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


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.

Authors & affiliation: 
Berit Schei1,2, Mirjam Lukasse1,3*, Elsa Lena Ryding4, Jacquelyn Campbell5, Helle Karro6, Hildur Kristjansdottir7,8, Made Laanpere6, Anne-Mette Schroll9, Ann Tabor9,10, Marleen Temmerman11, An-Sofie Van Parys11, Anne-Marie Wangel12, Thora Steingrimsdottir7,13 1 Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway, 2 Department of Obstetrics and Gynaecology, St.Olav’s University Hospital, Trondheim, Norway, 3 Department of Health, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Oslo, Norway, 4 Department of Women’s and Children’s Health, Division of Obstetrics and Gynaecology, Karolinska Institutet/University Hospital, Stockholm, Sweden, 5 John Hopkins University, School of Nursing, Baltimore, Maryland, United States of America, 6 Department of Obstetrics and Gynaecology, University of Tartu, Tartu, Estonia, 7 Department of Obstetrics and Gynaecology, Landspitali University Hospital, Reykjavik, Iceland, 8 Directorate of Health, Reykjavik, Iceland, 9 Centre of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark, 10 Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark, 11 Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium, 12 Malmo¨ University, Faculty of Health and Society, Malmo¨ , Sweden, 13 Primary Health Care of the Capital Area, Centre of Development, Reykjavik, Iceland
Published In: 
PLOS ONE | January 2014 | Volume 9 | Issue 1 | e87579
Publication date: 
Friday, January 31, 2014