In the study population, 69 % (11,493/16,775) of the women were very satisfied with childbirth and chose the three highest VAS scores (8, 9 or 10). However, 953 (5.7%) women reported VAS 1-3. Among the 16,775 women included in this study, the mean VAS score was 7.94 (SD 2.1). The mean maternal age was 29.7 years (range 14-49 years, SD 5.0). Forty percent (n = 6,632) of the women were primiparas and 54 percent (n = 8,722) were classified as normal weight (BMI 18-24.9 kg/m2). Table 1 presents a cross-tabulation of maternal characteristics in the study population according to satisfaction with childbirth.
No association was found between BMI and satisfaction with childbirth. Likewise, no difference in satisfaction with childbirth was shown when comparing normal weight women with the rest of the women in the study sample (p=0.052). Primiparas and women >35 years were more likely to report dissatisfaction.
The results of the univariable and multivariable logistic regression analyses including obstetric characteristics before delivery are presented in table 2.
Induction of labor (aOR 1.69, 95% CI 1.44-1.98), epidural anesthesia (aOR 1.90, 95% CI 1.64-2.20) and oxytocin augmentation (aOR 2.11, 95% CI 1.83-2.44) were found to be independent risk factors for dissatisfaction with childbirth. When epidural anesthesia was further adjusted for mode of delivery, the intervention was still a significant risk factor for dissatisfaction with childbirth (aOR 1.75, 95% CI 1.50-2.04).
The results from the analyses of mode of delivery are presented in table 3.
Emergency CS was the strongest predictor of reporting dissatisfaction with childbirth (aOR 3.98, 95% CI 3.27-4.86). Similarly, an instrumental vaginal delivery was an independent risk factor for dissatisfaction with childbirth (aOR 2.89, 95% CI 2.32-3.60), compared to a normal vaginal delivery. No significant association was found between elective CS and dissatisfaction with childbirth (aOR 1.12, 95% CI 0.83-1.50), using normal vaginal delivery as a reference. Obstetric complications after delivery in relation to dissatisfaction with childbirth are presented in table 4.
The multivariable analyses identified OASI as an independent risk factor for dissatisfaction with childbirth (aOR 2.07, 95% CI 1.51-2.83). PPH of all degrees was also significantly associated with a negative experience, compared with bleeding <500 ml. The adjusted analyses indicated a dose–response relation between amount of bleeding and dissatisfaction with childbirth, the more severe the bleeding, the greater the risk of dissatisfaction. Likewise, the immediate well-being of the infant seemed to highly influence the woman’s reported VAS score. Apgar score <7 at five minutes after delivery was found to be statistically significantly associated with dissatisfaction with childbirth (aOR 2.95, 95% CI 1.95-4.47), compared with the reference category Apgar ³7. Apgar score <4 was not related to dissatisfaction with childbirth but low numbers were included in that analysis.
Due to 21% (4429/21,204) missing values on VAS in women giving birth during the study period a comparison of available characteristics between women with and without a recorded VAS score was performed. The results of the analyses are presented in table 5.
The mean age of the study population (29.7 years) was similar to the mean age of the women without VAS (29.6 years) (p=0.377). The mean BMIs were also comparable between the groups (25.3 versus 25.8 kg/m2), although the difference was statistically significant (p<0.001). Moreover, 64% of the women excluded were multiparas, compared to 59% in the study population (p<0.001).