Negative birth experience – what matters most? Risk factors from three
time periods during pregnancy: a register-based study
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.