Lifetime sexual violence and childbirth expectations - A Norwegian population based cohort study

Abstract

Objective: this study aimed to explore the association between lifetime sexual violence and expectations about childbirth.

Design: Norwegian population-based cohort study.

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

Population: 78,660 pregnant women.

Methods: sexual violence and expectations about childbirth were self-reported during pregnancy using postal questionnaires. Risk estimations were performed using multivariable logistic regression analysis and stratified by parity.

Main outcome measures: fear of childbirth, the thoughts about pain relief, worries about the infant's health and looking forward to the arrival of the infant.

Findings: of 78,660 women, 18.4% reported a history of sexual violence and 0.9% were exposed to sexual violence within the last 12 months, including during the current pregnancy. We found that nulliparous women who reported previous or recent sexual violence had a decrease in the odds of looking forward to the arrival of the infant with an AOR of 0.8 (95% CI 0.7-0.9) and 0.4 (95% CI 0.3-0.6), respectively, compared to non-abused women. The same pattern was observed among multiparous women and they were more likely to report worries about the infant's health. Severe sexual violence (rape) was associated with concerns about childbirth, especially for nulliparous women that were more likely to express fear of birth, a hope for a pain-free birth, a desire for caesarean section and worries about the infant's health than non-exposed women.

Conclusions: women with a lifetime exposure to sexual violence, both past experiences and within the last 12 months, were less likely to look forward to the arrival of the infant than non-exposed women, and they were more likely to worry about the infant's health. Women with experiences of severe sexual violence (rape) had more concerns about childbirth than women without this experience. This finding shows that exploring women's attitudes toward childbirth may work as an approach when examining exposure to violence.

Keywords: Expectations; Fear of childbirth; MoBa; Pregnancy; Sexual violence.