Preferred and actual mode of delivery in relation to fear of childbirth

Birth expectations, birth experiences and childbirth-related post-traumatic stress symptoms in mothers and birth companions: Dyadic investigation using response surface analysis

OBJECTIVES

During the perinatal period, women and their birth companions form expectations about childbirth. We aimed to examine whether a mismatch between birth expectations and experiences predict childbirth-related post-traumatic stress symptoms (CB-PTSS) for mothers and birth companions. We also explored the influence of the mismatch between mothers' and birth companions' expectations/experiences on CB-PTSS.

DESIGN

Dyadic longitudinal data from the Self-Hypnosis IntraPartum Trial.

METHODS

Participants (n = 469 mothers; n = 358 birth companions) completed questionnaires at 27 and 36 weeks of gestation and 2 and 6 weeks post-partum. We used the measures of birth expectations (36 weeks gestation), birth experiences (2 weeks post-partum) and CB-PTSS (6 weeks post-partum).

RESULTS

Correlations revealed that birth expectations were associated with experiences for both mothers and birth companions but were not consistently associated with CB-PTSS. Birth experiences related to CB-PTSS for both mothers and birth companions. The response surface analysis results showed no support for the effect of a mismatch between expectations and experiences on CB-PTSS in mothers or birth companions. Similarly, a mismatch between mothers' and birth companions' expectations or experiences was unrelated to CB-PTSS.

CONCLUSIONS

Following previous literature, birth expectations were associated with experiences, and experiences were associated with CB-PTSS. By testing the effect of the match between birth experiences and expectations using an advanced statistical method, we found that experiences play a more substantial role than the match between experiences and expectations in CB-PTSS. The impact of birth experiences on CB-PTSS highlights the importance of respectful and supportive maternity care.

Validity and reliability of Turkish pregnant women's preferences for mode of delivery questionnaire

OBJECTIVE

The aim of this study was to determine whether Pregnant Women's Preferences for Mode of Delivery Questionnaire, created by Zamani-Alavijeh et al., is a valid and reliable measurement tool for Turkish pregnant women.

METHODS

This study has a methodological research design and was conducted with 139 pregnant women who were randomly selected from those aged 18-35 years, who applied to obstetric clinic,.who had no previous prenatal losses and no systemic diseases, and who had conceived naturally. The data for this study were collected with the Personal Information Form and the Pregnant Women's Preferences for Mode of Delivery Questionnaire. To test the reliability and validity of Pregnant Women's Preferences for Mode of Delivery Questionnaire, Cronbach's α, split-half method, item analysis, Kendall's coefficient of agreement (W), explanatory factor analysis, and confirmatory factor were used.

RESULTS

The study found that Cronbach's α was 0.94, the Spearman-Brown reliability coefficient was 0.883, and the Guttman split-half was 0.880. Explanatory factor analysis revealed an 18-item structure with three factors having an eigenvalue exceeding 1, explaining 67.593% of the total variability, and factor loading between 0.40 and 0.64.

CONCLUSION

Based on the scientific recommendations, the Turkish version of the Pregnant Women's Preferences for Mode of Delivery Questionnaire has adequate psychometric properties.

Fear of childbirth after induced abortion in primiparous women: Population-based register study from Finland

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.

Evaluation of a short in-person and online antenatal educational intervention for high-risk pregnant women linked to antenatal consultation

INTRODUCTION

The aim of this study was to evaluate a short educational intervention that focused on labor pain (through visual analogue scale, VAS), postpartum anxiety, and birthing experience before and during the SARS-CoV-2 (COVID-19) pandemic.

METHODS

This was a quasi-experimental study conducted between November 2019 and May 2021 in Brazil in 100 women with a high-risk pregnancy in the third trimester of pregnancy with an intervention group with in-person or virtual sessions (during the COVID-19 pandemic) and a non-intervention group. The antenatal intervention included breathing and relaxation techniques, upright positions, and information about labor. For evaluation, an antenatal questionnaire, State-Trait Anxiety Inventory (STAI) and a postpartum questionnaire were used. For data analysis, Student's t-test, chi-squared and Fisher's exact tests, ANOVA, bivariate, and multivariate regression analysis, were used.

RESULTS

When comparing the women in the intervention group to the non-intervention group, it was observed that the latter group reported higher fear of pain at labor during antenatal consultations (p<0.013); more women needed analgesia at 0-4 cm dilation (17/40) (p<0.018); the duration of labor was ≥12 hours (37/50) (p<0.037); while the intervention reported having a regular, good or excellent labor period (36/50) (p=0.014). The multiple regression analysis for labor pain showed a significant relationship between mode of delivery (cesarean delivery: RR; SE -21.43; 5.32, p<0.001) and labor pain, and good satisfaction with labor (RR; SE -13.86; 6.40, p=0.033).

CONCLUSIONS

Women from the intervention group had more satisfaction and less pain during labor than women from the non-intervention group.

Mode of delivery preferences: the role of childbirth fear among nulliparous women

Introduction

The increasing Cesarean Section (CS) rates may be attributed to women's increasing requests for elective CS. High Fear of Childbirth (FOC), especially among nulliparous women, may be significantly associated with CS preference without medical indications. The current study aims to investigate the impact of childbirth fear on the mode of delivery preference among nulliparous women.

Methods

A cross-sectional correlational study was performed in the Maternal and Children Hospital (MCH) from the beginning of October 2022 to the end of February 2023 and incorporated a convenience sample of 342 nulliparous women. The data was collected using a self-reported questionnaire comprising participants' demographic and obstetrics characteristics and the FOC questionnaire. A logistic regression model examined the relationship between CS preference and the other independent variables.

Results

The results indicated that 74.3% of the nulliparous women preferred vaginal delivery, while 25.7% preferred Cesarean Section. Concerning childbirth-related fear, the highest mean scores were related to fear of clinical procedures, fear of harming or distressing the infant, and fear of pain 5.19 ± 1.13, 5.12 ± 1.27, and 5.09 ± 1.22, respectively. High FOC was present among 74.6%, moderate in 17.3%, and severe in 6.7% of the participants. Logistic regression analysis showed maternal age and monthly income were the significant sociodemographic determinants of choosing CS as the preferred delivery mode (p < 0.05). Moreover, the participants who had increased fear of harming or distressing the infant, fear from pain, fear from the body's ability to give birth, fear from not being involved in decision-making, and overall FOC had a higher probability of choosing CS as the preferred delivery mode compared to the participants who had lower fear (p < 0.05).

Discussion

Having high FOC increases the CS preference among nulliparous women. Increased fear of harming or distressing the infant, fear from pain, fear from the body's ability to give birth, and fear from not being involved in decision- making seem to be significant dimensions of childbirth fear associated with CS preference among nulliparous women.

An idiosyncratic MIMBO-NBRF based automated system for child birth mode prediction

Predicting the mode of child birth is still remains one of the most complex and challenging tasks in ancient times. Also, there is no such strong methodologies are developed in the conventional works for birth mode prediction. Therefore, the proposed work objects to develop a novel and distinct optimization based machine learning technique for creating the child birth mode prediction system. This framework includes the modules of data imputation, feature selection, classification, and prediction. Initially, the data imputation process is performed to improve the quality of dataset by normalizing the attributes and filling the missed fields. Then, the Multivariate Intensified Mine Blast Optimization (MIMBO) technique is implemented to choose the best set of features by estimating the optimal function. After that, an integrated Naïve Bayes - Random Forest (NBRF) technique is developed by incorporating the functions of conventional NB and RF techniques. The novel contribution of this technique, a Bird Mating (BM) optimization technique is used in NBRF classifier for estimating the likelihood parameter to generate the Bayesian rules. The main idea of this paper is to develop a simple as well as efficient automated system with the use of hybrid machine learning model for predicting the mode of child birth. For this purpose, advanced algorithms such as MIMBO based feature selection, and NBRF based classification are implemented in this work. Due to the inclusion of MIMBO and BM optimization techniques, the performance of classifier is greatly improved with low computational burden and increased prediction accuracy. Moreover, the combination of proposed MIMBO-NBRF technique outperforms the existing child birth prediction methods with superior results in terms of average accuracy up to 99 %. In addition, some other parameters are also estimated and compared with the existing techniques for proving the overall superiority of the proposed framework.

Fear of Childbirth in Nulliparous Women

Purpose

The relation between fear of childbirth (FoC) and gestational age is inconclusive, and self-reported need for help regarding this fear has never been investigated. This study aimed to determine the prevalence and course of FoC according to gestational age, to identify risk factors for the development of FoC, the influence of this fear on preferred mode of delivery, and self-reported need for help.

Methods

Nulliparous pregnant women of all gestational ages completed an online survey. The study consisted of a cross-sectional and a longitudinal analysis. Women who completed the survey in the first or second trimester (T₀) were approached again in their third trimester (T₁). The Wijma Delivery Expectancy Questionnaire Version A (W-DEQ A) was used with a cut-off score ≥ 85 to define presence of fear of childbirth. Questionnaires indexing social support, anxiety, symptoms of depression, preferred mode of delivery, and self-reported need for help were included.

Results

In total, 364 women were enrolled at T₀, and 118 out of 184 eligible women were included in the longitudinal analysis. Point prevalence of FoC at T₀ was 18.4% with no significant difference between trimesters. In the longitudinal sample, the prevalence of FoC decreased from 18.6% (T₀) to 11.0% (T₁), p = 0.004. Although mean scores for FoC decreased significantly, p < 0.001, scores increased in 41 (34.7%) women. The presence of FoC was associated with elevated anxiety, less family support, prenatal care of the obstetrician by choice, preference for a cesarean section, and for pain relief. Women with FoC were more likely to actively seek for help compared to women without FoC.

Conclusion

While FoC is common in each trimester, prevalence decreases over the course of pregnancy. Women with FoC are often actively seeking for help, suggesting that this fear should be addressed better, and help should be offered accordingly.

Effect of Hypnobirthing Training on Fear, Pain, Satisfaction Related to Birth, and Birth Outcomes: A Randomized Controlled Trial

We aimed to determine the effect of Hypnobirthing training on fear of childbirth (FOC), birth pain, birth satisfaction and birth outcomes. This randomized controlled trial study was conducted with 80 nulliparous pregnant who were divided into two groups (experimental group n = 40 and control n = 40) in a maternity hospital. The couples received the training in groups(4 weeks, once a week, 3-hour, group session). The mean score of hypnobirthing group for the whole Wijma Birth Expectancy/Experience Scale was significantly lower than that of the routine care group (p < .001).In the latent, active, and transitional phases of labor, the Visual Analog Scale (VAS)scores of the experimental groups were found to be significantly lower than those of the control group (p < .001).The experimental group's rates of birth intervention were significantly lower and their deliveries period were shorter, than those that of the routine control group (p < .001).In addition, the vaginal delivery rates (p = .037)and the scores for the Birth Satisfaction Scale-Revised (BSS-R) were also found to be higher than those of the control group (p < .001).

The Role of Personality Traits and Delivery Experience in Fear of Childbirth: A Prospective Study

This study aimed to examine fear of childbirth (FOC) before and after delivery in relation to personality (anxiety and anxiety sensitivity) and birth experience (type of delivery, pain, and staff support). One-hundred and five women completed questionnaires during pregnancy and one month after childbirth. Participants completed the Wijma Delivery Expectancy/Experience Questionnaire; the State and Trait Anxiety Inventory and Anxiety Sensitivity Index, and the McGill Pain Questionnaire and a Support from staff questionnaire. FOC levels decreased after childbirth, but only in the high-level fear group. Path analysis showed that physical concerns, one aspect of anxiety sensitivity, shape FOC during pregnancy. Together with interventions at delivery (instrumental vaginal delivery and emergency caesarean section), pain and low staff support, this in turn modifies FOC after delivery. In conclusion, FOC decreases after childbirth. However, combined with adverse birth experience and certain personality traits, FOC during pregnancy affects FOC after delivery.

The prevalence and predictors of fear of childbirth among pregnant Chinese women: a hierarchical regression analysis

Background

Fear of childbirth (FOC) occurs before, during and after pregnancy and is harmful to both the pregnant woman and the fetus. Identifying the prevalence and predictors of FOC can help us generate strategies for alleviating women’s FOC.

Methods

A cross-sectional study was conducted among a convenience sample of 646 pregnant women receiving antenatal care at a subordinate hospital of a university in China. Data were collected using a basic information form, the Childbirth Attitude Questionnaire, the Childbirth Self-Efficacy Inventory, and the 10-item Connor-Davidson Resilience Scale. The minimum and maximum total scores of the Childbirth Attitude Questionnaire are 16 and 64, respectively, with higher scores reflecting a greater degree of FOC. We conducted hierarchical regression analysis to explore the predictors of FOC and used a structural equation model to further examine the direct and indirect associations between FOC, resilience and childbirth self-efficacy.

Results

The total prevalence of FOC was 67.1%. The percentages of women with mild (score of 28–39), moderate (40–51), and severe FOC (52–64) were 45.4, 19.5, and 2.2%, respectively. The average score on the Childbirth Attitude Questionnaire was 32.49, indicating mild FOC. The final regression analysis revealed six variables predicting FOC that explained 64.5% of the variance in FOC: age, gestational age, parity, spousal support, resilience, and childbirth self-efficacy. Furthermore, childbirth self-efficacy mediated the relationship between resilience and FOC, and the mediation effect rate was 53.5%.

Conclusions

A high prevalence of FOC among pregnant Chinese women was found in this study. Age, gestational age, parity, spousal support, resilience, and childbirth self-efficacy were predictors of FOC. It is suggested that healthcare professionals should pay close attention to FOC and implement targeted interventions in accordance with these predictors, especially resilience and childbirth self-efficacy.

When birth is not as expected: a systematic review of the impact of a mismatch between expectations and experiences

Background

Pregnancy and childbirth are significant events in women’s lives and most women have expectations or plans for how they hope their labour and birth will go. It is possible that strong expectations about labour and birth lead to dissatisfaction or other negative outcomes if these expectations are not met, but it is not clear if this is the case. The aim was therefore to synthesise prospective studies in order to understand whether unmet birth expectations are associated with adverse outcomes for women, their partners and their infants.

Method

Searches were carried out in Academic Search Complete; CINAHL; Medline; PsycINFO, PsychArticles, PubMed, SCOPUS and Web of Science. Forward and backward searches were also completed. Studies were included if they reported prospective empirical research that examined the association between a mismatch in birth expectations/experience and postnatal outcomes in women, their children and/or their partners. Data were synthesised qualitatively using a narrative approach where study characteristics, context and methodological quality were extracted and summarised and then the differences and similarities among studies were used to draw conclusions.

Results

Eleven quantitative studies were identified for inclusion from nine countries. A mismatch between birth expectations and experiences was associated with reduced birth satisfaction. Three studies found a link between a mismatch and the development of postnatal post-traumatic stress disorder (PTSD). The evidence was inconsistent for postnatal depression, and fear of childbirth. Only one study looked at physical outcomes in the form of health-related quality of life.

Conclusions

A mismatch between birth expectations and experiences is associated with birth satisfaction and it may increase the risk of developing postnatal PTSD. However, it is not clear whether a mismatch is associated with other postnatal mental health conditions. Further prospective research is needed to examine gaps in knowledge and provide standardised methods of measuring childbirth expectations-experiences mismatch. To ensure women’s expectations are met, and therefore experience a satisfying birth experience, maternity providers should provide sensitive care, which acknowledges women’s needs and preferences, is based on open and clear communication, is delivered as early in pregnancy as possible, and enables women to make their own decisions about care.

Trial registration

Protocol registration: PROSPERO CRD42020191081.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03898-z.

Validity and reliability of the Spanish version of the "Wijma Delivery Expectancy/Experience Questionnaire" (W-DEQ-B)

The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ-B) is an instrument that allows the experiences around fear of childbirth to be examined after the birth. It is currently the most widely used to measure different aspects related to the fear of childbirth and enables healthcare and additional assistance to women after birth to be adapted according to their needs. The objective of this study was to translate the W-DEQ-B into Spanish and analyse its reliability and validity. The study was carried out in two phases: (1) transcultural adaption of the questionnaire to Spanish and (2) a transversal study in a sample of 190 postpartum women from Sexual and Reproductive Health Clinics in the province of Barcelona (Spain). The psychometric properties were examined in terms of reliability (internal consistency and temporal stability) and construct validity (confirmatory factorial analysis [CFA] and exploratory factorial analysis [EFA]). The results of the CFA did not confirm unidimensionality of the W-DEQ-B questionnaire. The EFA suggested four very similar, but not identical, dimensions to those obtained in other studies in which the W-DEQ-B has been evaluated. Both the Cronbach's alpha and the omega coefficient were adequate for the total questionnaire and for each of the four dimensions. The results of this study confirm that the W-DEQ-B is multi-dimensional. In the Spanish version of the W-DEQ-B-Sp four dimensions have been identified that allow the experiences around fear of childbirth to be examined after the birth. The Spanish version of the WDEQ-B (WDEQ-B-Sp) is reliable and valid for the measurement of fear of childbirth in clinical practice and for use in future research.

Factors associated with fear of childbirth among Polish pregnant women

The purpose of our study was to elucidate the association between obstetric and psychological factors and fear of childbirth (FOC) during the third trimester of pregnancy and to identify women at risk of severe FOC in Poland. An additional goal of the study was to verify the Polish version of the Wijma Delivery Expectancy Questionnaire (W-DEQ) and to establish its psychometric characteristics. Cross-sectional study with a total of 359 women recruited during routine visits to an antenatal clinic in Poland during the third trimester (≥ 27 weeks gestation). The survey included obstetric details (parity, obstetric history and preferred mode of delivery), and standardized psychological measures: the W-DEQ (fear of childbirth) and the EPDS (depressive symptoms). We demonstrated the satisfactory psychometric properties of the Polish version of the W-DEQ. Our findings confirm the one-factor structure found by the authors of the original version of the scale. A greater FOC was reported by women with unplanned pregnancies, women whose preferred mode of delivery was a cesarean section, and women who had previously undergone psychiatric treatment. The risk factors for severe FOC were depression, unplanned pregnancy or parity, and disagreement with the birth plan proposed by the obstetrician. The W-DEQ is a widely used, valid instrument for the assessment of FOC in pregnant women and can be used in Poland. Findings support the key role of obstetric and psychological variables in predicting fear of childbirth.