Medical Interventions and Women's Perceptions of Respectful Intrapartum Care: A National Survey-Based Cohort Study

Abstract

Objective

To investigate whether women's perceptions of respectful intrapartum care are influenced by the use of epidural, oxytocin, or episiotomy.

Design

National survey-based cohort study using data from the Swedish Pregnancy Survey 8 weeks postpartum (NPS-8) merged with Swedish Pregnancy Register (SPR) data.

Setting

Sweden, 2022–2023.

Population

Primiparous women with a singleton pregnancy, cephalic presentation, spontaneous onset of labour, a live fetus at ≥ 37 weeks gestation, and a vaginal birth.

Methods

Associations between respectful care and epidural analgesia, oxytocin, or episiotomy and their combinations were analysed using logistic regression to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Main Outcome Measures

Four NPS-8 items assessing women's perceptions of being treated respectfully, receiving support, being informed, and being involved in decision-making during childbirth.

Results

Of 34 111 women, 20 363 (59.7%) responded, with the majority feeling respected during childbirth. Compared with women who had spontaneous vaginal births, those with instrumental births more frequently reported inadequate support (17.7% vs. 11.0%), insufficient information (25.1% vs. 16.2%), and lack of involvement in decision-making (29.2% vs. 17.1%). Among women with spontaneous vaginal births, those subjected to an episiotomy were less likely to report being involved in decision-making (77.8% vs. 83.8%; aOR 0.60, 95% CI 0.50–0.73). The combination of episiotomy and oxytocin was associated with the lowest adjusted odds of involvement in decision-making (77.0% vs. 84.6%; aOR 0.54, 95% CI 0.43–0.69).

Conclusion

Women with spontaneous vaginal births were less likely to report being involved in decision-making when they underwent an episiotomy, or if oxytocin augmentation was followed by an episiotomy.