To investigate whether advanced maternal age is associated with preterm birth, irrespective of parity.
Population-based registry study.
Swedish Medical Birth Register.
First, second, and third live singleton births to women aged 20 years or older in Sweden, from 1990 to 2011 (n = 2 009 068).
Logistic regression analysis was used in each parity group to estimate risks of very and moderately preterm births to women at 20-24, 25-29, 30-34, 35-39, and 40 years or older, using 25-29 years as the reference group. Odds ratios (ORs) were adjusted for year of birth, education, country of birth, smoking, body mass index, and history of preterm birth. Age-related risks of spontaneous and medically indicated preterm births were also investigated.
Very preterm (22-31 weeks of gestation) and moderately preterm (32-36 weeks) births.
Risks of very preterm birth increased with maternal age, irrespective of parity: adjusted ORs in first, second, and third births ranged from 1.18 to 1.28 at 30-34 years, from 1.59 to 1.70 at 35-39 years, and from 1.97 to 2.40 at =40 years. In moderately preterm births, age-related associations were weaker, but were statistically significant from 35-39 years in all parity groups. Advanced maternal age increased the risks of both spontaneous and medically indicated preterm births.
Advanced maternal age is associated with an increased risk of preterm birth, irrespective of parity, especially very preterm birth. Women aged 35 years and older, expecting their first, second, or third births, should be regarded as a risk group for very preterm birth.
Women aged 35 years and older should be regarded as a risk group for very preterm birth, irrespective of parity.
Objective To investigate the prevalence of fear of childbirth in a nationwide sample and its association with subsequent rates of caesarean section and overall experience of childbirth. Design A prospective study using between-group comparisons. Setting About 600 antenatal clinics in Sweden. Sample A total of 2662 women recruited at their first visit to an antenatal clinic during three predetermined weeks spread over 1 year. Methods Postal questionnaires at 16 weeks of gestation (mean) and 2 months postpartum. Women with fear of childbirth, defined as 'very negative' feelings when thinking about the delivery in second trimester and/or having undergone counselling because of fear of childbirth later in pregnancy, were compared with those in the reference group without these characteristics. Main outcome measures Elective and emergency caesarean section and overall childbirth experience. Results In total 97 women (3.6%) had very negative feelings and about half of them subsequently underwent counselling. In addition, 193 women (7.2%) who initially had more positive feelings underwent counselling later in pregnancy. In women who underwent counselling, fear of childbirth was associated with a three to six times higher rate of elective caesarean sections but not with higher rates of emergency caesarean section or negative childbirth experience. Very negative feelings without counselling were not associated with an increased caesarean section rate but were associated with a negative birth experience. Conclusions At least 10% of pregnant women in Sweden suffer from fear of childbirth. Fear of childbirth in combination with counselling may increase the rate of elective caesarean sections, whereas fear without treatment may have a negative impact on the subsequent experience of childbirth.
To investigate if advanced maternal age at first birth increases the risk of psychological distress during pregnancy at 17 and 30 weeks of gestation and at 6 and 18 months after birth.
National cohort study.
A total of 19 291 nulliparous women recruited between 1999 and 2008 from hospitals and maternity units.
Questionnaire data were obtained from the longitudinal Norwegian Mother and Child Cohort Study, and register data from the national Medical Birth Register. Advanced maternal age was defined as = 32 years and a reference group of women aged 25-31 years was used for comparisons. The distribution of psychological distress from 20 to = 40 years was investigated, and the prevalence of psychological distress at the four time-points was estimated. Logistic regression analyses based on generalised estimation equations were used to investigate associations between advanced maternal age and psychological distress.
Psychological distress measured by SCL-5.
Women of advanced age had slightly higher scores of psychological distress over the period than the reference group, also after controlling for obstetric and infant variables. The youngest women had the highest scores. A history of depression increased the risk of distress in all women. With no history of depression, women of advanced age were not at higher risk. Changes over time were similar between groups and lowest at 6 months.
Women of 32 years and beyond had slightly increased risk of psychological distress during pregnancy and the first 18 months of motherhood compared with women aged 25-31 years.
To investigate rates of caesarean delivery in Sweden and Norway from 1973 to 2008 in relation to advanced and very advanced maternal age.
Sweden and Norway.
All nulliparous women aged over 30 years with a singleton pregnancy, with the fetus in a cephalic presentation, and delivering at term between 1973 and 2008 were evaluated. The study population comprised 329 824 women in Sweden and 127 810 women in Norway.
Data from the national Medical Birth Registers were used to describe caesarean section rates in three age groups: 30-34 years (reference group); 35-39 years (advanced age group); and = 40 years (very advanced age group). Logistic regression analyses estimated the risk in each age group over four decades, in each of the two national samples.
Caesarean delivery decreased from 1973-1979 to 2000-2008 in the two oldest age groups in Sweden (35-39 years, OR = 0.53, 95% CI = 0.50-0.58; = 40 years, OR = 0.36, 95% CI = 0.30-0.43) and Norway (35-39 years, OR = 0.61, 95% CI = 0.54-0.68; = 40 years, OR = 0.45, 95% CI = 0.34-0.58), but increased in women aged 30-34 years. The caesarean delivery rate in the two oldest groups peaked in the second half of the 1970s. Regardless of time point, the caesarean delivery rate was always highest in women aged = 40 years, followed by women aged 35-39 years and lowest in women aged 30-34 years.
Caesarean delivery in nulliparous women of advanced and very advanced age peaked by end of the 1970s in Sweden and Norway. The subsequent reduction was contemporaneous with the introduction of electronic fetal monitoring and a more consistent use of the partogram, suggesting that more effective surveillance of labour increased the chance of a vaginal birth in these high-risk women.
The purpose of this study was to describe the characteristics of women choosing alternative maternity care compared with women who preferred conventional care. The former group of women had their antenatal, intrapartum and postpartum care at birth center in Stockholm, Sweden. Characteristics of the birth center care were continuity of care, restriction of medical technology, parental responsibility and self care. Altogether 1086 women enrolled for birth center care were included in the Alternative Group (AG). A sample of 630 was selected from among pregnant women who preferred conventional care (CG). Both groups filled in a structured questionnaire, and the response rate was 100% (1086) in the AG and 70% (441) in the CG. Besides having a more critical attitude to conventional procedures of maternity care, women in the AG were older, better educated and had other professions than CG women. They were in better physical health, and tended to be less anxious when thinking of the approaching birth and motherhood. They had more positive expectations of the coming birth, and a greater interest in not being separated from the newborn and the rest of the family immediately after the birth. They were also more interested in being actively involved in their own care. Generally speaking, AG women were more concerned about the psychological aspects of childbirth. No differences were found between the groups regarding civil status, proportion of native Swedes, or parity. Women whose characteristics coincide with those of the AG may be a growing proportion of the female population, due to better education and a growing concern about the disease orientation of maternity care.(ABSTRACT TRUNCATED AT 250 WORDS)
BACKGROUND: The childbirth experience is multidimensional, and therefore difficult to describe and explain. Studies of it have produced inconsistent findings, and the phenomenon is often confused with satisfaction with the care provided. This study aimed to clarify different aspects of the birth experience, and to identify factors that could explain the variation in women's overall assessment of it. METHODS: All Swedish-speaking women in a large city who gave birth during a two-week period in 1994 were given a questionnaire one day after the birth, and 295 (91%) of the questionnaires were returned. Information about the labor process and medical interventions was collected from hospital records. RESULTS: Women usually experienced severe pain and various degrees of anxiety, and most were seized with panic for a short time or some part of their labor. Despite these negative feelings, most women felt greatly involved in the birth process, were satisfied with their own achievement, and thought they had coped better than expected. The overall experience was assessed as positive by 77 percent of women and negative by 10 percent. No statistical difference was observed between primiparas and multiparas in total birth experience, and few differences in the specific aspects of the birth. Of the 38 variables tested in regression analysis, the six that contributed to explaining women's overall birth experience were support from the midwife (sensitivity to needs), duration of labor, pain, expectations of the birth, involvement and participation in the birth process, and surgical procedures (emergency cesarean section, vacuum extraction, forceps, episiotomy). CONCLUSIONS: The study showed that negative and positive feelings can coexist, thus confirming the multidimensional character of the birth experience. Women's assessment of their childbirth is influenced by both physical and psychosocial factors, highlighting the importance of a comprehensive approach to care in labor.
All women giving birth over a period of 2 weeks in a major city of Sweden, except non-Swedish speaking women and those with elective Caesarean sections, were asked about their experience of pain 2 days after the birth. The sensory (pain intensity) and effective (negative or positive experience) dimensions of pain, as well as need for pain relief during labor were explored. The 278 women who returned completed questionnaires (91%) reported high levels of pain, 41% worst imaginable pain, in spite of wide use of pharmacological pain relief. Only 9% had no analgesia. Pain was not an entirely negative experience, 28% assessing it as more positive than negative, suggesting that coping with pain is a rewarding experience for some women. More than 30 different explanatory variables were included in regression analysis to explain the variation in pain intensity and pain attitude scores, but only five contributed to the respective model. Most of the variables explaining pain intensity, namely anxiety during labor, expected pain, expected birth experience, midwife support and duration of labor, differed from the variables explaining attitude to pain. These were pain intensity, anxiety, expected birth experience physical well-being during pregnancy and emergency Caesarean section. The explanatory values were relatively low, especially for the model explaining pain intensity (R2 = 15%). The findings are discussed in the light of the different character and meaning of childbirth pain compared with pain related to disease.
OBJECTIVE: To study the association between continuity of carer and satisfaction with antenatal, intrapartum and postpartum domiciliary care. DESIGN: A descriptive study comparing satisfaction measures between women cared for by a known or unknown midwife. Data on satisfaction were extracted from the intervention group of a birth centre trial, and the names of the individual carers from two clinical databases kept at the birth centre. SETTING: An in-hospital birth centre in Stockholm. SUBJECTS: 410 women who had been randomly allocated to birth centre care during pregnancy, and who had a normal vaginal delivery at the centre. Complete data, including the names of the caregivers and the women's satisfaction scores, were available in 175 cases (43%) during the antenatal episode, 404 cases (98%) during the intrapartum episode and in 254 cases (62%) during the episode of postpartum domiciliary care. MAIN OUTCOME MEASURES: Overall satisfaction with antenatal care, intrapartum care, labour and birth, and postpartum domiciliary care. FINDINGS: No statistical differences were observed in satisfaction with antenatal care between women who had seen only one, two, or more than two midwives at their check-ups during pregnancy; in satisfaction with intrapartum care or the birth itself when comparing women who were delivered by a known or unknown midwife; or in satisfaction with domiciliary care when the midwife was known or unknown. CONCLUSION: The findings suggest that continuity of carer is less important in a birth centre. The high levels of satisfaction in women having birth centre care were probably more affected by the attitudes of the carers, the philosophy of care, and the nice and calm environment than by knowing the individual midwife well.