Women's Childbirth Experiences in the WILL Randomised Trial (When to Induce Labour to Limit Risk in Pregnancy Hypertension): A Mixed Methods Analysis

Objective

To compare childbirth satisfaction in women with chronic or gestational hypertension, randomised to ‘planned early term birth at 38^+0–3 weeks' gestation’ (intervention) or ‘usual care at term’ (control).

Design

Randomised trial.

Setting

Forty-two consultant-led maternity units, United Kingdom.

Population

357/403 women randomised completed the Childbirth Experience Questionnaire (CEQ).

Methods

Mixed-methods analysis of the 22-item CEQ, assessing: ‘Own capacity’, ‘Professional support’, ‘Perceived safety’ and ‘Participation’. Directed content analysis sorted free-text comments into themes covered by the CEQ and two additional themes.

Main Outcome Measures

CEQ scores overall and by domain.

Results

In intervention (vs. control) groups, the CEQ was completed by 177/202, 88.1% (vs. 180/202, 89.1%) participants, and 378 free-text comments were made by 93/177, 52.5% (vs. 98/180, 54.4%) participants. There was no significant difference in CEQ scores overall (3.1 ± 0.4 vs. 3.1 ± 0.4, respectively) or by domain (‘Own capacity’ [2.8 ± 0.5 vs. 2.7 ± 0.5, respectively]; ‘Professional support’ [3.7 ± 0.5 vs. 3.7 ± 0.6, respectively]; ‘Perceived safety’ [3.2 ± 0.6 vs. 3.1 ± 0.6, respectively]; and ‘Participation’ [2.6 ± 0.7 vs. 2.7 ± 0.6]). Most comments were positive (222/378, 58.7%), and about ‘Relational care and care interactions’ (CEQ ‘Professional support’). Neither the number nor positivity of comments appeared to differ between groups.

Conclusion

For women with chronic or gestational hypertension who remain well at term, we found no difference in childbirth experience between women randomised to planned early term birth versus usual care at term. Shared decisions about timing of birth may be more influenced by differences in clinical outcomes and costs.

Trial Registration

ISRCTN: 77258279