Objective To examine fear of childbirth according to parity, gestational age, and obstetric history.Design A questionnaire study.Population and setting 1400 unselected pregnant women in outpatient maternity clinics of a university central hospital.Methods Visual analogue scale (VAS) and Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) and preferred mode of delivery.Main outcome measures W-DEQ and VAS scores according to parity, gestational age, obstetric history, and preferred mode of delivery.Results The W-DEQ and VAS scores were higher in nulliparous (W-DEQ 72.0 ± 20.0 [mean ± SD] and VAS 4.7 [median]) than parous women (65.4 ± 21.9; 3.2, P < 0.001 for both W-DEQ and VAS). Higher W-DEQ and VAS scores were found for those beyond 21 weeks of gestation compared with those before (W-DEQ 71.6 ± 23.0 versus 66.6 ± 20.0, P < 0.001; VAS 4.7 versus 3.2, P < 0.001). Caesarean section was preferred mode of delivery for 8.1% and these women scored higher on fear (W-DEQ 87.6 ± 26.5, VAS median 7.0) than those who preferred vaginal delivery (W-DEQ 61.8 ± 18.7, VAS 2.7, P < 0.001, respectively). Those with a previous caesarean scored higher on fear (W-DEQ 73.2 ± 23.5, VAS 5.1) than parous women without previous caesarean (W-DEQ 63.3 ± 20.8, VAS 2.9, P < 0.001, respectively). Those with a history of a vacuum extraction (VE) (W-DEQ 70.6 ± 19.7, VAS 5.0) had higher fear scores than those without (W-DEQ 64.8 ± 22.0, P < 0.05 and VAS 3.0, P < 0.001).Conclusion Severe fear of childbirth was more common in nulliparous women, in later pregnancy, and in women with previous caesarean section or VE. Caesarean section as a preferred mode of childbirth was strongly associated with high score in both W-DEQ and VAS.

Objective To compare the numbers of vaginal deliveries and delivery satisfaction among women with fear of childbirth randomised to either psychoeducation or conventional surveillance during pregnancy.Design Randomised controlled trial.Setting Maternity unit of Helsinki University Central Hospital.Population Fear of childbirth was screened during early pregnancy by the Wijma Delivery Expectancy Questionnaire (W-DEQ-A). Of 4575 screened nulliparous women, 371 (8.1%) scored ‡100, showing severe fear of childbirth.Methods Women with W-DEQ-A ‡100 were randomised to intervention (n = 131) (psychoeducative group therapy, six sessions during pregnancy and one after childbirth) or control (n = 240) (care by community nurses and referral if necessary) groups. Obstetric data were collected from patient records and delivery satisfaction was examined by questionnaire.Main outcome measures Delivery mode and satisfaction.Results Women randomised to the intervention group more often had spontaneous vaginal delivery (SVD) than did controls (63.4% versus 47.5%, P = 0.005) and fewer caesarean sections (CSs) (22.9% versus 32.5%, P = 0.05). SVD was more frequent and CSs were less frequent among those who actually participated in intervention (n = 90) compared with controls who had been referred to consultation (n = 106) (SVD: 65.6% versus 47.2%, P = 0.014; CS: 23.3% versus 38.7%, P = 0.031). Women in intervention more often had a very positive delivery experience (36.1% versus 22.8%, P = 0.04, n = 219).Conclusions To decrease the number of CSs, appropriate treatment for fear of childbirth is important. This study shows positive effects of psychoeducative group therapy in nulliparous women with severe fear of childbirth in terms of fewer CSs and more satisfactory delivery experiences relative to control women with a similar severe fear of childbirth.

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Objective To investigate whether women with fear of childbirth have more mental health problems than women of childbearing age in general.Design Register-based retrospective study.Setting The maternity clinic of Helsinki University Central Hospital.Population In all, 2405 women referred for consultation because of fear of childbirth during 1996-2002 and 4676 comparable control women.Methods Data were linked to the Medical Birth Register, the Hospital Discharge Register and the Drug Reimbursement Register 5-12 years before and after the initial childbirth (during 1990-2008).Main outcome measures Prevalence of psychiatric care as evidenced by the use of psychotropic medication, and episodes of either psychiatric inpatient or outpatient care in women with fear of childbirth compared with nonfearful controls.Results Women with fear of childbirth had significantly more often had psychiatric care (54.0% versus 33.6%, P < 0.001) during the study period. Fearful and nonfearful women differed from each other (P < 0.001) regarding psychiatric inpatient care (7.2% versus 3.6%), outpatient care (19.0% versus 9.8%) and the use of psychotropic medication (51.3% versus 31.3%). Mood and anxiety disorders were the most common psychiatric diagnoses in both groups. The major predictors for a need for psychiatric care after the initial childbirth were previous psychiatric care (adjusted odds ratio 4.5; 95% CI 4.0-5.1) and fear of childbirth (adjusted odds ratio 1.9; 95%CI 1.7-2.1).Conclusions A remarkable mental morbidity was seen among women of childbearing age. Mental health problems were twice as common among women with a fear of childbirth as in nonfearful controls. Clinical practice on how to evaluate and treat women fearing childbirth should be developed.Keywords Fear of childbirth, psychiatric care, psychotropic medication.Please cite this paper as: Rouhe H, Salmela-Aro K, Gissler M, Halmesmäki E, Saisto T. Mental health problems common in women with fear of childbirth. BJOG 2011;118:1104-1111. IntroductionIt has been estimated that 6-10% of all pregnant women suffer from a severe fear of childbirth. [1][2][3][4][5] Several studies have shown a connection between fear of childbirth and psychiatric disorders (such as depression, anxiety disorders, eating disorders, bipolar disorder), 6-8 but there are also contradictory results suggesting that only a small part of fear is related to general anxiety and depression 9 or that postpartum depression is not related to fear of vaginal delivery. 10 Previously, all studies have concentrated on symptoms of depression and anxiety during pregnancy 6-9 or they have excluded women with diagnosed psychiatric illnesses, 10 but the well-being of fearful women before and after pregnancy and childbirth has not been examined using large-scale registers. As far as psychological predictors of fear of childbirth are concerned, previous studies have shown that the fear of childbirth is related to certain personality types, anxiety, low self-esteem, nonfunctional relationship with the partner and lac...

In nulliparous women with severe fear of childbirth, participation in a targeted psychoeducative group resulted in better maternal adjustment, a less fearful childbirth experience and fewer postnatal depressive symptoms, compared with conventional care.

This RCT intervention among nulliparous pregnant women with an intense fear of childbirth sought to promote preparedness for childbirth and to enhance positive parenting. Pregnant women (n = 8,611) filled in a 'fear of childbirth' questionnaire. Nulliparous women with severe fear of childbirth (n = 355) were randomized into intervention (n = 131; 41 refused) and control (n = 224) groups. They rated themselves on a preparedness scale in middle and late pregnancy, and on a motherhood scale three months after childbirth. The intervention included six psycho-education group sessions during pregnancy and one after childbirth. This intervention increased the mothers' preparedness for childbirth, which predicted an increase in positive motherhood.

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Through an association with safer childbirth and equal well-being after delivery, psychoeducative group treatment for nulliparous women with fear of childbirth can be a recommended choice for the same overall costs as conventional treatment.