Demographic characteristics of the medical students
The study group consisted of 748 medical students, aged 18–46 years (mean 22.22), studying in different medical fields. For all of them, the scope of practice will include (on different levels) pregnant women and women of reproductive age. The biggest group of respondents comprised Medicine Faculty students (31.6%). Detailed demographic characteristics are presented in Table 1.
Table 1
Characteristics of the group/General information about the respondents
|
N
|
%
|
Age; mean ± SD (standard deviation) 22.22 M ± SD 2.61
|
748
|
|
Place of residence
|
|
|
Rural
|
176
|
23.5
|
Urban
|
572
|
76.4
|
Sex
|
|
|
Female
|
646
|
86.4
|
Male
|
102
|
13.6
|
Field of study
|
|
|
Midwifery
|
131
|
17.5
|
Nursing
|
82
|
11
|
Medicine Faculty
|
236
|
31.6
|
Clinical Nutrition
|
43
|
5.7
|
Physiotherapy
|
61
|
8.2
|
Pharmacy
|
88
|
1.8
|
Emergency Medicine
|
13
|
1.7
|
Medical Analytics
|
46
|
6.1
|
Health Psychology
|
14
|
1.9
|
Electroradiology
|
25
|
3.3
|
Public Health
|
5
|
0.7
|
Dentistry
|
4
|
0.5
|
Year of study
|
|
|
I
|
213
|
28.5
|
II
|
183
|
24.5
|
III
|
141
|
18.9
|
IV
|
78
|
10.4
|
V
|
96
|
12.8
|
VI
|
37
|
4.9
|
Overall knowledge about Polish perinatal care practice and opinions about vaginal birth (VB) and caesarean birth (CB) (Table 2)
Table 2
Overall opinions and knowledge concerning vaginal/cesarean birth.
Statements
|
N
|
%
|
Most births in Poland
|
|
|
VB
|
617
|
82.5
|
CB
|
131
|
17.5
|
The current proportion of VB in Poland
|
|
|
0–20%
|
4
|
0.5
|
21–40%
|
114
|
15.2
|
41–60%
|
414
|
55.3
|
More than 60%
|
216
|
28.9
|
The current proportion of CB in Poland
|
|
|
0–20%
|
62
|
8.3
|
21–40%
|
460
|
61.5
|
41–60%
|
188
|
25.1
|
More than 60%
|
38
|
5.1
|
The Polish CB rate follows WHO recommendations
|
|
|
Yes
|
85
|
11.4
|
No
|
350
|
46.8
|
I don’t know
|
313
|
41.8
|
Type of birth recommended for pregnant women from groups at low risk for vaginal birth (VB)-related complications
|
|
|
VB
|
716
|
95.7
|
CB
|
32
|
4.3
|
VB is safer and more beneficial for the mother and baby compared with CB
|
|
|
Yes
|
515
|
68.9
|
No
|
233
|
31.1
|
Every woman should have the right to opt for CB in any situation, independent of existing medical indications
|
|
|
Yes
|
625
|
83.6
|
No
|
123
|
16.4
|
Stress influence the birth pain experience
|
|
|
Definitely yes
|
519
|
69.4
|
Yes
|
209
|
27.9
|
I don’t know
|
17
|
2.3
|
Definitely no
|
2
|
0.3
|
No
|
1
|
0.1
|
Factors that are independent of the childbearing woman but can intensify the birth pain experience (lack of information, temperature in the room, too many people in the room, light intensity)
|
|
|
Definitely yes
|
332
|
44.4
|
Yes
|
349
|
46.7
|
I don’t know
|
57
|
7.6
|
Definitely no
|
10
|
1.3
|
No
|
0
|
0
|
The total group results revealed that Polish medical students have appropriate knowledge about basic Polish perinatal care rates. However, it should be noted that most medical students (61.5%) are not aware that the CB rate already exceeds 40%. In addition, most Polish medical students (62.2%) have the opinion that every woman should have the choice to undergo CB, regardless of medical indications. Students in Health Psychology (92.9%) and Electroradiology (88%) were convinced that every woman should have free choice within the birth route. The χ2 tests showed a statistically significant difference between the results of these two groups and the other groups. The group most opposed to women choosing between VB and CB in every situation was that of Midwifery students (68%): In their view, medical indications are crucial in decision making for CB [χ2(9) = 93.77; p = 0.000]. In addition, I- and II-year students were statistically likely to express that every woman should be able to choose the birth route [χ2(5) = 24.60; p = 0.000; Fig. 1]. In addition, students living in urban areas were more often supportive of VB/CB choice possibility [χ2(5) = 8.17; p = 0.043]. We did not find that sex and age were statistically significant in this issue.
Midwifery students (96.2%) definitely thought that VB is safer and more beneficial for the mother (pregnant women from groups at low risk for VB-related complications) and newborns compared with CB [χ2(9) = 78.89; p = 0.000]. Students from the III, IV, V and VI years of study were statistically significant different then I and II years students in their view that VB is safer and more beneficial, especially for women at low risk for VB-related complications [χ2(5) = 16.85; p = 0.005].
Medical students were aware that stress level and factors external to the childbearing woman (lack of information, temperature in the room, too many people in the room, light intensity) correlate with birth pain level experience. Respondents stated that the pain level is greater during VB than CB, but 24 hours after the procedure, women experience greater pain after CB (Table 3).
Table 3
Opinions about birth pain level experience (VAS scale)
VAS Score for Birth Pain Intensity
|
N
|
Min
|
Max
|
M
|
SD
|
VAS score for VB pain level
|
748
|
4
|
10
|
9.03
|
1.04
|
VAS score for CS pain level
|
748
|
0
|
10
|
4.11
|
2.65
|
VAS score for pain level 24 h after VB
|
748
|
0
|
10
|
5.41
|
2.19
|
VAS score for pain level 24 h after CS
|
748
|
0
|
10
|
5.76
|
2.23
|
We were also interested in whether there would be any connections between medical students’ stress coping strategies and their general attitudes towards VB and CB. We found differences between the groups giving different answers to the questions about CB and VB, especially in the context of two stress coping strategies—helplessness and turning to religion (Table 4). The respondents who thought that VB is safer, women recover faster after it and women should not be able to choose the mode of delivery independently were statistically significantly lower in their helplessness level and higher in religiosity. Those who were more helpless and less religious were also less convinced of the safety of VB, believed in faster recovery after CB and expressed that the woman herself (not medical factors) should determine how to give birth.
Table 4
Comparison of groups giving different answers to questions about VB and CB in terms of helplessness and turning to religion as stress coping strategies
Stress coping strategy
|
Statement
|
Group 1
|
Group 2
|
Z
|
p
|
Helplessness
|
VB safer and more beneficial for the woman and newborna compared with CB
|
Yes
|
No
|
3.01
|
0.003
|
N 515
M 1.64
SD 0.94
|
N 233
M 1.90
SD = 1.06
|
Recovery is faster after VB or CB
|
VB
|
CB
|
2.04
|
0.041
|
N 625
M 1.69
SD 0.99
|
N 123
M 1.87
SD 0.99
|
Every womana should have a right to choose between VB and CB in every situation, independently from existing medical indications
|
Yes
|
No
|
2.48
|
0.013
|
N 465
M 1.80
SD 1.01
|
N 283
M 1.60
SD 0.94
|
Turn to religion
|
VB safer and more beneficial for the woman and newborna compared with CB
|
Yes
|
No
|
2.22
|
0.026
|
N 515
M 1.73
SD 1.98
|
N 233
M 1.33
SD 1.70
|
Recovery is faster after VB or CB
|
SN
|
CC
|
3.17
|
0.002
|
N 625
M 1.70
SD 1.95
|
N 123
M 1.12
SD 1.64
|
Every womana should have a right to choose between VB and CB in every situation, independently from existing medical indications
|
Yes
|
No
|
2.76
|
0.006
|
N 465
M 1.46
SD 1.85
|
N 283
M 1.85
SD 1.99
|
a Pregnant women from groups at low risk for VB-related complications |
Table 5 lists the Spearman’s ρ correlations between the estimation of the intensity of pain experienced during VB and CB (VAS and NRS scales) and stress coping strategies. A correlation was again found between helplessness and the assessment of the intensity of pain during VB, as well as 24 hours later (the greater the helplessness, the greater the anticipated pain during VB). The turn to religion correlated only with the assessment of pain intensity 24 hours after CB.
Table 5
Spearman’s ρ correlations between stress coping strategies and the assessment of the intensity of pain during VB and CB (VAS and NRS scales)
Assessment of the intensity of pain during VB and CB
|
Helplessness
|
Turn to religion
|
Score for VB pain level
|
0.11a
|
-0.04
|
Score for CB pain level
|
0.06
|
-0.009
|
Score for pain level 24 hours after VB
|
0.08a
|
-0.03
|
Score for pain level 24 hours after CB
|
-0.04
|
0.1a
|
ap < 0.05 |