A history of abuse and operative delivery--results from a European multi-country cohort study

PLoS One. 2014 Jan 31;9(1):e87579. doi: 10.1371/journal.pone.0087579. eCollection 2014.


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.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cesarean Section*
  • Emergency Medical Services*
  • European Union
  • Female
  • Humans
  • Medical Records*
  • Pregnancy
  • Risk Factors
  • Sex Offenses*

Grant support

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.