Virginia Commonwealth University VCU Scholars Compass Theses and Dissertations Graduate School 2009 Relationship Among Stress of Labor, Support, and Childbirth Experience in Postpartum Mothers Sasamon Srisuthisak Virginia Commonwealth University Follow this and additional works at: https://scholarscompass.vcu.edu/etd Part of the Maternal, Child Health and Neonatal Nursing Commons © The Author Downloaded from https://scholarscompass.vcu.edu/etd/1916 This Dissertation is brought to you for free and open access by the Graduate School at VCU Scholars Compass. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of VCU Scholars Compass. For more information, please contact [email protected]. RELATIONSHIPS AMONG STRESS OF LABOR, SUPPORT, AND EXPERIENCE OF CHILDBIRTH IN POSTPARTUM MOTHERS by SASAMON SRISUTHISAK Virginia Commonwealth University Richmond, Virginia ii © Sasamon Srisuthisak August, 2009 All Rights Reserved iii Acknowledgement This dissertation would not have been possible without support of several people. I would like to express deepest gratitude to my dissertation chair, Dr. Jacqueline M. McGrath, who provided not only academic guidance, but also emotional support during the trying time when I got lost with my dissertation. She was very kind and patient with me throughout the dissertation process. She always kept me updated about new literature related to my dissertation. Without her help and encouragement, I certainly would not have completed this project. I also would like to extend my deepest appreciation to the other members of my dissertation committee for their encouragement, support, and critiques of drafts of my manuscript. First, to Dr. Judith A. Lewis, who provided in-depth knowledge and expertise in the field of maternal and child nursing and directed me to the right path for finishing the doctoral study. Second, to Dr. Martha W. Moon, who gave advice for a good research study I could do within a limited time frame and showed her understanding as well as helped editing my English language. Third, to Dr. Dianne F. Simons, who shared her expertise in how to formulate a good survey questionnaire and assisted me to create the questionnaire that was used to collect data. Without their help and support, I positively would not have finished this dissertation. iv It would be remiss if I did not acknowledge the support and help of two other faculty members of VCU School of Nursing. First, to Dr. Janet B. Younger, Associate Dean, who gave me the permission to modify her stress sub-scale and used it as one of the tools in this project. Second, to Dr. Inez Tuck, the former Director of the doctoral program was very kind and supportive during the time of excessive stress. My sincere thanks also go to the staff, School of Nursing, Virginia Commonwealth University for their help and support. My appreciation also goes to Arlene Yuan for her support, encouragement, and help editing my English language. My best regards also goes to my participants who volunteer to fill out the questionnaire just because they want to help me finish the program. I would like to acknowledge my sponsor, the Ministry of Public Health, Thailand, which gave me an opportunity to further my studies in USA. Finally, my thanks go to the School of Nursing, Virginia Commonwealth University for financial support on my dissertation and tuition during the last two years of my study. v Table of Contents Page Acknowledgements............................................................................................................ iii List of Tables .......................................................................................................................x List of Figures................................................................................................................... xii Abstract............................................................................................................................ xiii Chapter 1 STATEMENT OF THE PROBLEM.................................................................1 Background and Significance........................................................................1 Statement of Purpose.....................................................................................6 Conceptual Theoretical Empirical Framework .............................................8 Definition of Terms .....................................................................................15 Summary .....................................................................................................16 2 CONCEPTUAL FRAMEWORK AND REVIEW OF LITERATURE ..........17 The Conceptual Framework ........................................................................17 Personal factors.....................................................................................18 The Interpretation of Labor Pain...........................................................19 Perceived Benefits or Barrier to Pain Management Strategies .............20 Participation in Decision Making..........................................................21 Initial Contact with the Baby Following Birth......................................22 vi Support Received from The nursing staff .............................................22 Positive or Negative Evaluation of the Childbirth Experience .............23 Historical Development of Childbirth in the United States ........................24 The Gate Control Theory ............................................................................32 Pain associated with Labor..........................................................................33 Labor Pain Management Strategies.............................................................35 Perception of the Childbirth Experience .....................................................39 Support ........................................................................................................40 Summary .....................................................................................................42 3 METHODOLOGY ..........................................................................................43 Research Design..........................................................................................43 Sample and Setting......................................................................................43 Sample Selection and Recruitment..............................................................44 Instruments and Measures...........................................................................46 The Questionnaire Measuring Attitudes About Labor and Delivery Experience.............................................................................................46 The Stress of Labor Pain Scale..............................................................50 Demographic Questionnaire..................................................................51 Data Collection............................................................................................51 Research Subject Protection..................................................................52 vii Data Analysis ..............................................................................................53 Summary .....................................................................................................55 4 FINDINGS.......................................................................................................57 Demographic Characteristics of the Sample ...............................................58 Specific Aim 1: Factors Related to a Positive Childbirth Experience ........61 Assessment of Normal Distribution of the Model Variables ......................61 Descriptive Statistics for the Model Variables............................................74 Specific Aims 2: Correlational Analysis.....................................................77 Relationship between the Dependent Variable and Independent Variables......................................................................................................82 Relationship among Independent Variables ...............................................82 Specific Aim 3: Hierarchical Regression Analysis .....................................83 Summary .....................................................................................................87 5 DISCUSSION..................................................................................................89 Representative of the Sample......................................................................89 Factors Contributing to a Positive Childbirth Experience...........................92 Predictors of a Positive Perception of the Childbirth Experience ..............97 Limitations.................................................................................................100 Implication for Research ...........................................................................101 Implication for Practice.............................................................................102 viii Summary ...................................................................................................102 References........................................................................................................................104 Appendices A The Questionnaire Measuring Attitude About Labor and Delivery Experience......................................................................................................117