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Q&A

Obstetric Quality and Safety

Poster Session 1

(260) Quantitative analysis of birth experience narratives identifies drivers of trauma among parturients with hypertensive pregnancy

Tuesday, February 13, 2024

10:30 AM – 12:00 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Presenting Author(s)

Hana G. Murphy, BA (she/her/hers)

Medical Student
University of Michigan School of Medicine
Ann Arbor, MI, United States

Primary Author(s)

Ashley Hesson, MD, PhD (she/her/hers)

MFM Fellow
University of Michigan
Ann Arbor, MI, United States

Coauthor(s)

AN

Angelina Noll, BS

Medical Student
University of Michigan
Ann Arbor, MI, United States
HS

Hannah Slater, BS

Medical Student
University of Michigan School of Medicine
Ann Arbor, MI, United States
HW

Haley White, BA

Medical Student
University of Michigan School of Medicine
Ann Arbor, MI, United States
EL

Elizabeth S. Langen, MD

Associate Clinical Professor
University of Michigan
Ann Arbor, MI, United States

Objective: Hypertensive disorders of pregnancy (HDP) are associated with traumatic birth experiences. We aim to identify obstetric, interactional, and relational predictors of traumatic experiences as potential targets for quality improvement.

Study Design: Participants were recruited nationally via social media. Semi-structured interviews were conducted and transcripts were reviewed for patient-reported birth events. Analysts subjectively assessed participants’ characterization of their birth experience as “positive”, “neutral”, or “negative”. Logistic regression was used to predict birth experience based on intrapartum events. Sentiment analysis was used to quantify patterns in words and phrases with specific emotive or relational content. A custom lexicon was built from an independent training dataset of parturients recalling their self-identified traumatic births, in addition to a validated set of emotive terms representing joy, trust, anticipation, surprise, sadness, disgust, fear, and anger. Natural language processing techniques were used to extract these sentiments from participants’ descriptions of their birth.

Results: A total of 67 interviews were analyzed; 74.6% (N=50) of respondents had inductions, 50.7% (N=34) received magnesium, and 35.8% (N=27) were delivered preterm. None of these intrapartum events were significantly associated with a negatively framed birth story. Among people with negative birth experiences, fear was the dominant negative emotion in their birth narratives, driven by discussion of the “hospital” environment. “Medical”, “emergency”, “pain”, and “healthy” also contributed to sentiments of Trauma and Sadness (Fig 1).

Conclusion: For patients with HDP, expressed fears of medicalized birth were associated with negatively framed birth experiences, as opposed to specific interventions (e.g., magnesium infusion, preterm induction). Supportive and proactive counseling on the birth process may decrease medical anxiety and the experience of birth trauma.