HEALTH CONSEQUENCES OF PREGNANCY AND CHILDBIRTH AS PERCEIVED BY WOMENAND CLINICIAN

Objective: To develop patient-centered outcome measures for clinical r esearch by characterizing the effects of pregnancy and childbirth on f unctioning Methods: Five focus groups of mothers (n = 33) and three fo cus groups of clinicians (midwives [n = 8], obstetricians [n = 4], and family practitioners [n = 7]) were convened. Discussions were audiota ped and transcribed, Major narrative themes were identified by using t wo independent readers and were confirmed by participants and addition al clinicians. Results: Themes were grouped into four outcome domains: physical, psychologic, sexual, and social. Themes identified included lack of knowledge about postpartum health, emotional lability, sexual satisfaction, depression, parenting skills, body image, fatigue, and incontinence. Lack of knowledge about typical postpartum health was th e dominant theme for mothers and clinicians. Mothers felt unprepared f or the health consequences of pregnancy and delivery. Clinicians lamen ted Mat paucity of data made counseling and treating patients difficul t. Decreased functioning months after delivery was reported. Differenc es between mother and clinician concerns surfaced, particularly in emp hasis. Mothers wanted more information about their health; providers e mphasized newborn care. Mothers reported inspiration to improve their economic circumstances; clinicians emphasized improving maternal healt h. Mothers wanted control during labor, whereas clinicians believed co ntrol was not always possible. Conclusion: Women often felt poorly pre pared for the postpartum period in part because functional health cons equences are not well understood. This study suggests maternal functio nal health may be decreased for months after delivery, even among unco mplicated patients. This study identified new maternal outcome measure s, which are being incorporated into an outcomes questionnaire. (Obste t Gynecol 1998;92:842-8. (C) 1998 by The American College of Obstetric ians and Gynecologists.).