Maternal health literacy and decisions related to childbirth

Background

Evidence suggests that arriving at the hospital at an appropriate stage of labour can reduce unnecessary interventions and complications, while access to and use of suitable pain relief options may improve the overall birth experience. Although healthcare information is widely available in high-income settings, the extent to which maternal health literacy shapes these aspects of childbirth remains insufficiently understood. This study aimed to examine the association between maternal health literacy and birth progression upon hospital arrival and the use of epidural analgesia.

Methods

This prospective cohort study drew on self-reported questionnaire data (HeLP-Q) collected from pregnant women attending antenatal care at two Danish hospitals. Maternal health literacy was measured using the nine domains of the Health Literacy Questionnaire (HLQ). These data were linked with electronic maternity records to obtain information on cervical dilation at admission (≤3 cm/>3 cm) and use of epidural analgesia (yes/no). Associations were analysed using logistic regression models, adjusting for maternal age, education, occupation, household income, and country of birth.

Results

The study included 691 participants. Higher scores on HLQ domain 4 (social support for health) were associated with increased odds of arriving at the maternity ward with cervical dilation greater than 3 cm (aOR 1.63, 95% CI 1.01–2.63), indicating more timely admission. In addition, higher scores on HLQ domain 3 (actively managing health) were linked to greater likelihood of epidural use (aOR 1.69, 95% CI 1.10–2.59). A similar pattern was observed for HLQ domain 5 (appraisal of health information), where higher scores were associated with increased use of epidural analgesia (aOR 2.06, 95% CI 1.35–3.15).

Conclusions

Findings suggest that aspects of maternal health literacy may influence both the timing of hospital admission during labour and the use of epidural analgesia.

Key messages

• Social support for health is associated with more appropriate timing of hospital admission for labour, reflected in greater cervical dilation on arrival.

• Women with greater abilities to actively manage and appraise health information are more likely to use epidural analgesia.