Obstetric interventions and childbirth experience: A population-based cohort study

BACKGROUND: A negative birth experience can have profound and lasting consequences for women's health and family planning. Obstetric interventions have been associated with increased likelihood of a negative birth experience. However, the impact of accumulated and varying combination of interventions remains less understood. METHODS: In this retrospective cohort study, we used data from 22,585 singleton births among 10,903 women (8705 primipara births, 13,880 multipara births) who participated in the Stress-And-Gene-Analysis (SAGA) study and had a record in the Icelandic Medical Birth Register, where information on obstetric interventions (induction, epidural analgesia, instrumental birth, episiotomy and caesarean section) were obtained. We used Poisson regression with robust standard errors to assess the association between number of interventions (0, 1, 2, or ≥3) and negative birth experience, calculating crude and adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs). RESULTS: Among primiparous women, the prevalence of negative birth experiences increased stepwise with number of obstetric interventions, from 11.5% (no intervention) to 39.5% (≥3 interventions). Adjusted PRs were 1.94 (95%CI:1.751-2.20) with 1, 2.66 (2.36 - 3.00) with 2, and 3.40 (2.97-3.90) with ≥3 interventions, compared with no intervention. For multiparous women, the PRs followed a similar pattern but were slightly higher. CONCLUSIONS: In this population-based study, number of obstetric interventions was associated with a stepwise higher prevalence of negative birth experience among both primiparous and multiparous women. Combinations of obstetric interventions including instrumental birth or emergency cesarean section were most strongly associated with negative birth experience.