A logistic analysis of timing of hospital admission and pain relief for childbirth: the Danish Health Literacy in Pregnancy (HeLP) cohort study

Introduction Women with higher maternal health literacy (MHL) are more likely to make informed decisions, advocate for their needs, and adopt preventive care. Appropriate timing of hospital admission for labour has been shown to reduce unnecessary interventions and complications, and use of relevant pain relief during birth has been shown to provide a better birth experience. Despite widespread provision of healthcare information in high-income countries, it remains unclear how MHL influences these outcomes in childbirth.Aim This study aimed to examine the association between MHL and birth progression upon hospital arrival and the use of epidural analgesia.Methods This prospective cohort study utilised self-administered survey data (HeLP-Q) from women receiving antenatal care at two Danish hospitals. MHL was assessed using the nine scales of the Health Literacy Questionnaire (HLQ). Survey data were linked to electronic birth records, which provided data on cervical dilation at hospital arrival (≤3 cm, >3 cm) and use of epidural analgesia (yes, no). Logistic regression analysis was applied, adjusting for potential confounders, including maternal age, educational level, occupation, household income, and country of birth.Results A total of 691 women were included in the study. Women with higher scores on HLQ scale 4: social support for health had significantly higher likelihood of cervical dilatation (>3 cm) at arrival to the maternity ward (aOR 1.63 (95% CI 1.01, 2.63)) indicating relevant timing of hospital admission for birth. Higher scores on HLQ scale 3: abilities to actively manage health were significantly associated with higher likelihood of using epidural analgesia during birth (aOR 1.69 (95% CI 1.10, 2.59)). This was also found for women reporting higher scores on HLQ scale 5: appraising health information (aOR 2.06 (95% CI 1.35, 3.15)).Conclusion MHL related to social support for health, ability to actively manage health and assess health information may play a role in women’s decisions regarding timing of hospital arrival during birth and decisions on use of epidural analgesia in birth. Further research is warranted to explore the complexity of hospital admission for childbirth and use of epidural analgesia during childbirth and MHL.