Association between childbirth attitudes and fear on birth preferences of a future generation of Australian parents

Preconception fear of childbirth: experiences and needs of women fearing childbirth before first pregnancy

Background

Although early case studies have indicated that fear of childbirth can predate a woman’s first pregnancy, the concept of preconception fear of childbirth is largely unexplored. The few studies reporting on the prevalence of preconception fear of childbirth found higher levels than most prevalence estimates in pregnant populations. However, little is known about women’s fear of childbirth before becoming pregnant. The aim of this qualitative study was to give voice to the experiences of this often-neglected group of women.

Methods

To address the experiences and needs of women who do not dare become pregnant due to fear of childbirth, we conducted nine qualitative interviews and analyzed these using reflexive thematic analysis.

Results

The women perceived childbirth as an extremely risky event and doubted their abilities to cope with it. With increasing age, the fear became more real. It was associated with thoughts of becoming too old to be able to conceive. The women did their best to cope with fear on their own by seeking information, trying not to think about it, and using multiple strategies to avoid becoming pregnant. Despite expressing a strong wish for professional support, they all described very limited opportunities to receive support from maternal care services. They felt abandoned, left on their own in a stressful and constantly ongoing negotiation with themselves, feeling the pressure to decide whether to dare become pregnant or not.

Conclusion

In this study, women expressed having experienced fear of childbirth long before a first pregnancy. They felt abandoned as they had to deal with their fear by themselves, without support from maternal care services. The results point to the necessity of an increased awareness of preconception fear of childbirth. We encourage maternal care services to consider their opportunities to support these women.

Many researchers have studied the experiences of pregnant women who are afraid of giving birth. Although it is known that women can fear childbirth long before becoming pregnant, little research has investigated this issue. In this study, we interviewed nine women who wanted to have children but did not dare become pregnant because they were afraid of giving birth. The women perceived childbirth as an extremely risky event and doubted their abilities to cope with it. They tried to cope with their fear by seeking information about pregnancy and childbirth. They also tried not to think about these issues and did what they could to avoid becoming pregnant. The women felt abandoned as they had to deal with their fear on their own. They wanted support from maternal care services, but this was seldom the case. Instead, they felt pressured to decide whether to dare become pregnant or not without support. Here, we want to give voice to the experiences of this often-neglected group of women and make researchers, policy makers, and health care personnel aware of the needs of women who are afraid of giving birth before becoming pregnant. We encourage maternal care services to consider how they can support these women.

Premenstrual Syndrome and Childbirth Fear Prior to Pregnancy in Young Women: An Association and Cross-Sectional Study

OBJECTIVE

The aim of the study was to determine the association between premenstrual syndrome and the childbirth fear prior to pregnancy.

METHODS

This was an association and cross-sectional study conducted on 327 university students. Data were collected using "Participant Information Form," "Premenstrual Syndrome Scale," and "Childbirth Fear-Prior to Pregnancy Scale."

RESULTS

It was found that the childbirth fear had increased in students with premenstrual syndrome. The Women Childbirth Fear-Prior to Pregnancy Scale score was statistically significantly higher among students who preferred caesarean section than those who preferred vaginal delivery. There was a weak, positive, and statistically significant correlation between the students' depressive sensation, anxiety, fatigue, nervousness, depressive thoughts, pain, appetite changes, sleep pattern changes, and bloating subscales of Premenstrual Syndrome Scale and Women Childbirth Fear-Prior to Pregnancy Scale.

CONCLUSION

The score of the Women Childbirth Fear-Prior to Pregnancy Scale increases with an increase in the score of the Premenstrual Syndrome subscale. It should be evaluated whether or not women experiencing premenstrual syndrome have the childbirth fear prior to pregnancy.

Reproducing fear: the effect of birth stories on nulligravid women's birth preferences

OBJECTIVE

Preference for caesarean birth is associated with higher fear and lower self-efficacy for vaginal birth. Vicarious experience is a strong factor influencing self-efficacy in nulligravid women, and is increasingly accessible via digital and general media. This study assessed the effect of exposure to different birth stories on nulligravid women's childbirth preferences and the factors mediating these effects.

METHODS

Nulligravid women (N = 426) were randomly allocated to one of four conditions exposing them to written birth stories. Stories varied by type of birth (vaginal/caesarean) and storyteller evaluation (positive/negative) in a 2 × 2 design. Childbirth preference, fear of labour and vaginal birth, and self-efficacy for vaginal birth were measured before and after exposure via a two-way between groups analysis of covariance. Hierarchical regression models were used to determine the mediating effects of change in childbirth fear and childbirth self-efficacy.

RESULTS

Variations in type of birth and storyteller evaluation significantly influenced childbirth preferences (F (1, 421) = 44.78, p < 0.001). The effect of vaginal birth stories on preference was significantly mediated by fear of labour and vaginal birth and self-efficacy. Effects of exposure to caesarean birth stories were not explained by changes in fear or self-efficacy.

CONCLUSIONS

Childbirth preferences in nulligravid women can be significantly influenced by vicarious experiences. For stories about vaginal birth, the influence of birth stories on women's fear and self-efficacy expectancy are partly responsible for this influence. The findings highlight the importance of monitoring bias in vicarious experiences, and may inform novel strategies to promote healthy childbirth.

Understanding childbirth pain in Brazilian women: A qualitative descriptive study

BACKGROUND

The pain associated with childbirth is a cause of severe pain, and the literature suggests that it can be influenced by psychosocial influences, the environment, and cognitive processes, creating the overall experience of childbirth. Therefore, the investigation of women's childbirth pain experience is essential.

AIM

The purpose of this study is to understand women's childbirth pain and determine which influences can contribute to building different experiences.

METHOD

A qualitative descriptive approach was adopted to explore the women's childbirth pain experiences, by understanding the influences on their experiences. Data were collected through in-depth interviews with 21 women in a hospital setting in São Paulo, Brazil, and analysed by thematic analysis.

RESULTS

Three major themes emerged from the analysis: (1) experiencing childbirth pain, (2) face-to-face with pain, and (3) empowerment needs.

DISCUSSION

Many factors influence how Brazilian women manage pain and shape their experience during childbirth. The findings suggest that when women had a positive experience, they asked for minimal support, demonstrated balance, and expressed that the pain was manageable; when they had unfavourable experiences, they regarded pain as a threat and a punishment and associated it with unpleasant emotions.

CONCLUSION

The results outlined concerns that should be addressed in the provision of specific, appropriate care for women, to support them in improving their experience during childbirth.

'No to unnecessary caesarean sections': Evaluation of a mass-media campaign on women's knowledge, attitude and intention for mode of delivery

Introduction

Improvement of women’s knowledge and attitude toward vaginal birth is recognized as an important strategy to control caesarean sections (CS) on maternal request. This study aimed to evaluate the effectiveness of a mass-media campaign in improving knowledge, attitude and intention of women for vaginal birth.

Methods

This was a population-based study carried out in Tehran, Iran. A national ‘No to unnecessary caesarean sections’ campaign was launched in April 2016 and was televised for ten days. A random sample of pregnant women from all defined geographical areas of Tehran were recruited and assessed for knowledge about the benefits of vaginal birth and the risk of CS, attitude and intention toward mode of delivery at two points in time: before and after the campaign. A comparison was made to evaluate outcome measures among those who had seen the campaign and those who had not.

Results

In all, 37 public and private maternity care centers were selected randomly and 702 eligible pregnant women attending these centers were entered in the study. Pre- and post-intervention data for 466 women were available for analysis. Of these, 194 women indicated that they had seen the campaign and the remaining 272 women said that they had not. A comparison of the outcome measures between the two study groups showed that there were significant differences between those who had seen the campaign and those who had not. Those who had seen the campaign reported increased knowledge, had a more positive attitude and indicated increased behavioral intention toward vaginal birth.

Conclusions

In general, the findings indicated that the mass-media campaign improved pregnant women’s knowledge, attitude and intention towards vaginal birth. However, the long-term effects of such campaigns need further investigation.

A Survey of University Students' Preferences for Midwifery Care and Community Birth Options in 8 High-Income Countries

INTRODUCTION

Midwifery care is associated with positive birth outcomes, access to community birth options, and judicious use of interventions. The aim of this study was to characterize and compare maternity care preferences of university students across a range of maternity care systems and to explore whether preferences align with evidence-based recommendations and options available.

METHODS

A cross-sectional, web-based survey was completed in 2014 and 2015 by a convenience sample of university students in 8 high-income countries across 4 continents (N = 4569). In addition to describing preferences for midwifery care and community birth options across countries, this study examined sociodemographic characteristics, psychological factors, knowledge about pregnancy and birth, and sources of information that shaped students' attitudes toward birth in relation to preferences for midwifery care and community birth options.

RESULTS

Approximately half of the student respondents (48.2%) preferred midwifery-led care for a healthy pregnancy; 9.5% would choose to give birth in a birthing center, and 4.5% preferred a home birth. Preference for midwifery care varied from 10.3% among women in the United States to 78.6% among women in the United Kingdom. Preferences for home birth varied from 0.3% among US women to 18.3% among Canadian women. Women, health science students, those with low childbirth fear, those who learned about pregnancy and birth from friends (compared with other sources, eg, the media), and those who responded from Europe were significantly more likely to prefer midwifery care and community birth. High confidence in knowledge of pregnancy and birth was linked to significantly higher odds of community birth preferences and midwifery care preferences.

DISCUSSION

It would be beneficial to integrate childbirth education into high school curricula to promote knowledge of midwifery care, pregnancy, and childbirth and to reduce fear among prospective parents. Community birth options need to be expanded to meet demand among the next generation of maternity service users.

Effects of reviewing childbirth scenarios on choice of delivery type: a randomized controlled trial

Objective

The incidence of cesarean section (CS) was estimated as about 48% between 2000 and 2012 in Iran. This study was conducted to assess the effects of reviewing written childbirth scenarios on the selection of delivery method.

Materials and Methods

This randomized controlled trial was conducted in Shohada Women's Hospital in Behshahr, Mazandaran, Iran, from May to December 2015. A total of 223 women at 28 to 32 weeks of gestation were randomly allocated into three groups; the standard care (control), theory of planned behavior (TPB)-based education, and TPB education plus additional support via written childbirth scenarios (scenario). Participants were assessed at baseline (weeks 28-32) and intervention (week 37 of pregnancy) periods. Both intervention groups (TPB and scenario groups) participated in three learning sessions that were based on TPB, whereas the control group received routine care service.

Results

The frequencies of normal vaginal delivery (NVD) in the scenario, TPB, and control groups were 73.2%, 58.5%, and 45.7%, respectively (p=0.004). The results showed that the relative risks of CS decision in the scenario and TPB groups in comparison with the control group were both 0.87 and statistically significant (p=0.018 and p=0.013, respectively). The relative risk of choosing CS after the removal of obligatory CS cases in the scenario group compared with the control was 0.85.

Conclusion

Written childbirth scenarios that contain information on NVD and CS as additional support are effective educational tools for reducing CS rates.

First-time mothers' birth beliefs, preferences, and actual birth: A longitudinal observational study

PROBLEM

Birth preferences, such as mode and place of birth and other birth options, have important individual and societal implications, yet few studies have investigated the mechanism which predicts a wide range of childbirth options simultaneously.

BACKGROUND

Basic beliefs about birth as a natural and as a medical process are both predictive factors for childbirth preferences. Studies investigating birth beliefs, preferences, and actual birth are rare.

AIM

To test a predictive model of how these beliefs translate into birth preferences and into actual birth related-options.

METHODS

Longitudinal observational study including 342 first-time expectant mothers recruited at women's health centres and natural birth communities in Israel. All women filled out questionnaires including basic birth beliefs and preferred birth options. Two months postpartum, they filled out a questionnaire including detailed questions regarding actual birth.

FINDINGS

Stronger beliefs about birth being natural were related to preferring a more natural place and mode of birth and preferring more natural birth-related options. Stronger beliefs about birth being medical were associated with opposite options. The preferences mediated the association between the birth beliefs and actual birth. The beliefs predicted the preferences better than they predicted actual birth.

DISCUSSION

Birth beliefs are pivotal in the decision-making process regarding preferred and actual birth options. In a medicalized obstetric system, where natural birth is something women need to actively seek out and insist on, the predictive powers of beliefs and of preferences decrease.

CONCLUSION

Women's beliefs should be recognized and birth preferences respected.

Testing a biopsychosocial model of the basic birth beliefs

BACKGROUND

Women perceive what birth is even before they are pregnant for the first time. Part of this conceptualization is the basic belief about birth as a medical and natural process. These two separate beliefs are pivotal in the decision-making process about labor and birth. Adapting Engel's biopsychosocial framework, we explored the importance of a wide range of factors which may contribute to these beliefs among first-time mothers.

METHOD

This observational study included 413 primiparae ≥24 weeks' gestation, recruited in medical centers and in natural birth communities in Israel. The women completed a questionnaire which included the Birth Beliefs Scale and a variety of biopsychosocial characteristics such as obstetric history, birth environment, optimism, health-related anxiety, and maternal expectations.

RESULTS

Psychological dispositions were more related to the birth beliefs than the social or biomedical factors. Sociodemographic characteristics and birth environment were only marginally related to the birth beliefs. The basic belief that birth is a natural process was positively related to optimism and to conceiving spontaneously. Beliefs that birth is a medical process were related to pessimism, health-related anxiety, and to expectations that an infant's behavior reflects mothering. Expectations about motherhood as being naturally fulfilling were positively related to both beliefs.

CONCLUSION

Psychological factors seem to be most influential in the conceptualization of the beliefs. It is important to recognize how women interpret the messages they receive about birth which, together with their obstetric experience, shape their beliefs. Future studies are recommended to understand the evolution of these beliefs, especially within diverse cultures.

The Elevated Rate of Cesarean Section and Its Contribution to Non-Communicable Chronic Diseases in Latin America: The Growing Involvement of the Microbiota

The current recommendation of the World Health Organization (WHO) regarding cesarean section (C-section) is that this clinical practice should be carried out only under specific conditions, when the health or life of the mother/newborn dyad is threatened, and that its use should not exceed 10-15% of the total deliveries. However, over the last few decades, the frequency of C-section delivery in medium- and high-income countries has rapidly increased worldwide. This review describes the evolution of this procedure in Latin American countries, showing that today more than half of newborns in the region are delivered by C-section. Given that C-section delivery is more expensive than vaginal delivery, its use has increased more rapidly in the private than the public sector; nevertheless, the prevalence of C-section deliveries in the public sector is higher than the WHO's recommendations and continues to increase, representing a growing challenge for Latin America. Although the medium- and long-term consequences of C-section delivery, as opposed to vaginal delivery, on the infant health are unclear, epidemiological studies suggest that it is associated with higher risk of developing asthma, food allergy, type 1 diabetes, and obesity during infancy. These findings are important, as the incidence of these diseases in the Latin American pediatric population is also increasing, particularly obesity. Although the link between these diseases and delivery mode remains controversial, recent studies indicate that the establishment of the gut microbiota is delayed in infants born by C-section during the postnatal period, i.e., during a critical developmental window for the maturation of the newborn's immune system. This delay may favor the subsequent development of inflammatory and metabolic disorders during infancy. Accordingly, from a public health perspective, it is important to slow down and eventually reverse the pattern of increased C-section use in the affected populations.