Wijma Delivery Expectancy Questionnaire Research Articles

Validation of the Chinese version of the Fear of Birth Scale among pregnant women

Aim: Adapt Fear of Birth Scale (FOBS) for the Chinese context, evaluate psychometric properties and determine optimal cutoff point for pregnant women in 3rd trimester.Design: This is a descriptive cross-sectional study. Cultural guidelines informed the development of the Chinese version of FOBS (FOBS-C) incorporating validation on translation, equivalence index, content validity index, and cognitive debriefing. Thirty pregnant women took a test-retest survey and another 1019 took three cross-sectional surveys. Convergent validation of the FOBS-C involved comparison with Childbirth Attitudes Questionnaire (CAQ), Wijma Delivery Expectancy Questionnaire (WDEQ-A), Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder Scale (GAD-7), and physiological indicators. Cutoff points for FOBS-C were identified using receiver operating characteristic analysis against medical indicators.Findings: FOBS-C demonstrated high translation equivalence (0.833–1), content validity (0.800–0.933), internal consistency (0.897), and test-retest reliability (0.860). Convergent validity was supported by statistically significant correlations between FOBS scores, heart rate, skin conductance changes, as well as scores from WDEQ-A, CAQ, EPDS, and GAD-7. Known-group validity was observed with different medical indicators. FOBS-C cutoff points indicating severe fear of childbirth were identified as 65, 68, 71, and 56, respectively, against WDEQ-A ≥ 85, CAQ ≥ 52, preference for C-section birth, and preference for analgesia, demonstrating known-group validity. A cutoff point of 65 showed the FOBS-C's strongest known-group validity.Conclusion: The FOBS-C exhibits robust psychometric properties, making it a valid screening tool for identifying severe fear of birth. Establishing a cutoff point at 65 facilitates effective screening.

Pelvic Pain and Sexual Function in Primiparous Pregnant Women with and without High/Severe Fear of Childbirth

Abstract Introduction This study aimed to determine pelvic pain and sexual dysfunction in primiparous pregnant women with varying levels of fear of childbirth (FOC). Methods This is a descriptive correlational study. This study was conducted with 400 pregnant women at 24–40 weeks of gestation who applied to the obstetrics polyclinic of a hospital between January 2022 and March 2022. Data were collected through a personal information form, the Wijma Delivery Expectancy Questionnaire (W-DEQ-A), the Pelvic Pain Impact Questionnaire (PPIQ), and Golombok-Rust Inventory of Sexual Satisfaction (GRISS) Female Form. Results Of the 400 pregnant women, 232 (58%) had high/severe FOC. High/severe FOC was a risk factor that negatively affected pelvic pain and sexual function (frequency of sexual intercourse, communication, sexual satisfaction, avoidance, touching, vaginismus, and anorgasmia) in pregnant women (p < 0.000). In addition, pregnant women with high/severe FOC avoided vaginal examination (p = 0.016), had higher fear of vaginal examination (p = 0.004), experienced more pain or burning during sexual intercourse (p = 0.017), and had more fear of pain during sexual intercourse (p = 0.003). Conclusions High/severe FOC during pregnancy is an important risk factor that negatively affects pelvic pain and sexual function. Policy Implications Identifying pregnant women with high/severe FOC and support programs such as antenatal education programs or cognitive coping strategies to cope with FOC may be useful in preventing pelvic pain and sexual functions that may be negatively affected.

Embracing Motherhood: Impact of Nurse Led Fear and Apprehension Related to Labour or Childbirth Improving Intervention (FALCI) in Reducing Childbirth Fear Among Pregnant Women.

Childbirth is a complex process with various dimensions including physical, psychological, emotional, social, and cultural aspects. The study intended to assess the effectiveness of Nurse led FALCI (Fear and Apprehension related to Labour or Childbirth Improving) Intervention in reducing childbirth fear among pregnant women. A quasi-experimental study was conducted among 115 pregnant women (selected through purposive sampling) at antenatal OPD of tertiary care hospital of Bhopal. Data was collected using Wijma Delivery Expectancy Questionnaire (DEQ) and self-structured questionnaire on socio-demographic and clinical variables. The intervention (FALCI) was carried out in two phases, each lasting for 30 minutes conducted at week 3-4 and week 5-6 and information booklet was provided for reinforcement. The data was analysed using two-way repeated measures mixed ANOVA (within group and between groups). Findings revealed that most of the pregnant women in both experimental (68.5%) and control (90.2%) group had high level of childbirth fear. Post-intervention data revealed mean of pretest, posttest 1 and posttest 2 were 73.85, 46.94 and 37.90 in experimental group and the mean of pretest, posttest 1 and posttest 2 were 75.49, 72.59 and 72.67 in control group respectively and found that there is significant difference in childbirth fear (within group, F value=114.69, p<0.001 in experimental group and F =0.575, p=0.564 in control group) and between groups (F value= 81.52, p value <0.001). However, no significant association was found between childbirth fear and sociodemographic/clinical variables. The study findings revealed that Nurse led FALCI intervention was effective in reducing childbirth fear among the pregnant women and it is recommended that such intervention must be planned at all levels and implemented as routine protocol in maternity services.

The RETHINK Study: Could pain catastrophising explain why some women are more likely to attend hospital during the latent phase of labour

ObjectiveTo examine the prevalence of pain catastrophising and identify whether it impacts on the timing of hospital admission when in labour. MethodsA longitudinal cohort study. Nulliparous women, experiencing an uncomplicated pregnancy in England, were recruited between 25 and 33 weeks gestation. Participants completed two online questionnaires, (1) on recruitment, including the Pain Catastrophizing Scale (PCS) and the Wijma Delivery Expectancy Questionnaire (WDEQ-A) (2) at three weeks postnatal. ResultsA total of 389 eligible participants entered the study. The percentage of women who were pain catastrophisers (PCS ≥ 20) was 28.1 %, while 7.6 % had a high pain catastrophising score (PCS ≥ 30). There was no association between pain catastrophising and the timing of hospital admission. The percentage of women reporting fear of childbirth (WDEQ-A score of ≥ 85) was 10.6 %. Fear of childbirth was highly associated with PCS scores (p <.001) at both the lower (≥20) and higher (≥30) thresholds. ConclusionAlthough not statistically significant, there was a tendency for women who pain catastrophise to present to hospital in the latent phase. The highly significant association between PCS and WDEQ-A scores has implications for the identification of these women and suggests that the PCS can be used as a screening tool to identify those women who have heightened fear around pain and who may also go on to develop clinically relevant fear of childbirth. Further studies are needed to confirm the acceptability of the PCS as a screening tool with women.

Exploring the Relationship Between Childbirth Expectations and Fear Among Primigravida Women in Saudi Arabia.

Background Childbirth is a significant life event that is accompanied by fear, particularly among primigravida mothers. However, little is known about the expectations and fears of childbirth of primigravida women in Saudi Arabia. Aim This study aimed to explore expectations and fears of childbirth among primigravidas. Methods An exploratory, descriptive, cross-sectional study involving 369 primigravidas was conducted at antenatal outpatient clinics at the Maternity and Children's Hospital in Tabuk, Saudi Arabia. Results In the current study, most participants were aged 25-34 years 204 (55.3%), married 355 (96.2%), and had secondary or higher education 279 (75.6%). A majority of participants 265 (71.8%) reported financial difficulties and 244 unplanned pregnancies (66.1%), while most were pregnant beyond 30 weeks 254 (66.4%). The results showed that the mean total score on the Wijma Delivery Expectancy Questionnaire (W-DEQ) fear of childbirth scale was 57.56, indicating moderate levels of fear on average among primigravida women, with the highest subscale score for the moment of birth. The mean total score on the Childbirth Expectations Questionnaire (CEQ) childbirth expectations scale was 108.15, also indicating moderate expectations on average, with other significant expectations having the highest subscale score. A significant negative correlation was found between the fear and expectations scales (r=-0.775, p<0.001). Sociodemographic factors such as older age, higher education, income, employment, and planned pregnancy were associated with higher expectations and lower fear, whereas younger age, lower education, income, employment, unplanned pregnancy, and medical issues were associated with higher fear. Conclusions The findings of this study provide valuable insights into the expectations and fears of childbirth of primigravida women in Saudi Arabia. The results could inform healthcare providers and policymakers about the predictors of fear and effective interventions to reduce fear and improve birth experience in primiparous women.

The impact of fear of childbirth on mode of delivery, postpartum mental health and breastfeeding: A prospective cohort study in Shanghai, China

BackgroundThe prevalence and impact of fear of childbirth (FOC) has not been sufficiently understood. We aimed to investigate the prevalence of FOC among Chinese population and its impact on mode of delivery, postpartum mental health and breastfeeding. MethodsWe conducted a prospective cohort study, wherein pregnant women in their third trimester who underwent antenatal assessments at Shanghai Changning Maternity and Infant Health Hospital between September 2020 and March 2021 were recruited. Sociodemographic data of the participants were gathered by self-administered questionnaire, and their FOC was assessed using the Wijma Delivery Expectancy Questionnaire. Participants were followed up to 42 days postpartum. Information regarding their modes of delivery was retrieved from medical records, and data regarding postpartum mental health symptoms and one-month postpartum breastfeeding were obtained through self-administered questionnaires. ResultsAmong 1287 participants, 461 (35.8 %) had high-level FOC (W-DEQ ≥ 66). Logistic regressions showed that women with high-level of FOC had higher rates of caesarean delivery on maternal request (CDMR) (aOR = 1.55, 95 % CI: 1.00–2.41, p = 0.049), a higher incidence of postpartum mental health symptoms (aOR = 1.68, 95 % CI: 1.09–2.59, p = 0.018), lower rates of one-month postpartum exclusive breastfeeding (aOR = 0.33, 95 % CI: 0.16–0.69, p = 0.003) and mixed feeding (aOR = 0.44, 95 % CI: 0.21–0.91, p = 0.028). LimitationsThe long-term implications of FOC beyond the immediate postpartum period were not explored in the study. ConclusionsHigh-level FOC during the third trimester was associated with increased CDMR and postpartum mental health symptoms and reduced breastfeeding establishment. These results underscore the significance of FOC screening and tailored interventions for affected women.

Cost-Effectiveness of the Mindfulness-Based Childbirth and Parenting Program for Pregnant Women With Fear of Childbirth

ObjectiveTo examine the cost-effectiveness of the Mindfulness-Based Childbirth and Parenting (MBCP) program compared with enhanced care as usual (ECAU). DesignRandomized controlled trial. SettingMidwifery settings in the Netherlands, April 2014 to July 2017. ParticipantsSubset of pregnant women with high levels of fear of childbirth (N = 54: randomized to MBCP, n = 32, or to ECAU, n = 22) who were selected from the parent study because they completed all four cost questionnaires. MethodsWe measured self-reported health care and non-health care costs. A subset of participants from the parent study completed the questionnaires at all four assessment points. We used the Wijma Delivery Expectancy Questionnaire to measure fear of childbirth and used the EuroQol-5D to measure quality of life. We used these measures of effect together with societal costs in the primary cost-effectiveness analyses. In the secondary cost-effectiveness analyses, we used different estimates of effects and costs to test the robustness of the primary analyses. ResultsIn all but one scenario, MBCP was more effective and cost less than ECAU. As indicated by the acceptability curves, the likelihood of MBCP being cost-effective varied within a range of 70% to 98%. ConclusionOur findings indicate that MBCP is a cost-effective intervention to reduce fear of childbirth in pregnant women. Important next steps are to replicate the study in countries with different health care systems and to explore the potential for further integration of MBCP into midwifery care.

Fear of childbirth: prevalence and associated factors in pregnant women of a maternity hospital in southern Brazil

BackgroundThe fear of childbirth (FOC) harms maternal and fetal health, however it has been little studied in Brazil. This research aimed to determine the prevalence of FOC in a maternity hospital in southern Brazil and identify its associated factors.MethodsThe Wijma Delivery Expectancy Questionnaire – W-DEQ(A) was used to assess the prevalence of FOC, and its relationship with sociodemographic variables, gestational history, aspects of the current pregnancy, knowledge about childbirth, anxiety symptoms (Beck Anxiety Inventory), depressive symptoms (Edinburgh Postnatal Depression Scale), and perception of social support (Multidimensional Scale of Perceived Social Support) was investigated. Questionnaires about the content of FOC and information sources regarding childbirth were also applied.ResultsWe interviewed 125 pregnant women between 28 and 36 weeks of pregnancy between July and September of 2021, and 12% of them scored ≥ 85 on the W-DEQ(A), indicating severe FOC. There was a significant correlation between FOC and anxiety symptoms (r = 0.50, p < 0.001), depressive symptoms (r = 0.34, p < 0.001), and poor social support (r = -0.23, p = 0.008). FOC was lower in pregnant women with complete elementary education when compared to those with higher education (p = 0.003), however, those with negative experiences in previous deliveries had more FOC than those who had had positive experiences (p = 0.001). More than 85% of them fear fetal distress.ConclusionsFOC is a prevalent condition that impacts the mental health of pregnant women. Therefore, health professionals should recognize and address it during prenatal care to provide integral maternal–fetal care and improve the childbirth experience.

The effect of supportive intrapartum care during birth in Jordan: a quasi-experimental study

Background/Aims Childbirth is an important and unique event for mothers and families, but can cause fear and anxiety. All mothers have the right to adequate support for labour and a respectful birth. This study aimed to investigate the impact of supportive intrapartum care on women's perceptions of fear, pain and control during childbirth, as compared to routine care. Methods A quasi-experimental study was conducted at the Jordan University Hospital with 134 pregnant women between August 2019 and January 2020. Participants were assigned to either the intervention (n=65) or control group (n=69). Data were collected using a sociodemographic form, a visual analogue scale for pain, the Wijma delivery expectancy questionnaire (B) for fear during birth, and the perceived support and control in birth scale. Results Women receiving supportive care reported lower pain scores during the latent (t=4.15, P&lt;0.001), active (t=4.64, P&lt;0.001) and transition (t=2.34, P&lt;0.05) phases of labour, less fear (t=8.66, P&lt;0.001), and higher perceived control (t=12.46, P&lt;0.001) and support (t=10.54, P&lt;0.001), and had a shorter labour (t=10.367, P&lt;0.001) compared to women receiving routine care. Low control (β=-0.35), high levels of pain (β=0.20) and low support (β=-0.19) contributed to fear during childbirth. Conclusions Supportive intrapartum care decreased women's perceptions of pain and fear and improved perceptions of control and support. Training and support for midwives could be translated to similar settings in middle-income countries. Policies directed at routine implementation of supportive intrapartum care are essential to decrease pain and fear of childbirth.

Prenatal wellbeing of mothers, their partners, and couples: a cross-sectional descriptive study

BackgroundPrenatal posttraumatic stress symptoms (PTSS), fear of childbirth (FOC), and depressive symptoms have been related to various negative effects during pregnancy, childbirth, and in the postnatal period. This study evaluates the prevalence of PTSS, FOC, depressive symptoms, and health-related quality of life (HRQoL) among pregnant women, their partners, and as couples.MethodsIn a cohort of 3853 volunteered, unselected women at the mean of 17th weeks of pregnancy with 3020 partners, PTSS was evaluated by Impact of Event Scale (IES), FOC by Wijma Delivery Expectancy Questionnaire (W-DEQ-A), depressive symptoms by Edinburgh Postnatal Depression Scale (EPDS), and HRQoL by 15D instrument.ResultsPTSS (IES score ≥ 33) was identified among 20.2% of the women, 13.4% of the partners, and 3.4% of the couples. Altogether, 5.9% of the women, but only 0.3% of the partners, and 0.04% of the couples experienced symptoms suggestive of phobic FOC (W-DEQ A ≥ 100). Respectively, 7.6% of the women, 1.8% of the partners, and 0.4% of the couples reported depressive symptoms (EPDS ≥ 13). Nulliparous women and partners without previous children experienced FOC more often than those with previous children, but there was no difference in PTSS, depressive symptoms, or HRQoL. Women’s mean 15D score was lower than partners’ and that of age- and gender-standardized general population, while partners’ mean 15D score was higher than that of age- and gender-standardized general population. Women whose partners reported PTSS, phobic FOC, or depressive symptoms, often had the same symptoms (22.3%, 14.3%, and 20.4%, respectively).ConclusionsPTSS were common in both women and partners, as well as in couples. FOC and depressive symptoms were common in women but uncommon in partners, thus they rarely occurred simultaneously in couples. However, special attention should be paid to a pregnant woman whose partner experiences any of these symptoms.

Prevalence and risk factors for serious birth concerns in unselected population of mothers.

The aim of the study was to determine the prevalence of severe fear of childbirth in a group of pregnant women, to determine the risk factors, and to prove the impact of the fear of childbirth on various obstetrics outcomes in this group. The study population consists of pregnant women who gave birth at the 2nd Gynecology and Obstetrics Department of the Faculty of Medicine, Comenius University and University Hospital Bratislava, from January 1st, 2022, until April 31st, 2022. After signing an informed consent, the pregnant women were given a Slovak version of the Wijma Delivery Expectancy Questionnaire (S-WDEQ), which is a psychometric tool to evaluate the prevalence of severe fear of childbirth. They were given the S-WDEQ during the 36th and 38th week of gestational age. The childbirth data were collected from the hospital information system after the delivery of the baby. The studied group consists of 453 pregnant women who fulfilled the inclusion criteria. Extreme fear of childbirth was identified using S-WDEQ in 10.6% (48) of them. Level of education and age were not considered to be significant predictors of fear of childbirth. Statistically significant difference was not found in terms of the age groups and groups with different levels of education. At the edge of the statistical significance were primiparas, who made up 60.4% (RR: 1.29; 95% CI: 1.00-1.68; P = 0.0525) of all women with severe fear of childbirth. Women with a history of cesarean section were significantly more frequent in the group of women with serious concerns about childbirth (RR: 3.83; 95% CI: 1.56-9.40; P = 0.0033). Women who gave birth by cesarean section due to the indication of non-progressive labour were also more often represented in the group of women with serious concerns about childbirth (RR: 3.01; 95% CI: 1.07-8.42; P = 0.0358). A higher S-WDEQ score at the 36th week of gestational age in a group of primiparous women increased the statistical probability of cesarean delivery (P = 0.0030). The statistical results are not showing the impact of fear of childbirth on the induction success and the duration of the first stage of labour in primiparous women. The fear of childbirth prevalence is relatively high and it has impact on the outcome of childbirth. The use of a validated questionnaire as a screening tool to search for women with childbirth fear could positively influence their concerns by following psychoeducational interventions in clinical care settings.

Previous Trauma Exposure and Its Associations with Fear of Childbirth and Quality of Life among Pregnant Lesbian, Bisexual, Transgender, and Queer People and Their Partners

The primary aim of this study was to determine the prevalence of previous trauma exposure among expectant birth-giving parents and their partners within a LBTQ population. The secondary aims were to compare fear of childbirth (FOC) and quality of life (QoL) in relation to previous trauma exposure in pregnant LBTQ people and their partners. A further aim was to analyze associations between severe FOC and clinical and demographic factors in this population. Data was collected from a Swedish LGBTQ competent antenatal clinic. Trauma-exposed pregnant (n = 32) and non-pregnant (n = 21) individuals and pregnant (n = 48) and non-pregnant (n = 30) individuals without previous trauma experiences responded to instruments measuring FOC (Wijma Delivery Expectancy Questionnaire) and QoL (EuroQol 5 D-index/-visual analogue scale, VAS). Differences between groups were assessed using non-parametric tests. The proportion of trauma exposure was similar among pregnant responders and their partners (40.0% vs. 41.2%). Trauma-exposed pregnant respondents had a significantly higher prevalence of severe FOC compared to the pregnant respondents without previous trauma. Pregnant trauma-exposed respondents scored lower on EQ5D-VAS than pregnant respondents without trauma, as did non-pregnant trauma exposed respondents compared with non-pregnant ­respondents without trauma. Furthermore, trauma-exposed non-pregnant respondents scored lower on the EQ5D-index compared to non-pregnant respondents without trauma. Previous trauma was the only clinical and demographic factor that had any significant association withto severe FOC in the regression analysis. In conclusion, our results suggest that previous trauma exposure may contribute to the risk of suffering from severe FOC and lower QoL among LBTQ-identifying prospective parents.

Fear of childbirth among pregnant women in Eastern Ethiopia: A community-based study

IntroductionFear of childbirth refers to feelings of uncertainty and anxiety before, during, or after childbirth by thinking about future labor and birth or experience of others. Evidence on burden of fear of childbirth and its associated factors is limited in Ethiopia. In this study, we assessed magnitude of fear of childbirth and its associated factors among pregnant women in Eastern Ethiopia. MethodsA community-based cross-sectional study was conducted among randomly selected pregnant women recruited from Kersa Health and Demographic Surveillance System—an open cohort consisting of continuous registry of health and demographic conditions in eastern Ethiopia. Women were interviewed and fear of childbirth was assessed using the Wijma Delivery Expectancy Questionnaire. Data were entered using EpiData 3.1 and analyzed using SPSS 20. Factors associated with fear of childbirth were identified using binary and multiple logistic regression and described using adjusted odds ratio (aOR) along with 95% confidence interval (CI). Finally, statistical significance was set at p < 0.05 in the multiple logistic regression. ResultsOf a total of 476 pregnant women included in the study, 111(23.3%; 95% CI 19.3-26.9) had fear of childbirth. Fear of childbirth was more likely among women who had no antenatal care (aOR = 2.6; 95% CI:1.22-5.50), no husband support (aOR = 5.7; 95% CI: 2.32-13.10), unplanned pregnancy (aOR = 7.8; 95% CI: 3.92-15.42), and had history of complication in labor and pregnancy (aOR = 10.4; 95% CI: 5.20-20.81). ConclusionA quarter of pregnant women in eastern Ethiopia had fear of childbirth. Helping women to have positive pregnancy experience requires strengthening antenatal care, partner support, and prevention of unwanted pregnancy.

Fear of Childbirth in Nulliparous Women.

PurposeThe relation between fear of childbirth (FoC) and gestational age is inconclusive, and self-reported need for help regarding this fear has never been investigated. This study aimed to determine the prevalence and course of FoC according to gestational age, to identify risk factors for the development of FoC, the influence of this fear on preferred mode of delivery, and self-reported need for help.MethodsNulliparous pregnant women of all gestational ages completed an online survey. The study consisted of a cross-sectional and a longitudinal analysis. Women who completed the survey in the first or second trimester (T0) were approached again in their third trimester (T1). The Wijma Delivery Expectancy Questionnaire Version A (W-DEQ A) was used with a cut-off score ≥ 85 to define presence of fear of childbirth. Questionnaires indexing social support, anxiety, symptoms of depression, preferred mode of delivery, and self-reported need for help were included.ResultsIn total, 364 women were enrolled at T0, and 118 out of 184 eligible women were included in the longitudinal analysis. Point prevalence of FoC at T0 was 18.4% with no significant difference between trimesters. In the longitudinal sample, the prevalence of FoC decreased from 18.6% (T0) to 11.0% (T1), p = 0.004. Although mean scores for FoC decreased significantly, p < 0.001, scores increased in 41 (34.7%) women. The presence of FoC was associated with elevated anxiety, less family support, prenatal care of the obstetrician by choice, preference for a cesarean section, and for pain relief. Women with FoC were more likely to actively seek for help compared to women without FoC.ConclusionWhile FoC is common in each trimester, prevalence decreases over the course of pregnancy. Women with FoC are often actively seeking for help, suggesting that this fear should be addressed better, and help should be offered accordingly.

Fear of childbirth in pregnancy was not increased during the COVID-19 pandemic in the Netherlands: a cross-sectional study.

IntroductionFear of childbirth is a well‐known problem during pregnancy and can have implications for childbirth, including prolonged labor, use of epidural analgesia, obstetric complications, presence of traumatic stress symptoms, or request for an elective cesarean section. The coronavirus disease 2019 (COVID‐19) pandemic has affected mental health and therefore could have increased fear of childbirth during the pandemic. The aim of this study was to investigate fear of childbirth during the pandemic in the Netherlands compared with a reference group from before the pandemic.Material and methodsWe conducted a cross‐sectional study to evaluate pregnant women during the first and second waves of COVID‐19 compared with both each other and with pregnant women from before the pandemic. Participants were recruited through social media platforms, hospitals, and midwifery practices. Pregnant women aged ≥18 years who had mastered the Dutch language were eligible to participate. Fear of childbirth was measured with the Wijma Delivery Expectancy Questionnaire online using a cut‐off score of ≥85 to indicate clinically relevant fear of childbirth. The primary outcome was the prevalence of fear of childbirth. We undertook additional analyses to specifically look at possible effect modification.ResultsIn total, 1102 pregnant women completed the questionnaire during the first wave of the pandemic, 731 during the second wave, and 364 before the pandemic. Fear of childbirth was present in 10.6%, 11.4%, and 18.4%, respectively. We considered possible effect modification, which indicated that age and parity had a significant influence. In participants during the first wave of COVID‐19, nulliparous women had significantly lower odds (odds ratio [OR] 0.50; 95% confidence interval [CI] 0.34–0.73; p < 0.01) of having a fear of childbirth than did the reference group. Both younger participants in the first wave (OR 0.59; 95% CI 0.37–0.93; p < 0.05) and older participants in the first wave (OR 0.44; 95% CI 0.28–0.71; p < 0.01) and the second wave (OR 0.36; 95% CI 0.21–0.62; p < 0.01) of COVID‐19 had lower odds of fear of childbirth than the reference group.ConclusionsPregnant women during the first and second waves of COVID‐19 had lower fear of childbirth scores than pregnant women before the pandemic, indicating less fear of childbirth during the pandemic. This could be explained by an increased level of information, more time to consume information, and better work–life balance with more people working at home during the pandemic.

Prevalence and associated factors of fear for childbirth among pregnant women in eastern Sudan

ABSTRACT 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.

Predictors of fear of childbirth and depressive symptoms among pregnant women: a cross-sectional survey in Pwani region, Tanzania

BackgroundMany women experience fear of childbirth (FoB) and depressive symptoms (DS) during pregnancy, but little is known about FoB among Tanzanian women. The current study aimed to assess the prevalence of FoB and DS among pregnant women and determine predictors of each and both, focusing on sociodemographic and obstetric predictors.MethodsA cross-sectional study was conducted at six health facilities in two districts in Tanzania between 2018 and 2019. In total, 694 pregnant women with gestational age between 32 and 40 weeks and expecting vaginal delivery were consecutively recruited and assessed for FoB and DS. We collected data through interviews using 6 and 4-points Likert Scale of the Wijma Delivery Expectancy Questionnaire Version A and Edinburgh Postnatal Depression Scale, respectively. Women who scored ≥66 and ≥ 10 were categorised as having FoB and DS, respectively. We performed multivariable logistic regression to investigate the predictors of FoB and DS.ResultsThe prevalence rates of FoB and DS among pregnant women were 15.1 and 17.7%, respectively. FoB and DS were more likely in women aged above 30 years [Adjusted Odds Ratio (AOR) 6.29, 95%CI 1.43–27.84] and in single mothers (AOR 2.57, 95%CI 1.14–5.78). Women with secondary education and above (AOR 0.22, 95%CI 0.05–0.99) and those who had given birth previously (AOR 0.27, 95% CI 0.09–0.87) were less likely to have FoB in combination with DS Women who had previous obstetric complications, and those who did not receive any social support from male partners in previous childbirth were more likely to have FoB and DS. FoB was strongly associated with DS (AOR 3.42, 95%CI 2.12–5.53). DS only was more common in women who had inadequate income (AOR 2.35, 95%CI 1.38–3.99) or had previously experienced a perineal tear (AOR 2.32, 95%CI 1.31–4.08).ConclusionsNot having a formal education, having only primary education, being aged above 30 years, being single, being nulliparous, having experienced obstetric complications, and having a lack of social support from a male partner during previous pregnancy and childbirth were predictors of FoB and DS during pregnancy. FoB and DS were strongly associated with each other. It is vital to identify at-risk women early, to offer support during pregnancy and childbirth.

Systematic Birth Preparation Programs Positively Influence the Childbirth Fear: A cross-sectional study

Objective: The primary target of birth preparation program is guiding women to realistic expectations for the birth experience. The aim of the present study is to evaluate the influence of a systematic multidisciplinary birth preparation program on delivery expectation, childbirth fear, mode of delivery and neonatal outcomes.Methods: 159 nulliparous pregnant women in their 3rd trimester were enrolled in this cross-sectional cohort study between January 2018 and March 2020. Women who participated to the systematic birth preparation program were grouped as Group A (n = 80) and those who refused to participate were considered Group B (n = 79). Fear of childbirth was scanned by Wijma Delivery Expectancy Questionnaire Version-A; socio-demographic and obstetric features were assessed through a self-developed survey by face-to-face interview. The mode of delivery, labor induction needs, cesarean indications, birth weights, APGAR scores, newborns hospitalization requirements if any were noted.Results: The Wijma-A mean score was 44.60 ± 19.63 in those who attended the systematic birth preparation program and 72.05 ± 24.82 in those who did not (p&amp;lt;0.001). Childbirth fear was significantly lower in attended group when pregnant women were evaluated according to the four different level childbirth fear categories (p&amp;lt;0.001). The birth weights were significantly higher in attended group (p=0.017). There was no significant difference between the two groups in terms of mode of delivery, APGAR scores, neonatal hospitalization and labor induction requirements (p&amp;gt;0.05).Conclusion: The present study shows that systematic and multidisciplinary birth preparation program may positively influence the childbirth fear and increase the birth weights of neonates.

The influence of being pregnant during the COVID-19 pandemic on birth expectations and antenatal bonding

ABSTRACT Purpose The aim of the present study was to compare birth expectations and antenatal bonding of women pregnant prior to and during the COVID-19 pandemic. Materials and methods In total, 74 pregnant women (mean age: 33.9 ± 4.1 years, gestational age: 36 ± 2 weeks) participated in the study, who were pregnant either during the the COVID-19 pandemic (corona group, N = 35, April–July 2020) or before the pandemic (control group, N = 39, October 2017–January 2019). Birth expectations were measured using the Wijma Delivery Expectancy Questionnaire (WDEQ) and Salmon’s Item List (SIL) and antenatal bonding with the Maternal Antenatal Attachment Scale (MAAS). Additionally, the corona group indicated their level of worry regarding different pandemic-related aspects using visual analogue scales. Results The corona group displayed significantly elevated fear of childbirth measured by the WDEQ and lower antenatal bonding quality compared to the control group. The additional items regarding COVID-19 burdens highlighted that the aspects that the partner may not be present during labour and that no visitors will be allowed in hospital were associated with the highest worries. Conclusions Midwives and gynaecologists should be aware of the negative impact of the COVID-19 pandemic on fear of childbirth and antenatal bonding .

Interventions for fear of childbirth including tocophobia.

Many women experience fear of childbirth (FOC). While fears about childbirth may be normal during pregnancy, some women experience high tosevereFOC. At the extreme end of the fear spectrum is tocophobia, which is considereda specific condition that may cause distress,affect well-being during pregnancy and impede the transition to parenthood.Various interventions have been trialled, which support women to reduce and manage high to severeFOC, including tocophobia. To investigate the effectiveness of non-pharmacological interventions for reducing fear of childbirth (FOC) compared with standard maternity care in pregnant women with high to severe FOC, including tocophobia. In July 2020, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies. We contacted researchers of trials which were registered and appeared to be ongoing. We included randomised clinical trials which recruited pregnant women with high or severe FOC (as defined by the individual trial), for treatment intended to reduce FOC. Two review authors independently screened and selected titles and abstracts for inclusion. We excluded quasi-randomised and cross-over trials. We used standard methodological approaches as recommended by Cochrane. Two review authors independently extracted data and assessed the studies for risk of bias. A third review author checked the data analysis for accuracy. We used GRADE to assess the certainty of the evidence. The primary outcome was a reduction in FOC. Secondary outcomes were caesarean section, depression, birth preference for caesarean section or spontaneous vaginal delivery, and epidural use. We included seven trials with a total of 1357participants. The interventions included psychoeducation, cognitive behavioural therapy, group discussion, peer education and art therapy. We judged four studies as high or unclear risk of bias in terms of allocation concealment; we judged three studies as high risk in terms of incomplete outcome data; and in all studies, there was a high risk of bias due to lack of blinding. We downgraded thecertainty of the evidence due to concerns about risk of bias, imprecision and inconsistency. None of the studies reported data about women's anxiety. Participating in non-pharmacological interventions may reduce levels of fear of childbirth, as measured by the Wijma Delivery Expectancy Questionnaire (W-DEQ), but the reduction may not be clinically meaningful (mean difference (MD) -7.08, 95% confidence interval (CI) -12.19 to -1.97; 7 studies, 828 women; low-certainty evidence). The W-DEQ tool is scored from 0 to 165 (higher score = greater fear). Non-pharmacological interventions probably reduce the number of women having a caesarean section(RR 0.70, 95% CI 0.55 to0.89; 5 studies, 557 women; moderate-certainty evidence). There may be little to no difference between non-pharmacological interventions and usual care in depression scores measured with the Edinburgh Postnatal Depression Scale (EPDS) (MD 0.09, 95% CI -1.23to 1.40;2 studies, 399 women;low-certainty evidence). The EPDS tool is scored from 0 to 30 (higher score = greater depression). Non-pharmacological interventions probably leadto fewer women preferring a caesarean section (RR0.37, 95% CI 0.15 to 0.89; 3 studies, 276 women; moderate-certainty evidence). Non-pharmacological interventions may increase epidural use compared with usual care, but the 95% CI includes the possibility of a slight reduction in epidural use (RR 1.21, 95% CI 0.98 to 1.48;2 studies, 380 women; low-certainty evidence). The effect of non-pharmacological interventionsfor women with high to severe fear of childbirth in terms of reducing fear is uncertain.Fear of childbirth, as measured by W-DEQ, may be reduced but it is not certain if this represents a meaningful clinical reduction of fear. There may be little or no difference in depression, but there may be a reduction in caesarean section delivery. Future trials should recruit adequate numbers of women and measure birth satisfaction and anxiety.