Back to normal: A retrospective, cross-sectional study of the multi-factorial determinants of normal birth in Queensland, Australia.
BACKGROUND
currently, care providers and policy-makers internationally are working to promote normal birth. In Australia, such initiatives are being implemented without any evidence of the prevalence or determinants of normal birth as a multidimensional construct. This study aimed to better understand the determinants of normal birth (defined as without induction of labour, epidural/spinal/general anaesthesia, forceps/vacuum, caesarean birth, or episiotomy) using secondary analyses of data from a population survey of women in Queensland, Australia.


METHODS
women who birthed in Queensland during a two-week period in 2009 were mailed a survey approximately three months after birth. Women (n=772) provided retrospective data on their pregnancy, labour and birth preferences and experiences, socio-demographic characteristics, and reproductive history. A series of logistic regressions were conducted to determine factors associated with having labour, having a vaginal birth, and having a normal birth.


RESULTS
overall, 81.9% of women had labour, 66.4% had a vaginal birth, and 29.6% had a normal birth. After adjusting for other significant factors, women had significantly higher odds of having labour if they birthed in a public hospital and had a pre-existing preference for a vaginal birth. Of women who had labour, 80.8% had a vaginal birth. Women who had labour had significantly higher odds of having a vaginal birth if they attended antenatal classes, did not have continuous fetal monitoring, felt able to 'take their time' in labour, and had a pre-existing preference for a vaginal birth. Of women who had a vaginal birth, 44.7% had a normal birth. Women who had a vaginal birth had significantly higher odds of having a normal birth if they birthed in a public hospital, birthed outside regular business hours, had mobility in labour, did not have continuous fetal monitoring, and were non-supine during birth.


CONCLUSIONS
these findings provide a strong foundation on which to base resources aimed at increasing informed decision-making for maternity care consumers, providers, and policy-makers alike. Research to evaluate the impact of modifying key clinical practices (e.g., supporting women׳s mobility during labour, facilitating non-supine positioning during birth) on the likelihood of a normal birth is an important next step.
School of Public Health & Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, Queensland 4059, Australia; School of Psychology, The University of Queensland, Brisbane, Queensland, Australia. Electronic address: yvette.miller@qut.edu.au.
Yvette D
YD
Miller
School of Psychology, The University of Queensland, Brisbane, Queensland, Australia. Electronic address: s.prosser@psy.uq.edu.au.
Samantha J
SJ
Prosser
School of Psychology, The University of Queensland, Brisbane, Queensland, Australia; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, United States. Electronic address: Rachel.L.Thompson@dartmouth.edu.
Rachel
R
Thompson
D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008880:Midwifery; D011181:Postnatal Care; D011247:Pregnancy; D011793:Queensland / Q000453:epidemiology; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
Caesarean section; Childbirth; Informed decision-making; Normal birth; Patient-reported data