Up to now it has been difficult to study fear of childbirth because of a shortage of adequate psychological measurements. Therefore the Wijma Delivery Expectancy/ Experience Questionnaire (W-DEQ) was developed. This paper presents the theoretical background of the W-DEQ together with a documentation of the first psychometric studies. Examination of construct validity indicates that it seems to be possible to penetrate a psychological construct related to fear of childbirth by means of the W-DEQ, both before and after delivery, in nulliparous as well as in parous women. The questionnaire measures the construct more clearly in parous than in nulliparous women. Internal consistency reliability and split-half reliability of the W-DEQ of > or = 0.87 are good for a new research instrument. More research is on its way to make the W-DEQ suitable even for measurements in applied settings.

This is the accepted version of the paper.This version of the publication may differ from the final published version. Etiology of PTSD after birth 3 Permanent repository link

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Objective The objective of this study was to find risk factors in pregnancy for post-traumatic stress and depression 1 month after childbirth. Furthermore, the relation between post-traumatic stress and depression was explored.Design A prospective longitudinal study.Setting Pregnant women in Linköping and Kalmar, Sweden.Population A total of 1224 women were assessed in pregnancy, week 12-20 and 32, as well as 1 month postpartum.Methods Post-traumatic stress and depression after delivery were assessed 1 month postpartum. Potential risk factors were assessed in early and late pregnancy. Variables measured during pregnancy were trait anxiety, depression, fear of childbirth, childbirth-related traumatic stress, stress coping capacity, social support, parity, educational level, age, gestation week, parity, educational level, civil status, previous psychological/psychiatric counselling, and previous experience of any traumatic events. Delivery mode was assessed from the medical records.Main outcome measures Prevalence of post-traumatic stress (criteria A, B, C, D, E, and F according to Diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV)) and depression (Beck's depression inventory).Results One month postpartum, 12 (1.3%) women had posttraumatic stress (met symptom criteria B, C, and D for posttraumatic stress disorder according to Diagnostic and statistical manual of mental disorders, 4th edition [DSM-IV]). The most important risk factors in pregnancy were depression in early pregnancy (OR = 16.3), severe fear of childbirth (OR = 6.2), and 'pre'-traumatic stress (in view of the forthcoming delivery) in late pregnancy (OR = 12.5). The prevalence of depression was 5.6%. Post-traumatic stress and depression were positively related 1 month postpartum and were predicted by mainly the same factors.Conclusions Risk factors for post-traumatic stress and depression after childbirth can be assessed in early pregnancy. Post-traumatic stress and depression also seem to share the same underlying vulnerability factors.

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Fear of childbirth during the third trimester of pregnancy may increase the risk of subsequent emergency cesarean section.

Fear of childbirth during the third trimester of pregnancy may increase the risk of subsequent emergency cesarean section.

In a sample of 1550 recently delivered women, traumatic stress after childbirth was studied in relation to obstetric variables. A post-traumatic stress disorder (PTSD) symptom profile and traumatic stress symptoms were assessed by means of the Traumatic Event Scale (TES). Obstetric data comprised delivery mode, duration of the second stage of labor (the time from cervical dilation of 10 cm to partus) and the use of analgesia/anesthesia. Traumatic stress symptoms and having a PTSD symptom profile were both significantly related to the experience of an emergency cesarean section or an instrumental vaginal delivery. It is of clinical importance, however, that most women with a PTSD symptom profile were found in the normal vaginal delivery group (NVD). This implies that a normal vaginal delivery can be experienced as traumatic, just as an emergency cesarian section is not necessarily traumatic. Traumatic stress symptoms were neither substantially correlated to the duration of the second stage of labor, nor to the use of analgesia/anesthesia.