Birth Outcomes After Sexual Violence and the Role of Disclosure to the Maternity Care Provider

Background: Sexual violence (SV) history is associated with various birth outcomes. Yet, the underlying mechanisms of these associations have not been sufficiently explained. Disclosure of SV history to a maternity care provider may play an important role in maternity care providers' choice for birth interventions and in women's birth experience. Methods: A cross-sectional nationwide survey was conducted among women who had given birth in the 5 years prior to completing the questionnaire. Logistic regression analysis was performed to compare the associations between SV history (total, disclosed, and undisclosed) and birth outcomes. Results: Of 10,867 respondents, 1121 (10.3%) reported SV, of whom 582 (52%) disclosed to their maternity care provider. Respondents who disclosed their SV history had lower adjusted odds of episiotomy than respondents without an SV history (adjusted odds ratio [AOR] 0.71, 95% confidence intervals [95% CI] 0.56–0.90). Primiparous respondents who disclosed their SV history had increased odds of unplanned cesarean birth compared to spontaneous (OR 1.37, 95% CI 1.04–1.81) and assisted vaginal birth (OR 1.75, 95% CI 1.17–2.61). Primiparous respondents with both a disclosed and undisclosed SV history had increased adjusted odds of negative birth (AOR 1.78, 95% CI 1.50–2.12). There were no differences in referral to obstetrician-led care, home birth, preterm labor, and pharmaceutical pain relief between groups. Conclusions: When people disclose their SV history, maternity care providers are less likely to perform an episiotomy, and more likely to choose an unplanned cesarean birth over vaginal birth. However, disclosure of SV history does not ameliorate the birth experience and we therefore recommend better implementation of trauma-informed birth support for women with an SV history.