Factors associated with fear of childbirth among pregnant women in Malaysia

The aims of this study were to determine prevalence of childbirth fear among uncomplicated pregnant women in Siriraj Hospital and possible associated factors. A total of 305 uncomplicated, singleton pregnant women were enrolled during early third trimester. All participants were interviewed regarding baseline demographic, social, economic, family, and obstetric characteristics. Fear of childbirth (FOC) was evaluated by Thai version of Wijma Delivery Expectancy/Experience Questionnaire Version A (W-DEQ). W-DEQ scores and level of FOC were compared between various characteristics to determine possible associated factors. Mean W-DEQ score was 51.9. Prevalence of low, moderate, high, and severe FOC were 18.4%, 64.9%, 16.1%, and 0.7%, respectively. Mean FOC score was significantly higher in women with unplanned than planned pregnancy (p = .033). Women with high to severe FOC were significantly less likely to have adequate income (p = .03), have family support (p = .02), have been told about delivery (p = .03), and have witnessed delivery (p = .01).IMPACT STATEMENTWhat is already known on this subject? Prevalence of fear of childbirth (FOC) in Western countries varies from 8 to 27%. FOC have been related to several unwanted conditions, including obstetrics complications, operative vaginal delivery, increased analgesic use in labour, elective caesarean section, postpartum depression, and impaired maternal-infant relation. Several factors related to FOC have been reported, including maternal age, parity, gestational age, history of a vacuum or forceps extraction, previous caesarean section, previous adverse perinatal outcome, low education, low socio-economic level, psychiatric problems, personality, lack of social support, and low self-esteem.What do the results of this study add? Prevalence of low, moderate, high, and severe FOC in Siriraj Hospital were 18.4%, 64.9%, 16.1%, and 0.7%, respectively. This was relatively lower than those reported from Western countries. Mean FOC score was significantly higher in women with unplanned than planned pregnancy. High to severe FOC was significantly related to low financial and family support and less understandings on delivery process. Differences in the results might be partly due to the differences in study population characteristics of Thais, including ethnics, religions, beliefs, perceptions, social structures, and social norms.What are the implications of these findings for clinical practice and/or further research? Future researches are suggested to explore and understand more about social and cultural factors associated with FOC. Identification of women with high or severe degree of FOC could help in preparing the women at risk before or during pregnancy to lessen FOC in order to improve their childbirth experiences. In addition, effective interventions to reduce FOC should be developed, evaluated, and implemented in the future.

BackgroundAbout six percent of pregnant women suffer from severe fear of childbirth. These women are at increased risk of obstetric labour and delivery interventions and pre- and postpartum complications, e.g., preterm delivery, emergency caesarean section, caesarean section at maternal request, severe postpartum fear of childbirth and trauma anxiety. During the last decade, there is increasing clinical evidence suggesting that haptotherapy might be an effective intervention to reduce fear of childbirth in pregnant women. The present study has been designed to evaluate the effects of such intervention.Methods/DesignIncluded are singleton pregnant women with severe fear of childbirth, age ≥ 18 year, randomised into three arms: (1) treatment with haptotherapy, (2) internet psycho-education or (3) care as usual. The main study outcome is fear of childbirth. Measurements are taken at baseline in gestation week 20–24, directly after the intervention is completed in gestation week 36, six weeks postpartum and six months postpartum. Secondary study outcomes are distress, general anxiety, depression, somatization, social support, mother-child bonding, pregnancy and delivery complications, traumatic anxiety symptoms, duration of delivery, birth weight, and care satisfaction.DiscussionThe treatment, a standard haptotherapeutical treatment for pregnant women with severe fear of childbirth, implies teaching a combination of skills in eight one hour sessions. The internet group follows an eight-week internet course containing information about pregnancy and childbirth comparable to childbirth classes. The control group has care as usual according to the standards of the Royal Dutch Organisation of Midwives and the Dutch Organization of Obstetrics and Gynaecology.Trial registrationThis trial was entered in the Dutch Trial Register and registered under number NTR3339 on March 4th, 2012.

BackgroundThere are few support interventions for women with fear of childbirth tailored towards type of fears and parity. To inform the future development of an acceptable and relevant intervention for women with severe fear of childbirth, primary objectives were to examine: (1) pregnant women’s experiences of and preferences for support and (2) barriers and facilitators to help-seeking. Secondary objectives were to examine if there are any differences based on pregnant women’s parity.MethodsPregnant women with a severe fear of childbirth in Sweden completed an online cross-sectional survey between February and September 2022. Severe fear of childbirth was measured using the fear of childbirth scale. Quantitative data were analysed using descriptive and inferential statistics and free answers were analysed using manifest content analysis. A contiguous approach to integration was adopted with qualitative and quantitative findings reported separately.ResultsIn total, 609 participants, 364 nulliparous and 245 parous women, had severe fear of childbirth. The main category “A twisting road to walk towards receiving support for fear of childbirth” was explored and described by the generic categories: Longing for support, Struggling to ask for support, and Facilitating aspects of seeking support. Over half (63.5%), of pregnant women without planned or ongoing treatment, wanted support for fear of childbirth. Most (60.2%) pregnant women with ongoing or completed fear of childbirth treatment regarded the treatment as less helpful or not at all helpful. If fear of childbirth treatment was not planned, 35.8% of women would have liked to have received treatment. Barriers to help seeking included stigma surrounding fear of childbirth, previous negative experiences with healthcare contacts, fear of not being believed, fear of not being listened to, and discomfort of having to face their fears. Facilitators to help seeking included receiving respectful professional support that was easily available, flexible, and close to home.ConclusionsMost pregnant women with severe fear of childbirth felt unsupported during pregnancy. Findings emphasise the need to develop individual and easily accessible psychological support for women with severe fear of childbirth, delivered by trained professionals with an empathetic and respectful attitude.

Support for pregnant women identified with fear of childbirth (FOC)/tokophobia – A systematic review of approaches and interventions

Background Prenatal fear of childbirth (FOC) is a major health problem. In spite of its importance, there are few studies on FOC in Africa and no published studies on FOC in Sudan. Objectives This research aims to assess the prevalence of FOC amongst pregnant Sudanese women and to determine its associated factors. Method A cross-sectional study was conducted in Gadarif , eastern Sudan. The sociodemographic and obstetric data were gathered through a questionnaire. Fear of childbirth was assessed with the Wijma Delivery Expectancy Questionnaire (W-DEQ. The three-item Oslo social support scale was used to measure the psychosocial condition of the participants. A logistic regression analysis was performed with severe FOC as dependent variable and sociodemographic, obstetric factors and social support as independent factors. Results A total of 475 women were enrolled in the research. Their median age (interquartile range) was 26.0 (8.0) years. Of these 475 women, 110 (23.2%) were primigravidae, 270 (56.8%) were parous and 95 (20%) were grandmultiparae. Fitty -three (11.1%) women experienced severe FOC (scored ≥66 on the W-DEQ). In a multivariable logistic regression analysis, primiparity (adjusted odds ratio = 23.26) was associated with severe FOC. There was no significant association between age, education or social support and severe FOC. Conclusions This study demonstrates that 11.1% of pregnant Sudanese women exhibited FOC. Primigravidae were more likely to have severe FOC. The implementation of birth education programmes for this risk group is recommended in Sudan.

We aimed to investigate how factors such as age, education level, planned delivery method and fear of childbirth were affected in pregnant women before and during the pandemic. This cross-sectional study compared a pre-pandemic pregnant group (July 2019 and December 2019) and a pandemic group (November 2020 and May 2021) of patients at Kütahya Health Sciences University Evliya Çelebi Training and Research Hospital. A total of 696 pregnant women in their second trimester were included in the study. All of them were literate and voluntarily agreed to participate in the study. Data were collected with the Wijma delivery expectancy/experience questionnaire (WDEQ-A), and the outpatient doctor asked the questions face-to-face. The mean age of the pregnant women participating in the study was 31.6 ± 6.8 years. While the total Wijma score was 62.1 ± 25.1 in the pre-pandemic group, it was 61.3 ± 26.4 in the pandemic group, and there was no significant difference between the two groups (p = 0.738). Upon analyzing the fear of childbirth among groups based on education level, no statistically significant differences were observed between the pre-pandemic and pandemic periods within any of the groups. While 25.7% (n = 179) of all participants had a normal fear of childbirth, 22% (n = 153) had a mild fear of childbirth, 27% (n = 188) had a moderate fear of childbirth, and 25.3% (n = 176) had a severe fear of childbirth (Wijma score of 85 and above). When the pre-pandemic and the pandemic period were compared, the fear of childbirth was unchanged in pregnant women at all education levels (p = 0.079, p = 0.957, p = 0.626, p = 0.539, p = 0.202). When comparing fear of childbirth before and after the pandemic, it was found that patients with a high school education level have a significantly higher fear of childbirth. To alleviate the fear of childbirth in pregnant women who have completed high school, training or psychosocial support interventions may be prioritized.

Purpose: We aimed to investigate the level of fear of childbirth in pregnant women in terms of factors such as age, number of births, education level, and immigration status. Materials and Methods: This cross-sectional study was carried out by including 444 pregnant women who have 32-36 weeks of pregnancy and voluntarily agree to participate in the research, all of them are literate and applied to Kütahya Health Sciences University Evliya Çelebi Training and Research Hospital between 25.07.2019 - 01.11.2019. The data were collected using the Wijma Birth Expectation / Experience Scale (W-DEQ), and the questionnaire was administered to the immigrant patients by an outpatient doctor via an interpreter. Results: The average age of the pregnant women was 31.65 ± 6.83 years. 24.8% (n = 110) of all the participants had low levels of fear of childbirth, 21.8% (n = 97) had moderate fear, 27.9% (n = 124) had severe fear, and 25% (n = 113) were identified as having very severe fear of childbirth. The W-DEQ score increased as the education level increased, but there was no difference between university graduates and postgraduate pregnant women. Fear of childbirth in migrant women was found to be significantly lower compared to Turkish women. Conclusion: Fear of childbirth is affected by age, education, immigration, and these conditions vary among societies. Pre-determining conditions that can increase fear of childbirth and implementing social support programs in selected patient groups may decrease the fear of childbirth and lower the number of cesarean sections in Turkey.

This study investigated levels of childbirth fear and related prenatal factors (self-confidence for childbirth, prenatal depression, knowledge about childbirth, and spousal support) among pregnant women in South Korea. A correlational study design was used to explore levels of childbirth fear and related prenatal factors in 200 pregnant women over 28 weeks of gestation. A self-administered questionnaire was used to measure fear of childbirth and related factors, such as self-confidence for childbirth, prenatal depression, knowledge about childbirth, and spousal support. One-third of the pregnant women were aged 35 years and older. Sixty-one percent of women were nulliparae, but only 26.0% had experienced prenatal education. The mean score for fear of childbirth was 66.99 out of 165. The prevalence of fear of childbirth was 72.0%, and childbirth fear was severe in 26.5% of the participants and moderate in 45.5%. Fear of childbirth was negatively related to self-confidence (r=-.45, p<.001), but positively related to prenatal depression (r=.21, p=.002). Two significant predictors were found to explain the fear of childbirth. Higher self-confidence for childbirth was associated with less severe fear of childbirth (β=-.44, p<.001), while higher prenatal depression was associated with more severe fear of childbirth (β=.13, p=.038). The level of fear of childbirth was higher among pregnant women with lower self-confidence and higher prenatal depression. Reasonable evidence should be provided for implementing prenatal and childbirth classes to reduce pregnant women's depression and to increase their confidence.

Pregnancy outcomes in women with severe fear of childbirth

Prevalence and predictive factors for fear of childbirth in pregnant Portuguese women: A cross-sectional study

BackgroundFear of natural childbirth has become a common concern among women. One of the most important risk factors for fear of childbirth is gestational diabetes. The present study aimed to determine the relationship between self-compassion and fear of childbirth in pregnant women with gestational diabetes.MethodThis cross-sectional study was conducted on 75 primiparous pregnant women with gestational diabetes referred to health centers in Kermanshah city, Iran in 2023, who were selected through multi-stage random sampling. Data collection was performed from May to October 2023. Data were collected using a demographic form, the Wijma Delivery Expectancy/Experience Questionnaire Version A and the Self-Compassion Scale, and were analyzed using SPSS version 25 with Kruskal Wallis test, ANOVA, Spearman’s correlation coefficient, and the multiple linear regression analysis.ResultsThe mean fear of childbirth score in pregnant women with diabetes was 89.77 ± 32.99. 7 participants (9.3%) had moderate fear (score 38–65), 12 participants (16%) had severe fear (score 66–84), and 47 participants (62.7%) had clinical fear (score 85 or higher) of childbirth. According to the study results, there was a significant negative correlation between the total fear of childbirth score and the total self-compassion score, as well as its subscales including self-kindness, self-judgment, common humanity, isolation, mindfulness, and over-identification.ConclusionThe present study demonstrated a significant negative relationship between fear of childbirth and self-compassion. Therefore, specific interventions or training for providers to help women build self-compassion, and culturally tailored interventions are recommended.

Objectives: Fear of childbirth may be associated with increased anxiety, cesarean section, and delayed delivery. The study aimed to screen for fear of childbirth and the factors affecting it in pregnant women from 2019 to 2020 in Babol, Iran. Materials and Methods: In this cross-sectional study, a total of 600 pregnant women with gestation age &gt; 20 weeks referred to antenatal care clinics of Ayatollah Rouhani, Shahid Yahya Nejad Hospital, four health centers, and three private offices of obstetricians in Babol, Iran from 2019 to 2020 were surveyed using the Wijma Fear of Childbirth Questionnaire. Considering the cut-off point of 85, women with severe fear of childbirth were identified. Results: The fear of childbirth prevalence in pregnant women in this study was 29.2% (175/600). Fear of childbirth in women with postgraduate education was 3.27 times higher than in women with undergraduate education (P&lt;0.001). Pregnancy fears were 0.42 times higher in pregnant women with self-employed spouses than in employee spouses (P&lt;0.001). Also, women with a history of infertility were 2.73 times more likely to fear childbirth than women without a history of infertility (P=0.01). Women with a history of psychiatric disorders were 6.86 times more afraid of childbirth than women without a history of psychiatric disorders (P=0.02). Conclusions: Due to the high prevalence of fear of childbirth in pregnant women in Babol, Iran, the need for particular psychological interventions to reduce the fear of childbirth and identify risk factors is suggested.

The objective of this study was to calculate costs associated with severe fear of childbirth (FOC) during pregnancy and peripartum by comparing two groups of women expecting their first child and attending an ordinary antenatal program; one with low FOC and one with severe FOC. In a prospective case-control cohort study one group with low FOC [Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) sum score ≤60, n = 107] and one with severe FOC (W-DEQ ≥85, n = 43) were followed up till 3 months postpartum and included in the analysis. Medical records were assessed and medical parameters were mapped. Mean costs for healthcare consumption and sick leave during pregnancy were calculated and compared. When means were compared between the groups, the group with severe FOC had more visits for psychosocial reasons (p = 0.001) and more hours on sick leave (p = 0.03) during pregnancy, and stayed longer at the maternity ward (p = 0.04). They also more seldom had normal spontaneous deliveries (p = 0.03), and more often had an elective cesarean section on maternal request (p = 0.02). Postpartum, they more often than the group with low FOC paid visits to the maternity clinic because of complications (p = 0.001) and to the antenatal unit because of adverse childbirth experiences (p = 0.001). The costs for handling women with severe FOC was 38% higher than those for women with low FOC. Women with severe FOC generate considerably higher perinatal costs than women with low FOC when handled in care as usual.

Fears of delivery are the uncertainty and worry experienced before, during, and following labor. It hurts women's health and affects 5–40% of all moms globally. If not recognized, it could cause expectant mothers to feel alone and unsupported. Studies on this subject, however, are scarce at the woreda level. Therefore, this study amis to assess the prevalence and associated factors of fear of childbirth among pregnant women in Dejen Woreda, East Gojjam Zone, Northwest Ethiopia. A community-based cross-sectional study was conducted among 575 pregnant women selected by Cluster Sapling from December 15 to December 25, 2022. Data were gathered using a structured questionnaire that was presented by an interviewer. Data were entered using Epi-data version 3.1 and analyzed using SPSS Version 23 statistical software. Descriptive statistics and inferential statistics were done, and ordinary logistic regression was used to examine the associated factor for fear of childbirth. Finally, a P-value < 0.05 was used to determine statistical significance. Among the 575 pregnant women supposed to have participated, 560 agreed and participated in the survey, with a response rate of 97.4%. This study showed that 133(23.8%; CI 20.4–26.8) of the study participants had low fear of childbirth, 67(12%; CI (9.3–14.8 moderate, 217 (38.8%; CI 34.6–42.7) high, 143 (25.5%; CI 21.8–29.1) severe fear of childbirth. Having maternal age 18–24 (adjusted odds ratio/AOR = 1.6; 95% CI (1.1–2.3), p-value = -0.08), occupation daily laborer and other (AOR = 0.3,95%; CI 0.3, 0–74; p-value = 0.004),gestational age in third trimester (AOR = 1.9,95%; CI 1.1–3.4), p-value = 0.022) showed significant factor for a fear of childbirth. Maternal age, occupation, and third-trimester pregnancy were found to be significantly associated with fear of childbirth. Women should engage in special attention to keep them healthy by consistent monitoring during pregnancy. Healthcare providers should identify pregnant women with high fear of childbirth early, offer cognitive behavioral therapy, support psychological and physical well-being, provide early age and preventive measures, and use uniform instruments for assessing women's anxiety, promoting systematic reviews and longitudinal studies.

ObjectivesTo estimate the population prevalence of severe fear of childbirth (FOC) during pregnancy and investigate its association with: (a) antenatal common mental disorders (depression and anxiety disorder) and (b) elective cesarean birth.Methods545 participants from an inner‐city London maternity population were interviewed soon after their first antenatal appointment (mean gestation: 14 weeks). Current mental disorders were assessed using the Structured Clinical Interview DSM‐IV. FOC was measured using the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ‐A) at approximately 28 weeks gestation (n = 377), with severe FOC defined using a cutoff of WDEQ‐A ≥ 85. Birth mode information was collected at 3 months post‐delivery using an adapted Adult Service Use Schedule. Linear regressions were used to model associations, adjusting for the effects of covariates (age, parity, relationship status, education, and planned pregnancy). Sampling weights were used to adjust for bias introduced by the stratified sampling. We also accounted for missing data within the analysis.ResultsThe estimated population prevalence of severe FOC was 3% (95% CI: 2%‐6%) (n = 377). Depression and anxiety were significantly associated with severe FOC after adjustment for covariates (45% vs 11%; coefficient: 15.75, 95% CI: 8.08‐23.42, P &lt; .001). There was a weak association between severe FOC and elective cesarean birth.ConclusionsSevere FOC occurs in around 3% of the population. Depression and anxiety are associated with FOC. Pregnant people with depression and anxiety may be at increased risk of experiencing severe FOC. Attitudes toward childbirth should be assessed as part of routine clinical assessment of pregnant people in contact with mental health services.