A History of Abuse and Operative Delivery – Results from a European Multi-Country Cohort Study

Abstract

ObjectiveThe main aim of this study was to assess whether a history of abuse, reported during pregnancy, was associated with an operative delivery. Secondly, we assessed if the association varied according to the type of abuse and if the reported abuse had been experienced as a child or an adult.DesignThe Bidens study, a cohort study in six European countries (Belgium, Iceland, Denmark, Estonia, Norway, and Sweden) recruited 6724 pregnant women attending routine antenatal care. History of abuse was assessed through questionnaire and linked to obstetric information from hospital records. The main outcome measure was operative delivery as a dichotomous variable, and categorized as an elective caesarean section (CS), or an operative vaginal birth, or an emergency CS. Non-obstetrically indicated were CSs performed on request or for psychological reasons without another medical reason. Binary and multinomial regression analysis were used to assess the associations.ResultsAmong 3308 primiparous women, sexual abuse as an adult (≥18 years) increased the risk of an elective CS, Adjusted Odds Ratio 2.12 (1.28–3.49), and the likelihood for a non-obstetrically indicated CS, OR 3.74 (1.24–11.24). Women expressing current suffering from the reported adult sexual abuse had the highest risk for an elective CS, AOR 4.07 (1.46–11.3). Neither physical abuse (in adulthood or childhood <18 years), nor sexual abuse in childhood increased the risk of any operative delivery among primiparous women. Among 3416 multiparous women, neither sexual, nor emotional abuse was significantly associated with any kind of operative delivery, while physical abuse had an increased AOR for emergency CS of 1.51 (1.05–2.19).ConclusionSexual abuse as an adult increases the risk of an elective CS among women with no prior birth experience, in particular for non-obstetrical reasons. Among multiparous women, a history of physical abuse increases the risk of an emergency CS.

Emotional, physical, and sexual abuse and the association with symptoms of depression and posttraumatic stress in a multi-ethnic pregnant population in southern Sweden

“…The study has a cross-sectional design and uses the Swedish data from the Bidens study, a 6-country, European cohort study investigation of lifetime experiences and delivery expectations and outcomes [17]. The sample size of the Swedish part comprised 1025 women.…”

“…File 1) included questions about socio-demographic background, general health and obstetric history [17]. Information on abuse, depression and symptoms of posttraumatic stress disorder was also collected [17].…”

“…File 1) included questions about socio-demographic background, general health and obstetric history [17]. Information on abuse, depression and symptoms of posttraumatic stress disorder was also collected [17]. Where available and possible, we used the Swedish version of the applied items used by others [5,11].…”

“…We had the unique opportunity to investigate this, using the Swedish data from a European six-country cohort study [17]. At the time of the study, the Swedish city where women were recruited held a population of almost 300 000 people, with one third of its total population being foreign born [18].…”

Pregnant women’s preference for cesarean section and subsequent mode of birth – a six-country cohort study

“…Cultural factors, the structure of antenatal care and delivery services, as well as how they are funded, are likely to influence preferences for CS [14]. However, it may be argued that the perception of the upcoming birth is deeply embedded in a woman's personality and prior experiences, including traumas [15][16][17][18]. Based on this assumption, reported preference for CS would not be related to external factors and thus may not vary across countries.…”