Women's fear of childbirth and preference for cesarean section – a cross‐sectional study at various stages of pregnancy in Sweden

Nieminen, Katri; Stephansson, Olof; Ryding, Elsa Lena

doi:10.1080/00016340902998436

Cited by 296 publications

(309 citation statements)

References 26 publications

(34 reference statements)

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“…The finding that 6.2% of unselected pregnant women stated a preference for CS is low but comparable to previous Scandinavian research [22,24,[26][27]. According to a review that included 38 studies worldwide (including few Asian and African studies), the overall pooled preference was 15.6% [28], with the highest rates in the Americas.…”

Section: Discussionsupporting

confidence: 77%

“…Questionnaire (W-DEQ), Version A [22]. The W-DEQ is a 6-point, 33-item self-assessment rating scale with a minimum score of 0 and a maximum of 165.…”

Section: Fear Of Childbirth Was Assessed By the Wijma Delivery Expectmentioning

confidence: 99%

“…It has been used extensively in various countries and demonstrated good validity. Severe FOC was defined as a total score of 85 or greater [22].…”

Section: Fear Of Childbirth Was Assessed By the Wijma Delivery Expectmentioning

confidence: 99%

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Pregnant women’s preference for cesarean section and subsequent mode of birth – a six-country cohort study

Ryding

Lukasse

Kristjansdottir

et al. 2016

Journal of Psychosomatic Obstetrics & Gynecology

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Introduction: The rate of cesarean section (CS) for non-medical reasons has risen and is a concern for health care. Women's preferences may vary across countries for psychosocial or obstetric reasons.Methods: A prospective cohort study of 6,549 women in routine antenatal care, giving birth in Belgium, Iceland, Denmark, Estonia, Norway or Sweden. Preference for mode of birth was self-reported in mid-pregnancy. Birth outcome data were collected from hospital records.Results: A CS was preferred by 3.5% of primiparous women and 8.7% of the multiparous women. Preference for CS was associated with severe fear of childbirth, with a negative birth experience in multiparous women, and with depressive symptoms in the primiparous. Women were somewhat more prone to prefer a cesarean in Iceland, OR 1.70(1.02-2.83), adjusted for age, education, depression, fear of childbirth, history of abuse, previous cesarean and previous negative birth experience. Out of the 404 women who preferred CS during pregnancy, 286 (70.8%) were delivered by CS, mostly for a medical indication. A total of 9% of the cesareans in the cohort had a non-medical indication only.Conclusions: Women's preference for cesarean section often seems to be due to health concerns. Both medical and psychological factors need to be addressed in antenatal counseling. Obstetricians need to convey accurately to women the risks and benefits of CS in her specific case. Maternity professionals should identify and explore psychosocial reasons for women's preferences.

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Section: Discussionsupporting

confidence: 77%

“…Questionnaire (W-DEQ), Version A [22]. The W-DEQ is a 6-point, 33-item self-assessment rating scale with a minimum score of 0 and a maximum of 165.…”

Section: Fear Of Childbirth Was Assessed By the Wijma Delivery Expectmentioning

confidence: 99%

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Pregnant women’s preference for cesarean section and subsequent mode of birth – a six-country cohort study

Ryding

Lukasse

Kristjansdottir

et al. 2016

Journal of Psychosomatic Obstetrics & Gynecology

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“…Intense fear of childbirth occurs in 7 to 26 percent of pregnant women (Fenwick, Gamble, Nathan, Bayes, & Hauck, 2009;Laursen, Johansen, & Hedegaard, 2009), with a smaller proportion developing extreme fear or tokophobia (Nieminen, Stephansson, & Ryding, 2009). The BIDENS study of 7,200 women in six European countries found significant differences between countries with prevalence ranging from 1.9 to 14.2% (Van Parys, Ryding, Schei, Lukasse, & Temmerman, 2012).…”

Section: Fear Of Childbirthmentioning

confidence: 99%

“…There is good evidence from large epidemiological studies that women with fear of childbirth are more likely to want interventions such as epidural analgesia and caesarean sections (Nieminen et al, 2009;Rouhe et al, 2009). Evidence on the relationship between fear of childbirth and birth outcomes is inconsistent, however the balance of evidence suggests fear of birth is associated with negative outcomes such as increased labour duration (Adams, Eberhard-Gran, & Eskild, 2012) and caesarean section (Laursen et al, 2009;Sydsjo et al, 2013;Waldenstrom, Hildingsson, & Ryding, 2006).…”

Section: Fear Of Childbirthmentioning

confidence: 99%

Fear of childbirth, postnatal post-traumatic stress disorder and midwifery care

Ayers

2014

Midwifery

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Maternal motives behind elective cesarean sections

Reyes

Rosenberg

2019

American J Hum Biol

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ObjectivesThe World Health Organization recommends a target cesarean section rate of 10‐15%. In recent years, the US has had a nation‐wide rate of 30.3% and some developed countries are even higher. Many factors account for this high rate, but our hypothesis is that women who elect cesarean section do so at least in part because of unallayed fear.MethodsOur sample was comprised of American women of childbearing age who have not given birth but may in the near future. We received 368 online survey responses with a 92% completion rate. Responses were categorical and hypotheses tested with non‐parametric statistics.ResultsThose who reported a preference for cesarean section were significantly more likely to be extremely fearful of birth (43.9%) than those who reported a preference for vaginal delivery (20.6%). 73.2% of the cesarean section group state that fear is what influenced their birth preference, 9.8% said their fear had no influence, while in the vaginal birth group 18.9% said fear influenced their birth preference and 53.7% said it did not.ConclusionsIn our sample, women likely to elect cesarean sections are motivated at least in part by fear. They report both more extreme levels of fear than the group anticipating non‐surgical delivery and they more often say that this fear influences their birth decision. This study offers productive, non‐interventional, and inexpensive ways to address women's fears in the hope of reducing unnecessary cesarean sections.

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Women's fear of childbirth and preference for cesarean section – a cross‐sectional study at various stages of pregnancy in Sweden

Abstract: When a woman requests a cesarean section, both primary fear of birth and traumatic childbirth experiences need to be considered and dealt with. The W-DEQ can be used at any time during pregnancy in order to identify pregnant women who suffer from intense fear of childbirth.

Cited by 296 publications

References 26 publications

Pregnant women’s preference for cesarean section and subsequent mode of birth – a six-country cohort study

Pregnant women’s preference for cesarean section and subsequent mode of birth – a six-country cohort study

Fear of childbirth, postnatal post-traumatic stress disorder and midwifery care

Maternal motives behind elective cesarean sections

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