# Beyond the physical: exploring the complexities of Women’s health after severe perineal trauma—a cross-sectional study on predictors of health-related quality of life in Sweden

## TL;DR

This study explores how severe perineal trauma during childbirth affects women's long-term health and quality of life in Sweden.

## Contribution

The study identifies predictors of physical and mental health outcomes in women with severe perineal trauma at least 18 months postpartum.

## Key findings

- Women with severe perineal trauma had lower physical and mental health scores compared to the general population in Sweden.
- Physical health was predicted by symptom bother, work ability, education, and physical activity, while mental health was influenced by age and work ability.

## Abstract

Severe perineal trauma (SPT), defined as third- or fourth-degree lacerations during childbirth, is a known risk factor for adverse postpartum health-related quality of life (HRQoL). Although HRQoL may improve within six months postpartum, up to 30% of affected women in Sweden report long-term health problems beyond one year. While qualitative studies highlight the broad negative impact, quantitative findings remain inconclusive, particularly regarding the role of pelvic floor symptoms and the degree of SPT, underscoring the need for further research. The aim is to assess and compare HRQoL in a sample of women with SPT, and to identify predictors of physical and mental health at least 18 months postpartum.

A nationwide cross-sectional study was conducted in Sweden using an online questionnaire to assess HRQoL via the validated RAND-36 instrument. Linear regression analysis was employed to explore associations.

Two hundred and twenty-one women with SPT and varying symptom bother from SPT, at least 18 months after the childbirth, responded. The study population exhibited worse-than-average RAND-36 scores across most dimensions (apart from physical functioning and pain) compared to normative data for women in Sweden. Further, the mean physical health score was significantly lower in our study sample (M = 70.7, SD = 22.1) compared to the reference population of women in Sweden (M = 73.63, SD = 29.45), t [df (degrees of freedom) 220] = −1.99, p = 0.047, Cohen's d = 0.13. The mean mental health score was significantly lower in our study sample (M = 63.2, SD = 21.4) compared to normative Swedish women (M = 71.7, SD = 27.15), t (df 220) = −5.90, p < 0.001, Cohen's d = 0.40. Health change over the past year remained relatively static with a slight trend towards improvement (mean 54.5; SD 21.6; CI 95% 51.6–57.4). Physical health was predicted by the extent of symptom bother, perceived work ability, educational attainment, and level of physical activity. Mental health was predicted by age, extent of symptom bother, and perceived work ability.

These findings underscore the need for individualized, multidisciplinary care strategies that address both physical and psychological dimensions of recovery after sustaining SPT at childbirth. Future research should investigate the barriers and facilitators influencing HRQoL, to enhance HRQoL and support the reintegration of women with SPT into their social and professional spheres. A deeper understanding of the socioeconomic and occupational contexts of affected women is essential to promote more equitable health outcomes.