SIMILARITIES IN MOTHER-DAUGHTER LABOUR AND BIRTH CHARACTERISTICS: A TWO- GENERATION MATCHED COHORT STUDY

Abstract

Physiological length of labour is highly variable and population norms have low sensitivity and specificity for individuals. Care practices for nulliparous women may be
differentiated by using their mothers’ first birth labour progress histories. The aim of this study was to investigate mother-daughter labour and birth characteristics and the influence of mothers’ labour length on their nulliparous daughters’ first births.

The aim was achieved by conducting the research in four stages: a systematic review of inter- and intragenerational influences on pregnancy and birth outcomes; a summary review of medical record- keeping and a literature review on the agreement of maternal recall of birth outcomes with hospital birth records; a prospective comparative study of agreement of maternal recall of first birth events and hospital birth records; and a matched cohort study of
mother-daughter labour and birth characteristics focusing on length of labour and birth outcomes.

The systematic review of inter- and intragenerational influences on pregnancy and birth outcomes showed evidence of maternal, paternal and familial influences on pregnancy and birth outcomes in offspring. The literature review on the agreement of maternal recall of birth outcomes with hospital birth records showed that women remember important perinatal events even many years after giving birth. The empirical studies were conducted in Israel. In the first study, maternally recalled perinatal events were compared to archived hospital data. Eligible women (those who had given birth to their first child in those hospitals where the research was taking place and were willing to take part in the study) received a questionnaire, participant information sheet and consent form. Archived birth records were retrieved and compared for agreement with recalled data.

In the second study, using a matched cohort study design, nulliparous (index) women of >32 weeks’ gestation attending antenatal clinics in either of two hospitals were recruited. Eligible women received a questionnaire, participant information sheet for themselves and their mothers, and an individual consent form. Mothers’ perinatal information was collected from questionnaires.
Daughters’ perinatal information was collected from electronic hospital records.

Findings for the maternal recall study showed that maternal recall of distant first birth events is remarkably in agreement with hospital birth records, with highest measures for mode of delivery and infant birth weight.

Univariate logistic regression analysis for the mother-daughter matched cohort study showed that daughters of mothers who had had long labours were more likely to have long labours themselves [OR 1.91 (95%CI 1.19,3.05), p=0.007]. Multivariable logistic regression indicated that mothers’ length of labour [OR1.88 (95%CI 1.12,3.17)] and daughters’ age [OR 1.08 (95%CI 1.02,1.14)], weight gain in pregnancy [OR 1.10 (95%CI 1.04,1.16)] and non-use of anaesthesia [OR 0.27 (95%CI 0.12,0.60)], were statistically significant factors for daughters’ length of labour, with sensitivity, specificity, and positive and negative predictive values of 74%, 56%, 66%, and 64%, respectively. A linear regression model for time interval categorisations in labour (0-12 hrs, 12-18 hrs, 18+ hrs), demonstrated that daughters’ length of labour is associated with mothers’ length of labour in the 12-18 hour category, daughters’ age, weight gain in pregnancy, and use of anaesthesia.
The model explained 11% (R2 = 0.11) of the variance in daughters’ length of labour with an F-test of overall significance indicating that the relationship is statistically significant (F(5,285) = 6.75, p <0.001).
Length of labour in mothers’ first birth reasonably predicts length of labour in their nulliparous daughters. This work presents an important endeavour using empirical data to promote an individual approach to childbirth within the hospital setting. Clinical decisions made for healthy women in labour are often driven by standardised criteria based on population norms. Practitioners could inquire about familial labour patterns as an additional heuristic to guide practice, alongside formal evidence and the signs and symptoms exhibited by the individual woman.