Maternal birth experience at operative vaginal birth

Operative birth is a known risk factor for negative birth experience, yet the modifiable factors that shape these experiences remain underexplored.

This study examines factors associated with birth experience following operative second-stage birth, including operative vaginal birth (OVB) or fully dilated caesarean (FDCS).

We conducted a prospective mixed-methods study of women undergoing operative second-stage birth across four hospitals in one health network, in Melbourne Australia. A validated birth experience survey was administered, and responses were matched to clinical data. Logistic regression analysis identified factors associated with negative birth experience. Free-text survey responses were thematically analysed.

Of 2783 women who had an operative second-stage birth from July 2023 to March 2025, 402 (14.4 %) responded to the survey. Of those, 127 (31.6 %) scored < 25 indicating a negative experience. Negative experience was associated with prolonged second stage (odds ratio (OR) 2.00, 95 % confidence interval (CI) 1.26-3.20, p = 0.004), anal sphincter injury (OR 4.09, 95 % CI 1.59-11.00, p = 0.004) and postpartum haemorrhage (OR 2.01, 95 % CI 1.16-3.47, p = 0.013), while maternal age greater than 35 years (OR 0.41, 95 % CI 0.18-0.84, p = 0.020) and vacuum-assisted birth (OR 0.42 (0.22-0.77, p = 0.006) were protective. Qualitative analysis identified six overarching themes impacting birth experience: (1) preparation and expectations, (2) communication and care, (3) empowerment and control, (4) exhaustion and pain, (5) separation of the family unit, (6) physical and emotional safety.

Birth satisfaction is influenced by both clinical and contextual factors. Effective communication, emotional support, shared decision-making, and high-quality antenatal education are essential to improving maternal experience during operative birth.