Birth Experience Mediates the Association Between Fear of Childbirth and Mother-Child-Bonding Up to 14 Months Postpartum: Findings From the Prospective Cohort Study DREAM.

Lara Seefeld,Marie Kopp,Susanne Knappe,Susan Garthus-Niegel,Victoria Weise

doi:10.3389/fpsyt.2021.776922

Lara Seefeld, Marie Kopp + Show 3 more

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https://doi.org/10.3389/fpsyt.2021.776922

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Abstract

ObjectiveTo explore the longitudinal associations between prepartum fear of childbirth (FOC), birth experience, and postpartum mother-child-bonding, and the potential mediator role of the birth experience.DesignWomen from the prospective cohort study DREAM completed questionnaires during pregnancy, 8 weeks, and 14 months after the birth.ParticipantsA community sample of n = 645 pregnant women from a large city in Eastern Germany participated in the study.ResultsIn a regression analysis, FOC predicted negative birth experience (β = 0.208, p < 0.001) which in turn predicted poorer mother-child-bonding both at 8 weeks (β = 0.312, p < 0.001) and 14 months postpartum (β = 0.200, p < 0.001). FOC also predicted mother-child-bonding at 14 months postpartum (β = 0.098, p < 0.05). Of note, this association was mediated by birth experience both at 8 weeks, indirect effect ab = 0.065, 95% CI [0.036, 0.098], and 14 months postpartum, indirect effect ab = 0.043, 95% CI [0.023, 0.067]. These effects remained stable even when adjusting for potential confounders.Key ConclusionsThis study suggests that the association between FOC and mother-child-bonding is mediated by birth experience, pointing to the importance of a woman's positive subjective experience.Implications for PracticeFindings reveal two targets for peripartum interventions for women at risk for poor mother-child-bonding, namely the implementation of FOC screenings during pregnancy, and birth experience as mediating factor between FOC and mother-child-bonding. Focusing on the mother's subjective birth experience could aid to identify women at risk for impaired bonding who might need additional support.

Highlights

With an estimated pooled prevalence rate of 14% [1], severe fear of childbirth (FOC), referred to as tokophobia, is a common phenomenon among pregnant women, with most of the research focusing on populations from Scandinavia, Australia, and the UK [2,3,4,5]
Endocrine stress parameters can be influenced by the birth environment: less optimal, but modifiable circumstances may increase women’s biological stress response even if they are not affected by FOC [21, 22]
It will be analyzed whether the association between prepartum FOC and postpartum mother-child-bonding is mediated by birth experience

Summary

Introduction

With an estimated pooled prevalence rate of 14% [1], severe fear of childbirth (FOC), referred to as tokophobia, is a common phenomenon among pregnant women, with most of the research focusing on populations from Scandinavia, Australia, and the UK [2,3,4,5]. Findings suggest that cortisol awakening response and higher plasma levels of adrenalin (which could both be influenced by FOC) interfere with uterine contractions during labor [18] and in turn predict a more negative birth experience [19]. This explanation could be applying especially to primary FOC which describes a woman’s fear before her first childbirth [20]. Multiparous women who experienced one of those procedures as traumatic at their last birth may fear the recurrence of these events during their birth, which is referred to as secondary FOC [26,27,28,29]

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