Maternal childbirth experience and time of delivery: A retrospective 7-year cohort study of 105 847 parturients in Finland

Johanna Joensuu, Hannu Saarijärvi, Hanna Rouhe, Mika Gissler, Veli Matti Ulander, Seppo Heinonen, Tomi Mikkola

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Objectives To explore how the time of delivery influences childbirth experience. Design A retrospective cohort study. Setting Childbirth in the four Helsinki and Uusimaa Hospital District hospitals, Finland, from 2012 to 2018. Participants 105 847 childbirths with a singleton live fetus. Main outcome measures Childbirth experience measured by Visual Analogue Scale (VAS). Results The major difference in average childbirth experience measured by VAS was between primiparas (8.03; 95% CI 8.01 to 8.04) and multiparas (8.47; 95% CI 8.45 to 8.48). Risk ratio (RR) of the low VAS (≤5) was 2.3 when primiparas were compared with multiparas. Differences in VAS between distinct periods were found in two stages: annual and time of day. The decrease in VAS from 2012-2016 to 2017-2018 in primiparas was from 7.97 (95% CI 7.95 to 7.99) to 7.80 (95% CI 7.77 to 7.83) and from 2014-2016 to 2017-2018 in multiparas from 8.60 (95% CI 8.58 to 8.61) to 8.49 (95% CI 8.47 to 8.52). Corresponding RRs of low VAS were 1.3 for primiparas and 1.2 for multiparas. Hourly differences in VAS were detected in primiparas between office hours 08:00-15:59 (7.97; 95% CI 7.94 to 7.99) and other times (night 00:00-07:59; 7.91; 95% CI 7.88 to 7.94; and evening 16:00-23:59; 7.90; 95% CI 7.87 to 7.92). In multiparas differences in VAS were detected between evening (8.52; 95% CI 8.50 to 8.54) and other periods (night; 8.56; 95% CI 8.54 to 9.58; and office hours; 8.57; 95% CI 8.55 to 8.59). Conclusion The maternal childbirth experience depended on the time of delivery. Giving birth during the evening led to impaired childbirth experience in both primiparas and multiparas, compared with delivery at other times. The impact of labour induction on childbirth experience should be further examined. The reorganisation of delivery services and the reduction of birth preparations might affect annual VAS. VAS is a simple method of measuring the complex entity of childbirth experience, and our results indicate its ability to capture temporal variation.

Original languageEnglish
Article numbere046433
JournalBMJ Open
Issue number6
Publication statusPublished - 16 Jun 2021
Publication typeA1 Journal article-refereed


  • epidemiology
  • health services administration & management
  • obstetrics

Publication forum classification

  • Publication forum level 1

ASJC Scopus subject areas

  • General Medicine


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