April 2010

Document Type


Degree Name



Oregon Health & Science University


Purposes: To explore if women's expectations of childbirth in Thailand are being met and to examine the relative importance of self-efficacy for childbirth, fear of childbirth, and the match between expectations and experiences in predicting satisfaction with the childbirth experience. Background: Since the 1980's Thailand has made a major shift from home births to hospital births. While this change has been accompanied by decrease in Thailand's maternal mortality ratio from 374.3 per 100,000 in 1962 to 9.8 in 2006 and its infant mortality ratio from 84.3 per 1,000 to 11.3, the childbirth experience has also been altered significantly. Satisfaction with labor and birth in Thai hospitals and its associated factors have not been fully explored. Prior studies have focused on positive/negative experiences; however, one important factor may be the match between what a woman expects and what actually happens during childbirth. Methods: A longitudinal study of 195 pregnant women with a singleton fetus was conducted in Thailand. During their third trimester (32-42 weeks gestation) women were asked about their expectations for 36 possible events during labor and delivery, self-efficacy and fear of childbirth. Two days after giving birth, women were asked about their experiences with the 36 events during childbirth and their satisfaction with the process. Women's expectations and actual experiences were compared to determine fulfilled expectations (percent of the items that they expected that actually happened), unmet expectations (percent of the items that they expected that did not happen), unexpected experiences (percent of items that they did not expect that actually happened), and null experiences (percent of items that they did not expect that did not happen). Results: On average, 73% of the items women expected actually happened during childbirth (fulfilled expectations) while 27% of the items did not happen (unmet expectations). While, 38% of the items women did not expect actually happened during childbirth (unexpected experiences) and 62% of these items did not happen (null experiences). Nearly one-third of the women expected to, but did not get medication to reduce pain (37.6%) or have a relative by their side during labor (30.3%). Regression analysis found that the match between expectations and experiences accounted for 17.4% of the variance in satisfaction with the childbirth. Fulfilled expectations (β=.37, p<.001) was the strongest predictor of satisfaction followed by lower education (β=-.17, p=.007), higher self-efficacy (β=.17, p=.011), and attending childbirth class (β=.14, p=.026). Fear of childbirth was related to satisfaction (r=-.14, p<.05) but not after controlling for the match between expectations and experiences and self-efficacy. Implications: Results suggest that aligning women's expectations about childbirth with the actual labor and delivery experience could improve women's satisfaction with the childbirth process. For Thai women, there are areas such as receiving pain medication and having a relative present during labor and delivery where unmet expectations are more common. This research could inform the development of interventions that help women meet the challenges of childbirth with realistic expectations and help the health system identify areas where women's expectations are not being met.




School of Nursing



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