Fear of childbirth in nulliparous and multiparous women: a population‐based analysis of all singleton births in Finland in 1997–2010

Abstract

Objective To identify risk factors for fear of childbirth (FOC) according to parity and socioeconomic status, and to evaluate associations between FOC and adverse perinatal outcomes.Design A cohort study.Setting The Finnish Medical Birth Register.Population All 788 317 singleton births during 1997-2010 in Finland.Methods Fear of childbirth was defined according to the International Classification of Diseases code O99.80, and its associations with several risk factors and perinatal outcomes were analysed by multivariable logistic regression.Main outcome measures Prevalence of, risk factors for and outcomes of FOC.Results Fear of childbirth was experienced by 2.5% of nulliparous women and 4.5% of multiparous women. The strongest risk factors for FOC in nulliparous women were depression [adjusted odds ratio (aOR), 6.35; 95% confidence interval (CI), 5.25-7.68], advanced maternal age (aOR, 3.78; 95% CI, 3.23-4.42) and high or unspecified socioeconomic status. In multiparous women, the strongest risk factors for FOC were depression (aOR, 5.47; 95% CI, 4.67-6.41), previous caesarean section (CS) (aOR, 3.02; 95% CI, 2.93-3.11) and high or unspecified socioeconomic status. Among both nulliparous and multiparous women, FOC was associated with higher rates of CS (3.3-fold and 4.5-fold higher, respectively) and a lower incidence of low birthweight (<2500 g), small for gestational age babies, preterm birth and low Apgar scores at 1 minute.Conclusions High and unspecified socioeconomic status, advanced maternal age and depression are predisposing factors for FOC regardless of parity. Among multiparous women, a previous CS increases vulnerability to FOC. FOC is associated with increased rates of CS, but does not adversely affect other pregnancy outcomes.

Clinical aspects of childbirth-related anxiety

“…Our results support the findings that severe FOC is associated with a previous CS and instrumental delivery in parous women (Ryding et al 1998;Rouhe et al 2009;Nilsson et al 2012;Lucasse, Schei, Ryding 2014;Söderqvist, Wijma & Wijma 2002), and with elevated maternal age in nulliparous women (Räisänen et al 2014). We did not find any correlation between gestational age, social support (measured as marital status in our study) or educational level, as has been suggested by others (Saisto et al 2001;Laursen, Hedegaard & Johansen 2008;Lucasse, Schei, Ryding 2014).…”

“…In mixed samples of nulliparous and parous women, severe FOC is found to be associated with prolonged labour (Sydsjö et al 2014, Johnson & Slade 2003, more use of instrumental deliveries (Ryding 1993;Sjögren & Thomassen 1997), and more pain relief (Sjögren & Thomassen 1997;Alehagen, Wijma & Wijma 2006) and CS (Ryding et al 1998;Gottvall & Waldenström 2002;Sydsjö et al 2013;Räisänen et al 2014;Ryding et al 2015). In similar samples the aforementioned vicious circle has been reported: the phenomenon of finding women who report high FOC before, during and after delivery (Zar, Wijma & Wijma 2001;Alehagen, Wijma & Wijma 2006;Sluijs et al 2012), which thus augments the woman's risk for experiencing the delivery as traumatic.…”

Cross-cultural development and psychometric evaluation of a measure to assess fear of childbirth prior to pregnancy

“…Depression, anxiety and stress scores were positively but weakly associated with fear scores across samples, a relationship that has also been demonstrated among pregnant women (2,6,(44)(45)(46). The short version of the Depression-Anxiety Stress Scale was a reliable measure across student samples, adding to a growing body of evidence that supports use of the scale in non-clinical samples (41,42).…”

“…Severe fear of childbirth affects 2.5% of nulliparas and 4.5% of multiparas (6) and is characterized by nightmares, physical complaints, and difficulties concentrating on work or family activities. Common childbirth fears include worries about the health and safety of the baby, and fear of intolerable pain, prolonged labour, an inability to cope with labour and unsupportive hospital staff (5)(6)(7)(8).…”

“…Elevated risk perceptions were associated with increased fear of birth among men (15); when asked why young men and women preferred Cesarean section over vaginal birth, 56% of women and 32% of men chose CS to avoid labour pain and/or because they are afraid of pain (16). 6 This body of literature informed the development of a fear of childbirth measure for young women and men who plan to have children in the future. We report on the development of the new scale, the Childbirth Fear -Prior to Pregnancy (CFPP) scale and report the reliability and validity of the measure in young adults from six countries.…”