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Women's Attitudes and Pregnancy Experiences
As Predictors of Satisfaction
With Childbirth and Perception
Of Pain During Labor

presented by
Naomi Goldblum

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MOMEH'S ATT TUDQS AND PREGRARCY EXPERIERCSJ
A5 PREDICTORS OF SATISFACTION
JITH CHILDBIRTH Ahi PERCEPTIOK

OF PAIN UURING LABOR

By

Naomi Goldblum

A THESIS

Subnitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF ARTS

Department of Psychology

1980

ABSTRACT
womi's ATTITUDES AND PREGNANCY EXPERIE‘JCES
A3 PREDICTORS OF SATISFACTION

WITH CHILDBIRTH AND PERCEPTION
OF PAIN DURIhG LABOR

By
haomi Goldblum

This study investigated the role that psychological variables
associated with a positive pregnancy experience play in predicting
women's perception of pain during labor and their satisfaction with the
childbirth process. The subjects were 35 primiparous women who were
participating in local childbirth preparation classes. During the third
trimester of their pregnancy the women completed the Jourard Body
Cathesix Scale, Rosenberg Self Esteem Scale, and several questionnaires
designed to investigate attitudes toward childbirth, motherhood, men-
struation, identification with one's mother, and expectation of pain
and satisfaction. Four to six days after delivery the women completed
self reports of their perception of pain, their satisfaction with child-
birth, as well as completing again the Body Cathexis and Self-Esteem
Scales.

Satisfaction with childbirth was found to be predicted by attitudes
toward motherhood, whether or not the pregnancy was planned, and pre-
natal body image (multiple R = .51. a = .03). Pain during labor was

found to be predicted by attitude toward menstruation, positive attitudes

toward childbirth, and prenatal body image (multiple R = .50, a.= .04).
There was no relationship between the perception of pain during labor
and women's satisfaction with their childbirth experience.

These results suggest that the perception of pain and satisfaction
during childbirth are two separate aspects of women's birthing experience.
In addition, some variables associated with a positive pregnancy exper-
ience are also predictive of women's childbirth experience. Additional
factors which may contribute to women's experience of childbirth and

which merit additional research are discussed.

ACKNOWLEDGMENTS

I’d like to thank Gary Stollak, my chairperson, and Larry Messe'
and Elaine Donelson, the members of my committee, for encouraging me
to conduct this research. They gave me permission to attempt work
which seemed risky as well as the freedom to make decisions for*myself.
At the same time, they were all available for support and help when
I wanted and needed it.

Special thanks go to all the instructors from the Association for
Shared Childbirth, the Expectant Parent Organization, and the
childbirth education staff at Lansing General Hospital for giving me
their precious time and encouragement. My gratitude and admiration
also goes to all the women who were willing to share this special
time in their lives with me, and made this research a reality.

My final words and thoughts are for Rusty, whom I thank for

sharing his love and his life with me.

ii

TABLE OF CONTENTS

Page
L I S T OF TABLES I I I I I I I I I I I I I I I I I I I I I I I V

INTRODUCTION I I I I I I I I I I I I I I I I I I I I I I I I 1

Personality Developnent and the Experience of

Pregnancy and Childbirth . . . . . . . . . . . . . . 2
Pregnancy: A Period of Good or Poor Adjustment . . . . 5
Psychological Variables Related to Healthy

Pregnancies . . . . . . . . . . . . . . . . . . . . 6
Satisfaction with Labor . . . . . . . . . . . . . . . . 8
Perception of Pain during Labor . . . . . . . . . . . . 9
Summary of Issues . . . . . . . . . . . . . . . . . . . ll

MEN‘OD I I I I I I I I I I I I I I I I I I I I I I I I I I I 11+

Instruments . . . . . . . . .
Personal data form . . . .
Incomplete sentences . . .

Body Image Scale (BIS) . . . .
Rosenberg Self-Esteem Scale (Esteem Sca

Satisfaction with Labor Scale

Perception of Pain Scale . . .
Procaure I I I I I I I I I I I I

o o 0 Ho 0 o o
(D
0 00v. 0 o o
H
O\

RmULTS I I I I I I I I I I I I I I I I I I I I I I I I I I 20

Inter-Correlations Among Third Trimester Variables . . 20
Interrelationships Among Postpartum Variables . . . . . 22
Third Trimester Variables with Postpartum Variables . . 22
Multiple Regressions . . . . . . . . . . . . . . . . . 23
Change from Third Trimester to Postpartum . . . . . . . 2h

DISCUSSION I I I I I I I I I I I I I I I I I I I I I I I I I 26

Prediction of Satisfaction with Labor . . . . . . . . . 27
Relationship of Self-Esteem.heasure to Other

Variables...........o.........30
Prediction of Perception of Pain . . . . . . . . . . . 33
Considerations for'Future Research . . . . . . . . . . 35
Summary . . . . . . . . . . . . . . . . . . . . . . . . 39

REF'mENcm I I I I I I I I I I I I I I I I I I I I I I I I I 41

iii

APPENDICES
A

B

TABLE OF CONTENTS (cont'd.)

Letter to Parents . . . . . . . . . . . . .
Consent Form . . . . . . . . . . . . . . .
Personal Date Fonm . . . . . . . . . . . .
Incomplete Sentences and Scoring Procedures
Body Image Scale . . . . . . . . . . . . .
Rosenberg Self-Esteem Scale . . . . . . . .
Satisfaction with Labor Scale . . . . . . .

Pain scale I I I I I I I I I I I I I I I I

iv

Page

45
47

49

57
61

Table

LIST OF TABLES

Third Trimester and Postpartum Variables . . . .

Interrater Reliability for Incomplete Sentences

Significant Correlations. Third Trimester and

Postpartum Variables . . . . . . . . . . . .

Regression Analyses . . . . . . . . . .

Change from Third Trimester to Postpartum

Page
. 13

ITTROLJCTION

Pregnancy, like many other events in women's lives, has received
little attention from researchers in psychology. Most of the litera-
ture that does exist on women's experience of pregnancy and its relation—
ship to psychological variables has focused on women who have had
difficult pregnancies. For example, general moodiness, depression and
overdependency have been shown to be related to physical complications
in pregnancy, labor, and delivery (heinstein, 1961). Complications of
labor and delivery, including prolonged first and second stage of
labor, and uterine intertia have been shown to be related to fear of
self, fear for baby, and dependency (Erickson, 1976; Grimm, 1961).

Low ego-strengthand maternal anxiety have been shown to be related to
length of labor and birth weight (McDonald, Gynthur, & Christakos,
1963). These studies have demonstrated the impact that aspects of
women's personality have on their experience of pregnancy and child-
birth. However, since this type of research focused on experiences of
women who have had difficult pregnancies and labors, they contribute
little towards understanding the experiences of women who have normal
pregnancies and labors.

It is assumed that for most women the period of pregnaicy is a
period that provides both rewards and stresses. It is a period of

l

change and growth, a time for integrating new roles into one's sense
of self. Psychological, social and biological factors can influence
the way women experience pregnancy and labor. The present research
focused primarily on psychological variables that are associated with
a positive experience of pregnancy and two aspects of childbirth--the
sense of satisfaction with the birthing experience and the perception
of pain during childbirth.

Personality DevelOpment and the Experience of Pregnancy and Childbirth

Until fairly recently few personality theorists explored the
relationship between events in adulthood, whether in men or women,
and continued personality development. The early literature on the
relationship between personality development and pregnancy reflects
this bias. In addition, personality theory has reflected the biases
of the society at large which has failed to study women seriously
(Frieze, Parsons, Johnson, Ruble, & Zellman, 1978). Given this
pervasive attitude in psychology concerning women as an object of
study the lack of material on pregnancy and its relationship to women's
development should not be surprising.

One theorist who has made a major contribution in the area of
pregnancy and personality development was Helene Deutsch. She con-
sidered childbirth the primary opportunity for women to achieve a
sense of self esteem, master, and autonomy. She compared labor's
importance in a woman's life to the role of healthy sexual adjustment
in a man's. She described childbirth as a highly pleasurable, sensual
act, calling it "an orgy of masochistic pleasure" which "contains the
acme of sexual pleasure" (Deutsch, 1945, p. 242). Childbirth was
the sign of attaining mature personality development in a woman, and

the final goal of female development. Deutsch (1939) also explained

childbirth from a perspective of women's place in society. The repro-
ductive function gratified the female's urges for sublimation and

sexual gratification. If not for the joys of childbearing, women wOuld not
have suffered being denied the opportunities for sublimation and sexual
gratification available to men.

A major problem with Deutsch's view of pregnancy is that she
clearly views childbirth as the one and only "final" goal of a woman's
life. She accepts and reaffirms the idea that women's primary role
is to bear children. In fact, she sees childbearing as the candy to
sweeten and make palatable women's acceptance of their secondary
status. Her discussions of childbirth and its relationship to
psych010gical development justify women's role as it was, rather than
investigate what the experience of pregnancy and childbirth is like for
14011183 0

As more recent personality theorists began to perceive develop-
ment as an ongoing process throughout life, the view of childbirth as
the final attainment of mature development also changed. Bibring
for example, fit the experience of pregnancy and childbirth into a
more general framework of adult development. Bibring considered
pregnancy to be one of a number of turning points which demand a
developmental adaptation during an adult's life.

"Crises, as we see it, are turning points in the life
of the individual, leading to acute disequilibria which
under favorable conditions results in specific matura-
tional steps toward new functions. We find them as
developmental phenomena, as points of no return between
one phase and the next when decisive changes deprive
former central needs and mode of living of their
significance, forcing the acceptance of highly charged
new goals and functions" (Erickson, 1950). Pregnancy,
as a major turning point in the life of the woman,
represents one of these normal crises, especially for

the primigrivada who faces the impact of this event
for the first time. (Bibring, 1950, p. 119)

Benedek (1950) also developed the idea that pregnancy and labor are
developmental tasks that are a part of a woman's continuing develop-
ment, not merely the sign of attaining a mature personality.

These theoreticians considered pregnancy a develogmental task
which was dependent on a woman's prior development and which affected
all future development. These theorists, however, still considered
pregnalcy a period of crisis, and usually explored pregnancy in women
with poor psychological development. They were not interested in
elaborating or exploring the experience of pregnancy and labor for
women who did not experience it as a period of crisis and upheaval.

A differing view of pregnaxcy is portrayed in the literat re on
childbirth that has bee: writtel by people who have worked llLGlSiVOly
with women during their pregwazcies and labors. Writers such as
Grantly Dick-Read, a british obstetrician, or Sheila hitzinger, a
mid-wife and anthropologist, agree that pregnancy and childbirth are
challenges that hold the potential for psychological difficulties.
However, they also feel that pregnancy and childbirth hold the poten-
tial for "a sense of exaltation and incomparable happiness . . .

Many women have described their experience of childbirth as being
associated with a spiritual uplifting the power of which they have

never previously been aware" (flick-Read, 19h4, p. 13). Or as Kitzinger
(1978, p. 13) states, "Giving birth is one expression of the individual's
personality. It is not a matter of success or failure, of beating
records or putting on a splendid performance, but of giving oneself,

mind and body to a creative experience." These authors describe
pregnancy and childbirth is language reminiscent of what haslow

describes as a "peak experience" (Maslow, 1970). Thus these writers

perceived the experience of pregnancy and childbirth as an opportunity
for new growth and development.
‘Eregnancy: A Period of Good or Poor Adjustment

In trying to understand the experience of pregnancy, some researchers
have tried to determine if pregnancy is, on the whole, a period of
good or poor psychological adjustment. Hooke and Markes (1962)
administered the MMPI to 24 women during their 8th month of pregnancy.
These women scored higher than the original normative female group on
seven scales, results that were interpreted as evidence that pregnazcy
is a period of good adjustment. These findings were supported by
Robin (1962) who, through interviews with pregnant women, concluded
that pregnancy is a period of well-being. Further, Osborne (1977)
compared the MMPI score of 84 pregnant women in their first trimester
to the MMPI scores of 1690 Medical patients. The pregnant women were
coxsidered to show better psychological adjustments, and showed
especially high ego—strength. On the other hand Tolor and Legrazia
(l977) using different methods, came to the opposite conclusion.
They had 206 women, approximately fifty in each trimester of pregnancy
and postpartum, make human figure drawings. The drawings by the
pregnant women were compared to drawings by a group of gynecolOgical
patients. The drawings by the pregnant women showed more nide fig1res,
emphasized the genitals more, and were smaller than the drawings made
by the control group. These results were interpreted as evidence that
pregnancy is a period of heightened body preoccupation, increased
insecurity, and diminished self-esteem.

A problem with all these studies is that they make gross judge-

ments of pregnancy as a whole being a period of increased or decreased

6

psychological health. They did not, for'example, analyze what variables
contributed to a woman's ability to maintain her well-being during
pregnancy. It seems that pregnancy and childbirth, like any event in
an adult's life, holds the potential for extreme pleasure and joy,
extreme pain and despair, or any combination of a variety of emotions
that people experience. Researchers must begin to more carefully
explore the variables which are associated with different types of
pregnancy experiences.

Psychological Variables Related to Healthngrggnancies

There is a large body of literature that exists on the relation-
ship between psychological variables such as stress and anxiety and the
experience of pregnancy. This literature. which explores the exper-
ience of pregnancy of women with various psychological difficulties,
will not be reviewed here. For summaries of this literature. see the
papers by Leifer (1977) and Cohler (1970). Reviewed below are those
studies that explore the relationship between psychological variables
and the experience of pregnancy for women who have normal pregnancy and
childbirth experiences.

Meyerowitz (1970) studied #07 primiparous couples. Over 300 items
from interview material were factor analyzed and correlated with satis-
faction during pregnancy. The cluster of items that accounted for
almost all of the women's sense of satisfaction during pregnancy
included having a positive body image. high self-esteem, and husband's
support of her self-esteem. The women who felt most proud during
pregnancy, liked their bodies even when distended. and were married
to men who thought they were sexy when pregnant, had the best adjust-

ment to pregnancy and the most satisfaction.

McConnel and Daston (1960) similarly found a strong relationship
between positive body image and good adaptation to pregnancy. They
administered the Rorschach and Osgood Semantic Differential to 28
multiparous women from three different clinics. and interviewed the
women to derive their attitudes toward pregnancy. These instruments
were given during the third trimester. and again three days postpartum.
Findings indicated that women with the most positive body images had
the most positive attitude toward pregnancy. In addition women
experienced their bodies during pregnancy as potent and strong on the
one hand and vulnerable on the other. Moreover. the women with the
most positive body images showed less vulnerability, though this trend
did not reach statistical significance.

Leifer (1976) intensively studied 19 white, middle class, primi-
parous women through their entire pregnancy and seven months postpartum.
Those with high self-esteem and positive body image early in pregnancy
not only had a satisfying pregnancy, but experienced it as a period of
personal growth. Women who had the most positive feelings about their
bodies reported feeling an increase in their sense of womanliness.
Leifer also reported that particularly in the third trimester. women
experienced more emotional stress. This study, as well as the one by
McConnel and Daston, begins to demonstrate the complexity of the
experience of pregnancy, a period when women may feel increased
vulnerability and stress at the same time that they feel increased
strength and womanliness

These studies indicate that women with a positive body image, good
self-concept, and positive attitudes toward pregnancy experience their

pregnancy positively: but women also experience stress and vulnerability,

particularly toward the end of pregnancy. The results of these studies
suggest that the psychological variables body image. self-concept, and
attitudes towards pregnancy and childbirth are critical for under-
standing women's experience of pregnancy. However, it is unclear how
these variables. which seem associated with the positive experience of
pregnancy, are related to the women's experience of the childbirth
process.

Satisfaction with Labor

Some recent research has tried to explore the experience of child-
birth and discern what type of woman has a positive childbirthing
experience. Grimm and Venet (1966) studied 125 normal pregnant
women through their entire pregnancy. A series of attitudinal ratings
scales were used to study the relationship between emotional character-
istics and childbirth experience. Obstetricians and nurses rated how
well the women tolerated labor and delivery. Women who expressed the
most favorable attitudes toward labor and delivery and who were
"independent", tolerated labor and delivery best. "Independent"
women were typified as self-reliant peOple who did not accept rigid
cliches and who did not adapt a sick role during pregnancy.

Doering and Entwisel (1975) interviewed 279 mothers 9 weeks after
childbirth. They found a strong positive correlation between prepara-
tion for childbirth, level of awareness during delivery, and sense of
satisfaction with labor and delivery. They also found that women who
prepared and actively participated in their labor and delivery felt
the most satisfaction with the birthing process.

Davenport-Slack and Boylan (197h) studied 75 women, interviewing

them four weeks prior to delivery and within 18 hours after delivery.

Women's verbatim accounts of their delivery experience were analyzed.
It was found that women who had had training, who had a positive
attitude toward childbirth, and described themselves as showing less
pain than average described their birthing experience most positively.

All these studies suggest that women who have positive attitudes
toward labor. who actively prepare for childbirth. who tend to be
self-reliant. and do not perceive their pregnancy as a time of illness
experience the most satisfaction with their labor. None of these
studies, however, investigated how the sense of satisfaction with labor
is related to the variables found to be associated with a positive
experience of pregnancy. One purpose of the present research was to
explore the relationship between satisfaction with labor and body
image. self-esteem, and attitudes toward childbirth. all of which are
psychological factors that are related to a positive pregnancy experb
ience. It was hypothesized that the variables related to a positive
pregnancy experience would also predict women's sense of satisfaction
with childbirth.
Perception of Pain duringLLabgr

One aspect of the experience of women during childbirth is their
perception of the pain, an experience subject to modification of personal
experiences. expectations, and culture (Melzak, 1961). Research on
the perception of pain during labor indicates strong relationships
between expectations about childbirth, personal attitudes towards
becoming a.mother’and the perception of pain.

Eysenck (1961) studied 100 primiparous women who delivered without
a history of miscarriage or Caesarian section. Prior to the delivery

the women were given the Maudsley Personality Inventory and interviewed.

10

Following delivery, they were interviewed again and given a self-report
of pain. The self-report of pain was highly correlated with fear'during
labor, hesitancy to have other children, and a sense of losing control
during labor. Interestingly, there was no correlation between the
women's self-reports of pain and ratings of pain made by the attendant
nurses.

Davenport-Slack and 80an (1974) related self-report of pain to
11 psychological and background variables in a study of 75 women.
The women were interviewed 4 weeks prior to delivery, and within 18
hours after delivery. The perception of pain was not related to
gravida, prenatal training. menstrual experience. sexual desire,
medication expectation, wanting husband present. or general overt
reaction to pain. The authors concluded that childbirth pain is
relatively uniform and invariant. They found that training did reduce
body-tenseness, as rated by nurses during delivery, but this fact did
not affect the women's own self-report of pain. This result is similar
to the finding of Eysenck (1961) that there was no relationship between
the women's self-report of pain and nurses' ratings of pain. Measures
of pain made by observers, even trained observers such as nurses, do
not appear to accurately reflect how labor feels to the woman giving
birth.

Standley (1978) interviewed a group of 53 primiparous couples
late in pregnancy, and observed them during labor. The degree of pain
exhibited by the women in labor was related to their "psychological
perspective”--their ability to reconcile the anticipated conflict and
changes parenting would bring. ‘The greater the women's conflict about

becoming a mother, the more pain she exhibited during labor.

11

Thus, data on the perception of pain during labor yield a rather
complex inconsistent picture. The work of Eysenck, using a self-report
of pain, and the work of Standley, using exhibition of pain, relate
the perception of pain to fears about labor, conflicts about becoming
a mother, hesitance to have other children, a sense of lack of control
during childbirth. The work of Davenport-Slack and Boylan, using a
self-report of pain, found no relationship between pain and 11 pre-
dictor variables. Given the lack of a relationship between self-report
of pain and ratings of pain by attendant nurses, it is particularly
difficult to interpret the results of these studies that used different
instruments for'measuring pain. Thus it is unclear if the perception
of pain is invariant, as Davenport-Slack and Boylan claim, or if it is
related to the conflicts mentioned above.

Further, none of these researchers related pain to variables found
to be associated with a positive pregnancy experience--body image, and
self-concept. Some of them did find a relationship between fears
about childbirth and pain, though it is unclear how a positive exper-
ience of pregnancy is related to the perception of pain during child-
birth. Thus, the proposed research also explored how the perception
of pain during labor, when measured by self-report, was related to
variables associated with a positive pregnancy experience.
gumma£y_of Issues

Some of the literature on psychological aspects of pregnancy
suggests that women who have a positive pregnancy experience have a
positive body image, good self-concept, and positive attitudes toward
childbirth. No research to date, however, has studied the relationship

between these variables and the experience of satisfaction with

12

childbirth itself or the perception of pain during labor. The present
research studied these relationships. This research assumes that
pregnancy and childbirth are not events that happen to women, but that
they are experiences which cannot be separated from the woman's develop-
ment as an individual. It is expected that psycholOgical variables
which are associated with a positive pregnancy experience will also

be related to satisfaction with the birthing process. These similar
relationships exist because the same aspects of a woman's personality
which enable her to experience her pregnancy positively will also

enable her to experience the birthing process positively.

This research also hopes to clarify the relationship between
women's experience of pain during labor and their sense of satisfaction
with childbirth. Few researchers have attempted to evauate both
women's satisfaction and their perception of pain during labor in
relation to the same set of variables. Evaluating the contribution
of the same variables to both women's sense of satisfaction and their
perception of pain during childbirth should clarify if these are
separate aspects of women's experience of childbirth.

In order to address these issues, measurements of body image,
self-esteem, attitudes toward childbirth, demographic variables,
and attitudes towards motherhood, menstruation, and one's own mother
were made during the participants' third trimester of pregnancy.
Multiple regression analyses were performed to determine the contri-
bution of these variables towards the prediction of satisfaction with
childbirth and the perception of pain during labor. Table 1 presents

a list of variables examined.

13

TABLE 1

Third Trimester*and Postpartum Variables

 

 

Third Trimester Variables ‘Epstpartum Variables

Body Image Body Image

Self-Esteem Self-Esteem

Expectation of Satisfaction Satisfaction with Labor
Expectation of Pain Perception of Pain during Labor

Positive Attitude towards Childbirth
Negative Attitude towards Childbirth
Attitude towards Menstruation
Identification with own Mother
Attitude towards Motherhood

Age

Socioeconomic Status
Training for Childbirth
Pregnancy Planned
Length of Relationship

METHOD

Subjects

The subjects were 35 women from various childbirth education
classes in the Lansing, Michigan area. About 10% of the women solicited
to participate in the research volunteered. The average age of the
women was 25.11; years (SD = 3.40), and mean length of marriage was
3.41 years (SD = 2.35). All women but one were married. Twenty-five
of the women had planned their pregnancies, 10 had not.

All the women had been involved in childbirth education classes.
Twenty-six of the women received Lamaze training, from one of two
sources—-the Association for Shared Childbirthl, or Lansing General
Hospital. Both of these sources hold classes which teach the Lamaze
breathing procedures, and the classes are taught by certified Lamaze
instructors. Nine of the women were trained through the Expectant
Parent Organization (EPO). EPO training differs from Lamaze in that
it teaches additional breathing techniques, uses only registered
nurses as instructors, and seans to teach a greater acceptance of

hospital procedures. There was very little substantive difference

between either of the Lamaze prams or the EPO program.

 

1 One woman participated in Lamaze classes taught by her doctor's wife,
a certified Lamaze instructor no longer associated with the Associa-
tion for Shared Childbirth.

1h

15

Instruments

The following instruments were completed by all the women:

1. Personal data form

2. Incomplete sentences

3- Body Image Scale

4. Rosenberg self-esteem scale

5. Satisfaction with labor scale

6. Perception of pain scale

Personal data form: The personal data form collected information
on the women's age, education, occupation, length of'marriage or
relationship, type of training for childbirth, whether the pregnancy
was planned, and the husband's occupation. See Appendix C for a copy
of this instrument.

Incomplete sentences: The incomplete sentences were designed to
provide an unstructured stimulus through which the women's attitudes
towards childbirth and several other variables could be freely expressed.
The following variables were derived from the scoring of the incomplete
sentences: positive attitudes towards childbirth, negative attitudes
towards childbirth, attitude towards motherhood, identification with one's
mother, and attitude towards menstruation.

The positive and negative attitudes toward childbirth expressed
in the sentences were scored using Vestbrook's (1977) classification
of positive and negative aspects of childbearing. Trained raters
counted the total number of positive and negative aspects of childbirth
in the women's responses to the first four sentence stems.

Attitude towards motherhood was derived from rating the response
of sentence stem #5 on a five point scale ranging from negative atti-
tude, scored as l, to positive attitude, scored as 5. Identification
with one's mother was derived from rating on a similar 5 point scale,

the response to items six through eight, and then averaging these scores.

l6

Attitude towards menstruation was similarly derived from rating items
9 and 10. See Appendix D for a copy of the incomplete sentences and
scoring procedures.

All the variables derived from the incomplete sentences were rated
independently by four trained raters; the rater's scores were then
averaged to produce each woman's score for each of the variables.

Table 2 contains the interrater reliability for each variable, and
for each pairbwise combination of the h raters.

Body_Image Scale (BIS : The BIS consists of 50 items rated on a
5 point scale ranging from very dissatisfied (1) to very satisfied (5).
The BIS is a.modification of the Jourard Body-Cathexis scale, modified
to include reference to genitals and overall satisfaction with one's
body. The BIS score is the sum of the endorsed responses divided by
50. This overall score has been shown to be highly related to satis-
faction with self and to security with one's self-image. The measure
has been shown to have good internal consistency and construct validity
(Secord and Jourard, 1953: Jourard and Secord, 1955). See Appendix E
for a copy of the BIS.

(Rosenberg Self-Esteem Scale (Esteem Scale): The Esteem Scale

consists of 10 items scored on a h point scale ranging from strongly

 

agree to strongly disagree. It was chosen for its brevity and its
high reliability (Rosenberg, 1955). See Appendix F for a copy of
the Esteem Scale.

Satisfaction with Labor Scale: This self-report scale contains
10 items and was developed for this study. The items were scored on
5 point Likert scales, and the score for satisfaction was the sum of

the endorsed items divided by the number of items endorsed. There

Interrater Reliability for Incomplete Sentences

1?

TABLE 2

 

 

 

 

 

 

 

Pairwise Combinations of Raters Avg.
Variable 1:2 1:3 1:4 2:3 2:4 3:4 Reliability
Positive Attitude .61 .77 .74 .63 .52 .52 .63
Negative Attitude .76 .74 .66 .73 .61 .57 .68
Motherhood .70 .65 .54 .71 .67 .64 .65
Identification with .75 .71 .73 .64 .74 .67 .71

Mother

Menstruation .72 .73 .85 .93 .82 .84 .81
Avg. Reliability .71 .73 .70 .73 .67 .65 .70

 

 

 

18

were two types of items on the scale. Items 1, 8, 9, and 10 were
overall ratings of feelings such as satisfaction, pleasure, etc.,
associated with bodily sensations during delivery. Items 2 through 7
were the women's ratings of their ability to relax and feel in control
of their bodies during the three stages of labor, and the support they
received from their husband during childbirth. These items were based
on the work of Doering and Entwisel (1975) which found an association
between the expression of satisfaction with childbirth and taking an
active role during childbirth. This scale was administered both during
the third trimester and postpartum, with phrasing modified to make

it appropriate to the particular time of administration. See Appen-
dix G for both versions of the Satisfaction Scale.

Perception of Pain Scale: This scale is a 10 item self-report
measure developed for this research. Each item is scored on a 5 point
Likert scale. The total pain score was the total score for all endorsed
items divided by the number of items endorsed. The items were derived
from questionnaire items previously shown to be related to the per»
ception of pain during labor (Eysenck, 1961: Davenport-Slack.& Boylan,
1974) and from anecdotal accounts of childbirth (The Boston Women's
Health Book Collective, 1976; Kitzinger, 1978). This scale was
administered both during the third trimester and postpartum, with
phrasing modified to make it appropriate to the particular time of
testing. See Appendix H for both versions of this instrument.
Procedure

The participants in this study were contacted through local child-
birth education classes. The researcher gave a brief presentation of

the research including what volunteers would be expected to do during

19

the research. Interested women were then given an envelope containing
a cover letter explaining the research again (see Appendix A), a
consent form (see Appendix B), the personal data form, the incomplete
sentences, BIS, Esteem Scale, Satisfaction Scale, and Pain Scale. The
women completed these at home during their third trimester and mailed
them back to the researcher at that time. The women were then contacted
by phone by a research assistant, thanked for their help, and asked to
contact the researcher when they gave birth. The women were also
contacted periodically by research assistants to ensure that the time
of birth would be accurately noted.

Four to six days after delivery, the BIS, Esteem Scale, Satis-
faction Scale, and Pain Scale were administered to the women in their
homes. If the women could not be interviewed within this time period,
they were not included in the final sample. In addition, women who
had Caesarian deliveries, or medical complications that required an
extended stay in the hospital were not included in the final sample.
Every effort was made to have the final contact made by the same

research assistant who had been contacting the women prior to the birth.2

 

2In addition to the procedures described above, all the women in the

sample were interviewed during this contact, and the interviews tape
recorded. The women were asked to respond to the following three
questions: 1. Describe whatever thoughts or feelings you can recall
experiencing from the time you first thought you were in labor until
you gave birth. 2. In what way did your birthing experience differ
from what you had expected? 3. Based on your own experience, what
advice would you now give to someone about to have their first child-
birth? This data has not yet been evaluated, and therefore will not
be discussed in the remainder of this paper.

RESULTS

One step multiple regressions were performed to assess the contri-
bution of third trimester variables toward variation among the women
in the satisfaction and the pain that they reported. The first step
in these analyses consisted of constructing a simple correlation
matrix for all the possible pairwise combinations of the variables.
The expected number of significant correlations for 18 pairwise
combinations with alpha less than or equal to .05 is 7.62. This
value is much less than the 32 significant correlations found in the
present data. Before presenting the results of the multiple regression
analyses, some comments are made regarding the significant simple
correlations (see Table 3 for the significant correlations. a :_.05).
InterbCorrelations_Among;Thigd;Trimester'Variables

There were a number of unexpected relationships present among the
third trimester variables. The significant relationships between age
and self-esteem, and length of relationship with positive and negative
attitudes towards childbirth were unexpected. They suggest that in
this sample, women who were older had higher self-esteem and women with
longer*marriages had more positive attitudes toward childbirth. The
negative relationship between body image and expectation of satisfaction

with labor was also unexpected. The literature reviewed earlier in

20

TABLE 3

Significant Correlations*, Third Trimester and Postpartum Variables

 
   

partum
Variables

   

 
 
  
 
 

Third Trimester Variables

 
 

O

  

Sati faction
Identification

Pregnancy

 

  
  

  
 
  
  

  
  

Self Esteem
Satisfaction
Pain

Positive Attitude
N tive Attitude
Menstruation

Motherhood
ca on
with Mother

  

  
  
    
  
 

 

Third Trimester Variables

 
    

 
  

Bod
Self Esteem
Satisfaction
Pain

 
 
 
 

Postpartum
Variables

* o i .05

   
  
 
 

22

this paper suggested that there would be a positive relationship between
body image and the expectation of satisfaction with labor.

Self-esteem did not show the expected relationships to body image,
positive attitude towards childbirth, or expectation of satisfaction
with labor. This variable, however, did show a positive relationship
to age, identification with one's mother, and attitude towards mother-
hood.

Having a positive attitude towards childbirth was positively
related to body image, and attitude towards menstruation, which were
as expected. Positive attitude towards childbirth was also positively
related to length of relationship and whether the pregnancy was
planned, which were results not previously found in the literature.
linterrelationships Among Postpartum Varigbigg

Only two intercorrelations of the postpartum variables were
significant, and both of these were in the expected direction. There
was a positive correlation between self-esteem and perception of satis-
faction. There was also a negative correlation between body image with
the perception of pain during labor.

As in the third trimester'measures, there was no relationship
between body image and self-esteem.

Third Trimester Variables with Postpartum Variables

A number of variables were predictive of esteem following birth,
though not all of them as expected. The length of the marital relation-
ship, and having planned the pregnancy were both associated with lower
self-esteem after childbirth. Body image in the third trimester was
also negatively related to esteem postpartum. This pattern of findings

indicate that for this sample, a more positive body image prior to

23

childbirth, a longer'marital relationship, and having planned the
pregnancy were associated with lower self-esteem postpartum. Other
correlations, however, were in the expected direction. There was a
positive relationship between identification with one's own mother and
self-esteem postpartum. There was also a positive relationship between
self-esteem in the third trimester and postpartum self—esteem.

The correlations between third trimester variables and body image
postpartum were as expected. Body image and self—esteem during the
third trimester were positively related to body image postpartum.

The variables that were significantly related to the perception
of pain were all in the expected directions. Women who expressed
positive attitudes towards childbirth and viewed their'menstruation
as more comfortable than most women's reported less pain. There was
also a positive relationship between the expectation of pain in the
third trimester and the report of pain following the birth.

The relationship between third trimester variables and the
perception of satisfaction were all in the expected direction. There
was a strong relationship between the expectation of satisfaction and
the actual report of satisfaction following childbirth. Women who
expressed more positive attitudes towards becoming mothers and who were
older also reported more satisfaction with their labors.

Multiple Regressions

Simple one-step multiple regressions were performed to see if a
cluster of third trimester variables would account for’much more of the
variance of either the perception of pain or sense of satisfaction
than individual variables. One-step regression analyses were performed

because there were no hypotheses about which variables had a more

24

primary causal relationship with criterion variables. Table 4 contains
the significant multiple regression results.

The multiple regression analysis revealed that the motherhood,
body image, and planned pregnancy variables accounted for 25% of the
variance of satisfaction with childbirth. It was also found that the
following variables accounted for 26% of the variance of the perception
of pain: attitude towards menstruation, a positive attitude towards
childbirth, and body image.

Change:§£om Third Trimester to Postpartum
Body image, self—esteem, satisfaction with labor, and perception

 

of pain were measured both during the third trimester and postpartum.
Two tailed t-tests were performed to evaluate if there was a significant
change in any of these measures from the third trimester to postpartum.
See Table 5 for a summary of the results. There were two significant
results. Self—esteem postpartum was significantly higher than esteem
during the third trimester. The perceived pain was also significantly

greater than the expectation of pain during the third trimester.

25

Table 4

Regssion Analyses
Postpartum Third Trimester Multiple Simple Overall

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Variable Variable R R F PrOMbi lit
F""'"""' i _.___.Y
igffmtm‘ Attitude towards
Childbirth Motherhood .36 .36 4.2g .04
30d: Image 0’45 ”£7 10?“ 001+
Premgncy planned .51 .20 3.42 .03
Perception
of Menstruation .42 - .4; 6. 55 . 02
Pain
. Positive Attitude .49 -.40 4.76 .02
Mi! Image 050 “ogj 30g; 004
Table 5
Chapge from Third Trimester to PostErtum
Third Trimester Postpartum Two-tailed
_V_l_a__riable Me_ap Mean JDF t Probability .
Body Image 3.58 3.75 J4 1.61 .116
Self Esteem 3.42 3.56 33 3.;4 .004
Satisfaction J.3§ _3.42 34 J9 .432
7 Pain 2.47 2.81 33 3.34 .002

 

 

 

 

 

DISCUSSION

One of the motivations behind this research was the hope of
collecting data that would represent a wide range of women's birthing
experiences. It had been hoped that women from a wide range of back—
grounds with various training experiences would be participants. The
actual sample did not reflect the diversity that had been hoped for.

The greatest limitation was the fact that all the women were involved

in extensive training for childbirth. Attempts were made to include in
the sample women training for homebirths with a local midwife. Unfor-
tunately only one woman from this group volunteered and gave birth
prematurely so she could not be included in the sample. This sample
showed no variability in terms of training, and also was more intensively
involved in training for childbirth than is common.

The sample was almcst entirely from the middle classes. In 43%
of the families, the husbands were involved in factory jobs, trades, and
other nonprofessional occupations. The rest of the sample included
college graduates and professionals. The sample was entirely White.

The mean age for the women was 25 years, which is typical of the age
of subjects in other research on childbirth, but may be a bit old for
a sample of primipari. Finally, the women who participated were

volunteers. No attanpts were made to explore the women's motivation

26

27

for participating. However, it is likely that these women were more
motivated to learn about their pregnancies and to speculate on its
role in their lives than other women who did not volunteer.

The special character of these women.must be kept in mind when
interpreting the results. The homogeneity of the sample may have
tended to decrease the variance of the research variables, attenuating
the possible range of the regression coefficients. In addition, it
limits the degree to which the results are generalizable.

Prediction of Satisfaction with Labor

The hypothesis that body image, self-esteem, and attitudes towards
childbirth would have a positive relationship with a sense of satis-
faction with labor was partially supported. The single variable that
contributed most towards the prediction of the women's satisfaction
with childbirth was the women's attitude towards motherhood (r = .34).
The prediction of satisfaction was strengthened when body image and the
fact that the pregnancy was planned were included into the regression
equation (multiple R = .51). In this sample, women who had the most
positive attitude towards becoming a mother, who planned their preg-
nancies, and who in the third trimester had less positive body images,
tended to express the most satisfaction with their labors.

It is interesting that in the multiple regression equation, body
image has a negative relationship with sense of satisfaction. It had
been hypothesized that a positive body image in the third trimester
would be associated with satisfaction with the childbirth experience.
This hypothesis was not supported. Myra Leifer (1977) studied the
progress of 19 primipari from their first trimester through the seventh

month postpartum. She reported considerable change in body image for

28

her sample throughout pregnancy. The women in her study reported
less positive body images as the pregnancy progressed. It may be
that in the present sample the decrease in body image by the third
trimester was so great that the relationship between body image and
satisfaction with labor was not in the expected direction. Another
possible explanation is that women with very high body image scores
in the third trimester were attempting to deny some of the increased
anxiety and stress they were experiencing. In this case, women who
could admit to their concerns, as expressed in a decreased body image,
would also be able to most honestly feel satisfied with their experience
of childbirth. Another consideration is that women in this sample
were tested at varying points in their third trimester. While it is
extremely difficult to determine with accuracy when women enter their
third trimester, it may be important to control more precisely when
testing is done during women's pregnancy.

A result that makes a great deal of intuitive sense is the con-
tribution of whether the pregnancy was planned to the sense of satis-
faction with labor. Women who planned their pregnancies showed
greater satisfaction with labor. While this is not a surprising
finding, the impact of planning for pregnancy on women's experience of
childbirth has only been evaluated in one other study. Leifer (1977)
reported that 4 women in her sample had unplanned pregnancies. These
4 women were the only respondents in Leifer‘s sample of 19 to experience
a decrease in self-esteem during pregnancy. They did not show signs
of increased maturation during pregnancy and experienced even more
stress postpartum when confronting their new role as mother. They

also showed less emotional attachment toward their infants than the

29

other women in the sample. These results, as well as the results of
the present sample, suggest that exploring whether a woman has planned
her pregnancy has implications for her experience of the birthing
process. Leifer's study raises the additional concern of the impact
of having a planned pregnancy on a woman's attachment to her child.

In the present sample, planning the pregnancy was also positively
related to length of relationship and positive attitude towards child-
birth. These correlations suggest that women who have been in their
relationships longer, who view childbirth as having a positive impact
on their lives, and planned to become pregnant were more likely to
feel more satisfaction with their childbirth experience. Women who
thought about the consequences of becoming pregnant, and who felt they
were ready to assume the role of mother expressed greater satisfaction
with delivery. Perhaps Grimm and Venet's (1966) and Doering and
Entwisel's (1975) finding that women who actively prepare for labor
find it more satisfying should include whether the pregnancy was
planned as an aspect of active preparation for labor.

While women's age had a positive relationship with satisfaction
when the simple correlations were examined, age did not enter into the
multiple regression equation. Adding this variable to the equation
with motherhood, the fact that pregnancy was planned, and body image
both decreased the size of the regression coefficient and decreased
the precision of the estimate. All the variables which did enter
into the regression equation for satisfaction were correlated with
positive attitude towards childbirth in the third trimester (mother—
hood r'= .30, body image r'= .49, pregnancy planned r'= .50). These

variables form an interrelated cluster of variables (motherhood, body

30

image, pregnancy planned) which are primarily related to the women's
decisions to become mothers. On the other hand, the impact of age on
satisfaction may represent the influence of broader socioeconomic and
biological factors on the sense of satisfaction. Age was related to
length of relationship (r'= .35), socioeconomic status (r'= .61) and
self-esteem (r'= .31). It is interesting to note that it is the
psychological variables related to assuming the role of mother which
accounts for’most of the variance of the women's sense of satisfaction.

The women's expectations of their satisfaction actually had the
strongest predictive relationship with their reported satisfaction,
r'= .72. The women's estimate of their satisfaction with labor had
more predictive power than the cluster of third trimester variables
which made a significant contribution toward the variance of satis-
faction with 1abor. It seems that by the third trimester, women who
have chosen to become pregnant, who have positive attitudes about
motherhood, and have a less positive body image, have settled enough
of their concerns about childbirth to accurately predict how satisfied
they will be with their experience of labor. This is possible since
the women who have taken an active role from the moment of planning
their pregnancies will also actively plan for and arrange to have the
type of childbirth experience they want.

Relationship of Self-Esteem Measure to Other Variables
The most difficult results to explain are those involving the

 

relationship of the selfresteem measure to other variables. Self-esteem
did not contribute to the prediction of satisfaction with labor, nor
did it show the expected relationship to body image or positive atti-

tudes toward childbirth. There are several possible explanations for

31

the lack of relationship between the self-esteem measure and the other
variables. The first possibility to consider is how the data fit the
assumptions of regression analysis. One may calculate a regression
coefficient for any set of data, whether or not it is normally dis-
tributed. However, the possible range of the regression coefficients
is constricted to the extent that the distributions involved differ
from others in the sample (Carroll, 1961). Examining the distributions
of the variables in the present study revealed that the distribution
of the self-esteem measure was more lepto-kurtic than any other
variable (Kurtosis = -l.l3) and that it had the smallest standard
deviation (32 = .32). Research has demonstrated that the sampling
distribution of Pearson r in leptokurtic populations is significantly
different than the theoretical distribution of r in samples of size

15 and 90. (Norris and Hjelm, 1961). Small, leptokurtic samples
produce fewer significant correlations than expected. The distri-
bution of the values of the self-esteem measure in this sample may
have precluded obtaining a significant multiple regression coefficient
which contained the self-esteem measure.

Several aspects of this sample probably contributed to the small
variance of the self-esteem measure. All of the women in the sample
may actually have had very high self-esteem. They all were volunteers
and it is highly unlikely that women who had low self-esteem would have
volunteered to participate in a study of this type. In addition,
social desirability may have contributed to the women's tendency to
endorse items reflecting high self-esteem. The power of the social
desirability may have been especially strong for a sample of women

involved in preparing for childbirth, and participating in the extensive

32

prenatal training of this sample. All of these factors would act
together to decrease the variance of the self-esteem measure and
decrease the range of possible regression coefficients.

The other factor to consider when evaluating the results involving
the self-esteem measure was the instrument used. The Rosenberg Scale
was chosen primarily because of its brevity. It is extremely simple,
and only measures one aspect of self-esteem--the aspect of self-
acceptance. It may be that this one notion is not complex enough to
capture the contribution that previous researchers have described as
self-image (Meyerawitz, 1970), or self-reliance and independence
(Davenport-Slack & Boylan, 1974). By choosing a measure that would
not intimidate potential volunteers, the meaningfulness of the
variable may have been sacrificed.

A more meaningful measure which might be interesting to apply to
research of women's pregnancy and birthing experience is Jane Loevinger's
(1977) scale of ego development. Loevinger views ego development as
related to psychosexual and cognitive development, yet at the same
time separate. She also views it as related to the development of
optimum mental health. Her scale provides both a develOpmental system,
and a characterological system. Thus defining a person according to
Loevinger's 10 stage scale provides one with information about their
impulse control, character development, interpersonal style, conscious
preoccupations and cognitive style. It would be interesting to explore
how women who have higher ego development experience their labor.

Would they tend to be the women who experience it as a "peak experience",
a moment of growth and fulfillment? These speculations deserve future

consideration.

33

‘Prediction of Perception of Pain
The results of the analysis of the perception of pain were

 

interesting in that they gig demonstrate a relationship between third
trimester variables and the perception of pain during childbirth.

The variable that contributed the most towards the perception of pain
was the women's attitude toward menstruation. Women who reported their
periods as more comfortable than most and as not painful also reported
less pain during childbirth (R = .42). Positive attitudes towards
childbirth increased the amount of variance of reported pain accounted
for to 24%. Women with both positive attitudes towards menstruation
and who expressed many positive feelings about childbirth were likely
to experience less pain during childbirth, according to their self-
report.

Body image did contribute to the regression equation for the
perception of pain. Women with a higher body image reported less pain.
However, the increase in the amount of variance accounted for by the
addition of body image to the multiple regression equation was very
small-~only 1 percent. It is clear from research reviewed earlier
that body image is a sensitive measure of women's experience of
pregnancy. However, in terms of predicting women's perception of pain
during labor, body image contributed little compared to women's
attitude towards menstruation and attitude towards childbirth.

It is interesting that the regression equation that predicted
pain contained positive attitudes towards childbirth, and not negative
attitudes. The expression of negative feelings about childbirth was
not associated with the report of more pain. Women who expressed both

positive and negative feelings about childbirth were not more likely

34

to experience pain than women who expressed only positive feelings

about childbirth. Women who have more positive feelings about child-
birth perceive it as less painful, even if they are aware of and express
some negative feelings about childbirth. This pattern is suggestive

to women with higher ego development, who are able to perceive and
articulate the complexity of their experiences.

These results do not support the work of Davenport-Slack and
Boylan (1974), which found the perception of pain during childbirth
invariant and unrelated to 11 predictor variables. Not only was there
a significant relationship between reported pain and menstrual attitude
and positive attitude towards childbirth, but there was clearly
variation in the women's perception of pain during labor. This research
suggests that the amount of pain which women perceive during childbirth
does vary, and that having a positive attitude towards childbirth and
a positive attitude towards menstruation are related to the perception
of less pain during labor.

The women's expectation of pain was not as accurate a predictor
of their self-report of pain as the combination of variables used in
the regression analysis. In addition, women's expectation of pain
in the third trimester tended to underestimate their’actual self-report
of pain following delivery. The difference between their expectation
of pain during the third trimester and their actual self-report of
pain was significant, a = .002. It may be that while one may prepare
for childbirth, and try to ready oneself for dealing with the pain,
one cannot accurately anticipate how painful childbirth will actually
be. It is also possible that different training procedures are better

able to help women prepare and anticipate the pain during childbirth.

35

All the women in this sample participated in very similar training
prOgrams. In fact, there were no differences which training accounted
for in this study. It would be interesting to see if women's expecta-
tion of pain differed if they went through different training proce-
dures.

There was no direct relationship between the perception of pain
and the sense of satisfaction with childbirth. For this sample, women
who had very satisfying childbirth experiences were just as likely
to experience as much pain as women who had less satisfying childbirth
experiences. This is interesting in light of some of the interview
material that was collected when the postpartum measures were admin-
istered, but which has not yet been analyzed. A number of the women
in this sample, when describing their childbirth experience, reported
some concern that if they had experienced pain, they were somehow
failing at their childbirth experience. Some of them felt that if they
had gone to class and studied their breathing techniques, they should
not have experienced any pain. They saw pain as a sign of having
failed in some sense. Fortunately, for*the sample as a whole, the
perception of pain did not diminish the women's sense of satisfaction
with their childbirth experience.
gppgiderations for Future Research

The association between satisfaction with labor and attitude
towards motherhood suggests a relationship between women's satisfaction
with childbirth and Erik Erickson's theory of development (1965).
Erickson outlines a theory of personality development that extends
through adulthood. Each of the stages he defines is based in the out-

comes of the previous stages and adds a new conflict for the individual

36

to confront. While he does not elaborate upon the adult stages, he
lists the task of adulthood as developing "generativity". Generativity
includes productivity, creativity, and also the concern with estab-
lishing and guiding the next generation. Erickson explicitly states
that the mere fact of having children does not insure the achievement
of generativity. For generativity marks the attainment of new growth,
a new ego quality. Nor must one have children to attain generativity.
However, I wonder if the women who found childbirth satisfying,
who had chosen to become pregnant and saw motherhood as a positive
role, were people who had begun to successfully resolve the conflict
between generativity and stagnation. As Erickson so clearly states,
their ability to resolve this task was determined by their previous
development, their prior personality development. A fruitful course
of research may be to explore whether or not women giving birth had
begun to achieve Erickson's VII stage of developnent, of generativity
vs. stagnation. One would predict that women at lower stages of
Erickson's epigenetic chart would experience less satisfaction during
childbirth. Women at the stage of generativity vs. stagnation would
be more likely to find their childbirth experiences satisfying. This
does not presume that childbirth is the only way to fulfill this
stage of development. Rather, it can be hypothesized that women who
have reached this stage, whose "identity" and "intimacy" needs have
been filled or conflicts around these issues resolved, and who choose
to become mothers will experience the most satisfaction and a sense of
growth through the birthing process (Stollak, personal communication).
This research was primarily concerned with examining the relation-

ship between certain aspects of women's personality and their

37

experience of childbirth. The research variables were able to account
for approximately 25% of the variance of satisfaction and pain. The
question remains, what may account for the other 75% of the variance?
An area that was not explored in this research was the impact of
interpersonal variables on the women's birthing experience. Inter-
personal variables include the woman's relationship with her husband,
her doctor, and the support she received from those present during the
actual delivery. The impact of the support from others must be studied
in conjunction with when it occurs during the pregnancy and delivery.
For'example, in exploring the impact of a husband's support on his
wife's birthing experience, one must evaluate the marital relationship
during pregnancy as well as the husband's actual participation during
the birthing process. Some research has demonstrated the impact of
the marital relationship on the women's sense of satisfaction during
childbirth (Novi, Block, Charles, Myering, Meyers, 1977: Meyerowitz,
1970. Davenport-Slack a Boylan, 1974). Some of the results of this
study also suggest a relationship between the marital relationship and
a woman's experience of pregnancy and delivery. For this sample, the
length of the relationship was positively correlated with the pregnancy
being planned (r = .46), and positive attitudes towards childbirth
(r = .33). Research by William Henneborn and Rosemary Cagan (1975)
demonstrated the need to explore not just the marital relationship
during pregnancy, but the impact of how the husband participates during
the labor. Henneborn and Cogan compared the labors of women whose
husbands attended labor and delivery with the labors of women whose
husbands attended only during the first stage of labor. All the

subjects were enrolled in equivalent childbirth education pragrams,

38

and there were no differences between the two groups of husbands on

a number of attitudinal measures recorded prior to childbirth. However,
the women whose husbands remained present through the entire childbirth
process reported more positive feelings and less pain than the women
whose husbands were only present during the first stage of labor.

The women whose husbands were present during delivery also took less
medication during the birthing process.

The importance of the women's support during labor is also
suggested by the work of Doering and Entwisel (1975). In this study,
there was a significant relationship between awareness during child-
birth and women's attitudes towards the birthing experience. Aware-
ness during labor was strongly related to Lamaze training which
emphasized the active participation of the women's husbands during the
entire birthing process. Awareness during childbirth was also positively
related to a positive initial reaction to the newborn child. This
study suggests a relationship between the husband's support during
labor, the quality of the wife's birthing experience, and the parent's
attachment to their child. The results of this study and the study
by Menneborn and COgan suggest that the impact of support that women
receive from others must be explored both during the period of
pregnancy and during the actual birthing process.

In addition to the individual and interpersonal psychological
variables, the impact of social factors must be considered. Social
factors which need to be explored include social status (all the
research on "normal" childbirths have had primarily middle class
participants), roles which women are allowed to assume, and availability

of alternative birthing facilities (i.e., hospital births vs. homebirths).

39

All of these larger social issues affect the amount of choice and control
women can exercise over their birthing experiences. They also affect
when and why women decide to become pregnant and whether her decision
will be supported within her community.

It is clear that there are many additional avenues to explore
to understand the forces that influence women's childbirth experiences.
It is important that this work continue for at least several reasons.
First, and most importantly, additional research will increase women's
access to information about a major life event. Secondly, as more is
known about the birthing process, professionals such as obstetricians
and childbirth educators will be better prepared to help women. As
the present research suggests, caring for women during their pregnan-
cies must go beyond consideration of their physical condition alone.
It seems important that doctors explore with women whether the
pregnancy was planned, and what supports are available for them.
It also seems important to examine how husbands are asked to join in
the process of their wife's pregnancy. Doctors should evaluate what
message they communicate if they do not invite husbands to participate
in regular checkrups during the prenatal period. Finally, some
researchers have suggested a relationship between women's childbirth
experiences and their attachment to their children (Doering and
Entwisel, 1975; Leifer, 1977). Given the work of Marshall Klaus and
John Kennel (1976) on the attachment of parents to their children,
research on women's birthing experience has implications not only for
the women but for their children's development as well.
Summapy

This research attempted to investigate psychological variables

associated with a positive pregnancy experience and their relationship

40

to the perception of pain during childbirth and the sense of satis-
faction with childbirth. The results suggest that women's experience
with pregnancy and childbirth are affected by many of the same variables.
A woman's pregnancy experience alone, however, cannot account for all
the variance of women's response to the birthing process. In addition,
one must explore the impact of the marital relationship both during
pregnancy and the birthing process, as well as broader social factors
which may influence a woman's decision of when and how to experience
childbirth. In this study, some of the variables associated with a
positive pregnancy experience, such as body image and attitudes toward
childbirth, contributed towards the prediction of satisfaction with
childbirth and the perception of pain during childbirth. Only self-
esteem, which has been found to be associated with the positive
experience of pregnancy did not contribute to either the prediction

of pain or satisfaction.

For this sample, women who had a positive attitude toward mother-
hood, who had lower body images in their third trimester, and who
planned their pregnancies reported the most satisfaction with the
childbirth process. Women who had less discomfort during menstruation,
expressed more pasitive attitudes towards childbirth, and had higher
body images experienced less pain during the childbirth process.

These results suggest that the perception of pain and satisfaction are
two separate aspects of women's birthing experience. Satisfaction
seems to be related to women's active decision to assume the new rOle
of mother: pain seems to be related to prior menstrual experience and

attitudes about childbirth in general.

REFEREN CES

REFERENCES

Benedek, Therese. 'ngchgpexual functions in wopgp. New York: The
Ronald Press Co., 1952.

Bibring, Crete L. Some considerations of the psychological processes
in pregnancy. The Psychoanalytic Study of the Child, 1959,
‘14, 119-121.

Boston Women's Health Book Collective. ‘93; bodies._0ugselves- New
York: Simon & Schuster, 1976.

Cohler, Bertram J., Weiss, Justin L., and Grunebaum, Henry J. Child
care attitudes and emotional disturbance among mothers of

young children. Genetic PsycholOgy.Monog;§phs, 1970,
_8_2_: 3"“80

Colman, Arthur, and Colman, Libby. Pregpancy: The psychological
.experience. New York: Seabury Press, 1971.

Carroll, John B. The nature of the data, or how to choose a correlation
coefficient. Psychometrica, 1961, gé, 347-372.

Davenport-Slack, Barbara, and Boylan, Claire H. Psychological
correlates of childbirth pain. Psychos0matic Medicine,
1974,‘3§, 215-223.

Deutsch, Helene. The psychology of women. Vol. II. New York: Grune
& Stratton, 1945.

 

Deutsch, Helene. Psychology of women in relation to functions of
reproduction. The International Jogpnal of Psychoanalysis,
1925, 6, 405-418.

Deutsch, Helene. The significance of masochism in the mental life of
women. The International Journal of Psyghoanalygig, 1930,
3.}, “8-60 0

Dick-Read, Grantly. Childbirth without feag. New York: Harper«&
Brothers, 1944.

41

42

Doering, Susan C., and Entwisle, Doris R. Preparation during preg-
nancy and ability to cope with labor and delivery. American
Journal of Orthopsychiatpy, 1975, 45, 825-836.

Erickson, Marilyn T. The relationship between psychological variables
and specific complications of pregnancy, labor, and delivery.
Journal of ngchosomatic Research, 1976, 29, 207-210.

Erikson, Erik H. Childhood and societ . New York: W. W. Norton 8:
Company, 1983 (second edition).

Eysenck, S. B. G. Personality and pain assessment in childbirth of
married and unmarried mothers. JournaLgf Mental Science,

1961, 192, 417-430.
Freedman, L. Z., Redlick, F. C., Eron, L. D., and Jackson, E. B.
Training for childbirth: Remembrance of labor. Psycho-
Frieze, I. H., Parsons, J. E., Johnson, P. B., Ruble, D. N., Zellman,
G. L. Women and sex roles: A social psychological pgrsEc-
tive. New York: W. W. Norton 3. Company, 197 .
Grimm, Elaine R. Psychological tension in pregnancy. Psychosomatic
Medicine, 1961, _2_8_, 520-527.

 

Grimm, Elaine, and Venet, Wanda. The relationship of emotional
adjustment and attitudes to the course and outcome of

pregnancy. Psychosomatic Medicine, 1966, 28, 34-49.

Heinstein, Martin I. Expressed attitudes and feelings of pregnant
women and their relations to physical complications of

pregnancy. Merrill-Palmer Quarterly, 1967, 13,

Henneborn, W. J. & Cogen, R. The effect of husband participation on
reported pain and probability of medication during labor and
birth. Journal of Psychosomatic Research, 1975, _12, 215-222.

Hook, J. F., and Marks, P. A. MMPI characteristics of pregnancy.
Journal of Clinical Psycholog, 1962, _l§, 316-317.

Jourard, Sidney J ., and Secord, Paul F. Body cathexis and personality.
British Journal of Psychology, 1955, _4§, 130-138.

Klaus, Marshall, and Kennell, John. Maternal-infant bonding. St.
Louis: C. V. Mosby Company, 1976.

 

Kitzinger, Sheila. The emrience of childbirth. New York: Penguin
Books, 1978.

Leifer, Myra. Psychological changes accompanying pregnancy and
motherhood. Genetic Psychology Monographs, 1977, 25, 57-95.

43

Loevinger, Jane. Egg develoment. San Francisco: Jossey-Bass
Publishers, 1977.

Maslow, Abraham. Motivation and Jegonalijy. New York: Harper and
Row Publishers Inc., 1970.

McConnell, Owen L., and Daston, Paul G. Body image changes in
pregnancy. Journal of Projective Techniques, 1961, _2_5,
“51"“560

McDonald, Robert, Gynther, Malcolm, and Christakos, Arthur. Relations
between maternal anxiety and obstetric complications.

Psychosomatic Medicine, 1963, g5, 357-362.

Melzack, Ronald. The perception of pain. Scientific American, 1961,
.221—“' hl-u9o

Meyerowitz, J. H. Satisfaction during pregnancy. Journal of Marriage
and the Famil ’ 1970. 22., 38-420

Norr, Kathleen, Block, Carolyn, Charls, Allen, Meyering, Suzanne,
and Meyers, Ellen. Explaining pain and enjoyment in child-
birth. Journal of Health and So_c_i_.ra1 Behavifpr, 1977, 18,
260-275.

Norris, Raymond C. and Hjelm, Howard F. Nonnormality and product moment
cgrrelation. Journal of Exmrimental Educat9_r_s_, 1961, _2_9,
2 1.270-

Osborne, David. Comparison of MP1 scores of pregnant women and
female medical patients. Journal of Clinicalisycholog,
1977, 53, 448-450.

Robin, A. A. The psychological changes of normal parturition.
Psychiatric Quarterly, 1962, E, 129-150.

Rosenberg, M. Spoigty and the adolescent self-ima e. Princeton, N.J.:
Princeton University Press, 1965.

Secord, Paul F., and Jourard, Sidney M. The appraisal of body-
cathexis: Body cathexis and the self. Journal of Consulting

251320, J10 o 1953: 2:2: 343-3147.

Standley, Kay. Psychosocial pgedictors during pregnangy of opstetrical
conditions and events. Presented in a symposium on
Parenthood: Coping with a critical psychophysiological life
event. American Psychological Association Annual Meeting,
Toronto, 1978.

 

Tolor, Alexander, and Digrazia, Paul V. The body image of pregnant
women as reflected in their human figure drawings. Journal
of Clinical Psycholog, 1977, 53, 566-571.

41,

Westbrook, Mary T. The effect of the order of a birth on women's
experience of childbearing. Journal of Marrigge and the
my. 1978. it. 715-719.

APPENDICES

APPENDIX A

LETTER TO PARENTS

APPENDIX A

LETTER TO PARENTS

Dear Parent-to-be:

I would like to enlist your help for some research I am con-
ducting. The goal of the research is to gain a better understanding
of the relationship between a woman's experience during pregnancy
and her experience during labor and delivery. The ability to do
this type of research depends on the willingness of women like you to
share their time and experience so that we can all better understand
pregnancy and childbirth.

I am seeking volunteers who are having their first child and have
no history of miscarriage. You need not be married to volunteer.
If you decide to volunteer, you will be asked to do two things:
the first is to pick up a packet of questionnaires from your instructor
during your third trimester.* Fill these questionnaires out and
return them as soon as possible; the second is to permit one of the
project's staff members to interview you within 4-6 days after giving
birth and to complete a few brief questionnaires. Participation in
this research will involve a maximum of 2-3 hours of your time.

All of the questionnaires you complete will be an anonymous part

of the data. If you are interested, you may receive a summary of the
results when the study is completed.

If you want to volunteer, please ask your instructor for a
packet of questionnaires. Complete these as soon as possible. I
will then contact you by phone to answer any questions you might have.
Or, feel free to contact me at either of the following nwmbers:

487-6298 (my home at night)
353-8877 (Dr. Stollak's office)

I appreciate your time and consideration.

Sincerely,

Naomi Goldblum

45

46

APPENDIX A (cont'd.)

*It is very important that the first set of questionnaires be
completed during the third trimester. If you wish to participate,
but are not yet in your third trimester, please give your name and

phone number to your instructor. I will contact you to make arrange-
ments for your participation.

APPENDIX B

CONSENT FORM

APPENDIX B

MICHIGAN STATE UNIVERSITY
Department of Psych010gy

DEPARTMENTAL RESEARCH CONSENT FORM

I have freely consented to take part in a scientific study being
conducted by:
Naomi Goldblum;

under the supervision of:
Gary Stollak

Academic Title: Adaptation during_Pregn§ncy a the Experience of
Labor 11_

_.._..___

The study has been explained to me and I understand the explana-
tion that has been given and what my participation will involve.

I understand that I am free to discontinue my participation in
the study at any time without penalty.

I understand that the results of the study will be treated in
strict confidence and that I will remain anonymous. Within these
restrictions, results of the study will be made available to me
at my request.

I understand that my participation in the study does not guarantee
any beneficial results to me.

I understand that, at my request, I can receive additional
explanation of the study after my participation is completed.

Signed:_

DateL_

47

APPENDIX C

PERSONAL DATA FORM

APPENDIX C

PERSONAL DATA FORM

Name

Address

Phone Number__, Age_

 

Expected date of delivery
Expected location of delivery
Type of training for delivery
Highest level of education attained

Occupation Yrs. in occupation
Husband's (or important male friend) name

Length of marriage (or relationship)

 

Occupation Yrs. in occupation

Pregnancy planned?

APPENDIX D

INCOMPLETE SENTENCES AND SCORING PROCEDURES

APPENDIX D
INCOMPLETE SENTENCES AND SCORING PROCEDURES

Below is a set of incomplete sentences. Please complete each sentence
in a way which best describes your feelings at this time.

1. I am having a baby because

2. When I imagine myself giving birth I feel

3. When I feel excited about childbirth, it's because

4. When I feel less excited about childbirth it's because
5. When I imagine myself as a mother

6. When I think about how I was cared for by my mother

7. In caring for my child I will be similar to my mother
8. In caring for my child I will differ from my mother

9. During my periods, I usually feel

10. Compared to most women my periods are

49

50

APPENDIX D (cont'd.)

A CLASSIFICATION OF NEGATIVE AND POSITIVE ASPECTS OF CHILDBEARING
DERIVED FRQ‘I MULTIDD’IENSIONAL SCALING, SHOWING TITLES AND SCME DEFINING
STIMULI OF CATEGORIES

 

 

Disturbed_g§y of lifg

 

Disturbance of way of life

From: .Journal of'Margiage_and the Family, February, 1978, Mary T.
Westbrook
Negative Agpects of Chiidbearing
1. Rejection 7.
Embarrassment at baby's
shortcomings

2.

Disappointment at sex of
child
Pregnancy unwanted

‘Problems in Labg;
Fear of labor
Not dealing with labor as well

as you hoped
Lack of support during labor

Fears for self

Wear and tear on body and
beauty

Fear of damage to self at
birth

Physical_problep§
Exhaustion, fatigue
Nausea, morning sickness
Awkwardness and discomfort
during late pregnancy

_Problep§,concerninggmarriage

Interference of relationship
with husband

Disturbed sexual relations

Financial cost to marriage

(Upsepping environments

Hospital environment and
routine upsetting

Too much visiting from family
and friends

General hubbub (confusion,
mess, noise)

Loss of status (feeling "just
a housewife and Mum")
Being tied down

Worries

Worry because of conflicting
advice

Worry about how family will
cope

Worry over baby's well being

Problemggconcerninggcare of baby
Feeding problems with baby
Overwhelmed by work involved

in care of baby

51

APPENDIX D (cont'd.)

Positive Aspects of Childbearing

Feelings of well beigg 7.

Feeling of physical well being

The enjoyment of coping with a
new experience

Makes you feel complete as a
woman

Sapisfaction from the baby

The satisfaction of fulfilling 8.
the baby's needs

Seeing the baby develop

Having a baby to love

.Wider family;sati§factions

Pleases grandparents

Improved relationship with 9.
your own mother

Satisfactions concerning

gnhancement of motherl§

femininity

Demonstrates your fertility

Gives you a feeling of impor-
tance

Proves your femininity

Value satisfactions

Something worthwhile to do
with your life

Fulfilling God's plan

Your interest in a new ongoing
life

Satisfactions to the marrigge
Makes your marriage stronger
Makes your'marriage happier
Makes your husband happy

51

Fpture satisfactions

Having someone who'll care
about you when you're old

Gives you security for your
old age

Provides continuity of the
family

 

Traditional role domestic
patisfactions

Being at home all day

Being able to leave work

Feel like all your friends who

have babies

Growth of maturipy
Makes you a more mature person

52

APPENDIX D (cont'd.)

Incomplete Sentences: Third Trimester Subject #

 

Scored by
Date

Instructions for Items l-h: ‘Attitude Towards Childbearigg

A. Positive Aspects: Mark.down a score of one (1) for each positive
aspect of childbearing. The score in any item will equal the
total number of positive aspects for that item and can be greater
than 1. Refer to the sheet on classification of positive and
negative aspects of childbearing.

Item # # of Positive Aspects
l

2

 

 

Total Positive Aspects

 

B. Ne tive Aspects: Same as for Positive Aspects, only score one
(1 for each Negative Aspect of Childbearing. The score on any
item can be greater than 1.

Item # A£_of Negative Aspects

l

N

 

 

‘F’w

 

Total Negative Aspects

53

APPENDIX D (cont'd.)

‘Attitude toward motherhood - Item 5

Rate response of woman on scale below.

Negative attitude
1 2

Ambivalent
3

Identification with mgthgg - Item 6-8

Rate response of woman on scales below.

Item 6

Negative attitude
1 2

Item 2

Not similar at all
I 2

Item 8

 

Very Different
l 2

Positive Attitude
Li 5

Identification with mother = sum of scores on items 6:§

Identification with mother

 

 

 

Ambivalent Positive Attitude
3 4 5
Ambivalent Very Similar
3 1+ 5
Ambivalent Not Different at all
3 4 5
3
+ + :1
3

Items 9 f_lO - Attitude towards menstruation
Rate responses on scales below:

Item 2

Great discomfort
l 2

Item 10

Worse than most
1 2

Attitude towards menstruation = sum of spores on

Some Discomfort
3

Same as Most
3

No discomfort
a 5

Better than Most
1* 5

item49«+ 10

 

Attitude towards menstruation :

2

 

APPENDIX E

BODY IMAGE SCALE

APPENDIX E

BODY IMAGE SCALE
_B_I§

Below are listed various aspects of the body and its functioning.
Please rate the extent to which you currently are satisfied or dis-
satisfied with these aspects as they apply to you. A "5" would
indicate that you are currently very satisfied with the particular
item you are rating. A “3" would indicate no feeling one way or the
other. A "1" would indicate that you are currently very dissatisfied
with the particular item you are rating.

Please circle the number that best represents your current satisfaction
or dissatisfaction with each item. ’

Very Dissatisfied Very Satisfied
1. Hair

2. Hands

3. Fingers

4. Breathing

5. Back

6. Exercise

7. Shape of Head

8. Height

9. Arms

10. Digestion

ll. Lips

12. Forehead

13. Voice

1“. Knees

. Height

16. Trunk

l7. Facial Complexion

18. Distribution of hair
over body

19. Sex drive

20. Waist

21. Ears

22. Ankles

23. Body Build

24. Age

25. Breasts

26. Hips

27. Legs

28. Feet

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kttttttttk scattererseeecctcc

uwuwuwwwwu uwwwwuuwuuuuuuuwuw
\nan‘tU'IUIUKUIU'IU‘U‘ \nknknknmknknknknmknknmknmu‘mu

HHHHHHHHHH

3.1

55

APPENDIX E (cont'd.)

Very Dissatisfied Very Satisfied

29. Health 1 2 3 4 5
30. Posture 1 2 3 4 5
31. Genitals 1 2 3 4 5
32. Appetite 1 2 3 4 5
33. Nose 1 2 3 4 5
34. Wrists 1 2 3 4 5
35. Energy Level 1 2 3 4 5
36. Chin 1 2 3 4 5
3?. Neck 1 2 3 4 5
38. Profile 1 2 3 4 5
39. Width of shoulders 1 2 3 4 5
no. Size of stomach I 2 3 4 5
41. Skin texture 1 2 3 4 5
1.2. Teeth 1 2 3 4 5
43. Sleep 1 2 3 4 5
44. Sex activities 1 2 3 4 5
45. Face 1 . 2 3 4 5
1:6. Back view of head 1 2 3 4 5
47. Buttocks (seat) 1 2 3 4 5
48. Eyes 1 2 3 4 5
49. General muscle tone or 1 2 3 4 5
development
3 4 5

H
N

50. Overall body appearance

APPENDIX F

ROSENBERG SELF-ESTEEM SCALE

APPENDIX F

ROSENBERG SELF-ESTEE: SCALE
SEE

The following statements are concerned with your feelings about
yourself. Please respond to each statement by circling the number
which represents how much you agree or disagree with each statement:

If you circle a 1, you strongly agree with the statement. If you
circle a 2, you agree with the statement. A 3 means you disagree
with the statement. A 4 means you strongly disagree with the state-
ment: it doesn't state how you feel.

Strongly Strongly
Agree Disagree

1. I feel that I'm a person of l 2 3 4
worth, at least on an equal
basis with others.

2. I feel that I have a number of l 2 3 4
good qualities.

3. All in all, I am inclined to l 2 3 4
feel that I am a failure.

4. I am able to do things as well 1 2 3 4
as most other people.

5. I feel I do not have much to be 1 2 3 4
proud of.

6. I take a positive attitude toward 1 2 3 4
myself.

7. 0n the whole, I am satisfied 1 2 3 4
with myself.

8. I wish I could have more respect 1 2 3 4
for myself .

9. I certainly feel useless at times. 1 2 3 4

10. At times I think I am no good at l 2 3 4

all.

56

APPENDIX G

SATISFACTION WITH LABOR SCALE

APPENDIX G

SATISFACTION WITH LABOR SCALE

ESL (Expectation of Satisfaction with labor - third trimester)

Please answer all the following questions about your approaching
experience of labor. Answer each question by circling the appropriate
number.

1.

Compared to other intense bodily experiences you have had, do you
expect to find labor and delivery:

Not at all / Moderately / Very much

exciting I 2 3 4 5
frightening 1 2 3 4 5
satisfying 1 2 3 4 5
sensual l 2 3 4 5
2. Do you expect your doctor to respect your plans for the type of

childbirth you want?

No respect Moderate Complete respect
1 2 3 4 5

In general, how satisfied do you expect to be with the support you
receive from your husband (or important male friend)?

Not at all Moderately Extremely
Satisfied Satisfied
1 2 3 4 5

Do you expect to be able to relax between contractions during the
first phase of labor?

Not at all Moderately Completely
1 2 3 4 5

When you do relax, do you expect that it will require

Great Effort Moderate No Effort
1 2 3 4 5

10.

58

APPENDIX C (cont'd.)

During the transition period, when your cervix will be stretching
to its widest before the baby begins to descend, do you expect
to be able to relax between contractions?

Not at all Moderately Completely
1 2 3 4 5

When you do relax during the transition period, do you expect it
to be with

Great effort Moderate No effort
1 2 3 4 5

Do you expect the process of actually pushing down and delivering
the child to be

Not at all /'Moderately / Very Much

exciting l 2 3 4 5
frightening l 2 3 4 5
satisfying 1 2 3 4 5
sensual l 2 3 4 5

In general, how pleasurable to do you expect your experience of
childbirth to be?

Not at all Moderately Completely
1 2 3 4 5

In general, how satisfying do you expect your actual experience of
childbirth to be?

Not at all Moderately Completely
1 2 3 4 5

Please write down any reactions you had to completing this questionnaire.
Your comments will be greatly appreciated.

59

APPENDIX c (cont'd.)

gig, (Satisfaction with Labor - Postpartum)

Please answer all the following questions about your approaching
experience of labor. Answer each question by circling the appropriate
number.

1.

Compared to other intense bodily experiences you have had did you
find your childbirth

Not at all / Moderately / Very Much
3 5

exciting I 2 4

frightening l 2 3 4 5
satisfying 1 2 3 4 5
sensual l 2 3 4 5

Did you feel that your doctor respected your plans for the type of
childbirth you wanted?

Not at all Moderately Completely
1 2 3 4 5

In general, how satisfied were you with the support you received
from your husband (or important male friend) during the labor and
delivery?

Not at all Moderately Completely
l 2 3 4 5

In general, were you able to relax between contractions during the
first phase of labor?

Not at all Moderately Completely
1 2 3 4 5

When you did relax was it with

Great effort Moderate No effort
effort
1 2 3 4 5

During the transition period, were you able to relax between
contractions?

Great effort Moderate No effort
effort
1 2 3 4 5

60

APPENDIX c (cont'd.)

7. When you did relax, was it with

Great effort Moderate No effort
effort
1 2 3 4 5

8. Was the process of actually pushing down and.delivering the child

Not at all / Moderately / Extremely

exciting l 2 3 4 5
frightening l 2 3 4 5
satisfying 1 2 3 4 5
sensual l 2 3 4 5

9. In general, how pleasurable was your experience of childbirth?

Not at all Moderately Extremely
1 2 3 4 5
10. In general, how satisfied were you with your experience of
childbirth?
Not at all Moderately Extremely
1 2 3 4 5

Please write down any reactions you had to completing this question-
naire. Your input will contribute to our understanding of your
experience.

APPENDIX H

PAIN SCALE

APPENDIX H

PAIN SCALE

EES,(Expectation of pain — third trimester)

Please answer all the following questions about your approaching
experience in labor. Answer each question by circling the appropriate
number.

1.

During labor, do you expect that the pain may feel overwhelming?

Not at all Moderately Extremely
1 2 3 4 5

What drugs do you plan on taking during labor? You may check more
than one type if that is necessary.

General anesthesia

Caudal, epidural or spinal block
Pudendal block

Sedatives or tranquilizers
Inhalation of gas

Other. Please describe.

Did you request these drugs or were they someone else's recommen—
dation?

My decision A mutual Someone else's
agreement recommendation
1 2 3 4 5

The other person involved in this decision was

 

Do you expect that you may want to ask for additional drugs during
labor?

Not at all Moderately Extremely
l 2 3 4 5

Compared to other intense bodily experiences you have had, how
painful do you expect your labor to be?

Not at all Moderately Extremely
l 2 3 4 5

61

62

APPENDIX H (cont'd.)

6. In general, do you expect your contractions during the first phase
of labor to be painful?

Not at all Moderately Extremely
1 2 3 4 5

7. In general, do you expect the contractions during the transition
period to be painful?

Not at all Moderately Extremely
1 2 3 4 5

8. Do you expect the process of actually pushing down and delivering
the child to be painful?

Not at all Moderately Extremely
1 2 3 4 5

9. Do you expect the delivery of the afterbirth to be painful?

Not at all Moderately Extremely
1 2 3 4 5

10. Do you expect the pain you may experience in labor to enter into
your decisions to have other children?

Not at all Moderately Extremely
1 2 3 4 5

Please write down any reactions to this questionnaire. Your comments
will help us to understand your experience better.

63

APPENDIX H (cont'd.)

‘§§§ (Perception of Pain - Postpartum)

Please answer all the following questiona about your recent experience
of labor. Answer each question by circling the appropriate number.

1.

During labor, did you ever feel that the pain would overwhelm you?

Not at all Moderately Extremely
l 2 3 4 5

What drugs did you take that you had planned on taking?

General anesthesia

Caudal, epidural or spinal block
Pudendal block

Sedatives or tranquilizers
Inhalation of gas

Other. Please describe.

 

Did you consider asking for additional drugs during your labor?

Not at all Moderately Extremely
1 2 3 4 5

Which drugs did you take which you had not planned on?

General anesthesia

Caudal, epidural or spinal block
Pudendal block

Sedatives or tranquilizers
Inhalation of gas

Other. Please describe.

 

Was this your choice or someone else's?

My choice Mutual Someone else
agreement
1 2 3 4 5

Compared to other intense bodily experiences that you have had,
was your labor painful?

Not at all Moderately Extremely
1 2 3 4 5

Were your contractions during the first phase of labor painful?

Not at all Moderately Extremely
1 2 3 4 5

64

APPENDIX H (cont'd.)

8. Were your contractions during the transition phase of labor

painful?
Not at all Moderately Extremely
l 2 3 4 5
9. Was the process of actually pushing down and delivering the child
painful?
Not at all Moderately Extremely
1 2 3 4 5

10. Was the delivery of the afterbirth painful?

Not at all Moderately Extremely
1 2 3 4 5

11. Will the pain you experienced during labor enter into your
decision to have other children?

Not at all Moderately Extremely
l 2 3 4 5

Please write down any reactions to this questionnaire. Your comments
will help us understand your experience better.

HICHIceN STATE UNIV. LIBRQRIES
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