Sexual violence and mode of delivery: a population-based cohort study

Authors

  • L Henriksen,

    Corresponding author
    1. Section of Obstetrics, Department for Women's and Children's Health, Oslo University Hospital, Oslo, Norway
    • Correspondence: L Henriksen, Section of Obstetrics, Department for Women's and Children's Health, Oslo University Hospital, Postboks 4950 Nydalen, N-0424 Oslo, Norway. Email uxhelz@ous-hf.no

    Search for more papers by this author
  • B Schei,

    1. Department of Public Health and General Practice, Faculty of Medicine, The Norwegian University of Science and Technology, Trondheim, Norway
    2. Department of Obstetrics and Gynaecology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
    Search for more papers by this author
  • S Vangen,

    1. National Resource Centre for Women's Health, Department for Women's and Children's Health, Oslo University Hospital, Oslo, Norway
    Search for more papers by this author
  • M Lukasse

    1. Department of Public Health and General Practice, Faculty of Medicine, The Norwegian University of Science and Technology, Trondheim, Norway
    2. Department of Health, Nutrition and Management, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
    Search for more papers by this author

Abstract

Objective

This study aimed to explore the association between sexual violence and mode of delivery.

Design

National cohort study.

Setting

Women presenting for routine ultrasound examinations were recruited to the Norwegian Mother and Child Cohort Study between 1999 and 2008.

Population

A total of 74 059 pregnant women.

Methods

Sexual violence was self-reported during pregnancy using postal questionnaires. Mode of delivery, other maternal birth outcomes and covariates were retrieved from the Medical Birth Registry of Norway. Risk estimations were performed using multivariable logistic regression analysis.

Main outcome measures

Mode of delivery and selected maternal birth outcomes.

Results

Of 74 059 women, 18.4% reported a history of sexual violence. A total of 10% had an operative vaginal birth, 4.9% had elective caesarean section and 8.6% had an emergency caesarean section. Severe sexual violence (rape) was associated with elective caesarean section, adjusted odds ratio (AOR) 1.56 (95% CI 1.18–2.05) for nulliparous women and 1.37 (1.06–1.76) for multiparous women. Those exposed to moderate sexual violence had a higher risk of emergency caesarean section, AOR 1.31 (1.07–1.60) and 1.41 (1.08–1.84) for nulliparous and multiparous women, respectively. No association was found between sexual violence and operative vaginal birth, except for a lower risk among multiparous women reporting mild sexual violence, AOR 0.73 (0.60–0.89). Analysis of other maternal outcomes showed a reduced risk of episiotomy for women reporting rape and a higher frequency of induced labour.

Conclusions

Women with a history of rape had higher odds of elective caesarean section and induction and significantly fewer episiotomies.

Ancillary