section and vaginal delivery) versus 'unplanned' delivery (vacuum extraction or emergency cesarean section); the intervention itself (vacuum extraction versus emergency cesarean section); and indications for intervention (arrest of labor versus risk to the mother or fetus).
  
  
  METHODS
  A total of 469 women, up to 72 hours post-partum, in the maternity ward of one tertiary health care institute completed the Subjective Childbirth Experience Questionnaire (score: 0-4, a higher score indicated a more negative experience) and a Personal Information Questionnaire. Intra-partum information was retrieved from the medical records. One-way analysis of variance and two-way analysis of variance, followed by analysis of covariance, to test the unique contribution of variables, were used to examine differences between groups in outcome. Tukey's Post-Hoc analysis was used when appropriate.
  
  
  RESULTS
  Planned delivery, either vaginal or elective cesarean section, was associated with a more positive experience than unplanned delivery, either vacuum or emergency cesarean section (mean respective Subjective Childbirth Experience scores: 1.58 and 1.49 vs. 2.02 and 2.07, P <0.01). The difference in mean Subjective Childbirth Experience scores following elective cesarean section and vaginal delivery was not significant; nor was the difference following vacuum extraction and emergency cesarean section. Interventions due to immediate risk to mother or fetus resulted in a more positive birth experience than interventions due to arrest of labor (Subjective Childbirth Experience: 1.9 vs. 2.2, P <0.01).
  
  
  CONCLUSIONS
  Compared to planned interventions, unplanned interventions were shown to be associated with a more negative maternal childbirth experience. However, the indication for unplanned intervention appears to have a greater effect than the nature of the intervention on the birth experience. Women who underwent emergency interventions due to delay of birth (arrest of labor) perceived their birth experience more negatively than those who underwent interventions due to risk for the mother or fetus, regardless of the nature of the intervention (vacuum or emergency cesarean section). The results indicate the importance of follow-up after unexpected emergency interventions, especially following arrest of labor, as negative birth experience may have repercussions in a woman's psychosocial life and well-being.
authors.affiliation: School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel.
authors.forename: Jonathan E
authors.identifier: http://orcid.org/0000-0002-9045-6057
authors.initials: JE
authors.lastname: Handelzalts
authors.affiliation: School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel.
authors.forename: Avigail
authors.initials: A
authors.lastname: Waldman Peyser
authors.affiliation: The Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Haim
authors.initials: H
authors.lastname: Krissi
authors.affiliation: School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel.
authors.forename: Sigal
authors.initials: S
authors.lastname: Levy
authors.affiliation: The Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Arnon
authors.initials: A
authors.lastname: Wiznitzer
authors.affiliation: The Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Peled
mesh_terms: D000328:Adult; D002585:Cesarean Section; D003695:Delivery of Health Care; D036861:Delivery, Obstetric; D017558:Elective Surgical Procedures; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D008875:Middle Aged; D036801:Parturition; D011247:Pregnancy; D012306:Risk; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult