Birth outcomes after sexual violence and the role of disclosure to the maternity care provider: a cross-sectional study

Objective: To compare birth outcomes of women who disclosed their sexual violence (SV) history to their maternity care providers and women who did not disclose. Design: Cross-sectional nationwide survey. Setting: The Netherlands. Sample 10,867 women who had given birth within five years before completing the questionnaire. Methods: Logistic regression analyses comparing SV history (total, disclosed and undisclosed) to no SV history, stratified for parity. Main Outcome Measures Self-reported mode of birth and birth experience. Results: Of 10,867 women, 1,121 (10.3%) reported SV, of whom 582 (52%) disclosed to their maternity care provider. Women who disclosed their SV history had lower adjusted odds of episiotomy than women without an SV history (AOR 0.71, 95% CI 0.56-0.90). Primiparous women who disclosed their SV history had increased odds of unplanned caesarean section 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 women with either a disclosed or undisclosed SV history had increased adjusted odds of negative birth experience than those without an SV history (AOR 1.78, 95% CI 1.50-2.12). There were no differences in referral to obstetrician-led care, home birth, preterm labour and pharmaceutical pain relief between groups. Conclusions: Disclosure is an important factor in explaining differences between women with and without an SV history for mode of birth and episiotomy use. However, disclosure did not influence women’s birth experience. Trauma-informed care during birth is recommended.