Do primigravidae and their carers have a realistic expectation of uncomplicated labour and delivery?: a survey of primigravidae in late pregnancy, obstetric staff and medical students.

Background: Women who experience unexpected labour and birth interventions describe feeling distressed and have an increased risk of postnatal depression. Primigravidae who have an unrealistic expectation of labour and birth may be at higher risk of these outcomes.

Aims: To determine whether primigravidae and their carers have a realistic expectation of uncomplicated labour and birth.

Methods: One hundered and ninety-five primigravidae, 32 obstetricians, 76 midwives, 198 medical students prior to their obstetric term and 131 medical students after their obstetric term completed a short questionnaire about the likelihood of primigravid women undergoing spontaneous onset of labour, no augmentation of labour and a cephalic vaginal birth without instrumental assistance, defined as birth without intervention. This number was compared to the local published data.

Results: Overall, the study subjects believed that women had a 48% chance of birth without intervention, and a 26% chance of birth without intervention or perineal sutures. The statewide published figures for these two outcomes are 21 and 8%, respectively. Staff, both obstetric and midwifery, were more accurate than medical students who were in turn more accurate than pregnant women. Attendance at antenatal education classes by pregnant women did not improve accuracy. Level of experience did not improve accuracy by medical staff. Medical students were more accurate after teaching than before teaching.

Conclusion: Primigravidae in late pregnancy and maternity staff do not have a realistic expectation of a labour and birth that is free from medical intervention. This may impact on choices women make about care in pregnancy and labour.