Presence of anxiety and depression increased the prevalence of fear of childbirth; however, the majority of women with fear of childbirth had neither anxiety nor depression.

BackgroundThis population-based cohort study aimed to investigate the demographic and psychosocial characteristics associated with fear of childbirth and the relative importance of such fear as a predictor of elective caesarean section.MethodsA sample of 1789 women from the Akershus Birth Cohort in Norway provided data collected by three self-administered questionnaires at 17 and 32 weeks of pregnancy and 8 weeks postpartum. Information about the participants’ childbirths was obtained from the hospital records.ResultsEight percent of the women reported fear of delivery, defined as a score of ≥85 on the Wijma Delivery Expectancy Questionnaire. Using multivariable logistic regression models, a previous negative overall birth experience exerted the strongest impact on fear of childbirth, followed by impaired mental health and poor social support. Fear of childbirth was strongly associated with a preference for elective caesarean section (aOR 4.6, 95 % CI 2.9–7.3) whereas the association of fear with performance of caesarean delivery was weaker (aOR 2.4, 95 % CI 1.2–4.9). The vast majority (87 %) of women with fear of childbirth did not, however, receive a caesarean section. By contrast, a previous negative overall birth experience was highly predictive of elective caesarean section (aOR 8.1, 95 % CI 3.9–16.7) and few women without such experiences did request caesarean section.ConclusionsResults suggest that women with fear of childbirth may have identifiable vulnerability characteristics, such as poor mental health and poor social support. Results also emphasize the need to focus on the subjective experience of the birth to prevent fear of childbirth and elective caesarean sections on maternal request. Regarding the relationship with social support, causality has to be interpreted cautiously, as social support was measured at 8 weeks postpartum only.

The association between a previous subjectively negative birth experience and fear of childbirth was high and was greater than the association between previous obstetric complications and fear of childbirth.

Fear of childbirth (FOC) is an important women's health issue. The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) is currently the most frequently used instrument to measure FOC. The scale is designed to measure different aspects of FOC but is conceptualized as a uni-dimensional instrument. Our aim was to investigate the underlying factor structure of the W-DEQ version A. A total of 1642 women scheduled to give birth at Akershus University Hospital (Norway) during 2009 and 2010 completed the W-DEQ in the third trimester. Validity and reliability were estimated by means of exploratory and confirmatory factor analyses and correlations with other relevant variables. Results confirmed a multidimensional structure of the W-DEQ. Six factors were identified, each measuring different domains: 'Fear', 'Negative appraisal', 'Loneliness', 'Lack of self-efficacy', 'Lack of positive anticipation', and 'Concerns for the child'. The final model resulted in a 25-item version of the instrument with adequate psychometric properties. Subfactors correlated differently with several relevant variables. Especially the factor 'Fear' was highly correlated with both the overall W-DEQ and several important outcomes. Future studies could examine whether this factor may serve as a good proxy for the full W-DEQ version A.