Birth interventions and outcomes among first time mothers: a population-based register study in four Nordic countries

Introduction: Although the Nordic countries generally report lower caesarean section rates compared with middle- and high-income settings, caesarean section represents only one dimension of obstetric intervention. Limited evidence exists regarding the prevalence of physiological birth across the Nordic region. We aimed to describe and compare cross-country variations in intrapartum intervention rates and birth-related complications among nulliparous women in Finland, Iceland, Norway, and Sweden. Methods: This Nordic observational study used data from the Finnish, Icelandic, Norwegian, and Swedish Medical Birth Registers for all nulliparous births in 2020. Three composite outcomes described levels of obstetric intervention and complications: (1) births without major interventions or complications, (2) births without interventions or complications (may include epidural/spinal analgesia), and (3) physiological births without complications. Prevalence was calculated for each outcome and logistic regression used to estimate odds ratios and 95% confidence intervals. Results: Prevalence of births without major interventions or complications differed between countries and were most common in Sweden (62.4%; 95%CI:64.0–64.9) and least common in Finland (45.0%; 95%CI:44.3–45.7). Births without interventions and complications was most common in Iceland (29.4%; 95%CI:27.4–31.5) and least common in Finland (15.9%; 95%CI:15.4–16.4). Physiological births without complications were most common in Iceland (19.1%; 95%CI:17.4–20.0) and least common in Finland (6.1%; 95%CI:5.8–6.5). Conclusion: Overall, about one in eight primiparous women in four Nordic countries experienced a physiological birth without complications. This finding invites reflection on how maternity care systems, professional practices, and cultural attitudes toward birth may shape opportunities for women to experience childbirth as a normal physiological process.