Emotional factors, medical interventions and mode of birth among low-risk primiparous women in Poland

Ilona Nenko; Katarzyna Kopeć-Godlewska; Mary C Towner; Laura D Klein; Agnieszka Micek

doi:10.1093/emph/eoad013

Emotional factors, medical interventions and mode of birth among low-risk primiparous women in Poland

Evol Med Public Health. 2023 May 14;11(1):139-148. doi: 10.1093/emph/eoad013. eCollection 2023.

Authors

Ilona Nenko¹, Katarzyna Kopeć-Godlewska², Mary C Towner³, Laura D Klein⁴, Agnieszka Micek⁵

Affiliations

¹ Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland.
² Laboratory of Fundamental Obstetric Care, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland.
³ Department of Integrative Biology, Oklahoma State University, Stillwater, OK, USA.
⁴ Business Growth and Innovation, Australian Red Cross Lifeblood, Alexandria, Australia.
⁵ Department of Nursing Management and Epidemiological Nursing, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland.

Abstract

Background and objectives: Birth is a critical event in women's lives. Since humans have evolved to give birth in the context of social support, not having it in modern settings might lead to more complications during birth. Our aim was to model how emotional factors and medical interventions related to birth outcomes in hospital settings in Poland, where c-section rates have doubled in the last decade.

Methodology: We analysed data from 2363 low-risk primiparous women who went into labor with the intention of giving birth vaginally. We used a model comparison approach to examine the relationship between emotional and medical variables and birth outcome (vaginal or c-section), including sociodemographic control variables in all models.

Results: A model with emotional factors better explained the data than a control model (Δ_AIC = 470.8); women with continuous personal support during labor had lower odds of a c-section compared to those attended by hospital staff only (OR = 0.12, 95% CI = 0.09 - 0.16). A model that included medical interventions also better explained the data than a control model (Δ_AIC = 133.6); women given epidurals, in particular, had increased odds of a c-section over those who were not (OR = 3.55, 95% CI = 2.95 - 4.27). The best model included variables for both the level of personal support and the use of epidural (Δ_AIC = 598.0).

Conclusions and implications: Continuous personal support during childbirth may be an evolutionarily informed strategy for reducing complications, including one of the most common obstetrical complications in modern hospital settings, the c-section.