Abstract
BackgroundChildbirth fear is a health concern in women living in high-income countries; however, little is known about childbirth fear among women living in low-income countries like Malawi. In this study, we explored childbirth fear and associated factors among pregnant and postpartum women in Malawi.MethodsA cross-sectional study of 152 pregnant and 153 postpartum women was conducted at a district hospital in Malawi. Participants were assessed for childbirth fear using the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ). Demographic and obstetric variables were collected using a structured questionnaire. The Multidimensional Scale of Perceived Social Support (MSPSS) was used to measure social support. Using a multinomial logistic regression, factors related to childbirth fears were examined, namely demographic and obstetric characteristics, and social support.ResultsThe mean age of participants was 26 (standard deviation: 6.4) years. During pregnancy, 39% women reported a low level of fear, 41% reported moderate fear, and 20% reported high fear; while after birth, 49, 41, and 10% women reported low, moderate, and high fear, respectively. Pregnant women who were illiterate (odds ratio (OR): 5.0, p < 0.01) or unemployed (OR: 12.6, p < 0.01) were more likely to report moderate and high fear. Postpartum mothers who were illiterate (OR: 4.2, p < 0.01) or unemployed (OR: 11.8, p < 0.01) were more likely to have moderate and high fear. Furthermore, postpartum women who sustained perineal tears had significantly higher odds of experiencing moderate (OR: 5.3, p < 0.01) or high (OR: 19.9, p < 0.01) fear than their counterparts.ConclusionsChildbirth fear is common in Malawi, and pregnant women are more likely to experience high levels of fear than postpartum women. This study highlighted the connection between childbirth fear with mother’s education, employment, and perineal tears during delivery. Identifying and developing interventions for women with these associated characteristics is of clinical importance for the reduction of childbirth fear before and after childbirth in Malawi.
Highlights
Childbirth fear is a health concern in women living in high-income countries; little is known about childbirth fear among women living in low-income countries like Malawi
Demographic factors associated with childbirth fear In this study, we found a significant association between childbirth fear and women’s educational level
We found that women with perineal damage after delivery tended to be at risk of childbirth fear
Summary
Childbirth fear is a health concern in women living in high-income countries; little is known about childbirth fear among women living in low-income countries like Malawi. We explored childbirth fear and associated factors among pregnant and postpartum women in Malawi. Evidence suggests that socio-cultural factors and health care services are likely to influence the extent of childbirth fear and the consequences associated with the fear [14, 15]. Despite considerable efforts are made to improve antenatal care (pregnant mothers have to attend at least 4 visits before delivery), hospital delivery with skilled birth attendant (i.e., by physicians or midwives), and postnatal coverage (including 1 week and 6 weeks of postpartum check-up) [18, 20, 21], mothers in Malawi are likely to be afraid of childbirth due to socio-cultural beliefs (i.e., witchcraft), health care providers’ attitudes (i.e., being rude), and lack of support/companion [22]. Childbirth fear continues to have a potential impact on women’s wellbeing, and this needs to be addressed directly with constant assessments and adequate care
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