Factors associated with fear of childbirth in a subsequent pregnancy: a nationwide case–control analysis in Finland

Abstract

Background Fear of childbirth can develop due to the concerns or adverse maternal or foetal outcomes experienced in a previous pregnancy. The aim of this study was to examine the main risk factors associated with the development of fear of childbirth during subsequent pregnancies and deliveries. Methods In this case–control study, data from the National Medical Birth Register were used to evaluate the events in previous pregnancies that were potential risk factors for fear of childbirth in subsequent pregnancies. The first and second pregnancies of women registered during our study period (2004–2018) were included. The exposure variable was delivery mode, obstetric challenge or adverse neonatal outcomes during the first pregnancy. The outcome was the development of FOC during the second pregnancy. Adjusted odds ratios with 95% CIs were used for comparison. Results A total of 13 064 pregnancies were included in the case group and 195 351 in the control group. Previous emergency caesarean section was the strongest risk factor for the development of FOC in the second pregnancy (adjusted odds ratio 5.27, CIs 4.83–5.75). In addition, unplanned CS (adjusted odds ratio 3.93, CIs 3.77–4.10) and vacuum delivery (adjusted odds ratio 1.69, CIs 1.61–1.77) also increased the odds of fear of childbirth. Of the obstetric complications, third- or fourth-degree tear of the perineum was the strongest risk factor (adjusted odds ratio 2.99, CIs 2.69–3.31), followed by shoulder dystocia (adjusted odds ratio 2.82, CIs 2.16–3.62). Neonatal mortality also increased the odds for the development of FOC (adjusted odds ratio 2.17, CIs 1.77–2.64). Conclusion The main risk factors for the development of fear of childbirth in the second pregnancy were previous fear of childbirth, unplanned CS, vacuum delivery, perineal tear or shoulder dystocia. The results of this study can be used in a clinical setting to improve the prevention of fear of childbirth.

Fear of childbirth and use of labor analgesia: A nationwide register‐based analysis in Finland

“…A previous painful or uncomfortable birth experience might increase the desire for pain relief in subsequent pregnancies, which might increase the rate of pain relief, especially in multiparous women. According to a recent nationwide study in Finland, the most common factors in first pregnancy associated with FOC in subsequent pregnancies were instrumental vaginal deliveries, in‐labor CS, third‐ or fourth‐degree tear of the perineum, and shoulder dystocia 7 . All of these factors might increase the intensity of the pain and therefore increase the desire for pain relief in subsequent pregnancies.…”

“…According to a recent nationwide study in Finland, the most common factors in first pregnancy associated with FOC in subsequent pregnancies were instrumental vaginal deliveries, in-labor CS, third-or fourth-degree tear of the perineum, and shoulder dystocia. 7 All of these factors might increase the TA B L E 1 Background information on patients with diagnosed fear of childbirth and without diagnosed fear of childbirth who started labor in Finland from 2004 to 2018. a intensity of the pain and therefore increase the desire for pain relief in subsequent pregnancies. Confounding factors, such as higher body mass index among women with FOC might partly explain the higher rate.…”

“…Advanced maternal age, depression, and high socioeconomic status have been reported to be predictive factors for FOC. Other predictive factors for FOC include previous operative deliveries such as vacuum or emergency cesarean delivery 6,7 …”

“…Other predictive factors for FOC include previous operative deliveries such as vacuum or emergency cesarean delivery. 6,7 During the last few years, FOC has raised the concerns of experts in this field, as in addition to rapidly increasing incidence, the negative effects of FOC on the health of the mother and fetus have been found to be wider than thought. 8 In addition, a new study found that women with FOC have notably lower subsequent birth rates.…”

Fear of childbirth prolongs interpregnancy interval: A nationwide register-based quantile logistic regression analysis

“…Studies have revealed that psychosocial factors, such as anxiety, neuroticism, depression, low self-esteem, and lack of social support, also play an important role in the development of FOC [3] . According to a recent case-control analysis in Finland, the main risk factors for the development of FOC in the second pregnancy were a previous fear of childbirth, unplanned cesarean section (CS), vacuum delivery, perineal tear, or shoulder dystocia [4] . Also, women with diagnosed FOC have been found to have a lower birth rate after the first pregnancy [5] .…”