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How Does Preference for Natural Childbirth Relate to the Actual Mode of Delivery? A Population-based Cohort Study from Norway

Authors

  • Tone Kringeland RNM, DrPH,

    1. Tone Kringeland is an Assistant Professor at the Stord/Haugesund University College, Haugesund, Norway, and a Research Fellow at the Nordic School of Public Health, Gothenburg, Sweden; Anne Kjersti Daltveit is an Epidemiologist and Professor at the Department of Public Health and Primary Health Care, University of Bergen and Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway; and Anders Møller is a Psychologist and Professor at the Nordic School of Public Health, Gothenburg, Sweden.
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  • Anne Kjersti Daltveit PhD,

    1. Tone Kringeland is an Assistant Professor at the Stord/Haugesund University College, Haugesund, Norway, and a Research Fellow at the Nordic School of Public Health, Gothenburg, Sweden; Anne Kjersti Daltveit is an Epidemiologist and Professor at the Department of Public Health and Primary Health Care, University of Bergen and Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway; and Anders Møller is a Psychologist and Professor at the Nordic School of Public Health, Gothenburg, Sweden.
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  • Anders Møller PhD

    1. Tone Kringeland is an Assistant Professor at the Stord/Haugesund University College, Haugesund, Norway, and a Research Fellow at the Nordic School of Public Health, Gothenburg, Sweden; Anne Kjersti Daltveit is an Epidemiologist and Professor at the Department of Public Health and Primary Health Care, University of Bergen and Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway; and Anders Møller is a Psychologist and Professor at the Nordic School of Public Health, Gothenburg, Sweden.
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  • The Norwegian Mother and Child Cohort Study was supported by the Norwegian Ministry of Health, NIH/NIEHS (grant no N01-ES-85433), Bergen, Norway, NIH/NINDS (grant no. 1 UO1 NS 047537-01) Oslo, Norway, and the Norwegian Research Council/FUGE (grant no 151918/S10) Oslo, Norway.

Address correspondence to Tone Kringeland, RNM, DrPH, Høgskolen Stord/Haugesund, Bjørnsonsgate 45, N-5528 Haugesund, Norway.

Abstract

Abstract:  Background:  In Norway, intervention in childbirth has increased from 3 percent in 1967 to 37 percent in 2006. The objectives of this study were, first, to estimate to which extent women who expressed a preference for natural birth actually were delivered vaginally without interventions, and second, to estimate the influence that emotions and maternal background factors have on the mode of delivery.

Methods:  We used data from 39,475 pregnancies of participants in the Norwegian Mother and Child Cohort Study in which the pregnant woman had expressed a preference for natural birth, and linked these data with the pregnancy outcome as registered in the population-based Medical Birth Registry of Norway during 2000 to 2006. The influence of maternal factors on the mode of delivery was estimated with log-binomial regression models, stratified by parity.

Results:  Among primiparas, 29.3 percent delivered vaginally without interventions (natural birth), 56.1 percent gave birth vaginally with interventions, and 14.5 percent had a cesarean section. The strongest predictor for actually having a natural birth was age below 25 years, having more than 12 years’ education, carrying a single fetus, and having a low score for anxiety and depression. Among multiparas, 61.1 percent gave birth vaginally without interventions, 30.6 percent vaginally with interventions, and only 8.3 percent had a cesarean section. The effects of maternal age, education, and anxiety or depression on the outcome were smaller for multiparas than for primiparas.

Conclusions:  The chance of actually having a natural birth for women with a preference for a natural birth is much greater for multiparas than for primiparas. The factors that influence the chance of having a natural birth are different for primiparas and multiparas. (BIRTH 37:1 March 2010)

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