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Kemppainen V, Mentula M, Seppälä T, Gissler M, Rouhe H, Terhi S, Heikinheimo O, Niinimäki M. Fear of childbirth after induced abortion in primiparous women: Population-based register study from Finland. Acta Obstet Gynecol Scand 2024; 103:241-249. [PMID: 37984811 PMCID: PMC10823389 DOI: 10.1111/aogs.14718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Fear of childbirth (FOC) is a common obstetrical challenge that complicates about every 10th pregnancy. Background factors of FOC are diverse. We evaluated the association of induced abortion (IA) and FOC in subsequent pregnancy. MATERIAL AND METHODS Population-based register study based on three Finnish national registers: the Register of Induced Abortions, the Medical Birth Register and the Hospital Discharge Register. The study cases were primigravid women undergoing an IA in 2000-2015 and subsequent pregnancy ending in live singleton birth up to 2017. Each case had three controls, matched by age and residential area, whose first pregnancy ended in a live birth. The main outcome was the incidence of FOC in the subsequent pregnancy. In a secondary analysis, we assessed other risk factors for FOC. RESULTS The study cohort consisted of 21 455 women and 63 425 controls. Altogether, 4.2% of women had a diagnosis of FOC. The incidence was higher in women with a history of IA than in controls (5.6% vs 3.7%, P < 0.001). A history of IA was associated with higher odds for FOC: adjusted odds ratio [aOR] 1.20 with 95% confidence interval (CI) 1.11-1.30. In addition, a history of psychiatric diagnosis (aOR 3.48, 95% CI 3.15-3.83), high maternal age, 30-39 years old (aOR 1.55, 95% CI 1.43-1.67; P < 0.001) and ≥40 years old (aOR 3.00, 95% CI 2.37-3.77; P < 0.001) and smoking (aOR 1.20, 95% CI 1.11-1.31; P < 0.001) were associated with increased odds for FOC. Women living in densely populated or rural areas and those with lower socioeconomic class had lower odds for FOC. CONCLUSIONS A history of IA is associated with increased odds for FOC in subsequent pregnancy. However, the associations of FOC with a history of psychiatric diagnosis and elevated maternal age (especially ≥40 years old) are more pronounced.
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Affiliation(s)
- Venla Kemppainen
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Maarit Mentula
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Tomi Seppälä
- Aalto UniversityAaltoFinland
- University of Eastern FinlandKuopioFinland
| | - Mika Gissler
- Finnish Institute of Health and Welfare (THL)Invest Research Flagship and University of TurkuTurkuFinland
- Karolinska InstituteStockholmSweden
| | - Hanna Rouhe
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Saisto Terhi
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Oskari Heikinheimo
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Maarit Niinimäki
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research CenterUniversity of Oulu and Oulu University HospitalOuluFinland
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Artieta-Pinedo I, Paz-Pascual C, Garcia-Alvarez A, Bully P, Espinosa M. Does the birth plan match what is relevant to women? Preferences of Spanish women when giving birth. BMC Womens Health 2024; 24:42. [PMID: 38225596 PMCID: PMC10789003 DOI: 10.1186/s12905-023-02856-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/20/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND To support women in making shared decisions, it is important to know what is relevant to them. The aim is to explore which of the options included in birth plans (BP) are of most interest to women, and which are more controversial. In addition, the possible association of this variability with personal characteristics. METHODS The data are part of a cross-sectional descriptive study, carried out in xxx, on the clinimetric characteristics of two instruments to measure women's needs in labour and postpartum. Women were recruited consecutively by their midwives during pregnancy check-ups, receive a link to a digital questionnaire and were allowed to provide links to the questionnaires to other pregnant women. Women were asked to determine their level of agreement with statements about the birth environment, accompaniment, pain relief, medical intervention and neonatal care. The relationship between agreement with each statement, socio-demographic variables and fear of childbirth (W-DEQ-A) was analysed using a combination of descriptive statistics to analyse frequencies, and regression models to test the effect of socio-demographic variables and fear of childbirth on those items with the greatest variability. RESULTS Two hundred forty-seven women responded. More than 90% preferred a hospital delivery, with information about and control over medical intervention, accompanied by their partner and continuous skin-to-skin contact with the newborn. There are other questions to which women attach less importance or which show greater variability, related to more clinical aspects, like foetal monitoring, placenta delivery, or cord clamping… Various factors are related to this variability; parity, nationality, educational level, risk factor or fear of childbirth are the most important. CONCLUSIONS Some items referring to the need for information and participation are practically unanimous among women, while other items on technical interventions generate greater variability. That should make us think about which ones require a decision after information and which ones should be included directly. The choice of more interventional deliveries is strongly associated with fear of childbirth.
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Affiliation(s)
- Isabel Artieta-Pinedo
- Primary Care Midwife OSI Barakaldo Sestao, Osakidetza, Barakaldo, Spain.
- Biobizkaia Health Research Institute, Plaza de Cruces 1, 48903, Bizkaia, Barakaldo, Spain.
- Department of Nursing I, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Basque, Bizkaia, Spain.
| | - Carmen Paz-Pascual
- Primary Care Midwife OSI Barakaldo Sestao, Osakidetza, Barakaldo, Spain
- Biobizkaia Health Research Institute, Plaza de Cruces 1, 48903, Bizkaia, Barakaldo, Spain
- Midwifery Training Unit of Basque Country, Bilbao, Spain
| | - Arturo Garcia-Alvarez
- Biobizkaia Health Research Institute, Plaza de Cruces 1, 48903, Bizkaia, Barakaldo, Spain
- Servicio Vasco de Salud-Osakidetza, Vitoria-Gasteiz, Alava, Spain
| | - Paola Bully
- Methodological and Statistical Consulting, Sopuerta, Bizkaia, Spain
| | - Maite Espinosa
- Biobizkaia Health Research Institute, Plaza de Cruces 1, 48903, Bizkaia, Barakaldo, Spain
- Servicio Vasco de Salud-Osakidetza, Vitoria-Gasteiz, Alava, Spain
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Dai J, Shi Y, Guo L, Wang Y, Kong X. Discrepancy in parental fear of childbirth: A scoping review. Midwifery 2023; 126:103830. [PMID: 37769587 DOI: 10.1016/j.midw.2023.103830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/15/2023] [Accepted: 08/25/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Fear of childbirth is a prevalent clinical psychological issue for both mother and father; however, there is a lack of research comparing and summarizing discrepancies in parental fear of childbirth. AIM This study aimed to explore differences in parental fear of childbirth, identify gaps in related research area, and provide directions for future studies. METHODS Original references were searched from six databases by using subject terms associated with fear of childbirth. The guideline of the scoping review framework proposed by Arksey and O' Malley were applied. RESULTS The review covered 203 publications in all. Of them, 181 were maternal studies and 22 were paternal studies. 105 articles examined prevalence and influencing factors ranging from 0.7 % to 89.3 % in mothers and 5 % to 54.3 % in fathers. The current study included 84 influencing factors, 9 of which were common to parents and 75 of which were different, containing fathers' specific influences on fear of childbirth are perceived pregnancy difficulties, perceived birth difficulties, feelings about the upcoming birth, more frequent thoughts of birth in the middle of pregnancy and not attending parent education classes. 12 articles dealt with the experience of fear of childbirth, and the parents' fear of childbirth had 5 common themes, including fear of the birthing process, fear related to the baby, fear of lack of support, fear of postnatal health and life, and adverse psychological problems. But they have different sub-themes. 61 articles on fear of childbirth interventions, including 8 mother-specific approaches and 4 identical approaches for parents, and all of these methods were effective in reducing the prevalence of parental fear of childbirth. CONCLUSION Factors such as marital status, personality, etc., that are specific to mothers can also be applied to paternal fear of childbirth. Cognitive-behavioral therapy and group discussion, which are unique to maternal fear of childbirth, may be attempted for paternal fear of childbirth. In addition, future research should be devoted to developing a specific measurement tool for fathers, studying paternal fear of childbirth in depth from various aspects.
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Affiliation(s)
- Jiayang Dai
- School of Nursing and School of Public Health, Yangzhou University, China
| | - Ya Shi
- School of Nursing and School of Public Health, Yangzhou University, China; School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, England
| | - Lu Guo
- School of Nursing and School of Public Health, Yangzhou University, China
| | - Yuanyuan Wang
- School of Nursing and School of Public Health, Yangzhou University, China
| | - Xiang Kong
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China; Jiangsu Key Laboratory of Experimental & Translational Non-coding RNA Research, Yangzhou, Jiangsu Province, China; Department of Obstetrics and Gynecology, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China.
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Sandström L, Kaunonen M, Klemetti R, Raussi-Lehto E, Aho AL. Factors helping pregnant multiparas cope with fear of birth: A qualitative study. Midwifery 2023; 125:103803. [PMID: 37659151 DOI: 10.1016/j.midw.2023.103803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE This study describes factors helping pregnant multiparas cope with their fear of birth and aims to contribute insight into measures that could be taken to support and develop care for multiparas with fear of birth. METHODS Purposive sampling was used for collecting data from closed discussion forums. An electronic questionnaire included structured background questions and qualitative open-ended questions related to the factors multiparas had found helped them cope with their fear of birth. After excluding respondents in early pregnancy (n = 20), the data consisted of answers from 78 pregnant multiparas from Finland. The data were analysed using inductive content analysis. RESULTS The factors helping pregnant multiparas to cope with their fear of birth included obtaining information, planning ahead, receiving empathic support, dealing with emotions in different ways, and focusing on the positive. CONCLUSIONS The support multiparas receive for their fear of birth from healthcare providers is insufficient and the quality and content of care varies widely. As a result, multiparas have been left to personally take responsibility for coping with their fear. IMPLICATIONS FOR PRACTICE The care for treating fear of birth in multiparas needs to be improved. This requires a critical evaluation of the maternity system, policies, and competence of healthcare professionals who work with pregnant people.
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Affiliation(s)
- Laura Sandström
- Faculty of Social Sciences, Health Sciences, Nursing Science, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.
| | - Marja Kaunonen
- Faculty of Social Sciences, Health Sciences, Nursing Science, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland; Pirkanmaa Hospital District, PO BOX 2000 FI-33521 Tampere, Finland
| | - Reija Klemetti
- Department of Knowledge Management and Co-Creation, Finnish Institute for Health and Welfare, Po Box 30, FI-00271 Helsinki, Finland
| | - Eija Raussi-Lehto
- Customer oriented Wellbeing and Health Hub, Metropolia University of Applied Sciences, PO BOX 4000, FI-00079 Metropolia, Helsinki, Finland
| | - Anna Liisa Aho
- Faculty of Social Sciences, Health Sciences, Nursing Science, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland
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Vaajala M, Kekki M, Mattila VM, Kuitunen I. Fear of childbirth and use of labor analgesia: A nationwide register-based analysis in Finland. Int J Gynaecol Obstet 2023; 162:945-949. [PMID: 37039963 DOI: 10.1002/ijgo.14781] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/05/2023] [Accepted: 03/22/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE To calculate the rates of labor analgesia among women with fear of childbirth (FOC) in multiparous and nulliparous women, because FOC might be associated with higher rates of labor analgesia. METHODS In this retrospective register-based cohort study, data from the National Medical Birth Register was used to evaluate the usage of labor analgesia in pregnancies with FOC, when compared with those without. The analgesia methods were stratified into neuraxial analgesia, pudendal, paracervical, nitrous oxide, other medical, other non-medical, and no analgesia. RESULTS A total of 19 285 pregnancies with diagnosed maternal FOC were found during our study period. The control group consisted of 757 997 pregnancies without diagnosed maternal FOC. Nulliparous women with diagnosed FOC had a higher rate of epidural analgesia (70.2% vs 67.1%), spinal analgesia (12.3% vs 7.6%), and pudendal block (17.6% vs 9.6%). Multiparous women with FOC had a notably higher rate for epidural analgesia (47.0% vs 29.0%). CONCLUSION The main finding in this study was that women with diagnosed FOC had a higher rate of labor analgesia. The results of this study can be used by midwives, obstetricians, and anesthesiologists to provide optimal pain relief for mothers with FOC.
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Affiliation(s)
- Matias Vaajala
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Maiju Kekki
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health, Center for Child, Adolescent and Maternal Health Research, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Department of Orthopedics and Traumatology, Tampere University Hospital Tampere, Tampere, Finland
| | - Ilari Kuitunen
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
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Vaajala M, Liukkonen R, Kuitunen I, Ponkilainen V, Mattila VM, Kekki M. Trends in the epidemiology of fear of childbirth and association with intended mode of delivery: A nationwide register-based cohort study in Finland. Acta Obstet Gynecol Scand 2023; 102:430-437. [PMID: 36737873 PMCID: PMC10008280 DOI: 10.1111/aogs.14521] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/04/2023] [Accepted: 01/20/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Fear of childbirth (FOC) is a common obstetrical challenge that affects the health of women. The epidemiology of FOC has not been studied in Finland for the last decade. The aim of this study was to analyze the epidemiology and risk factors for FOC and to evaluate the association between FOC and the rate of elective cesarean section (CS) as an intended mode of delivery. MATERIAL AND METHODS Data from the National Medical Birth Register were used to evaluate the epidemiology of FOC and to determine the main risk factors for FOC in Finland between 2004 and 2018. Nulliparous and multiparous women were analyzed separately. Logistic regression model was used to determine the main risk factors for FOC. Multivariable logistic regression model was used to assess the intended mode of delivery in those pregnancies with diagnosed maternal FOC. Adjusted odds ratios (aOR) with 95% confidence intervals (CIs) were calculated. RESULTS A total of 1 million pregnancies were included. The annual rate of pregnancies with maternal FOC increased from 1.5% (CI: 1.4-1.6) in 2004 to 9.1% (CI: 8.7-9.3) in 2018 for all women. For nulliparous women, the rate increased from 1.1% (CI: 1.0-1.3) in 2004 to 7.1% (CI: 6.7-7.5) in 2018, and from 1.8% (CI: 1.7-2.0) in 2004 to 10.3% (10.0-10.7) in 2018 for multiparous women. The strongest risk factors for maternal FOC were higher maternal age and gestational diabetes. For multiparous women, the strongest risk factors were gestational diabetes and previous CS. The total odds for elective CS were notably higher among women with FOC (aOR 8.63, CI: 8.39-8.88). CONCLUSIONS The incidence of maternal FOC rose six-fold during our study period. However, the numbers of elective CS among women with this diagnosis, which had earlier risen in parallel, leveled off in 2014.
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Affiliation(s)
- Matias Vaajala
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Rasmus Liukkonen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Ilari Kuitunen
- Department of Pediatrics, Mikkeli Central Hospital, Mikkeli, Finland.,Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
| | - Ville Ponkilainen
- Department of Surgery, Central Finland Central Hospital Nova, Jyväskylä, Finland
| | - Ville M Mattila
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Orthopedics and Traumatology, Tampere University Hospital Tampere, Finland
| | - Maiju Kekki
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.,Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Vaajala M, Liukkonen R, Ponkilainen V, Mattila VM, Kekki M, Kuitunen I. Birth rate among women with fear of childbirth: a nationwide register-based cohort study in Finland. Ann Epidemiol 2023; 79:44-48. [PMID: 36690228 DOI: 10.1016/j.annepidem.2023.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE The association between fear of childbirth (FOC) and subsequent birth rate is not well studied. The aim of this study is to evaluate the birth rate, and risk for second pregnancy ending in delivery among women with FOC compared to women without FOC in their first pregnancy. METHODS Data from the National Medical Birth Register were used to evaluate the birth rate after the first pregnancy in women with FOC. Cox regression model was used to evaluate the risk for the second pregnancy ending in delivery in women with FOC compared to reference individuals without FOC. The results were interpreted with adjusted hazard ratios (aHRs) and 95% confidence intervals (CI). RESULTS In total, 375,619 women were included in this study. Of these, 9660 (2.6%) had FOC in the first pregnancy (exposed group), and 365,959 (97.4%) had no FOC (non-exposed group). In the exposed group, 3600 (37.3%) women had second pregnancy ending in delivery during the study period, and 206,347 (56.4%) had the second pregnancy ending in delivery in the non-exposed group. The risk for the second pregnancy ending in delivery was lower among women with FOC (aHR 0.61, CI 0.59-0.63). CONCLUSIONS FOC complicates pregnancy and delivery and is strongly associated with lower likelihood to get pregnant again. Therefore, more research should be focused on the optimal prevention of FOC using a standardized procedure of care and treatment for women with FOC.
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Affiliation(s)
- Matias Vaajala
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
| | - Rasmus Liukkonen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Ville Ponkilainen
- Department of Surgery, Central Finland Central Hospital Nova, Jyväskylä, Finland
| | - Ville M Mattila
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; Department of Orthopaedics and Traumatology, Tampere University Hospital Tampere, Finland
| | - Maiju Kekki
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland; Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ilari Kuitunen
- Department of Pediatrics, Mikkeli Central Hospital, Mikkeli, Finland; Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
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Vaajala M, Liukkonen R, Kuitunen I, Ponkilainen V, Mattila VM, Kekki M. Factors associated with fear of childbirth in a subsequent pregnancy: a nationwide case-control analysis in Finland. BMC Womens Health 2023; 23:34. [PMID: 36694190 PMCID: PMC9872275 DOI: 10.1186/s12905-023-02185-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Fear of childbirth can develop due to the concerns or adverse maternal or foetal outcomes experienced in a previous pregnancy. The aim of this study was to examine the main risk factors associated with the development of fear of childbirth during subsequent pregnancies and deliveries. METHODS In this case-control study, data from the National Medical Birth Register were used to evaluate the events in previous pregnancies that were potential risk factors for fear of childbirth in subsequent pregnancies. The first and second pregnancies of women registered during our study period (2004-2018) were included. The exposure variable was delivery mode, obstetric challenge or adverse neonatal outcomes during the first pregnancy. The outcome was the development of FOC during the second pregnancy. Adjusted odds ratios with 95% CIs were used for comparison. RESULTS A total of 13 064 pregnancies were included in the case group and 195 351 in the control group. Previous emergency caesarean section was the strongest risk factor for the development of FOC in the second pregnancy (adjusted odds ratio 5.27, CIs 4.83-5.75). In addition, unplanned CS (adjusted odds ratio 3.93, CIs 3.77-4.10) and vacuum delivery (adjusted odds ratio 1.69, CIs 1.61-1.77) also increased the odds of fear of childbirth. Of the obstetric complications, third- or fourth-degree tear of the perineum was the strongest risk factor (adjusted odds ratio 2.99, CIs 2.69-3.31), followed by shoulder dystocia (adjusted odds ratio 2.82, CIs 2.16-3.62). Neonatal mortality also increased the odds for the development of FOC (adjusted odds ratio 2.17, CIs 1.77-2.64). CONCLUSION The main risk factors for the development of fear of childbirth in the second pregnancy were previous fear of childbirth, unplanned CS, vacuum delivery, perineal tear or shoulder dystocia. The results of this study can be used in a clinical setting to improve the prevention of fear of childbirth.
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Affiliation(s)
- Matias Vaajala
- grid.502801.e0000 0001 2314 6254Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Rasmus Liukkonen
- grid.502801.e0000 0001 2314 6254Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Ilari Kuitunen
- grid.414325.50000 0004 0639 5197Department of Pediatrics, Mikkeli Central Hospital, Mikkeli, Finland ,grid.9668.10000 0001 0726 2490Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
| | - Ville Ponkilainen
- grid.460356.20000 0004 0449 0385Department of Surgery, Central Finland Central Hospital Nova, Jyväskylä, Finland
| | - Ville M. Mattila
- grid.502801.e0000 0001 2314 6254Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland ,grid.412330.70000 0004 0628 2985Department of Orthopaedics and Traumatology, Tampere University Hospital Tampere, Tampere, Finland
| | - Maiju Kekki
- grid.412330.70000 0004 0628 2985Department of Obstetrics and Gynaecology, Tampere University Hospital, Tampere, Finland ,grid.502801.e0000 0001 2314 6254Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Olsen B, Forgaard A, Nordsletta AHS, Sommerseth E, Røseth I. “I shut it out”: expectant mothers’ fear of childbirth after a traumatic birth—a phenomenological study. Int J Qual Stud Health Well-being 2022; 17:2101209. [PMID: 35852421 PMCID: PMC9302015 DOI: 10.1080/17482631.2022.2101209] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose To describe expectant mothers’ experiences of fear of childbirth after a previous traumatic birth. Method Qualitative, individual, in-depth interviews were conducted with eight expectant mothers between September and November 2020. Data were analysed using a descriptive phenomenological approach. Results We identified four interconnected constituents: Suboptimal midwifery care, loss of control and agency; insufficient time and capacity to process a traumatic birth experience; “The baby has to be delivered!”, and finally, the path to a new childbirth with the hope of mastering fears. Conclusion Findings reveal an association between a previous history of traumatic birth and a fear of childbirth in expectant mothers. The trauma they experienced whilst giving birth strongly impacted their subsequent pregnancy, making it difficult for them to deal with the new pregnancy and impending birth. Women who have experienced a traumatic birth need to have the opportunity to process the trauma. Routines must therefore be developed that identify, support and follow up with the women. If these women are identified and given the help they need, this may help prevent and/or alleviate fear of childbirth in their subsequent pregnancy.
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Affiliation(s)
- Barbo Olsen
- Centre for Women, Family and Children’s Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Anikken Forgaard
- Centre for Women, Family and Children’s Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Anne-Hedvig Salmi Nordsletta
- Centre for Women, Family and Children’s Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Eva Sommerseth
- Centre for Women, Family and Children’s Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Idun Røseth
- Centre for Women, Family and Children’s Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
- Department of Child and Adolescent Mental Health, Telemark Hospital Trust, Skien, Norway
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Souto SPAD, Silva RCGD, Prata AP, Guerra MJ, Couto C, Albuquerque RSD. Midwives' interventions for reducing fear of childbirth in pregnant women: a scoping review. JBI Evid Synth 2022; 20:2867-2935. [PMID: 35976033 DOI: 10.11124/jbies-21-00382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this review was to map and analyze midwives' interventions for reducing fear of childbirth in pregnant women. INTRODUCTION Fear of childbirth is a phenomenon negatively affecting women's health and well-being before and during pregnancy. Over the past few decades, there has been growing research interest in interventions for reducing fear of childbirth in pregnant women. One of the challenges in midwifery care is to provide an appropriate model of care for pregnant women with fear of childbirth. Further research efforts are needed to identify midwives' interventions for reducing fear of childbirth in pregnant women and to examine their characteristics. INCLUSION CRITERIA This scoping review considered studies that included midwives' interventions for reducing fear of childbirth in pregnant women. Specifically, interventions were led and/or implemented by midwives during the antenatal period, and integrating all possible midwifery practice settings. Quantitative, qualitative, and mixed methods studies were included. This review also considered systematic reviews, text and opinion papers, and conference abstracts. METHODS The JBI methodology for conducting scoping reviews was used. Published and unpublished literature in English, Portuguese, and Spanish from January 1981 to October 2020 was included. MEDLINE (PubMed), CINAHL Complete, APA PsycINFO, Scopus, Embase, Web of Science, SciELO, MedicLatina, Academic Search Complete, ERIC, Psychology and Behavioral Sciences Collection, and the Cochrane Library databases were searched. Searches for gray literature were also undertaken on the Repositório Científico de Acesso Aberto de Portugal, ProQuest Dissertations and Theses, British Library EThOS, OvidSP Resource Center, Banco de Teses da CAPES, and OpenGrey. A three-step search strategy was followed, and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews checklist was used. Two independent reviewers extracted the data using a data extraction tool developed specifically for this scoping review. RESULTS A total of 3704 articles were identified and screened, of which 34 articles were included. The majority of studies had been published in the past 10 years (88%) in Scandinavian countries or Australia (79%). Several midwives' antenatal interventions were found, such as midwife-led team models of care. Midwives played a facilitator role that varied across the included studies. In 20 studies (59%), midwives led and implemented the interventions alone ( n = 13; 38%) or with the participation of other health professionals ( n = 7; 21%). In the remaining 14 studies (41%), midwives were part of a multidisciplinary team that included different health professionals (mainly obstetricians and psychologists) who had been involved in delivering interventions alongside midwives or with minor participation from midwives. Counseling ( n = 12; 35%) and psychoeducation ( n = 8; 24%) were the most common midwife interventions for reducing fear of childbirth in pregnant women. CONCLUSIONS Midwives working across their full scope of practice play a pivotal role in reducing fear of childbirth, which may explain the variety of midwives' antenatal interventions. Reducing fear of childbirth in pregnant women and promoting normal childbirth as a positive experience are key features of midwives' interventions, which should include women's empowerment measures. Evidence-based midwife-led intervention programs for pregnant women with fear of childbirth should be designed and tested to improve clinical practice as well as women's reproductive outcomes and perinatal experiences.
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Affiliation(s)
- Sandra Patrícia Arantes do Souto
- Centre for Interdisciplinary Research in Health: Institute of Health Sciences, Universidade Católica Portuguesa, Porto, Portugal.,Maternity unit, Hospital Center Póvoa de Varzim/Vila do Conde, Póvoa de Varzim, Portugal
| | - Rosa Carla Gomes da Silva
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC).,Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, Coimbra, Portugal
| | - Ana Paula Prata
- CINTESIS - Center for Health Technology and Services Research, Nursing School of Porto (ESEP), Porto, Portugal
| | - Maria João Guerra
- Centre for Interdisciplinary Research in Health: Institute of Health Sciences, Universidade Católica Portuguesa, Porto, Portugal
| | - Cristina Couto
- Centre for Interdisciplinary Research in Health: Institute of Health Sciences, Universidade Católica Portuguesa, Porto, Portugal.,Maternity unit, Hospital Center Tâmega e Sousa, Penafiel, Portugal
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11
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Kaya N, Guler H. Online solution-focused psychoeducation as a new intervention for treating severe fear of childbirth: A randomized controlled trial in the pandemic period. Perspect Psychiatr Care 2022; 58:2116-2126. [PMID: 35119113 DOI: 10.1111/ppc.13038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/04/2022] [Accepted: 01/23/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study was conducted to determine the effect of solution-focused psychoeducation (SFP) and childbirth preparation training (CPT) on women's fear of childbirth and self-efficacy. METHODS This randomized controlled trial was carried out at the family health center in Turkey. The sample of the study consisted of a total of 119 healthy primigravid women. These women were randomized into the SFP group (n = 39), CPT group (n = 40), and control group care (n = 40). FINDINGS After the intervention, the women in the experiment groups had decreased fear of childbirth and increased self-efficacy. PRACTICE IMPLICATIONS Midwifery care based on education and counseling provided by online synchronous video conferencing method during the pandemic period is an effective and safe method in reducing fear of childbirth in women and increasing their self-efficacy.
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Affiliation(s)
- Nurdan Kaya
- Midwifery Department, Health Sciences Faculty, Ondokuz Mayıs University, Samsun, Turkey
| | - Handan Guler
- Child Development Department, Vocational School of Health Care, Sivas Cumhuriyet University, Sivas, Turkey
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12
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Abstract
Background Between 5% and 14% of women suffer from fear of childbirth (FOC) which is associated with difficulties during birth and in postnatal psychological adjustment. Therefore, effective interventions are needed to improve outcomes for women. A systematic review and meta-analysis was used to identify effective interventions for treating women with FOC. Methods Literature searches were undertaken on online databases. Hand searches of reference lists were also carried out. Studies were included in the review if they recruited women with FOC and aimed to reduce FOC and/or improve birth outcomes. Data were synthesised qualitatively and quantitatively using meta-analysis. The literature searches provided a total of 4474 citations. Results After removing duplicates and screening through abstracts, titles and full texts, 66 papers from 48 studies were identified for inclusion in the review. Methodological quality was mixed with 30 out of 48 studies having a medium risk of bias. Interventions were categorised into six broad groups: cognitive behavioural therapy, other talking therapies, antenatal education, enhanced midwifery care, alternative interventions and interventions during labour. Results from the meta-analysis showed that most interventions reduced FOC, regardless of the approach (mean effect size = −1.27; z = −4.53, p < 0.0001) and that other talking therapies may reduce caesarean section rates (OR 0.48, 95% CI 0.48–0.90). Conclusions Poor methodological quality of studies limits conclusions that can be drawn; however, evidence suggests that most interventions investigated reduce FOC. Future high-quality randomised controlled trials are needed so that clear conclusions can be made.
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13
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Hildingsson I, Rubertsson C. Testing the birth attitude profile scale in a Swedish sample of women with fear of birth. J Psychosom Obstet Gynaecol 2021; 42:132-139. [PMID: 32081051 DOI: 10.1080/0167482x.2020.1729118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore the "Birth Attitude Profile Scale (BAPS)" in a selected sample of women with fear of birth. Another aim was to develop profiles of women according to their birth attitudes and levels of childbirth fear in relation to background characteristics. METHODS A secondary analysis of data collected in two different samples of women with fear of birth. Data were collected by a questionnaire in gestational week 36 and background data from mid-pregnancy. A principal component analysis and a cluster analysis were performed of the combined sample of 195 women. RESULTS The principal component analysis revealed four domains of the BAPS: "personal impact, birth as a natural event, freedom of choice and safety concerns". When adding the fear of birth scale, two clusters were identified: one with strong attitudes and lower fear, labeled "self-determiners"; and one with no strong attitudes but high levels of fear, labeled "fearful." Women in the "Fearful" cluster more often reported previous and current mental health problems, which were the main difference between the clusters. CONCLUSION The BAPS instrument seems to be useful in identifying birth attitudes in women with fear of birth and could be a basis for discussions and birth planning during pregnancy. Mental health problems were the main difference in cluster membership; therefore, it is important to ask women with fear of childbirth about physical, mental and social aspects of health. In addition, a qualitative approach using techniques such as focus groups or interviews is needed to explore how women come to form their attitudes and beliefs about birth.
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Affiliation(s)
- Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Christine Rubertsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Health Science, Lund University, Lund, Sweden
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14
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Kemppainen V, Niinimäki M, Bloigu A, Saisto T, Rouhe H, Gissler M, Heikinheimo O, Mentula M. Fear of childbirth after medical vs surgical abortion. Population-based register study from Finland. Acta Obstet Gynecol Scand 2021; 100:743-750. [PMID: 33393097 DOI: 10.1111/aogs.14078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To evaluate the effect of method of induced abortion and other abortion-associated variables on the incidence of fear of childbirth in subsequent pregnancy. MATERIAL AND METHODS This population-based register study cohort includes all nulliparous women with their first pregnancy ending in an induced abortion in 2000-2015 and subsequent pregnancy with live singleton delivery between 2000 and 2017 (n = 21 479). Data were derived from three national registers maintained by the Finnish Institute for Health and Welfare. We divided the study population in three cohorts: (a) medical and (b) surgical abortion during first trimester (≤84 days of gestation), and (c) medical abortion during second trimester (85-168 days of gestation). Primary outcome measures were the incidence of registry-identified fear of childbirth and cesarean delivery related to it. RESULTS The overall incidence of fear of childbirth was 5.6% (n = 1209). Altogether, 19.2% (n = 4121) of women underwent cesarean delivery. The odds were elevated especially for elective cesarean delivery (odds ratio [OR] 9.30, 95% CI 7.95-10.88, P < .001) in women with fear of childbirth. In multivariable analysis, the odds for fear of childbirth (adjusted OR [aOR] 0.80, 95% CI 0.68-0.94) and cesarean delivery (aOR 0.66, 95% CI 0.84-0.90) were decreased in women with a history of first-trimester medical abortion compared with those with first-trimester surgical abortion. Second-trimester medical abortion had no effect on the odds for fear of childbirth (aOR 1.04, 95% CI 0.71-1.50). Maternal age of 30-39 years and interpregnancy interval over 2 years were additional risk factors for both fear of childbirth and cesarean delivery, but surgical evacuation of uterus after the abortion was not. CONCLUSIONS One first- or second-trimester medical abortion does not increase the odds for fear of childbirth, and cesarean delivery related to it in subsequent pregnancy when compared with first-trimester surgical abortion. Older maternal age and longer interpregnancy interval emerged as risk factors for fear of childbirth.
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Affiliation(s)
- Venla Kemppainen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maarit Niinimäki
- Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Aini Bloigu
- Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Terhi Saisto
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Rouhe
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Gissler
- Finnish Institute of Health and Welfare (THL), Helsinki, Finland.,Karolinska Institute, Stockholm, Sweden
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maarit Mentula
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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