Fear of childbirth after medical vs surgical abortion. Population‐based register study from Finland

Abstract

Introduction To evaluate the effect of method of induced abortion and other abortion‐associated variables on the incidence of fear of childbirth in subsequent pregnancy. Material and methods This population‐based register study cohort includes all nulliparous women with their first pregnancy ending in an induced abortion in 2000‐2015 and subsequent pregnancy with live singleton delivery between 2000 and 2017 (n = 21 479). Data were derived from three national registers maintained by the Finnish Institute for Health and Welfare. We divided the study population in three cohorts: (a) medical and (b) surgical abortion during first trimester (≤84 days of gestation), and (c) medical abortion during second trimester (85‐168 days of gestation). Primary outcome measures were the incidence of registry‐identified fear of childbirth and cesarean delivery related to it. Results The overall incidence of fear of childbirth was 5.6% (n = 1209). Altogether, 19.2% (n = 4121) of women underwent cesarean delivery. The odds were elevated especially for elective cesarean delivery (odds ratio [OR] 9.30, 95% CI 7.95‐10.88, P < .001) in women with fear of childbirth. In multivariable analysis, the odds for fear of childbirth (adjusted OR [aOR] 0.80, 95% CI 0.68‐0.94) and cesarean delivery (aOR 0.66, 95% CI 0.84‐0.90) were decreased in women with a history of first‐trimester medical abortion compared with those with first‐trimester surgical abortion. Second‐trimester medical abortion had no effect on the odds for fear of childbirth (aOR 1.04, 95% CI 0.71‐1.50). Maternal age of 30‐39 years and interpregnancy interval over 2 years were additional risk factors for both fear of childbirth and cesarean delivery, but surgical evacuation of uterus after the abortion was not. Conclusions One first‐ or second‐trimester medical abortion does not increase the odds for fear of childbirth, and cesarean delivery related to it in subsequent pregnancy when compared with first‐trimester surgical abortion. Older maternal age and longer interpregnancy interval emerged as risk factors for fear of childbirth.

Trends in the epidemiology of fear of childbirth and association with intended mode of delivery: A nationwide register‐based cohort study in Finland

“…These changes can also be associated with the increased rate of FOC. According to the previous literature, other risk factors such challenging or complicated previous deliveries and maternal depression are not available in our data 2,3 . According to previous studies, maternal depression has lately had an increasing incidence 21 .…”

“…According to the previous literature, other risk factors such challenging or complicated previous deliveries and maternal depression are not available in our data. 2,3 According to previous studies, maternal depression has lately had an increasing incidence. 21 The temporal changes in The odds for elective CS were notably higher among women with diagnosed FOC.…”

“…1 Higher socioeconomic status, advanced maternal age, and depression as well as previous operative deliveries (vacuum or emergency cesarean delivery) are all predictive factors for FOC. 2,3 The most recent study of the incidence of FOC in Finland was published in 2014. According to the findings of that study, the prevalence of FOC increased between 1997 and 2010 from 1.1% to 3.6% in nulliparous women, and from 1.5% to 7.8% in multiparous women.…”

“…Fear of childbirth (FOC) is a common obstetrical challenge affecting the health of women 1 . Higher socioeconomic status, advanced maternal age, and depression as well as previous operative deliveries (vacuum or emergency cesarean delivery) are all predictive factors for FOC 2,3 . The most recent study of the incidence of FOC in Finland was published in 2014.…”

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

“…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 …”