Second Stage of Labor Questionnaire (SOL-Q) Validated, Measures Coping, Decision-Making, Pain, and Safety
Background
The second stage of labor is a critical phase of childbirth, profoundly impacting a woman's physical and psychological well-being. Despite its significance, there has been a notable absence of validated tools to comprehensively assess women's experiences during this period. This gap hinders both research into optimal birth practices and the ability of clinicians to understand and address patient-reported outcomes, potentially leading to unmet needs in postpartum care and long-term psychological sequelae. Developing a robust, multidimensional instrument is crucial for improving care and research in this area.
Study Design
Researchers developed the Second Stage of Labor Questionnaire (SOL-Q) within the context of the multicenter Oneplus randomized controlled trial. The questionnaire was distributed to 2831 women one month postpartum, with 2221 (78.1%) completing it within three months. To identify the underlying dimensions of the experience, an exploratory factor analysis was performed using principal component analysis and direct Oblimin rotation. Known-groups validity was assessed by comparing SOL-Q scores across subgroups hypothesized to differ in their childbirth experiences, such as those with fear of childbirth or prolonged labor duration.
Results
Factor analysis of the 16 items within the SOL-Q yielded a robust four-factor solution, collectively explaining 60% of the total variance in women's experiences. The identified dimensions demonstrated sufficient reliability, with coefficients ranging from 0.68 to 0.81. These dimensions were clearly labeled as Coping and empowerment, Decision making, Pain perception, and Safety and vulnerability. The SOL-Q exhibited good sensitivity and strong discriminatory power, effectively differentiating between groups with expected variations in childbirth experiences.
Women reporting fear of childbirth, those undergoing oxytocin augmentation, or experiencing a second stage duration exceeding 3 hours consistently scored significantly lower across all four SOL-Q domains. Conversely, no significant differences were observed in any domain between women assisted by one versus two midwives during the second stage of labor.
Key Findings
- The SOL-Q questionnaire was validated in 2221 first-time mothers, assessing their second stage labor experiences.
- A 16-item questionnaire yielded a four-factor solution, explaining 60% of variance, with reliability 0.68-0.81.
- Dimensions include Coping and empowerment, Decision making, Pain perception, and Safety and vulnerability.
- Women with fear of childbirth, oxytocin augmentation, or >3-hour second stage labor scored significantly lower in all domains.
- No differences in SOL-Q scores were found between women assisted by one versus two midwives.
Why It Matters
The development and validation of the SOL-Q provide a much-needed, standardized instrument for assessing women's experiences during the second stage of labor. This tool can significantly advance research into childbirth interventions and improve clinical practice by enabling a more nuanced understanding of patient-reported outcomes. For clinicians, it offers a structured way to identify women at risk for negative experiences, particularly those with fear of childbirth or prolonged labor, allowing for targeted support. Researchers can now use a validated measure to evaluate the impact of different birth practices or interventions on maternal experience, moving beyond purely physiological outcomes to encompass the psychological and emotional aspects of birth. This could lead to more patient-centered care models and better long-term maternal well-being.
sol-q
childbirth
labor
questionnaire
psychometric-validation
maternal-health