Mental health problems common in women with fear of childbirth

Abstract

Objective To investigate whether women with fear of childbirth have more mental health problems than women of childbearing age in general.Design Register-based retrospective study.Setting The maternity clinic of Helsinki University Central Hospital.Population In all, 2405 women referred for consultation because of fear of childbirth during 1996-2002 and 4676 comparable control women.Methods Data were linked to the Medical Birth Register, the Hospital Discharge Register and the Drug Reimbursement Register 5-12 years before and after the initial childbirth (during 1990-2008).Main outcome measures Prevalence of psychiatric care as evidenced by the use of psychotropic medication, and episodes of either psychiatric inpatient or outpatient care in women with fear of childbirth compared with nonfearful controls.Results Women with fear of childbirth had significantly more often had psychiatric care (54.0% versus 33.6%, P < 0.001) during the study period. Fearful and nonfearful women differed from each other (P < 0.001) regarding psychiatric inpatient care (7.2% versus 3.6%), outpatient care (19.0% versus 9.8%) and the use of psychotropic medication (51.3% versus 31.3%). Mood and anxiety disorders were the most common psychiatric diagnoses in both groups. The major predictors for a need for psychiatric care after the initial childbirth were previous psychiatric care (adjusted odds ratio 4.5; 95% CI 4.0-5.1) and fear of childbirth (adjusted odds ratio 1.9; 95%CI 1.7-2.1).Conclusions A remarkable mental morbidity was seen among women of childbearing age. Mental health problems were twice as common among women with a fear of childbirth as in nonfearful controls. Clinical practice on how to evaluate and treat women fearing childbirth should be developed.Keywords Fear of childbirth, psychiatric care, psychotropic medication.Please cite this paper as: Rouhe H, Salmela-Aro K, Gissler M, Halmesmäki E, Saisto T. Mental health problems common in women with fear of childbirth. BJOG 2011;118:1104-1111. IntroductionIt has been estimated that 6-10% of all pregnant women suffer from a severe fear of childbirth. [1][2][3][4][5] Several studies have shown a connection between fear of childbirth and psychiatric disorders (such as depression, anxiety disorders, eating disorders, bipolar disorder), 6-8 but there are also contradictory results suggesting that only a small part of fear is related to general anxiety and depression 9 or that postpartum depression is not related to fear of vaginal delivery. 10 Previously, all studies have concentrated on symptoms of depression and anxiety during pregnancy 6-9 or they have excluded women with diagnosed psychiatric illnesses, 10 but the well-being of fearful women before and after pregnancy and childbirth has not been examined using large-scale registers. As far as psychological predictors of fear of childbirth are concerned, previous studies have shown that the fear of childbirth is related to certain personality types, anxiety, low self-esteem, nonfunctional relationship with the partner and lac...

Psycho-Social Predictors of Childbirth Fear in Pregnant Women: An Australian Study

“…Women's emotional health in pregnancy, particularly a history of anxiety and/or depression, has also been linked to childbirth fear [13]- [15]. Women with antenatal childbirth fear and depression have been found to be at increased risk of postnatal depression and post-traumatic stress following birth [16].…”

Factors associated with fear of childbirth: It’s effect on women’s preference for elective cesarean section

“…[4] Several factors have been related to raised prevalence of fear of giving birth, include young maternal age, nulliparity, preexisting psychological issues, inadequate social support and a history of abuse or difficult obstetric procedures. [5,6] Childbirth fear has implications for women's health as it is a primary psychological issue that contributes to women's requests for interventions and disruption of physiological labor. Antenatal fears might expect pain and distress throughout labor and raise the risk of severe emotional instability postnatally.…”

Clinical aspects of childbirth-related anxiety

“…Such problems seem to be twice as common in women with severe FOC as in women with low FOC (Rouhe et al 2011). The most common mental health problems for women with severe FOC are anxiety and depression disorders (Zar, Wijma & Wijma 2002;Rouhe et al 2011). In a mixed sample of pregnant women anxiety disorders were diagnosed in 11% of women with severe FOC (Zar, Wijma & Wijma 2002), and in 73% of women with phobic FOC.…”

“…Such problems seem to be twice as common in women with severe FOC as in women with low FOC (Rouhe et al 2011). The most common mental health problems for women with severe FOC are anxiety and depression disorders (Zar, Wijma & Wijma 2002;Rouhe et al 2011).…”

“…Women with severe FOC (Ryding, Wirfelt, Wängborg, Sjögren & Edman 2007;Hall et al 2009;Rouhe, Salmela-Aro, Gissler, Halmesmäki, & Saisto 2011;Storksen, Eberhard-Gran, Garthus-Niegel & Eskild 2012;Lucasse, Schei & Ryding 2014) as well as women suffering from childbirth-related PTSD (Grekin & O'Hara 2014;Ayers, Bond, Bertullies & Wijma 2016) have a clear comorbidity with other mental health problems. Such problems seem to be twice as common in women with severe FOC as in women with low FOC (Rouhe et al 2011).…”