Purpose: This study aims to identify educational strategies to mitigate differences in pain experience among nulliparous and multiparous patients. Introduction: Research shows that patients’ understanding of the birthing process and pain control methods influences their labor experience (Hodnet, et al. 2002). Unfortunately, many patients lack comprehensive knowledge of pain relief options before labor begins (Garlock, et al. 2017 , Rhode, et al. 2022). Existing literature highlights the need for further education and research on how informed patients may experience labor differently (Garlock, et al. 2017). Furthermore, research demonstrates notable differences in pain experiences among nulliparous vs multiparous women. However, most studies focus on intervention rates (e.g., epidural utilization) rather than direct pain scoring, leaving gaps in understanding how education modulates pain experiences across parity (Lowe, et al. 1992, Labor, et al. 2008). This study evaluates patient-reported pain scores and birth experience satisfaction among nulliparous and multiparous patients receiving standardized prenatal pain education. Methods: An IRB approved randomized control trial was conducted (IRB Approval #16937). First a pilot survey was administered to a convenience sample of pregnant patients in the clinic setting to assess baseline knowledge about labor pain control options to inform creation of a standardized patient education guide about pain control options available during labor. Pregnant patients in the third trimester of all ages were then recruited from a high-volume urban OB/GYN clinic. Demographic information including age, parity, and race was collected. Recruited patients were then randomized into the experimental or control group via 1:1 randomization. The experimental group received the educational guide during a third trimester prenatal visit, and the control group received standard prenatal care. Patients were then followed through their delivery to the postpartum period where a final survey was administered to assess patients’ pain scores and satisfaction during labor and birth between the two groups. Patients of all ages with either singleton or multiple gestations were included regardless of parity and mode of prior deliveries. Exclusion criteria included patients who were non-English speaking, scheduled for delivery via planned Cesarean section, or experiencing chronic pain conditions or coagulopathy precluding spinal anesthesia. Statistical analysis was conducted through univariate testing, Wilcoxon rank-sum tests, to assess associations between survey variables and whether or not patients received guides. Results: This pilot analysis studied 22 patients comprised of various ages, races, and parity. 11 patients were randomly assigned to both experimental and control groups. Younger patients (age < 30) had higher overall birth satisfaction scores than older patients (age ≥ 30) (mean = 4.37, 95% CI 3.75, 4.99, compared to mean = 4.21, 95% CI 3.52, 4.90 in the ≥ 30 group), but lower pain control method satisfaction ratings (mean = 4.12, 95% CI 3.42, 4.82 compared to a mean = 4.28, 95% CI 3.62, 4.94, in the ≥30 group). Multiparous patients on average had higher pain control method satisfaction and birth satisfaction scores than nulliparous patients (mean = 4.50 95% CI 4.12, 4.87, and 4.78 95% CI 4.45, 5.11, respectively in multiparous patients, compared to mean = 3.75, 95% CI 2.58, 4.91, and 3.37 95% CI 2.48, 4.26, respectively in nulliparous patients). In the Wilcoxon rank sum tests, the difference in birth satisfaction scores between nulliparous and multiparous patients was statistically significant (p < .05). Conclusion: This pilot study suggests that younger patients may experience higher birth satisfaction and lower pain satisfaction compared to older patients with the addition of a standardized pain guide. Additionally, multiparous patients may have higher satisfaction with pain control and birth experience than nulliparous patients overall. Future larger datasets will allow for multivariate analysis to determine whether factors such as age, race, parity, and/or educational group, significantly affect pain and birth-related satisfaction scores.
Annira et al. (Sat,) studied this question.