Definitions, measurements and prevalence of fear of childbirth: a systematic review

Abstract

Background: Fear of Childbirth (FOC) is a common problem affecting women's health and wellbeing, and a common reason for requesting caesarean section. The aims of this review were to summarise published research on prevalence of FOC in childbearing women and how it is defined and measured during pregnancy and postpartum, and to search for useful measures of FOC, for research as well as for clinical settings. Methods: Five bibliographic databases in March 2015 were searched for published research on FOC, using a protocol agreed a priori. The quality of selected studies was assessed independently by pairs of authors. Prevalence data, definitions and methods of measurement were extracted independently from each included study by pairs of authors. Finally, some of the country rates were combined and compared. Results: In total, 12,188 citations were identified and screened by title and abstract; 11,698 were excluded and full-text of 490 assessed for analysis. Of these, 466 were excluded leaving 24 papers included in the review, presenting prevalence of FOC from nine countries in Europe, Australia, Canada and the United States. Various definitions and measurements of FOC were used. The most frequently-used scale was the W-DEQ with various cut-off points describing moderate, severe/intense and extreme/phobic fear. Different 3-, 4-, and 5/6 point scales and visual analogue scales were also used. Country rates (as measured by seven studies using W-DEQ with ≥85 cut-off point) varied from 6.3 to 14.8%, a significant difference (chi-square = 104.44, d.f. = 6, p < 0.0001). Conclusions: Rates of severe FOC, measured in the same way, varied in different countries. Reasons why FOC might differ are unknown, and further research is necessary. Future studies on FOC should use the W-DEQ tool with a cut-off point of ≥85, or a more thoroughly tested version of the FOBS scale, or a three-point scale measurement of FOC using a single question as 'Are you afraid about the birth?' In this way, valid comparisons in research can be made. Moreover, validation of a clinical tool that is more focussed on FOC alone, and easier than the longer W-DEQ, for women to fill in and clinicians to administer, is required.

Potential mechanisms in fear of birth: The role of pain catastrophizing and intolerance of uncertainty

“…Several labels are used interchangeably in the literature, and the concept has been operationalized and measured in a variety of ways. Irrespective of label, the concept generally captures fears and anxieties, relating to pregnancy in general and childbirth in particular …”

“…and anxieties, relating to pregnancy in general and childbirth in particular. 9 Not surprisingly, fear or anxiety relating to giving birth has repeatedly been associated with other measures of anxiety, for example, general symptoms of anxiety [10][11][12] and both state and trait anxiety. [13][14][15][16] Results like these are highly relevant in showing that psychological factors, more than demographic factors or obstetric history, may contribute to birth-related fear or anxiety.…”

Fear of child birth and associated factors among pregnant mothers who attend antenatal care service at Jinka public health facilities, Jinka town, Southern Ethiopia

“…The rst study participant was selected by lottery method using their card number, then every k value (k=N/n=900/423=2, where N is sample frame, n is sample size for this study and k is regular interval between study participants) were selected based on their order of entry for ANC follow up until reach 423 samples. Fear of Childbirth -Feelings of uncertainty and anxiousness arise from the woman's anticipation or experience of being captured in a situation where she faces the approaching delivery, which is unknown, uncontrollable and lead the woman to distress; and WDEQ scores more than 84 (2,14) Antenatal care attended: Pregnant women who had attended antenatal clinics during the recent pregnancy at least once.…”

Room 4 Birth - The effect of an adaptable birthing room on labour and birth outcomes for nulliparous women at term with spontaneous labour start: study protocol for a randomised controlled superiority trial in Sweden

“…), manual removal of placenta, stillbirth, neonatal death during hospital stay, Apgar score at 5 minutes (1 to 10, and grouped < 4 and < 7), umbilical cord blood samples at birth, sex of newborn, birth weight, skin to skin in the first hour, breastfeeding within first two hours, admission to the neonatal unit, and length of mother's hospital stay. Self-reported experiences and outcomes will be measured 2 hours after birth, after discharge, after 3 and 12 months with: specific questions concering: experience of the room, childbirth ecperience as a whole, Childbirth Experience Questionnaire (CEQ) [52], Fear of Birth Scale (FOBS) [53], Fear of giving birth again [54], and health-related quality of life using the EuroQol 5 Dimension (EQ-5D) health state questionnaire [55]. If the woman does not answer the 3 or 12 month questionaires she will get up to 3 reminders once a week, the first two reminders by email followed by one phone text message.…”