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Haines HM, Pallant JF, Fenwick J, Gamble J, Creedy DK, Toohill J, Hildingsson I. Identifying women who are afraid of giving birth: A comparison of the fear of birth scale with the WDEQ-A in a large Australian cohort. SEXUAL & REPRODUCTIVE HEALTHCARE 2015; 6:204-10. [PMID: 26614602 DOI: 10.1016/j.srhc.2015.05.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/01/2015] [Accepted: 05/11/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND The WDEQ-A is the most widely used measure of childbirth fear in pregnant women; however there is increasing discussion in the literature that simpler, more culturally transferrable tools may offer a better solution to identifying fearful women in clinical practice. AIM To compare the two item Fear of Birth Scale (FOBS) with the 33 item WDEQ-A in a large cohort of Australian pregnant women. METHOD Self-report questionnaires during second trimester including Wijma Delivery Expectancy Questionnaire (WDEQ-A) and Fear of Birth Scale (FOBS). Correlation of FOBS and WDEQ-A was tested using Spearman's correlation coefficients. Receiver operating characteristic (ROC) curve assessed the sensitivity and specificity of possible cut-points on the FOBS against WDEQ-A cut-point of ≥85. Sensitivity, specificity, positive and negative predictive values were determined. Fearful and non-fearful women as classified by both instruments were compared for differences in demographic, psycho-social and obstetric characteristics. RESULTS 1410 women participated. The correlation between the instruments was strong (Spearman's Rho = 0.66, p < 0.001). The area under the ROC was 0.89 indicating high sensitivity with a FOBS cut-point of 54. Sensitivity was 89%, specificity 79% and Youden index 0.68. Positive predictive value was 85% and negative predictive value 79%. Both instruments identified high fear as significantly associated with first time mothers, previous emergency caesarean and women with self-reported anxiety and/or depression. Additionally FOBS identified a significant association between fearful women and preference for caesarean. CONCLUSION This study supports the use of the FOBS in clinical practice to identify childbirth fear in pregnant women.
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Affiliation(s)
- H M Haines
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden; Rural Health Academic Centre, The University of Melbourne, 49 Graham St, Shepparton, Victoria, Australia; Northeast Health, Green St, Wangaratta, Victoria, Australia.
| | - J F Pallant
- Rural Health Academic Centre, The University of Melbourne, 49 Graham St, Shepparton, Victoria, Australia
| | - J Fenwick
- Griffith Health Institute and School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia; Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland 4215, Australia
| | - J Gamble
- Griffith Health Institute and School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia
| | - D K Creedy
- Griffith Health Institute and School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia
| | - J Toohill
- Griffith Health Institute and School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia
| | - I Hildingsson
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
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Nilsson C, Lundgren I, Smith V, Vehvilainen-Julkunen K, Nicoletti J, Devane D, Bernloehr A, van Limbeek E, Lalor J, Begley C. Women-centred interventions to increase vaginal birth after caesarean section (VBAC): A systematic review. Midwifery 2015; 31:657-63. [PMID: 25931275 DOI: 10.1016/j.midw.2015.04.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 03/23/2015] [Accepted: 04/07/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE to evaluate the effectiveness of women-centred interventions during pregnancy and birth to increase rates of vaginal birth after caesarean. DESIGN we searched bibliographic databases for randomised trials or cluster randomised trials on women-centred interventions during pregnancy and birth designed to increase VBAC rates in women with at least one previous caesarean section. Comparator groups included standard or usual care or an alternative treatment aimed at increasing VBAC rates. The methodological quality of included studies was assessed independently by two authors using the Effective Public Health Practice Project quality assessment tool. Outcome data were extracted independently from each included study by two review authors. FINDINGS in total, 821 citations were identified and screened by title and abstract; 806 were excluded and full text of 15 assessed. Of these, 12 were excluded leaving three papers included in the review. Two studies evaluated the effectiveness of decision aids for mode of birth and one evaluated the effectiveness of an antenatal education programme. The findings demonstrate that neither the use of decision aids nor information/education of women have a significant effect on VBAC rates. Nevertheless, decision-aids significantly decrease women's decisional conflict about mode of birth, and information programmes significantly increase their knowledge about the risks and benefits of possible modes of birth. KEY CONCLUSIONS few studies evaluated women-centred interventions designed to improve VBAC rates, and all interventions were applied in pregnancy only, none during the birth. There is an urgent need to develop and evaluate the effectiveness of all types of women-centred interventions during pregnancy and birth, designed to improve VBAC rates. IMPLICATIONS FOR PRACTICE decision-aids and information programmes during pregnancy should be provided for women as, even though they do not affect the rate of VBAC, they decrease women's decisional conflict and increase their knowledge about possible modes of birth.
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Affiliation(s)
- Christina Nilsson
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, SE-405 30 Gothenburg, Sweden.
| | - Ingela Lundgren
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, SE-405 30 Gothenburg, Sweden.
| | - Valerie Smith
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| | - Katri Vehvilainen-Julkunen
- University of Eastern Finland, Faculty of Health Sciences, POB 1627, Kuopio University Hospital, 70211 Kuopio, Finland.
| | - Jane Nicoletti
- Universita Degli Studi di Genova, Via Balbi 5, 16126 Genova, Italy.
| | - Declan Devane
- School of Nursing and Midwifery, Saolta University Healthcare Group, University Road, Galway, Ireland.
| | - Annette Bernloehr
- Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Evelien van Limbeek
- Zuyd University, Department of Midwifery Science, POB 1256, 6201 BG Maastricht, The Netherlands.
| | - Joan Lalor
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland.
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Larsson B, Karlström A, Rubertsson C, Hildingsson I. The effects of counseling on fear of childbirth. Acta Obstet Gynecol Scand 2015; 94:629-36. [DOI: 10.1111/aogs.12634] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 03/10/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Birgitta Larsson
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
- Research and Development Centre; Sundsvall Hospital; Sundsvall Sweden
| | - Annika Karlström
- Department of Nursing Sciences; Mid-Sweden University; Sundsvall Sweden
| | | | - Ingegerd Hildingsson
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
- Department of Nursing Sciences; Mid-Sweden University; Sundsvall Sweden
- Women's and Children's Health; Department of Reproductive Health; Karolinska Institute; Stockholm Sweden
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Exploring women's fear of childbirth in a high maternal mortality setting on the Arabian Peninsula. Glob Ment Health (Camb) 2015; 2:e10. [PMID: 28596858 PMCID: PMC5269624 DOI: 10.1017/gmh.2015.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 03/07/2015] [Accepted: 03/21/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Few studies from low-income countries have addressed women's fear of childbirth (FOC) although likely to affect women during both pregnancy and childbirth. The aim of this study was to explore FOC in a high maternal mortality setting in the Arab region, Yemen. METHODS A multi-stage (stratified-purposive-random) sampling process was used. We interviewed 220 women with childbirth experience in urban/rural Yemen. Answers to the question 'Were you afraid of giving birth?' were analyzed using qualitative content analysis. RESULTS Women perceived childbirth as a place of danger. Fear of death and childbirth complications stemming from previous traumatic childbirth and traumatic experience in the community was rampant. Husbands' and in-laws' disappointment in a girl infant constituted a strong sociocultural component of FOC. Women's perception of living in tension 'between worlds' of tradition and modernity reinforced fear of institutional childbirth. Women without FOC gave reasons of faith, social belonging and trust in either traditional or modern childbirth practice, past positive experience of childbirth and the desire for social status associated with children. CONCLUSIONS The numerous maternal and infant deaths have a strong impact on women's FOC. Antenatal care has an important role in reducing fear including that of institutional childbirth and in strengthening a couple in welcoming a female infant. Staff should be sensitized to the fears of both husband and wife and women be allowed support during childbirth. Within the scope of the Millennium Development Goals and strengthening of reproductive mental health programs, FOC urgently needs to be addressed.
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Nilsson C. The delivery room: Is it a safe place? A hermeneutic analysis of women's negative birth experiences. SEXUAL & REPRODUCTIVE HEALTHCARE 2014; 5:199-204. [DOI: 10.1016/j.srhc.2014.09.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/25/2014] [Accepted: 09/30/2014] [Indexed: 11/29/2022]
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Jespersen C, Hegaard HK, Schroll AM, Rosthøj S, Kjærgaard H. Fear of childbirth and emergency caesarean section in low-risk nulliparous women: a prospective cohort study. J Psychosom Obstet Gynaecol 2014; 35:109-15. [PMID: 25148362 DOI: 10.3109/0167482x.2014.952277] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess the association between fear of childbirth (FOC) and emergency caesarean section. DESIGN A prospective cohort study of low-risk nulliparous women at term. SETTING Nine obstetric departments in Denmark, May 2004-July 2005. POPULATION A total of 2598 nulliparous women in spontaneous labor with a single fetus in cephalic presentation at term. METHODS Self-reported FOC was assessed at 37 weeks of gestation by the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) version A and at admission to the labor ward by the Delivery Fear Scale (DFS). Mode of delivery was recorded by the attending staff. Logistic regression analyses were used to estimate unadjusted and adjusted odds ratios (OR). MAIN OUTCOME MEASURES Risk of emergency caesarean section in women who feared childbirth. RESULTS FOC (W-DEQ sum score ≥ 85 and DFS sum score ≥ 70) was not associated with emergency caesarean section: adjusted OR = 0.81 (95% CI: 0.48-1.36) and OR = 0.97 (95% CI: 0.55-1.71), respectively. CONCLUSION In this prospective observational study, women with FOC did not have an increased risk of emergency caesarean section compared to women with no such fear.
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Affiliation(s)
- Cecilie Jespersen
- Copenhagen University Hospital, Rigshospitalet, The Research Unit Women's and Children's Health, The Juliane Marie Centre for Women, Children and Reproduction , Copenhagen Ø , Denmark and
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Elvander C, Dahlberg J, Andersson G, Cnattingius S. Mode of delivery and the probability of subsequent childbearing: a population-based register study. BJOG 2014; 122:1593-600. [PMID: 25135574 DOI: 10.1111/1471-0528.13021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the relationship between mode of first delivery and probability of subsequent childbearing. DESIGN Population-based study. SETTING Nationwide study in Sweden. POPULATION A cohort of 771 690 women who delivered their first singleton infant in Sweden between 1992 and 2010. METHODS Using Cox's proportional-hazards regression models, risks of subsequent childbearing were compared across four modes of delivery. Hazard ratios (HRs) were calculated, using 95% confidence intervals (95% CIs). MAIN OUTCOME MEASURES Probability of having a second and third child; interpregnancy interval. RESULTS Compared with women who had a spontaneous vaginal first delivery, women who delivered by vacuum extraction were less likely to have a second pregnancy (HR 0.96, 95% CI 0.95-0.97), and the probabilities of a second childbirth were substantially lower among women with a previous emergency caesarean section (HR 0.85, 95% CI 0.84-0.86) or an elective caesarean section (HR 0.82, 95% CI 0.80-0.83). There were no clinically important differences in the median time between first and second pregnancy by mode of first delivery. Compared with women younger than 30 years of age, older women were more negatively affected by a vacuum extraction with respect to the probability of having a second child. A primary vacuum extraction decreased the probability of having a third child by 4%, but having two consecutive vacuum extraction deliveries did not further alter the probability. CONCLUSIONS A first delivery by vacuum extraction does not reduce the probability of subsequent childbearing to the same extent as a first delivery by emergency or elective caesarean section.
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Affiliation(s)
- C Elvander
- Division of Clinical Epidemiology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - J Dahlberg
- Department of Sociology, Stockholm University Demography Unit, Stockholm, Sweden
| | - G Andersson
- Department of Sociology, Stockholm University Demography Unit, Stockholm, Sweden
| | - S Cnattingius
- Division of Clinical Epidemiology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
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Toohill J, Fenwick J, Gamble J, Creedy DK. Prevalence of childbirth fear in an Australian sample of pregnant women. BMC Pregnancy Childbirth 2014; 14:275. [PMID: 25123448 PMCID: PMC4138382 DOI: 10.1186/1471-2393-14-275] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/25/2014] [Indexed: 11/25/2022] Open
Abstract
Background Childbirth fear is reported to affect around 20% of women. However reporting on levels of symptom severity vary. Unlike Scandinavian countries, there has been limited focus on childbirth fear in Australia. The aim of this paper is to determine the prevalence of low, moderate, high and severe levels of childbirth fear in a large representative sample of pregnant women drawn from a large randomised controlled trial and identify demographic and obstetric characteristics associated with childbirth fear. Method Using a descriptive cross-sectional design, 1,410 women in their second trimester were recruited from one of three public hospitals in south-east Queensland. Participants were screened for childbirth fear using the Wijma Delivery Expectancy/Experience Questionnaire Version A (WDEQ-A). Associations of demographic and obstetric factors and levels of childbirth fear between nulliparous and multiparous women were investigated. Results Prevalence of childbirth fear was 24% overall, with 31.5% of nulliparous women reporting high levels of fear (score ≥66 on the WDEQ-A) compared to 18% of multiparous women. Childbirth fear was associated with paid employment, parity, and mode of last birth, with higher levels of fear in first time mothers (p < 0.001) and in women who had previously had an operative birth (p < 0.001). Conclusion Prevalence of childbirth fear in Australian women was comparable to international rates. Significant factors associated with childbirth fear were being in paid employment, and obstetric characteristics such as parity and birth mode in the previous pregnancy. First time mothers had higher levels of fear than women who had birthed before. A previous operative birth was fear provoking. Experiencing a previous normal birth was protective of childbirth fear.
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Affiliation(s)
- Jocelyn Toohill
- School of Nursing & Midwifery, Griffith University, Logan Campus, University Drive, Meadowbrook, QLD 4131, Australia.
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Hildingsson I. Swedish couples’ attitudes towards birth, childbirth fear and birth preferences and relation to mode of birth – A longitudinal cohort study. SEXUAL & REPRODUCTIVE HEALTHCARE 2014; 5:75-80. [DOI: 10.1016/j.srhc.2014.02.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 02/04/2014] [Accepted: 02/16/2014] [Indexed: 10/25/2022]
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Elvander C, Cnattingius S, Kjerulff KH. Birth experience in women with low, intermediate or high levels of fear: findings from the first baby study. Birth 2013; 40:289-96. [PMID: 24344710 PMCID: PMC3868996 DOI: 10.1111/birt.12065] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND Fear of childbirth and mode of delivery are two known factors that affect birth experience. The interactions between these two factors are unknown. The aim of this study was to estimate the effects of different levels of fear of birth and mode of delivery on birth experience 1 month after birth. METHODS As part of an ongoing prospective study, we interviewed 3,006 women in their third trimester and 1 month after first childbirth to assess fear of birth and birth experience. Logistic regression was performed to examine the interactions and associations between fear of birth, mode of delivery and birth experience. RESULTS Compared with women with low levels of fear of birth, women with intermediate levels of fear, and women with high levels of fear had a more negative birth experience and were more affected by an unplanned cesarean section or instrumental vaginal delivery. Compared with women with low levels of fears with a noninstrumental vaginal delivery, women with high levels of fear who were delivered by unplanned cesarean section had a 12-fold increased risk of reporting a negative birth experience (OR 12.25; 95% CI 7.19-20.86). A noninstrumental vaginal delivery was associated with the most positive birth experience among the women in this study. CONCLUSIONS This study shows that both levels of prenatal fear of childbirth and mode of delivery are important for birth experience. Women with low fear of childbirth who had a noninstrumental vaginal delivery reported the most positive birth experience.
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Affiliation(s)
- Charlotte Elvander
- Charlotte Elvander is a Certified Nurse-Midwife and a doctoral student at the Department of Medicine, Division of Clinical Epidemiology, KarolinskaInstitutet, Stockholm
| | - Sven Cnattingius
- Sven Cnattingius is a senior Professor at the Department of Medicine, Division of Clinical Epidemiology, KarolinskaInstitutet, Stockholm
| | - Kristen H. Kjerulff
- Kristen H. Kjerulff is Professor in the Departments of Public Health Sciences and Obstetrics and Gynecology, College of Medicine, Penn State University, Hershey, Pennsylvania
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Dehghani M, Sharpe L, Khatibi A. Catastrophizing mediates the relationship between fear of pain and preference for elective caesarean section. Eur J Pain 2013; 18:582-9. [DOI: 10.1002/j.1532-2149.2013.00404.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2013] [Indexed: 11/06/2022]
Affiliation(s)
- M. Dehghani
- Family Research Institute; Shahid Beheshti University; G.C. Tehran Iran
| | - L. Sharpe
- Clinical Psychology Unit; University of Sydney; Australia
| | - A. Khatibi
- Research Group on Health Psychology; KU Leuven; Belgium
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Haines HM, Hildingsson I, Pallant JF, Rubertsson C. The role of women's attitudinal profiles in satisfaction with the quality of their antenatal and intrapartum care. J Obstet Gynecol Neonatal Nurs 2013; 42:428-41. [PMID: 23773005 DOI: 10.1111/1552-6909.12221] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To compare perceptions of antenatal and intrapartum care in women categorized into three profiles based on attitudes and fear. DESIGN Prospective longitudinal cohort study using self-report questionnaires. Profiles were constructed from responses to the Birth Attitudes Profile Scale and the Fear of Birth Scale at pregnancy weeks 18 to 20. Perception of the quality of care was measured using the Quality from Patient's Perspective index at 34 to 36 weeks pregnancy and 2 months after birth. SETTING Two hospitals in Sweden and Australia. PARTICIPANTS Five hundred and five (505) pregnant women from one hospital in Västernorrland, Sweden (n = 386) and one in northeast Victoria, Australia (n = 123). RESULTS Women were categorized into three profiles: self-determiners, take it as it comes, and fearful. The self-determiners reported the best outcomes, whereas the fearful were most likely to perceive deficient care. Antenatally the fearful were more likely to indicate deficiencies in medical care, emotional care, support received from nurse-midwives or doctors and nurse-midwives'/doctors' understanding of the woman's situation. They also reported deficiencies in two aspects of intrapartum care: support during birth and control during birth. CONCLUSIONS Attitudinal profiling of women during pregnancy may assist clinicians to deliver the style and content of antenatal and intrapartum care to match what women value and need. An awareness of a woman's fear of birth provides an opportunity to offer comprehensive emotional support with the aim of promoting a positive birth experience.
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Affiliation(s)
- Helen M Haines
- Department of Women's and Children's Health, Obstetrics and Gynaecology, Uppsala University, Akademiskasjukhuset, Uppsala, Sweden.
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Hall WA, Stoll K, Hutton EK, Brown H. A prospective study of effects of psychological factors and sleep on obstetric interventions, mode of birth, and neonatal outcomes among low-risk British Columbian women. BMC Pregnancy Childbirth 2012; 12:78. [PMID: 22862846 PMCID: PMC3449197 DOI: 10.1186/1471-2393-12-78] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 07/24/2012] [Indexed: 11/24/2022] Open
Abstract
Background Obstetrical interventions, including caesarean sections, are increasing in Canada. Canadian women’s psychological states, fatigue, and sleep have not been examined prospectively for contributions to obstetric interventions and adverse neonatal outcomes. Context and purpose of the study: The prospective study was conducted in British Columbia (BC), Canada with 650 low-risk pregnant women. Of those women, 624 were included in this study. Women were recruited through providers’ offices, media, posters, and pregnancy fairs. We examined associations between pregnant women’s fatigue, sleep deprivation, and psychological states (anxiety and childbirth fear) and women’s exposure to obstetrical interventions and adverse neonatal outcomes (preterm, admission to NICU, low APGARS, and low birth weight). Methods Data from our cross-sectional survey were linked, using women’s personal health numbers, to birth outcomes from the Perinatal Services BC database. After stratifying for parity, we used Pearson’s Chi-square to examine associations between psychological states, fatigue, sleep deprivation and maternal characteristics. We used hierarchical logistic regression modeling to test 9 hypotheses comparing women with high and low childbirth fear and anxiety on likelihood of having epidural anaesthetic, a caesarean section (stratified for parity), assisted vaginal delivery, and adverse neonatal outcomes and women with and without sleep deprivation and high levels of fatigue on likelihood of giving birth by caesarean section, while controlling for maternal, obstetrical (e.g., infant macrosomia), and psychological variables. Results Significantly higher proportions of multiparas, reporting difficult and upsetting labours and births, expectations of childbirth interventions, and health stressors, reported high levels of childbirth fear. Women who reported antenatal relationship, housing, financial, and health stressors and multiparas reporting low family incomes were significantly more likely to report high anxiety levels. The hypothesis that high childbirth fear significantly increased the risk of using epidural anaesthesia was supported. Conclusions Controlling for some psychological states and sleep quality while examining other contributors to outcomes decreases the likelihood of linking childbirth fear anxiety, sleep deprivation, and fatigue to increased odds of caesarean section. Ameliorating women’s childbirth fear to reduce their exposure to epidural anaesthesia can occur through developing effective interventions. These include helping multiparous women process previous experiences of difficult and upsetting labour and birth.
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Affiliation(s)
- Wendy A Hall
- University of British Columbia School of Nursing, T201, 2211 Westbrook Mall, Vancouver, British Columbia, Canada V6T 2B5.
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