Different labour outcomes in primiparous women that have been subjected to childhood sexual abuse or rape in adulthood: a case-control study in a clinical cohort

Abstract

Objective: To compare the duration and outcome of the first labour in women who have been subjected to childhood sexual abuse (CSA) and women who have been raped in adulthood (RA).

Design: Case-control study in a clinical cohort.

Setting: University Hospital of North Norway.

Sample: In all, 373 primiparas: 185 subjected to CSA, 47 to RA and 141 controls without a history of abuse.

Methods: Data on birth outcomes were retrieved from the patient files. Information on sexual abuse was reported in consultation with specialised midwives in the mental health team. Birth outcomes were analysed by multinominal regression analysis.

Main outcome measures: Vaginal births, delivery by caesarean section, operative vaginal delivery and duration of labour.

Results: As compared with controls, the RA group showed a significantly higher risk for caesarean section (adjusted OR 9.9, 95% CI 3.4-29.4) and operative vaginal delivery (adjusted OR 12.2, 95% CI 4.4-33.7). There were no significant differences between the CSA and the control group. The RA group displayed significantly longer duration of labour in all phases as compared with the control and CSA groups.

Conclusions: There were major differences in the duration of labour and birth outcomes in the two abuse groups. Despite a higher proportion of obstetric risk factors at onset of labour in the CSA group, women subjected to CSA had shorter labours and less risk for caesarean section and operative vaginal deliveries than women subjected to RA. The best care for birthing women subjected to sexual abuse needs to be explored in further studies.

Figure 1

Flow chart of inclusion in the study.

Figure 2

Flow chart for birth outcome and indications for operative delivery for 373 primiparous women: 185 with a history of child sexual abuse; 47 raped in adulthood; and 141 controls from the general birth cohort. Percentage of acute caesarean section, ventous and forceps deliveries and vaginal births, of the women going into labour.

Figure 3

Schematic partogram: course, outcome and active labour in vaginal births in 307 primiparous women, 152 of whom were sexually abused as children (CSA), 30 of whom were raped as adults (RA) and 125 of whom were controls (CG). Median (range) Kruskall–Wallis test. , fetal part descending; , cervical dilation.