Prevalence and Factors Affecting the Labor Experience: A Systematic Review

Introduction: Labor experiences have potential short and long term physical and psychological effects on women’s lives. Many factors influenced role in a mother’s experience of childbirth, both positively and negatively. This study aimed to determine the prevalence and factors that influence the delivery experience. Methods: This study searched for articles in the databases, namely Pub Med, Scopus, ProQuest, ScienceDirect, and Sage. The keyword used is labor experience. A total of 3654 articles were found, after selecting studies using PRISMA found 18 corresponding articles. Results: In this study, 18 studies were included in this systematic review, eight studies examined the prevalence of labor experiences. The prevalence of labor experience was 6.8-44%. Factors related to childbirth experiences included: individuals, such as age, parity, fear, self-efficacy, participation, control, expectations, preparation, and interpersonal, such as husband support, caregiver support, unwanted medical problems, such as prolonged labor, stimulation, and induction, forceps delivery, emergency cesarean section, and use of analgesics in mothers, low APGAR scores and transfer to the NICU. Conclusion: This review showed the various factors associated with the childbirth experience. This finding suggests conducting further research into the reason these factors influence the experience of labor. Hidayatin, N., Yunitasari, E., & Kurnia, I, D. (2021). Prevalence and Factors Affecting the Labor Experience: A Systematic Review. Pediomaternal Nurs. J., 7(2), 84-91. Doi: http://dx.doi.org/10.20473/pmnj.v7i2.27501 ARTICLE HISTORY Received : June 14, 2021 Revised : July 13, 2021 Accepted : September 8, 2021 Published : September 15, 2021


INTRODUCTION
Pregnancy and childbirth are physiological processes that are important and natural in every woman life and her family (Dahlberg et al., 2016). The physiology of childbirth is the same for all women, but understanding childbirth varies widely among different people. Understanding childbirth is influenced by cultural beliefs, traditions, and many other variables, and it is unique and specific to each woman (Mukamurigo et al., 2017). Childbirth and its associated experiences have potential physical and psychological effects on a woman's short and long term life.
The inclusive goal of caring for women during childbirth is to create positive experiences for them and their families while observing their physical and mental health, preventing complications, deaths, and emergency cases (Henriksen et al., 2017). Suppose the experience of childbirth is a positive perception. In that case, it can increase the amount of patience, responsibility, self-esteem, self-efficacy, self-sufficiency, and independence of the mother, improve the quality of life of women with better relationships between mother and baby, and generally empower women (Howarth & Swain, 2019). Empowering women makes them more involved in taking care of themselves and their children and controlling and managing other challenges (Karlström et al., 2015).
Many factors play an influential role in both positive and negative maternal experiences. Several studies have examined the factors that influence the experience of childbirth. Take into account the short-term and long-term physical and psychological importance. In addition, the effect of childbirth on women and the influence of different variables on the conception and experience of women's labor need to be explored. This study aims to examine the prevalence and factors that influence childbirth experience so that planning and strategies are appropriate (Hassanzadeh et al., 2020).

METHODS
This systematic review included five steps: formulating questions, identifying relevant databases, assessing the quality of papers based on a checklist, summarizing results, interpreting findings (discussion). In addition, this assessment evaluated the methodological quality of a study and determined the extent to which a study has addressed possible biases in its design, implementation, and analysis.

Formulation of Questions
The questions formulated for this systematic review are: What is the prevalence of negative childbirth experiences and the factors related to the birth experience?

Selection of articles
Full text or abstracts of all articles were documented from extracted search results. The researcher carefully studies the full text of the articles, and the related articles are selected, and then irrelevant items are excluded.

Inclusion and exclusion criteria
The inclusion criteria for the articles were all articles related to the experience of giving birth to women, which were published in the last ten years and are original articles. The exclusion criteria are articles in systematic reviews.

RESULTS
During the initial search through different databases, 3654 articles were found, 1784 articles were duplicated due to database overlap. Among the remaining 1852 articles, 1304 articles were excluded after reviewing the article titles and abstracts. Among the remaining 548 articles, 528 articles were excluded because the subjects were not relevant to the purpose of this study, and finally, 18 papers remained. In these 18 articles, eight studies examined the prevalence of childbirth experiences, and 18 studies examined the factors that influence childbirth experience.
The table 1 is basic characteristics of the included studies.
Of the eight studies, three studies conducted by Waldenstrom et al., the results of the first study showed that the prevalence of positive experiences was 71.1%. The second study results were the prevalence of non-positive post-partum experiences 28.9% (negative experiences 7.1%). The third study results showed that positive experiences amounted to 88.2% and negative experiences by 10.4%. In a study conducted by Gottvall and Waldenstrom, they examined the individual delivery experiences of 617 nulliparous women in Sweden. They found that the prevalence of positive experiences was 88.2% and negative experiences 11.8% (Waldenström et al., 2004).
A Canadian study conducted by Smarandache et al. reported a 90.7% prevalence of positive experiences and 9.3% negative experiences (Smarandache et al., 2016). Another study in Norway conducted by Henriksen et al. showed that the prevalence of positive experiences was 78.9%, and negative experiences were 21.1% (Henriksen et al., 2017). Another study conducted by Ulfsdottir et al. in Sweden found a prevalence of positive experiences 56% negative experiences 44% (Ulfsdottir et al., 2014). In Rwanda, a study conducted by Mukamurigo et al. reported a prevalence of positive experiences of 77.5% non-positive experiences of 22.5% (Mukamurigo et al., 2017).

Factors related to the experience of childbirth
Of 18 articles reviewed, the factors associated with the experience of childbirth can be categorized into three categories: individual, interpersonal factors and unexpected medical problems.

Demographic factors
Age Different results were obtained in terms of age in the articles reviewed. In the Smarandache et al. study, negative experiences were higher in older women. In Al Ahmar and Tarraf's study, older women (> 38 years) were more satisfied with their delivery experience. In a study conducted by Waldenstrom et al. in different years, there was no relationship between age and delivery experience (Al Ahmar & Tarraf, 2014;Waldenström et al., 2004).

Afraid
Two studies showed there was a link between fear and negative childbirth experiences. First, a study by Elvander found that women with moderate and high levels of fear, had higher rates of cesarean delivery and emergency deliveries than women with lower levels of fear, resulting in more negative experiences (Elvander et al., 2013).

Self Efficacy
This review showed that the level of self-efficacy decreases with increasing fear of pregnant women. Furthermore, this fear and decreased self-efficacy have been accompanied by an increase in negative childbirth experiences (Azmoude et al., 2017).

Participation
Researchers suggested in their study that women's participation and involvement in the labor process would reduce negative experiences of childbirth and increase women's satisfaction during delivery (Neerland et al., 2020).

Control
This review showed that seven studies reported an association between control and delivery experience. These studies determined that the higher the control of women in labor, the lower their negative childbirth experience, so that pain will be more tolerable and their labor more pleasant (Henriksen et al., 2020).

Hope
The results indicated that women whose expectations have been met tend to have negative childbirth experiences, indicating   (Karlström et al., 2015).

Preparation
Women who are ready to give birth, have labor scheduled, and are intentionally pregnant, have a more positive and enjoyable labor experience (Hassanzadeh et al., 2020;Henriksen et al., 2017).

Interpersonal factors
Husband's support The articles reviewed also showed that women's support from husbands reduced negative childbirth experiences and increased women's satisfaction with childbirth (Hildingsson, 2017).

Care provider support
Care provider support such as sufficient time allocated for women and support during delivery enhances positive delivery experiences (Dahlberg et al., 2016).

Unexpected medical problems
Mother A review of various studies showed that unexpected medical problems in mothers, such as prolonged labor, stimulation and induction, forceps delivery, emergency cesarean section, and analgesics in labor (epidurals and pethidine), have led to negative experiences in women (Baldino et al., 2020).

Child
Unexpected problems for the baby, including a low Apgar score and being transferred to the NICU, can lead to negative experiences. Conversely, touching the baby immediately after birth increases the level of positive experiences (Desmawati et al., 2020).

DISCUSSION
This study aimed to estimate the prevalence of negative post-partum experiences and associated factors. The cases that have proven effective in differing research results are: The studies used different questionnaires, different ranking and scoring methods in the questionnaires in the study. For example, in the study of Waldenstrom et al., the overall experience of childbirth was evaluated.
Responses were expressed on a 7-point scale; a score of 1 is considered very negative, and seven is considered very favourable. They rated 1-5 as non-positive experiences and perceived 6-7 as positive experiences (Waldenström et al., 2004).
In a study of the delivery experiences of 617 nulliparous women, answers were rated on a 7-option Likert scale. In this study, scores 1 and 2 were negative experiences, and

Sweden
To evaluate the impact of personality, sociodemographic and obstetric factors on birth experience in a cohort of healthy first-time mothers Cross-sectional 541 women were prospectively followed from the end of pregnancy until nine months post-partum US Identify factors associated with confidence and positive experiences during birth among a national sample of US mothers Mix method A nationally representative sample of women gave birth in 2005 to a singleton baby in a US hospital (N=1573).

Lebanon
To assess which socio-demographic factors are associated with this satisfaction.

Cross-sectional study
The sample consisted of 100 women who had given birth in the past three days before the interview.

Tehran
Determine the satisfaction degree of normal delivery and its relative factors in childbearing women at "Shaheed Chamran, Borujerd" and "Madiye, Tehran" Hospitals Descriptive correlative study 360 literate Iranian childbearing mothers were chosen via a non-probable quota sampling

Belgian and Netherlands
The purpose of our study is to assess the influence of expectations about childbirth, labor pain, personal control and self-efficacy on Belgian and Dutch women's satisfaction with childbirth Cross-national perspective 605 women, one at 30 weeks of pregnancy and one within the first two weeks after childbirth 3-7 were considered positive experiences. In the study conducted by Smarandache et al., answers are evaluated on a 5-point Likert scale; 1 and 2 are negative scores and scores 3-5 are considered positive experiences. The study of Mukamurigo et al., responses were classified from very bad experience with a score of 0 to very good experience with a score of 10; a score of 8-10 is considered a good and positive experience (77.5%) and a score of 7-0 is a bad or mixed experience (52.5%) (Smarandache et al., 2016).
A prior study was carried out on 1352 multiparous Norwegian women in which their first and last birth experiences were evaluated. The result was "Completely positive, moderately positive with negative elements, completely negative with positive elements, completely negative;" completely negative women with positive elements, negative responses are all considered negative experiences (Henriksen et al., 2017).
The result showed different study conditions, including sample size and characteristics. With a large sample size, relevant research results will be more precise. There was a difference between nulliparous and multiparous women, meaning that parity affects a woman's delivery experience. Negative experiences are more common in nulliparous women, indicating fear and anxiety in them (Levett et al., 2020). The experience of giving birth to women was evaluated at different post-partum periods. This act was conducted to examine the prevalence of childbirth experiences at different times of the puerperium.
Related factors in this review showed conflicting results concerning the relationship between age and labor experience. Women over the age of 30 had twice as many negative experiences as younger women. Older women are more satisfied with their deliveries. On the other hand, there was no relationship between age and childbirth experience (Sbrilli et al., 2020;Howarth & Swain, 2019). The cause of this inconsistency could be due to differences in the number of samples, the method of sampling, the type of questionnaire used, and times the post-partum experience was checked. Further studies were needed with a more significant number of samples and the appropriate time.
Women's physical and mental preparation is beneficial for enhancing a positive labor experience; this physical and psychological preparation can make them confident about coping with childbirth (Henriksen et al., 2017). Women can be prepared by attending childbirth classes or by receiving information from mothers, relatives, the mass media, and direct observation of childbirth. This information includes labor and obstetric problems (prolonged labor), labor techniques (breathing and relaxation).
This study found that women with high self-efficacy had reduced pain and stress and increased satisfaction during childbirth. Bandura's defines self-efficacy as an individual's belief in his or her ability to succeed in a particular position (Puspasari et al., 2018;Bandura, A, 2010). In studies, women claim that being confident about their abilities and strength will control their pain and problems.
In this study, one factor that had a significant effect on negative experiences was prolonged labor. Stress and anxiety are one of the causes of prolonged labor. In cases of anxiety and stress, epinephrine levels increase, leading to decreased uterine activity and prolonged labor. Hence, women who are more afraid of labor are more likely to give birth by forceps, emergency cesarean delivery and analgesic use, resulting in a higher rate of negative labor experiences (Hassanzadeh et al., 2020).
In this study, the infant's low Apgar score and transfer to the NICU negatively affected, and direct contact with the mother led to a positive labor experience. In the study of Hardin et al., women define having a healthy baby as a positive experience (Desmawati et al., 2020).

CONCLUSIONS
This review shows that different countries use various tools to examine the experience of childbirth, so it is necessary to provide standard mechanisms for accurately estimating the experience of giving birth to women. With this research, it can be seen the factors that can influence childbirth and how to handle it properly to deliver well.