Pregnant Women's Fear of Childbirth in Midwife- and Obstetrician-Led Care in Belgium and the Netherlands: Test of the Medicalization Hypothesis

Abstract

Fear of childbirth has gained importance in the context of increasing medicalization of childbirth.Belgian and the Dutch societies are very similar but differ with regard to the organization of maternity care. The Dutch have a high percentage of home births and low medical intervention rates.In contrast, home births in Belgium are rarer, and the medical model is more widely used. By comparing the Belgian and the Dutch maternity care models we explored the association between fear of childbirth and medicalization.An antenatal questionnaire was completed by 833 women at 30 weeks of pregnancy. Fear of childbirth was measured by a shortened Dutch version of the Childbirth AttitudesQuestionnaire. A four-dimensional model with baby-related, pain and injuries-related, general and personal control-related, and medical interventions and hospital care-related fear, fitted well in both countries. Multiple regression analysis showed no country differences, except that Belgian women in midwife-led care were more fearful of medical interventions and hospital care than the Dutch. For the other dimensions, both Belgian and Dutch women receiving midwifery care reported less fear compared to those in obstetric antenatal care. Hence, irrespective of the maternity care model, antenatal care providers are crucial in preventing fear of childbirth.

Preparedness of pregnant women for childbirth and the postpartum period: Their knowledge and fear

“…During the postpartum period, the most prominent areas causing fear and a dire need for information among mothers included: postpartum care and complications (Christiaens et al 2011); infant nutrition and care (Christie et al 2008;Karata ş 2001); postpartum exercises; adaptation to parenthood and family planning (Y ı ld ı z 2008). In Kitap ç ı o ğ lu et al (2008), the three most prominent fears among pregnant women were regarding the behaviour of healthcare personnel during childbirth (7.2); fear about infant health (7.0); and fear about childbirth itself (6.92).…”

Prevalence and associated factors of fear of childbirth in six European countries

“…In contrast to the other participating countries, almost all Belgian women receive all their antenatal care from one obstetrician who also supervises their subsequent birth at the hospital (9). Thus, Belgium has highly medicalized care and exceptional continuity of carer (9). None of the other countries achieves the same level of continuity of carer, except for a minority of women participating in special midwifery-led care models (12,28,29).…”

“…Denmark were more likely to meet a known midwife in labour (12). The second study explored the association between FOC and medicalization by comparing 833 Belgian and Dutch pregnant women's attitudes towards childbirth using a four-dimensional model based on the W-DEQ (9). This study concluded that Belgian women in midwifery care were more fearful of medical interventions and hospital care compared to Dutch women receiving midwifery care.…”

“…These expectations may be influenced by the organisation of the health care system and how women and society in a particular culture/country view childbirth (9,12). For example, in Sweden and Norway most maternity care units have specialised services for women with FOC, while Belgium and Estonia lack such a service.…”

“…Comparing countries is hampered by the lack of uniform instruments used to investigate the concept and different dimensions of FOC (1,3,(9)(10)(11).…”