Abstract
AbstractObjectivesTo 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 < .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.
Highlights
Fear of childbirth (FOC) has been broadly described as a spectrum of anxious thoughts and feelings relating to a women's1 appraisal of labor and birth.1-3 some apprehension about childbirth may be considered normal, especially for first-time mothers[1] or mothers with prior negative childbirth experiences, some women can experience clinically significant severe FOC.[4,5] Severe FOC is an intense fear that affects a women's day-to-day functioning, affecting her personal, social, and work life
Any anxiety disorder was estimated to occur in 24% of women with severe FOC and 8% of women with low FOC
Unadjusted linear regressions showed that depression, anxiety disorder, and common mental disorders (CMD) were all significantly associated with higher fear of childbirth
Summary
Fear of childbirth (FOC) has been broadly described as a spectrum of anxious thoughts and feelings relating to a women's1 appraisal of labor and birth.1-3 some apprehension about childbirth may be considered normal, especially for first-time mothers[1] or mothers with prior negative childbirth experiences, some women can experience clinically significant severe FOC.[4,5] Severe FOC is an intense fear that affects a women's day-to-day functioning, affecting her personal, social, and work life. A systematic review and meta-analysis reported a pooled prevalence of 14% (95% CI: 12%-16%).[10] These prevalence estimates were derived from countries including Australia, Canada, The Netherlands, Switzerland, the United States, Norway, Sweden, Denmark, Croatia, Belgium, Iceland, Finland, Italy, Estonia, Turkey, China, South India, Iran, and Japan.2,8-10 Methods of measuring severe FOC include questionnaires, face to-face interviews, and ICD classifications.[2] The Wijma Delivery Expectancy/Experience Questionnaire has been the most widely used method to measure FOC, with a cutoff of ≥85 indicating severe FOC. Despite national guidance stating that women with “childbirth anxieties” should be offered a specialist referral,[11,12] only about half of maternity units provide a specialist service.[13]
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