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

• Published in: PLoS ONE
• Main Authors: Schei, Berit, Lukasse, Mirjam, Ryding, Else Lena, Campbell, Jacquelyn, Karro, Helle, Kristjansdottir, Hildur, Laanpere, Made, Schroll, Anne-Mette, Tabor, Ann, Temmerman, Marleen, Van Parys, An-Sofie, Wangel, Anne-Marie, Steinsgrimsdottir, Thora
• Format: Article in Journal/Newspaper
• Language: English
• Published: Public Library of Science 2014
• Subjects: Antenatal care; Abuse; Labour and delivery; Norway; Iceland
• Online Access: https://hdl.handle.net/10642/2007; https://doi.org/10.1371/journal.pone.0087579

Objective The 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. Design The 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. Results Among 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). Conclusion Sexual 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. The Bidens study was supported by the Daphne II Program, European Commission for Freedom, Security, and Justice, Brussels, Belgium (Grant no. JLS/2006/DAP-1/242/W30-CE-0120887/00-87).Mirjam Lukasse received a postdoctoral fellowship from the Norwegian Research Council, Grant no. 204292. The funders had no role in study design, data collection and analysis, decision to publish, or presentation of the manuscript Copyright: © 2014 Schei et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.