Abstract / Summary
Objective: This study examined how six core perceptions of pregnancy and labour pain changed between the antenatal and postnatal periods among 301 women in Delhi, India, using a paired design in which the same women were assessed during pregnancy and again after childbirth, and used a concurrent ethnographic component to explore the meanings that might help explain these changes. Methods: This prospective, convergent mixed-methods study followed 301 women (of 379 recruited) from the first trimester of pregnancy to approximately one month postpartum at a tertiary care hospital. A structured interview schedule assessed agreement with statements on enjoyment of pregnancy, the influence of labour pain on reproductive decisions, beliefs about its normalcy and benefit, caesarean-section preference, and attitudes toward treatment, administered antenatally and repeated postnatally. Paired responses (the primary quantitative strand) were compared using McNemar's test. The concurrent ethnographic component (participant observation and longitudinal in-depth interviews with all participants in the paired sample, analysed using a grounded-theory approach) provided contextual interpretation, and the two strands were integrated at the interpretation stage using a joint display. Results: All six paired comparisons showed statistically significant shifts ( p < 0.001). The proportion agreeing that they enjoyed being pregnant fell from 77.4% to 57.1%, and agreement that labour pain is normal and beneficial declined similarly; agreement that labour pain will affect the decision to become pregnant again rose from 35.9% to 49.5%; and agreement with preferring caesarean section rose sharply from 49.8% to 74.1%. Conclusion: Women's attitudes and reproductive intentions changed substantially between pregnancy and the postnatal period. Ethnographic data from the same cohort suggest that these shifts may reflect not only clinical recalibration but also a renegotiation of the moral and spiritual meanings many women had attached to labour pain beforehand. Because mode of delivery, analgesia and labour characteristics were not analysed, causal attribution is not possible; the findings nonetheless have implications for antenatal counselling, equitable access to labour analgesia, and continuous intrapartum support.