The influence of women’s fear, attitudes and beliefs of childbirth on mode and experience of birth

Abstract

BackgroundWomen’s fears and attitudes to childbirth may influence the maternity care they receive and the outcomes of birth. This study aimed to develop profiles of women according to their attitudes regarding birth and their levels of childbirth related fear. The association of these profiles with mode and outcomes of birth was explored.MethodsProspective longitudinal cohort design with self report questionnaires containing a set of attitudinal statements regarding birth (Birth Attitudes Profile Scale) and a fear of birth scale (FOBS). Pregnant women responded at 18-20 weeks gestation and two months after birth from a regional area of Sweden (n = 386) and a regional area of Australia (n = 123). Cluster analysis was used to identify a set of profiles. Odds ratios (95% CI) were calculated, comparing cluster membership for country of care, pregnancy characteristics, birth experience and outcomes.ResultsThree clusters were identified – ‘Self determiners’ (clear attitudes about birth including seeing it as a natural process and no childbirth fear), ‘Take it as it comes’ (no fear of birth and low levels of agreement with any of the attitude statements) and ‘Fearful’ (afraid of birth, with concerns for the personal impact of birth including pain and control, safety concerns and low levels of agreement with attitudes relating to women’s freedom of choice or birth as a natural process). At 18 -20 weeks gestation, when compared to the ‘Self determiners’, women in the ‘Fearful’ cluster were more likely to: prefer a caesarean (OR = 3.3 CI: 1.6-6.8), hold less than positive feelings about being pregnant (OR = 3.6 CI: 1.4-9.0), report less than positive feelings about the approaching birth (OR = 7.2 CI: 4.4-12.0) and less than positive feelings about the first weeks with a newborn (OR = 2.0 CI 1.2-3.6). At two months post partum the ‘Fearful’ cluster had a greater likelihood of having had an elective caesarean (OR = 5.4 CI 2.1-14.2); they were more likely to have had an epidural if they laboured (OR = 1.9 CI 1.1-3.2) and to experience their labour pain as more intense than women in the other clusters. The ‘Fearful’ cluster were more likely to report a negative experience of birth (OR = 1.7 CI 1.02- 2.9). The ‘Take it as it comes’ cluster had a higher likelihood of an elective caesarean (OR 3.0 CI 1.1-8.0).ConclusionsIn this study three clusters of women were identified. Belonging to the ‘Fearful’ cluster had a negative effect on women’s emotional health during pregnancy and increased the likelihood of a negative birth experience. Both women in the ‘Take it as it comes’ and the ‘Fearful’ cluster had higher odds of having an elective caesarean compared to women in the ‘Self determiners’. Understanding women’s attitudes and level of fear may help midwives and doctors to tailor their interactions with women.

Satisfaction with childbirth services provided in public health facilities: results from a cross- sectional survey among postnatal women in Chhattisgarh, India

“…This finding is in line with other studies that have reported that processes surrounding childbirth have more influence on birth satisfaction compared with material aspects of care [4,5,29]. As others have reported, our findings show that having a fear of childbirth negatively influences the childbirth satisfaction of women who have vaginal births [57–59]. In this study, women who gave birth at CHCs were more satisfied with their birth experiences compared with those who gave birth at DHs.…”

A qualitative interview study into experiences of management of labor pain among women in midwife-led care in the Netherlands

“…The fact that the previously identified antepartum framework by Klomp et al (2013) [6] and our postpartum findings of approaches toward labor pain are quite similar to the framework identified by Haines et al (2012) toward childbirth in general [21], suggests that women's approaches to birth are highly determined by important personal characteristics as coping and pain-related fear [1,15,19].…”

“…Remarkably, the women in our postpartum study adopted the same approaches during labor compared to the identified adopted approaches during pregnancy, in the studies of Klomp et al and Haines et al [21]. One could argue that approaches of women during pregnancy reflect fixed approaches of dealing with labor pain in general, since postpartum women reflect similar aspects important for them in dealing with their labor pain experience.…”

“…fear avoidance) and is used as a way of reducing anticipatory distress [15,20]. Earlier research identified different approaches of women towards dealing with labor pain [6,21], that is, natural pragmatic, deliberately uninformed and pro medicinal pain relief approach. Interestingly, women with a deliberately uninformed approach felt more confident in approaching labor without knowing too much, perhaps in an effort to reduce anticipatory distress regarding labor pain.…”

The kaleidoscopic midwife: A conceptual metaphor illustrating first-time mothers' perspectives of a good midwife during childbirth. A grounded theory study

“…The uncertainty about childbirth that characterises first-time mothers is ongoing through the entire duration of pregnancy, labour and birth; a good midwife supports the woman's embodied limbo (defined as a period characterised by uncertainty while awaiting childbirth), especially in regard to insecurity about the labour progress, and care for her throughout the emotional and physical reactions during childbirth (Haines et al, 2012;McNiven et al, 1992;Seefat-van Teeffelen et al, 2011), including her ability to cope with pain (Hodnett, 2002;Kannan et al, 2001):…”