Abstract
BackgroundFear of childbirth (FOC) may contribute to postpartum depression, impaired maternal-infant relation, and preference for cesarean in future pregnancies. We aimed to investigate predictors of FOC and normal vaginal birth among postpartum women who had planned for a normal vaginal birth.MethodsThis cross-sectional study was conducted in 2019 with postpartum women during the first 24 h after the birth. A sample of 662 women, selected using a convenient sampling method, filled out the questionnaire composed of socio-demographic and obstetric questions and the Wijma Delivery-Expectancy Questionnaire (W-DEQ). We used multiple logistic regression analyses to determine predictors of FOC and normal vaginal birth.ResultsThe percentage of women with mild (score ≤ 37), moderate (38–65), high (66–84), severe (85–99), and intense FOC (score ≥ 100) were 7.9, 19.5, 40.9, 21.1, and 10.6% respectively. Predictors of intense FOC were age < 30, primiparity, low maternal satisfaction with pregnancy, and a low level of perceived marital satisfaction. Overall, 21.8% of women gave birth by cesarean. Predictors of normal vaginal birth were birth weight < 4 kg, spontaneous onset of labor pain, mother’s age < 30, term pregnancy, having a doula, multiparity, satisfaction with husband’s support, and overall satisfaction with pregnancy. A high level of perceived marital/sexual satisfaction was a risk factor for cesarean. Mode of birth was not a predictor of postpartum FOC.ConclusionsThe rate of severe and intense FOC among this group of postpartum women is high. Our findings highlight modifiable factors for reducing FOC and increasing normal vaginal birth. In designing programs to increase the rate of normal vaginal birth, the following factors should be considered: limiting induced labor, encouraging women to recruit a doula to help them at labor, facilitate husband’s attendance throughout antenatal/intrapartum, and postnatal care to support his wife, and pay attention to women’s common misunderstandings about the effect of vaginal birth on marital/sexual relationship. Our findings indicate that seeking novel ways to promote marital/sexual satisfaction and helping women to have a smooth, hassle-free pregnancy may contribute to a reduction in the rate of the FOC.
Highlights
Fear of childbirth (FOC) may contribute to postpartum depression, impaired maternal-infant relation, and preference for cesarean in future pregnancies
We investigated the relationship between having a doula and FOC in cesarean and vaginal birth using two t-test, one in the normal vaginal birth group and the other in the cesarean group
Of the 784 participants who were recruited for the validity study, we removed cases who had chosen elective cesarean (n = 101), vaginal birth after cesarean (VBAC), and instrumental vaginal birth (n = 21); so, the sample size for the present study is 662
Summary
Fear of childbirth (FOC) may contribute to postpartum depression, impaired maternal-infant relation, and preference for cesarean in future pregnancies. Fear of childbirth (FOC) is common among pregnant women in Western countries with a prevalence rate of eight to 27% [1]. Several adverse consequences were reported in women with a high level of FOC including postpartum depression, impaired maternal-infant relation [3], preference for cesarean birth [4, 5], dystocia, and emergency caesarean birth [6]. Several studies have found that a number of factors might increase FOC including advanced maternal age, high socio-economic status [7], insufficient antenatal education [8], obstetric complications, increased analgesic use in labor [9], postdate pregnancy [10], low selfesteem [11], and low level of acceptance of pregnancy [5]. It has been observed to reduce anxiety and stress and increase self-esteem and self-efficacy [13] and reduce the cesarean rate [14]
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