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Negative birth experience – what matters most? Risk factors from three time periods during pregnancy: a register-based study
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  • Frida Viirman,
  • Susanne Hesselman,
  • Anna-Karin Wikstrom,
  • Agneta Skoog Svanberg,
  • Alkistis Skalkidou,
  • Inger Sundström Poromaa,
  • Anna Wikman
Frida Viirman
Uppsala University Department of Womens and Childrens Health
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Susanne Hesselman
Uppsala University Department of Womens and Childrens Health
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Anna-Karin Wikstrom
Uppsala University Department of Womens and Childrens Health
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Agneta Skoog Svanberg
Uppsala University Department of Womens and Childrens Health
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Alkistis Skalkidou
Uppsala University Department of Womens and Childrens Health
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Inger Sundström Poromaa
Uppsala University Department of Womens and Childrens Health
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Anna Wikman
Uppsala University Department of Womens and Childrens Health
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Abstract

Objective: To explore the impact of risk factors from three different time periods on negative birth experience. Design: Register-based cohort study. Setting: Sweden. Population: Nulliparous women giving birth to singleton, term infants in 2013–2018 (n = 83 335), elective caesarean sections (CS) excluded. Methods: Hierarchical logistic regression was performed to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CIs) in three blocks, each representing risk factors from one of three time periods: I) before pregnancy, II) pregnancy, III) labour. Main Outcome Measurement: Negative birth experience, defined as ratings of ≤ 4 on a ten-point scale. Results: Poor self-rated health (SRH) was the only pre-gestational factor remaining associated with negative birth experience after adjustment for pregnancy- and labour-related factors (aOR 1.22, 95% CI 1.10–1.36). Fear of childbirth and treatment for psychiatric disorder during pregnancy were both associated with negative birth experience (aOR 1.53, 95% CI 1.36–1.73; aOR 1.51, 95% CI 1.35–1.68), as were all labour-related factors included in the model. Women giving birth by operative vaginal delivery or unplanned CS under regional anaesthesia had three-fold higher ORs for rating their overall birth experience as negative (aOR 3.23, 95% CI 2.99–3.50; aOR 3.04, 95% CI 2.77–3.33). The highest OR, 5.38, was seen among women undergoing unplanned CS under general anaesthesia (95% CI 4.52–6.40). Conclusions: The main contributing factors to a negative birth experience are labour-related. Poor SRH, psychiatric treatment and fear of childbirth places the woman in a vulnerable position requiring extra attention.

Peer review status:UNDER REVIEW

25 May 2021Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
27 May 2021Assigned to Editor
27 May 2021Submission Checks Completed
30 May 2021Reviewer(s) Assigned