Risk of negative birth experience in trial of labor after cesarean delivery: A population-based cohort study

Abstract

Background To improve care for women going through trial of labor after cesarean (TOLAC), we need to understand their birth experience better. We investigated the association between mode of delivery on birth experience in second birth among women with a first cesarean. Methods A population-based cohort study based on the Swedish Pregnancy Register with 808 women with a first cesarean and eligible for TOLAC in 2014-2017. Outcomes were mean birth experience measured by visual analogue scale (VAS) score from 1-10 and having a negative birth experience defined as VAS score �5. Linear and logistic regression analyses were performed with β-estimates and odds ratios (OR) with 95% confidence intervals (CI). Results Mean VAS score among women with an elective repeat cesarean (n = 251 (31%)), vaginal birth (n = 388 (48%)) or unplanned repeat cesarean (n = 169 (21%)) in second birth were 8.8 (standard deviation SD 1.4), 8.0 (SD 2.0) and 7.6 (SD 2.1), respectively. Compared to women having an elective repeat cesarean, women having an unplanned repeat cesarean delivery had five-fold higher odds of negative birth experience (adjusted OR 5.0, 95% CI 1.5-16.5). Women having a first elective cesarean and a subsequent unplanned repeat cesarean delivery had the highest odds of negative birth experience (crude OR 7.3, 95% CI 1.5-35.5). Conclusions Most women with a first cesarean scored their second birth experience as positive irrespective of mode of delivery. However, the odds of a negative birth experience increased among women having an unplanned repeat cesarean delivery, especially when the first cesarean delivery was elective.

Maternal childbirth experience and time in labor: a population-based cohort study

“…The evaluation of the overall childbirth experience by VAS score is an accessible, easy, and valid method that correlates with other birthing experience instruments such as the W-DEQ and the Childbirth Experience Questionnaire 24 – 26 . The VAS method is used nationwide in Sweden to assess women’s birth experiences a few days after childbirth and the VAS scores are registered in the national Swedish Pregnancy Register 2 , 3 , 14 , 35 . Another advantage of the VAS method is that it is part of the clinical routine and reaches the majority of all parturients and therefore is a good method to study a larger cohort.…”

Developing a woman‐centered, inclusive definition of positive childbirth experiences: A discussion paper

“…Overall, research on women’s experiences suggests that if women receive intrapartum care that enables them to feel supported, have a sense of control, and feel safe and respected, they can have a positive experience irrespective of the mode of childbirth 92 . This also holds true when expecting a sick baby, or when experiencing a stillbirth 93,94 .…”

Preferred mode of delivery and its associated factors in pregnant women with a previous cesarean scar at a tertiary care hospital in Ethiopia: institutional-based cross-sectional study

“…The findings indicate that once a mother had a previous post-cesarean complication, she preferred TOLAC due to her fear of the risk of recurrence of previous surgically related complications. Generally, a negative birth experience or outcome has an impact on the desired mode of delivery in that the prior negative experience had a significant influence on the choice of mode of delivery [ 36 ].…”