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Development of the Labor and Delivery Outcome Scale (LDOS): Validity and reliability of an intrapartal measurement tool for research use in developed nations

Abstract Despite numerous scholarly attempts to understand and improve the health outcomes of childbearing in highly technical, developed countries, a theoretical and methodological deficit persists in regard to capturing a woman and her newborn’s intrapartal experience. In an effort to construct a criterion measure and research tool that is not limited to one or two aspects of the labor and delivery experience, the authors created the Labor and Delivery Outcome Scale (LDOS). The LDOS survey was mailed to a nationwide, random sample of 1500 experienced U.S. accoucheurs, including nurse-midwives, family practice physicians, and obstetricians, and they were asked to rate 102 physiological and psychosocial events and outcomes along a Likert scale regarding their relationship to the overall intrapartal experience. The goal of this forced-choice format was to have practitioners quantify the quality of individual labor and delivery experiences. The authors received a total of 391 questionnaires, representing an overall response rate of 26.1%. On a scale of –16 to +16 the scores ranged from –15.7 (SD = 1.5) for the outcome of infant born as fetal demise (stillbirth) to +12.6 (SD = 4.4) for active involvement of support person(s) in assisting woman during labor. Reliability of the instrument was demonstrated with a Cronbach’s alpha score of r = 0.92. Criterion-related validity was established, since the LDOS scores were significantly related to type of delivery (vaginal versus Cesarean-section), Apgar scores at 1 and 5 min, gestational age, and the total number of labor and delivery complications experienced. The creation of the LDOS, and the subsequent testing of its reliability and validity as described here, has been an important step toward quantifying for research purposes the intrapartal experience of women in highly technical, developed countries. Potential uses for the LDOS are discussed.