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\begin{document}

\title{What women emphasise as important aspects of care in childbirth: An
online survey study of 8,401 women who have given birth in Norway}



\author[1]{Carina Vedeler}%
\author[2]{Anne Britt Nilsen}%
\author[1]{Ellen Blix}%
\author[3]{Soo Downe}%
\author[1]{Tine Eri}%
\affil[1]{Oslo Metropolitan University}%
\affil[2]{Western Norway University of Applied Sciences}%
\affil[3]{University of Central Lancashire}%


\vspace{-1em}



  
  \date{June 03, 2024}


\begingroup
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\selectlanguage{english}
\begin{abstract}
Objective To explore and describe what women who have given birth in
Norway emphasise as important aspects of care during childbirth. Design
The study is based on data from the Babies Born Better survey, version
2, a mixed-method online survey. Setting The maternity care system in
Norway. Study population Women who gave birth in Norway between 2013 and
2018. Method Descriptive statistics were used to describe sample
characteristics and to compare data from the B3 survey with national
data from the MBRN, using SPSS\selectlanguage{ngerman}® software (version 20). The open-ended
questions were analysed with an inductive thematic analysis, using NVIVO
12® software. Main outcome measures Themes developed from two open-ended
questions. Results The final sample included 8,401 women. There were no
important differences between the sample population and the national
population with respect to maternal age, marital status, parity, mode of
birth and place of birth, except for the proportion of planned
homebirths. Four themes and one overarching theme were identified;
Compassionate and Respectful Care, A Family Focus, Continuity and
Consistency, and Sense of Security, and the overarching theme Coherence
in Childbearing. Conclusions Socio-cultural and psychological aspects of
care are significant for women in childbirth, alongside physical and
clinical factors. Caring for the woman implies caring for her partner
and having a baby is about `becoming a family or expanding the family'.
Childbirth is a continuous experience in women's lives and continuity
and consistency are important for women to maintain and promote a
coherent experience.%
\end{abstract}\selectlanguage{ngerman}%



\sloppy


What women emphasise as important aspects of care in childbirth: An
online survey study of 8,401 women who have given birth in Norway

Carina Vedeler\textsuperscript{1}

Anne Britt Vika Nilsen\textsuperscript{2}

Ellen Blix\textsuperscript{1}

Soo Downe\textsuperscript{3}

Tine S. Eri\textsuperscript{1}

\textsuperscript{1}Faculty of Health Sciences, Oslo Metropolitan
University, Oslo, Norway

\textsuperscript{2}Faculty of Health and Social Sciences, Western Norway
University of Applied Sciences,~Bergen, Norway

\textsuperscript{3}Research in Childbirth and Health (ReaCH)
group/THRIVE Centre, University of Central Lancashire, Preston, UK

Corresponding author:

Carina Vedeler

Email: \emph{calian@oslomet.no}

Postboks 4, St. Olavs Plass

0130 Oslo, Norway

Phone: +47~40862987

Short running title: Important aspects of care during childbirth

Abstract

Objective

To explore and describe what women who have given birth in Norway
emphasise as important aspects of care during childbirth.

Design

The study is based on data from the Babies Born Better survey, version
2, a mixed-method online survey.

Setting

The maternity care system in Norway.

Study population

Women who gave birth in Norway between 2013 and 2018.

Method

Descriptive statistics were used to describe sample characteristics and
to compare data from the B3 survey with national data from the MBRN,
using SPSS\selectlanguage{ngerman}® software (version 20). The open-ended questions were
analysed with an inductive thematic analysis, using NVivo 12® software.

Main outcome measures

Themes developed from two open-ended questions.

Results

The final sample included 8,401 women. There were no important
differences between the sample population and the national population
with respect to maternal age, marital status, parity, mode of birth and
place of birth, except for the proportion of planned homebirths. Four
themes and one overarching theme were identified; Compassionate and
Respectful Care, A Family Focus, Continuity and Consistency, and Sense
of Security, and the overarching theme Coherence in Childbearing.

Conclusions

Socio-cultural and psychological aspects of care are significant for
women in childbirth, alongside physical and clinical factors. Caring for
the woman implies caring for her partner and having a baby is about
`becoming a family or expanding the family'. Childbirth is a continuous
experience in women's lives and continuity and consistency are important
for women to maintain and promote a coherent experience.

\subsection*{Key words}

{\label{key-words}}

Midwifery care; Childbirth experience; Intrapartum care; Salutogenesis;
Coherence in Childbearing; Thematic analysis

Tweetable abstract

A national survey of more than 8,000 women in Norway showed that
childbirth is a life event, not just a clinical procedure, and that
continuity and consistency of care are important to maintain and promote
a coherent experience.

Introduction

Childbirth is an important existential experience in a woman's life.
Childbearing women value a positive birth experience, and WHO recognises
a `positive childbirth experience' as a significant end point for all
women who have given birth.\textsuperscript{1-3}

Paying attention to service users' views and experiences is a crucial
part of improving and developing maternity
care.\textsuperscript{1,4,5}It is important to develop and provide
maternity services that women want and need.\textsuperscript{2} The
literature on women's negative and traumatic birth experiences is
extensive.\textsuperscript{6-10} However, there is much less evidence
about the nature of positive childbirth experiences and the impact on
good health for women and families.

Salutogenic theory focuses on what promotes good health. The theory was
first introduced by Antonovsky\textsuperscript{11} who suggested that
health is movement on a continuum of ease and dis-ease, unlike the
dichotomy of healthy or sick. There is good evidence that salutogenesis
is a useful theory for maternity care research.\textsuperscript{12-14}

To the best of our knowledge, this is the first study with such a large
sample of childbearing women, asking for women's views on what worked
well in their maternity care experience. The main objective of this
study is to explore and describe what women who have given birth in
Norway emphasise as important aspects of care during childbirth, with a
focus on salutogenic theory.

Methods

Design

This study is based on data from the Babies Born Better survey, version
2, a mixed-method online survey.

Setting

The context of the current paper is the Norwegian maternity care system,
which is part of the public health care system. It is tax funded and
provided free of charge at the point of use. Midwives and doctors have a
fixed salary, and thus have no economic interest in how a labour
proceeds. Virtually all women in Norway receive maternity care from the
public health care system. Intrapartum care is organised at three
levels; 1) specialised obstetric units, 2) smaller obstetric units and
3) alongside and freestanding midwifery units. Midwives attend all
births. Apart from a few independent midwives offering antenatal care,
homebirths and post-partum care, there are no private birth
institutions. There were 45 birth units in Norway in the study period,
and approximately 58,000 births per year. The population is widely
scattered and is characterised by both centralisation and
decentralisation. More than 45\% give birth in the five largest
hospitals, however there are 19 units with less than 500 births per
year, the caesarean section rate in 2019 was 16\%, epidural anaesthesia
36\%, and vacuum or forceps 10\%.\textsuperscript{15}

Study population

Women who gave birth in Norway during the period 2013 to 2018 were
eligible to participate.

Data collection

The survey was open from March to August 2018. It was launched through
social media, mainly through Facebook where the link was widely
disseminated to relevant Facebook groups. We also contacted specifically
targeted websites and asked them to post the survey on their web forums.

The questionnaire

The survey was an open online survey (SurveyMonkey®), comprising 22
questions (Appendix S1) with sub-questions divided into four sections,
including both closed and open-ended response options. The first three
sections comprised questions related to demographics and maternal
characteristics; age, marital status, migration, self-rated
socio-economic status, education, employment status, parity, gestational
age, mode of birth and place of birth. The fourth section included two
open-ended questions; the first designed to elicit women's views of what
worked well during their childbirth experience, and what they think
would have improved their experience of care, the second asked for an
honest description of the place where they had their baby, and reasons
why they would, or would not, recommend it as a birthplace to a close
friend or family member.

The Medical Birth Registry of Norway (MBRN)

To assess the representativeness of the study sample, a Norwegian
population-based sample with information about maternal age, marital
status, parity, place of birth and mode of birth, from the Norwegian
birth cohort of all women who gave birth in 2017 was retrieved from
MBRN.\textsuperscript{15}

Analysis

Descriptive statistics were used to describe sample characteristics and
to compare data from the B3survey with the national population-based
data sample from the MBRN, using SPSS® software (version 26).

We performed thematic analysis\textsuperscript{16} to analyse the two
open-ended questions (Q17, Q18). An inductive approach was chosen.
Thematic analysis is a method for identifying, analysing and reporting
patterns or themes within a data set. The analytical process was data
driven, dynamic and continuously discussed in the research group. The
stepwise process is illustrated in Figure 1. See Appendix S2 for a more
in-depth description of the analytical process. Quality assessment was
done using the CHERRIES checklist\textsuperscript{17} (Appendix S3).

Ethics

Ethical approval was granted by the Ethics Committee of the University
of Central Lancashire, UK (Ethics Committee BuSH 222). The study was
approved by the Norwegian Data Inspectorate (ref: 60547/3/HJTIRH), no
further ethical clearance was necessary (ref: 2017/1582).

Results

Altogether, 11,135 women who had given birth in Norway responded to the
survey. The final sample included 8,401 women (Figure 2).

\subsubsection*{Demographics of the
respondents}

{\label{demographics-of-the-respondents}}

Table 1 shows the main characteristics of the included respondents.
Whenever national data were available in the MBRN, our sample was
compared to the population-based sample in 2017 as a census group. Of
the included women, 92.3\% were born in Norway. The mean age was 29.9
years (SD 5.0), 45\% were nulliparous and 55\% multiparous. All 45 birth
units in Norway were represented in the sample, the response rates by
unit were similar to the rate of births in those units for the
population (Figure 3). There were no important differences between our
sample and the population-based sample regarding age, marital status,
parity, mode of birth, place of birth, except for the number of planned
homebirths (1.6\% in the study, 0.2\% in the population). Missing data
varied from 0.04-0.7\% across the variables, except for education level
which was 2.6\%.

\subsubsection*{Findings from the open-ended
questions}

{\label{findings-from-the-open-ended-questions}}

The analysis of the open-ended questions resulted in four themes;
Compassionate and Respectful Care; Sense of Continuity and Consistency;
A Family Focus; Sense of Security, and one overarching theme; Coherence
in Childbearing. See Appendix S4 for more quotes.

\subsubsection*{Compassionate and Respectful
Care}

{\label{compassionate-and-respectful-care}}

To be compassionate implied that the staff were genuinely engaged and
concerned about the woman's well-being, through empathy, kindness,
attentiveness, love, support, understanding and compassion during labour
and birth. If the staff were insensitive or lacked empathy, childbirth
was experienced as very difficult and something they would have wanted
to change. It was clear that childbirth was perceived as a vulnerable
situation that required a sensitive approach. The data implied that
simple politeness from the staff was insufficient: the birthing woman
needed to feel the care as genuinely intended to be perceived as caring.

`When we changed midwife, we got one that touched my arm looked me in
the eyes and said; this is going well. {[}she said{]} Do this and that.
{[}she was{]} Very clear'

Compassionate and respectful care was also connected to the midwife's
watchful attendance, perceived as the actual time present and an
emotional availability that led to a feeling that the midwife was there
for her and saw her. The midwife's emotional presence was perceived as
awareness and sensitivity to the woman's signals and needs.

`The first midwife I had was so present and accommodating. Almost didn't
have to say anything because she understood what I needed'

To be respected, empowered, seen and listened to as a unique individual
led to a sense of partnership when things were to be decided. Having
real influence and co-determination in terms of herself and the child
was important. If the midwives or doctors were sensitive and
acknowledged her wishes, it could lead to a sense of being special and
unique and experiencing individual care. If this central aspect was
missing, the respondents reported a sense of vulnerability, which was
problematic and difficult;

`Midwives don't have enough time, they don't see you as a separate
individual, midwives don't have empathy. A feeling that the hospital had
a ''yes but we see this so often'' attitude'

\subsubsection*{Sense of Continuity and
Consistency}

{\label{sense-of-continuity-and-consistency}}

Continuity refers to the woman's perception of pregnancy, labour and
birth and post-partum as a coherent whole that are not distinguished as
different phases. Being allowed to enter the hospital when she felt the
need to, in the early stages of labour, was essential;

`The person I spoke to on the phone before I came in seemed brusque and
incomprehensible. Asked me to wait to come in because she thought I was
not in enough pain. I had to ''argue'' to get an examination. When I
came in, I had 7-8 cm dilatation and frequent contractions'

Another facet of continuity was the midwives' availability throughout
the process; the importance of not being left to yourself; and that the
midwife had time for the parents and the baby after birth\emph{.}

Initiation of breastfeeding was also crucial for the sense of
continuity, including good breastfeeding support and care throughout the
postnatal period.

`Better help with breastfeeding. I felt that the staff was short of time
and had completely different opinions about this. This led to a chaotic
and stressful situation'

Continuation and consistency of information was also a part of this
concept. It seemed crucial that the staff had read the woman's birth
plan and medical notes, and that previous pregnancies or births were
taken into consideration. This does not merely mean that the woman saw
the same person, but that all the staff cooperated on sharing and
addressing prior information about her, in a way that optimised her
sense of seamless care. The sense of continuity was also connected to
receiving the information and explanations needed throughout the birth
process and to be offered a post-partum conversation.

\subsubsection*{A Family Focus}

{\label{a-family-focus}}

A family focus in care involved not only the partner's inclusion in the
birth process, but also that giving birth to a child is primarily about
'becoming a family' or 'expanding the family'.

`The father and I as a unit that did this together'

It was therefore crucial for the women that their partners were involved
and felt included and that his/her experiences, feelings and needs were
acknowledged.

`That staff listen to both the mother and father of the child. That
staff include the father more. The expensive accommodation for partners
meant we could not afford to be there together, very difficult and
tiring as a new mother all alone without sleep'

The partner's presence and care were crucial to the women, but the
midwife's care for the partner was also of great importance. A lack of
care for the partner raised difficult emotions for the woman. This was
so important that some women noted that it was very positive that their
partner was well cared for by staff. Involving and including the partner
seemed to be a twofold matter. Firstly, care for their physical
condition, including the opportunity for rest, to fetch food and be
present throughout the stay. Secondly, the emotional aspects which were
about the partner feeling included, that they were treated as a family,
and that they could spend time together with the new-born baby.

`Better care of the father both emotionally and physically, he should
automatically be able to sleep the first night at the hospital,
especially if the baby is born late at night'

\subsubsection*{Sense of Security}

{\label{sense-of-security}}

Feeling secure was emphasised as a fundamental part of care by many
respondents. While the women linguistically used the same terms, they
referred to different meanings regarding what made them feel safe.
Feeling secure seemed to encompass both medical, emotional and
relational safety. For some women, the aspect of emotional and
relational safety seemed most important;

`Then you'll have a sense of peace in a safe and familiar environment,
without unnecessary stress and interventions, with a midwife who knows
you and your wishes'

For others, the notion of medical safety was most important;

`There's good expertise among employees, and all the facilities you may
need in the event of any complications'

The sense of security was also linked to confidence in the staff's
competence and a perception that the staff was fundamentally trustworthy
and acting in the women's and their babies' best interest. This both
referred to medical competence as a competent hospital team of expert
midwives and doctors, and trust in their experience and knowledge. It
seemed that trusting the staff's competence could lead to a sense of
being able to lean on them and ''let go'' and not worry about whether
they knew what they were doing. Doubting whether the staff could offer
this sense of security was associated with uncertainty about how safe
their birth was, and in their capacity to negotiate it without harm.

`Didn't feel the midwife knew what to do when my pain was at its worst,
again, want a more secure and experienced midwife'

\subsubsection*{Overarching theme: Coherence in
childbearing}

{\label{overarching-theme-coherence-in-childbearing}}

\emph{Coherence in childbearing} encompasses all four themes. It refers
to the woman's experience of childbearing as a whole and that it is not
perceived as a separate event disconnected from both the antenatal and
postnatal period or women's lives in general. It implies an
understanding of the woman as a unique person with her own history,
cultural background, resources, perceptions and personality. Everything
she experiences will be related to this and thus, also, to how she
experiences care. The following quotes illustrate what `good' or `poor'
care felt like;

\subsubsection*{Good Care}

{\label{good-care}}

\emph{\textbf{W1:} You will be followed up as if you're the only one,
not just one of many on an `assembly line'. You will get peace and quiet
because this is a small hospital, and Dad is recognised as an important
part of the birth and maternity experience. You are seen, heard and
cared for with warmth and care. A wonderful place to bring new life into
the world.}

\subsubsection*{Poor Care}

{\label{poor-care}}

\emph{\textbf{W2:} They don't have respect for the female body and its
ability to give birth. There was no humanity, only medicine. The
environment among the staff was poor, they didn't appear to read the
medical record, and everyone had to come up with their own solutions.
They don't listen to one's objections and it was so poorly staffed that
the father basically had to help with everything, yet there was no room
for him. I didn't feel safe and didn't get the help I needed.}

Discussion

Main findings

The analysis resulted in a rich and nuanced body of information about
what women who have given birth in Norway emphasise as important aspects
of care during childbirth. The findings demonstrate that socio-cultural
and psychological aspects of care are significant for women in
childbirth, alongside physical and clinical factors. Some of the
findings reflect earlier research, including the desire for
compassionate and respectful care, continuity of care and safety. Women
who gave birth in Norway emphasise that respectful maternity care
encompasses more than absence of disrespectful care or mistreatment
during childbirth,\textsuperscript{18-21} they also value empathetic and
sensitive clinical staff. \textsuperscript{2,22} In our study,
continuity of care was highlighted as good care and called for when it
was missing. This reflects the desire for and satisfaction with
continuity of care, which is a common research
finding.\textsuperscript{22,23} In our study, the concept of continuity
encompasses consistency of information between clinical staff and wards,
and continuity of the experience of pregnancy, labour and birth, and
even continuity between pregnancies.

The Family Focus theme illustrates new and unique nuances in women's
views on the importance of family-oriented care; it is perceived as
pivotal that the partner is involved, included and cared for both
emotionally and through the provision of good facilities, which is also
found in studies on fathers' experiences and expectations of
childbirth.\textsuperscript{24-29} Furthermore, our results suggest that
the value of looking after birth companions is a way of looking after
the woman herself. If she does not have to worry about the wellbeing of
her partner, she can commit to the labour process.

The theme `sense of security' goes beyond `being safe'. The findings
demonstrate that the notion of safety and security varies, and that the
perception of the concept is individual and complex, which is also found
in other studies.\textsuperscript{28} This is reflected in the
contrasting rationale for feeling safe; some felt safe giving birth in a
high-tech hospital ward with monitoring and emergency preparedness,
while others felt safe giving birth at home with a midwife they knew
well in familiar surroundings.

Strengths and limitations

To our knowledge, this is the largest study of women's childbirth
experiences ever conducted in Norway. In 2018, 93\% of Norwegian women
between 18 and 44 had a profile on Facebook, 98\% of these used Facebook
weekly.\textsuperscript{30} Social media was thus a feasible platform
for recruiting participants. The study sample characteristics were very
similar to those of the eligible population.

We had limited opportunity to match more demographic characteristics of
the study population to the national data such as education, migration
and socio-economic inequity. Survey studies have some methodological
limitations such as response and recall bias. Further studies could
target specific and more marginalised groups.

Interpretation

Our interpretation of the findings identify new nuances in the care of
women during childbirth; the need for an increased family focus in care,
sensitivity to the women's individuality regarding the notion of safety
and security, to understand childbirth as a continuous experience in the
context of women's lives and to maintain and promote a coherent
experience.

The women expressed an explicit wish for family-oriented care. This
raises the suggestion that women might not be able to enter the `flow
state', neuropsychologically, if they are concerned about the wellbeing
of others in attendance who they care about.\textsuperscript{31} It also
underlines that women view the process of giving birth as a transition
towards 'becoming a family' or 'expanding the family'. Shifting roles
from woman to mother and man to father or from couple to parents. In
light of the theory of `rite de passage' and liminality, transition
refers to a change of status, and ambiguity and vulnerability in
connection with this change.\textsuperscript{32}

The women's notion of safety and security revealed a complexity that can
depend on multiple internal and external factors.\textsuperscript{28}One
interpretation is to assume that if the woman's ideas and beliefs are
shared, or at least respected, by the staff and the organisation where
the birth takes place, the associated notion of safety and security can
reinforce the woman's sense of security. The sense of freedom that women
reported when they felt totally secure was, as for family support, a
sense of relief that they could trust the staff to deal with extraneous
matters and threats. This meant that they were free to disconnect
external vigilance, enabling them to internalise their focus on giving
birth.\textsuperscript{31}

The women's experience of continuity comprised a sense that each stage
of the process, at each level of their experience, was interconnected
and this was reinforced if there was no sense of discontinuity even when
different staff were involved. The findings coincide with those of
others who have suggested that women's experiences during labour and
birth does not correspond to physically defined stages, but go beyond
this to a life-course concept of continuity, which needs to be
recognised by staff when they encounter women in
labour.\textsuperscript{33-36}

The overarching theme brings these findings of seamlessness together, by
incorporating the notion `Coherence'.\textsuperscript{11} In this sense,
a coherent labour and birth experience encompasses all the themes,
assuming that childbirth can be experienced as meaningful, manageable
and comprehensible. A strong sense of coherence (SOC) is associated with
positive emotions both regarding birth and the baby, while a weak SOC is
expressed through negative emotions and worries relating to labour and
birth.\textsuperscript{37} It is claimed that women need to organise
their childbearing experience into a coherent
narrative.\textsuperscript{38} However, it may be challenging for women
to create and maintain a coherent narrative, as the transition to
motherhood is both private and public, social and biological and
influenced by their own or others' expectations.\textsuperscript{38} Our
findings suggest that maternity care that reflects all four themes could
help women to create coherent experiential narratives optimising their
wellbeing, and that of their baby, partner and family, into the future.
Beyond this, it is plausible that women who feel a sense of coherence in
childbirth are more able to activate parts of the neocortex required for
the neurohormonal processes that facilitate optimal birth physiology and
post-birth adjustment.\textsuperscript{31}

Conclusion

Socio-cultural and psychological aspects of care are significant for
women in childbirth, alongside physical and clinical factors.
Compassionate and respectful care encompasses empathetic and sensitive
staff, and a sense of the care being genuinely intended. Caring for the
woman implies caring for her partner and having a baby is about
`becoming a family or expanding the family'. How maternity services meet
both parents' needs are therefore crucial. Women's notion of safety and
security is individual and complex. Childbirth is a continuous
experience in the context of women's lives and continuity and
consistency are important for women to maintain and promote a coherent
experience, which refers to the woman's experience of childbearing as a
whole.

\subsection*{Disclosure of interest}

{\label{disclosure-of-interest}}

The authors report no conflict of interest.

\subsection*{Contribution of
authorship}

{\label{contribution-of-authorship}}

The conception and design of the work: CV, ABVN, EB, SD, TSE.
Acquisition of data: CV, ABVN, EB, SD, TSE. Analysis and interpretation
of data: CV, ABVN, EB, SD, TSE. Drafting the work and revising it
critically for important intellectual content: CV, ABVN, EB, SD, TSE.

\subsection*{Details of ethics
approval}

{\label{details-of-ethics-approval}}

Ethical approval was granted by the Ethics Committee of the University
of Central Lancashire, UK (Ethics Committee BuSH 222). The study was
approved by the Norwegian Data Inspectorate (ref: 60547/3/HJTIRH), no
further ethical clearance was necessary (ref: 2017/1582).

\subsection*{Funding}

{\label{funding}}

CV was funded by a PhD scholarship from Oslo Metropolitan University.

\subsection*{Acknowledgement}

{\label{acknowledgement}}

This study was derived from the Babies Born Better project, developed as
a part of two EU COST Actions supported by the Cost (European
Cooperation in Science and Technology Programme as a part of European
Horizon 2020): 1) COST-Action IS0907 ``Childbirth Cultures, Concerns,
and Consequences: Creating a dynamic European Union framework for
optimal maternity care''; and 2) COST-Action IS1405: Building
Intrapartum Research Through Health---an interdisciplinary whole system
approach to understanding and contextualizing physiological labour and
birth (BIRTH).

\section*{References}

{\label{references}}

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WHO model of intrapartum care for a positive childbirth experience:
transforming care of women and babies for improved health and wellbeing.
BJOG: An International Journal of Obstetrics \& Gynaecology.
2018;125(8):918-22.

2. Downe S, Finlayson K, Oladapo OT, Bonet M, Gülmezoglu AM. What
matters to women during childbirth: A systematic qualitative review.
PloS one. 2018;13(4):e0194906-e.

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\subsection*{Table/Figure Caption List}

{\label{tablefigure-caption-list}}

Figure 1. The stepwise analytical process as described by Braun and
Clarke\textsuperscript{16}

Figure 2. Flowchart illustrating inclusion in the study

Figure 3. Proportion and distribution of place of birth in study sample
(n=8,401) and MBRN 2017 (n=56,553)

Table 1. Sociodemographic and obstetric characteristics of included
respondents (n=8,401), compared to a national Norwegian sample
(n=56,553) from year 2017

Table 1. Sociodemographic and obstetric characteristics of included
respondents (n=8,401), compared to a national Norwegian sample
(n=56,553) from year 2017\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
\textbf{Sociodemographic} & \textbf{Study sample} & \textbf{Study
sample} & \textbf{MBRN 2017*} & \textbf{MBRN 2017*}\tabularnewline
\midrule
\endhead
& n=8,401 & (\%) & n= 56,553 & (\%)\tabularnewline
\textbf{Maternal age} & & & &\tabularnewline
Mean (SD) & 29.9 & 5.0 & 30.9 & 4.9\tabularnewline
\textless{}19 & 60 & 0.7 & 500 & 0.8\tabularnewline
20-24 & 940 & 11.3 & 5,872 & 10.4\tabularnewline
25-29 & 2,904 & 34.8 & 18,672 & 33.0\tabularnewline
30-34 & 2,944 & 35.3 & 19,943 & 35.3\tabularnewline
35-39 & 1,257 & 15.1 & 9,429 & 16.7\tabularnewline
\textgreater{}40 & 233 & 2.8 & 2,137 & 3.8\tabularnewline
\textbf{Education} & & & &\tabularnewline
No higher education & 1,805 & 22.1 & &\tabularnewline
Higher education [?] 4 years & 3,653 & 44.6 & &\tabularnewline
Higher education \textgreater{} 4 years & 2,727 & 33.3 &
&\tabularnewline
\textbf{Employment} & & & &\tabularnewline
Employed & 6,701 & 79.9 & &\tabularnewline
Student & 674 & 8.0 & &\tabularnewline
Unemployed & 410 & 4.9 & &\tabularnewline
Other & 601 & 7.2 & &\tabularnewline
\textbf{Socio-economic status}** & & & &\tabularnewline
1 (Much worse) & 276 & 3.3 & &\tabularnewline
2 & 351 & 4.2 & &\tabularnewline
3 (Average) & 5,787 & 69.0 & &\tabularnewline
4 & 1,313 & 15.6 & &\tabularnewline
5 (Much better) & 667 & 7.9 & &\tabularnewline
\textbf{Marital Status} & & & &\tabularnewline
Married or in a relationship, cohabiting & 7,863 & 93.7 & 52,984 &
93.7\tabularnewline
Other & 533 & 6.3 & 3,568 & 6.3\tabularnewline
\textbf{Obstetric characteristics} & \textbf{Study sample} &
\textbf{Study sample} & \textbf{MBRN 2017*} & \textbf{MBRN
2017*}\tabularnewline
& n=8,401 & (\%) & n=56,553 & (\%)\tabularnewline
\textbf{Place of birth} & & & &\tabularnewline
Obstetric unit*** & 7,673 & 91.3 & 52,693 & 93.2\tabularnewline
Alongside midwifery unit**** & 485 & 5.8 & 3,000 & 5.3\tabularnewline
Freestanding midwifery unit & 69 & 0.8 & 387 & 0.7\tabularnewline
Planned homebirth & 132 & 1.6 & 126 & 0.2\tabularnewline
Born before arrival & 38 & 0.5 & 347 & 0.6\tabularnewline
\textbf{Parity} & & & &\tabularnewline
Nulliparous & 3,772 & 45.0 & 23,841 & 42.2\tabularnewline
Multiparous & 4,606 & 55.0 & 32,712 & 57.8\tabularnewline
\textbf{Mode of birth*****} & & & &\tabularnewline
Spontaneous vaginal delivery & 6,240 & 74.4 & 42,075 &
73.7\tabularnewline
Instrumental vaginal delivery***** & 907 & 10.8 & 5,968 &
10.3\tabularnewline
Caesarean section (emergency) & 828 & 9.9 & 5,870 & 10.4\tabularnewline
Caesarean section (planned) & 407 & 4.9 & 3,159 & 5.6\tabularnewline
\bottomrule
\end{longtable}

*The Norwegian birth cohort Medical Birth Registry of Norway (MBRN) data
from year 2017

** My living standard compared to the people in the country I am
currently living in. Likert scale 1-5

*** Includes specialised obstetric units and smaller obstetric units

****Not registered in MBRN, all alongside units were contacted to obtain
number of births.

***** In MBRN, this refers to number of babies born and not births

\selectlanguage{english}
\FloatBarrier
\end{document}

