Fear of childbirth and risk of cesarean delivery: a cohort study in six European countries

Synchronization of a Virtual Reality Scenario to Uterine Contractions for Labor Pain Management: Development Study and Randomized Controlled Trial

Background: Labor is described as one of the most painful events women can experience through their lives, and labor pain shows unique features and rhythmic fluctuations. Purpose: The present study aims to evaluate virtual reality (VR) analgesic interventions for active labor with biofeedback-based VR technologies synchronized to uterine activity. Materials and Methods: We developed a VR system modeled on uterine contractions by connecting it to cardiotocographic equipment. We conducted a randomized controlled trial on a sample of 74 cases and 80 controls during active labor. Results: Results of the study showed a significant reduction of pain scores compared with both preintervention scores and to control group scores; a significant reduction of anxiety levels both compared with preintervention assessment and to control group and significant reduction in fear of labor experience compared with controls. Conclusion: VR may be considered as an effective nonpharmacological analgesic technique for the treatment of pain and anxiety and fear of childbirth experience during labor. The developed system could improve personalization of care, modulating the multisensory stimulation tailored to labor progression. Further studies are needed to compare the synchronized VR system to uterine activity and unsynchronized VR interventions.

Effect of mode of delivery on postpartum weight retention: A systematic review and meta-analysis

OBJECTIVE

Retention of weight gained over pregnancy increases the risk of long-term obesity and related health concerns. While many risk factors for this postpartum weight retention have been examined, the role of mode of delivery in this relationship remains controversial. We carried out a systematic review and meta-analysis to determine the effect of mode of delivery on postpartum weight retention.

METHODS

Ten electronic databases including PubMed, Cochrane Library, EMBASE, Web of Science, MEDLINE, CINAHL, China National Knowledge Infrastructure (CNKI), Wan-Fang database, the VIP database and China Biology Medicine Database (CBM) were searched from inception through November 2022. Review Manager 5.4 was used to pool the study data and calculate effect sizes. For dichotomous data, the odds ratio and 95 % confidence interval were used to report the results. For continuous data, the mean difference (MD) and 95 % confidence interval were used to report the results. The outcomes were the amount of postpartum weight retention and the number or proportion of women who experienced postpartum weight retention. The Newcastle- Ottawa Scale (NOS) and GRADE Guidelines were used to assess the methodological quality of the included studies.

FINDINGS

A total of 16 articles were included in the systematic review and 13 articles were included in the meta-analysis. The results showed that the mode of delivery had a significant effect on postpartum weight retention, women who delivered by caesarean section were more likely to experience postpartum weight retention compared to those who delivered vaginally. Sensitivity analysis showed that the results were stable and credible.

CONCLUSION

Due to the limitations of this study, the findings need to be treated with caution. And, to better prevent the postpartum weight retention, future practice and research need to further focus on upstream modifiable factors.

Fear of childbirth and its associated factors among pregnant women in Dejen Woreda, East Gojjam Zone, Northwest Ethiopia: a community-based cross-sectional study

Fears of delivery are the uncertainty and worry experienced before, during, and following labor. It hurts women's health and affects 5-40% of all moms globally. If not recognized, it could cause expectant mothers to feel alone and unsupported. Studies on this subject, however, are scarce at the woreda level. Therefore, this study amis to assess the prevalence and associated factors of fear of childbirth among pregnant women in Dejen Woreda, East Gojjam Zone, Northwest Ethiopia. A community-based cross-sectional study was conducted among 575 pregnant women selected by Cluster Sapling from December 15 to December 25, 2022. Data were gathered using a structured questionnaire that was presented by an interviewer. Data were entered using Epi-data version 3.1 and analyzed using SPSS Version 23 statistical software. Descriptive statistics and inferential statistics were done, and ordinary logistic regression was used to examine the associated factor for fear of childbirth. Finally, a P-value < 0.05 was used to determine statistical significance. Among the 575 pregnant women supposed to have participated, 560 agreed and participated in the survey, with a response rate of 97.4%. This study showed that 133(23.8%; CI 20.4-26.8) of the study participants had low fear of childbirth, 67(12%; CI (9.3-14.8 moderate, 217 (38.8%; CI 34.6-42.7) high, 143 (25.5%; CI 21.8-29.1) severe fear of childbirth. Having maternal age 18-24 (adjusted odds ratio/AOR = 1.6; 95% CI (1.1-2.3), p-value = -0.08), occupation daily laborer and other (AOR = 0.3,95%; CI 0.3, 0-74; p-value = 0.004),gestational age in third trimester (AOR = 1.9,95%; CI 1.1-3.4), p-value = 0.022) showed significant factor for a fear of childbirth. Maternal age, occupation, and third-trimester pregnancy were found to be significantly associated with fear of childbirth. Women should engage in special attention to keep them healthy by consistent monitoring during pregnancy. Healthcare providers should identify pregnant women with high fear of childbirth early, offer cognitive behavioral therapy, support psychological and physical well-being, provide early age and preventive measures, and use uniform instruments for assessing women's anxiety, promoting systematic reviews and longitudinal studies.

Women's preference for a vaginal birth in Brazilian private hospitals: effects of a quality improvement project

BACKGROUND

In 2015, a quality improvement project called "Adequate Childbirth Project" (PPA) was implemented in Brazilian private hospitals in order to reduce cesarean sections without clinical indication. The PPA is structured in four components, one of which is directed at women and families. The objective of this study is to evaluate the effects of PPA on women's preference for vaginal birth (VB) at the end of pregnancy.

METHODS

Evaluative research conducted in 12 private hospitals participating in the PPA. Interviews were carried out in the immediate postpartum period and medical record data were collected at hospital discharge. The implementation of PPA activities and women's preference for type of birth at the beginning and end of pregnancy were compared in women assisted in the PPA model of care and in the standard of care model, using a chi-square statistical test. To estimate the effect of PPA on women's preference for VB at the end of pregnancy, multiple logistic regression was performed with selection of variables using a causal diagram.

RESULTS

Four thousand seven hundred ninety-eight women were interviewed. The implementation of the planned activities of PPA was less than 50%, but were significantly more frequent among women assisted in the PPA model of care. Women in this group also showed a greater preference for VB at the beginning and end of pregnancy. The PPA showed an association with greater preference for VB at the end of pregnancy in primiparous (OR 2.54 95% CI 1.99-3.24) and multiparous women (OR 1.44 95% CI 0.97-2.12), although in multiparous this association was not significant. The main factor associated with the preference for VB at the end of pregnancy was the preference for this type of birth at the beginning of pregnancy, both in primiparous (OR 18.67 95% CI 14.22-24.50) and in multiparous women (OR 53.11 95% CI 37.31-75.60).

CONCLUSIONS

The PPA had a positive effect on women's preference for VB at the end of pregnancy. It is plausible that more intense effects are observed with the expansion of the implementation of the planned activities. Special attention should be given to information on the benefits of VB in early pregnancy.

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

BACKGROUND

The prevalence and impact of fear of childbirth (FOC) has not been sufficiently understood. We aimed to investigate the prevalence of FOC among Chinese population and its impact on mode of delivery, postpartum mental health and breastfeeding.

METHODS

We conducted a prospective cohort study, wherein pregnant women in their third trimester who underwent antenatal assessments at Shanghai Changning Maternity and Infant Health Hospital between September 2020 and March 2021 were recruited. Sociodemographic data of the participants were gathered by self-administered questionnaire, and their FOC was assessed using the Wijma Delivery Expectancy Questionnaire. Participants were followed up to 42 days postpartum. Information regarding their modes of delivery was retrieved from medical records, and data regarding postpartum mental health symptoms and one-month postpartum breastfeeding were obtained through self-administered questionnaires.

RESULTS

Among 1287 participants, 461 (35.8 %) had high-level FOC (W-DEQ ≥ 66). Logistic regressions showed that women with high-level of FOC had higher rates of caesarean delivery on maternal request (CDMR) (aOR = 1.55, 95 % CI: 1.00-2.41, p = 0.049), a higher incidence of postpartum mental health symptoms (aOR = 1.68, 95 % CI: 1.09-2.59, p = 0.018), lower rates of one-month postpartum exclusive breastfeeding (aOR = 0.33, 95 % CI: 0.16-0.69, p = 0.003) and mixed feeding (aOR = 0.44, 95 % CI: 0.21-0.91, p = 0.028).

LIMITATIONS

The long-term implications of FOC beyond the immediate postpartum period were not explored in the study.

CONCLUSIONS

High-level FOC during the third trimester was associated with increased CDMR and postpartum mental health symptoms and reduced breastfeeding establishment. These results underscore the significance of FOC screening and tailored interventions for affected women.

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.

The effect of cognitive-behavioral therapy and haptonomy on fear of childbirth in primigravida women: a randomized clinical trial

BACKGROUND

Considering the role of fear of childbirth (FOC) in the enhancement of unnecessary cesarean sections (CS), the present study aimed at evaluating the effect of Cognitive-Behavioral Therapy (CBT) and haptonomy on the FOC (as primary outcome) and intended birth method and final birth method (as secondary outcomes) among primigravida women.

METHODS

This randomized clinical trial was conducted on 99 primigravida women in Tabriz, Iran 2022. Participants were assigned to three groups with a ratio of 1:1:1 using stratified block randomization based on the fear intensity. One of the intervention groups (n = 33) received eight group sessions of CBT from 24 to 28 weeks of gestation and the other intervention group (n = 33) received haptonomy during seven sessions once a week. The control group (n = 33) received routine prenatal care. The Wijma questionnaire was completed by the participants before the intervention, after the intervention at 35-37 weeks of gestation, and after birth. The intended birth method was investigated before and after the intervention at 35-37 weeks of gestation. The final birth method and the reasons for CS were recorded based on the mother's medical profile. The one-way ANOVA was used before the intervention and RMANOVA after the intervention to compare the mean scores of FOC among the three groups. Further, chi-square test was applied to compare the intended and final birth method.

RESULTS

The mean (standard deviation: SD) of FOC in the CBT group changed from 74.09 (11.35) at 24-28 weeks of gestation to 46.50 (18.28) at 35-37 weeks and 48.78 (20.64) after birth (P < 0.001). The means (SDs) of FOC in the haptonomy group were 76.81 (13.09), 46.59 (15.81), and 45.09 (20.11), respectively (P < 0.001). The mean (SD) of FOC in the control group decreased from 70.31 (6.71) to 66.56 (18.92) and then, increased to 71.00 (21.14) after birth (P = 0.878). After the intervention, there was no statistically significant difference among the three groups in terms of the intended birth method (P = 0.278), and final birth method (P = 0.107).

CONCLUSION

The findings of the present study revealed that both CBT and haptonomy interventions reduce FOC. Although the desire for vaginal birth and final vaginal birth in the haptonomy group was more than that in the other two groups, there was no statistically significant difference among the three groups.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials: IRCT20170506033834N9. Date of registration: 02.01.2022. URL: http://en.irct.ir .

Fear of childbirth and sleep quality among pregnant women: a generalized additive model and moderated mediation analysis

OBJECTIVES

This study aims to examine the associations among fear of childbirth, psychological distress, resilience, and sleep quality among Chinese pregnant women.

METHODS

A cross-sectional survey was carried out between January 2022 to March 2022 among pregnant women who met the inclusion criteria and sought healthcare services at The First Affiliated Hospital of Guangzhou University of Chinese Medicine in Guangdong Province, Southern China. Data was collected using a structured questionnaire that included sociodemographic characteristics, childbirth attitudes questionnaires (CAQ), hospital anxiety and depression scale (HADS), Connor-Davidson resilience scale (CD-RISC), and Pittsburgh sleep quality index (PSQI). A generalized additive model and moderated mediation analysis were employed for data analysis.

RESULTS

A non-linear and negative association between fear of childbirth and sleep quality was found in the second trimester and antenatal period. Psychological distress significantly mediated the relationship between fear of childbirth and sleep quality (first trimester: β = 0.044, 95%CI:0.022-0.071; second trimester: β = 0.029, 95%CI:0.009-0.056; third trimester: β = 0.064, 95%CI:0.046-0.088; antenatal period: β = 0.050, 95%CI:0.037-0.063). The moderating role of resilience between fear of childbirth and sleep quality was significant (second trimester: β=-0.006, 95%CI:-0.012-0.001, P = 0.025; antenatal period: β=-0.004, 95%CI:-0.007--0.001, P = 0.014), as well as between fear of childbirth and psychological distress (first trimester: β=-0.016, 95%CI:-0.026--0.005, P = 0.004; antenatal period: β=-0.005, 95%CI:-0.009--0.001, P = 0.014).

CONCLUSIONS

Fear of childbirth, psychological distress, and resilience are three important factors affecting sleep quality in Chinese pregnant women.

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.

Psychiatric illness and pregnancy: A literature review

Background

Women of reproductive age frequently suffer from psychiatric disorders. The risk of developing anxiety, bipolar, and depressive disorders is especially significant during the perinatal period.

Objectives

This article aims to identify and discuss the different psychiatric conditions that might affect pregnant women and update the mother's carers about the recent and updated bidirectional relationship between psychiatric disease and adverse pregnancy outcomes, As well as the most updates in diagnostic and management strategies.

Methods

A thorough analysis of the literature was conducted using database searches in EMBASE, Science Direct, Google Scholar, Scopus, and PubMed to obtain the objectives and aim of the study.

Results

The presence of maternal mental illness during pregnancy has been linked to preterm delivery, newborn hypoglycemia, poor neurodevelopmental outcomes, and disturbed attachment. Placental anomalies, small-for-gestational-age foetuses, foetal discomfort, and stillbirth are among more undesirable perinatal outcomes.

Conclusions

Pregnancy-related psychiatric disorders are frequent. The outcomes for pregnant women, infants, and women's health are all improved by proper diagnosis and treatment of psychiatric problems.

The relationship of perceived social support, personality traits and self-esteem of the pregnant women with the fear of childbirth

This research was conducted to examine the relationship of perceived social support, personality traits, and self-esteem of pregnant women with fear of childbirth. The study was performed between April 15, 2016 and May 15, 2016 using face-to-face interviews with 128 pregnant women who were at 28-40 weeks of pregnancy. A negative correlation between the fear of childbirth and the levels of social support perceived by pregnant women and a positive correlation between the fear of childbirth and self-esteem were observed. Furthermore, a negative correlation between the fear of childbirth and extraversion, self-discipline, and openness to development and a positive correlation between the fear of childbirth and neurotic personality traits were noted. Hence, we propose that social support status, personality traits, and self-esteem of pregnant women should be viewed as risk factors for the fear of childbirth.

"I felt like I had no options": Navigating an ultrasound prediction of a large baby in pregnancy

BACKGROUND

Pregnancy ultrasound is deeply embedded in maternity care worldwide, undertaken routinely and in response to clinical indicators. Though ultrasound fetal size predictions can be inaccurate, they heavily influence clinical decision-making. As a result, women with a scan prediction of a 'large' baby may be more likely to have unnecessary interventions.

AIM

This study aimed to explore the implications of an ultrasound prediction of a 'large' baby on birthing women's experiences of their pregnancies and births.

METHODS

The study was underpinned by feminist poststructural theory. Semi-structured interviews were undertaken with women who had an ultrasound prediction of a 'large' baby. Transcripts were analysed using reflexive thematic analysis, with particular attention to discourse.

FINDINGS

Dominant medicalising discourses prioritised surveillance and risk-centric care, and problematised large babies. Engagement with these produced oppressive effects on women including loss of control as they were directed towards high intervention care, and the experience of fear and guilt.

DISCUSSION

A 'large' baby prediction has a negative impact on women's experiences. Women take up dominant discourses that frame predicted large babies as a medical problem to be managed, with little tangible improvement in outcomes. They struggle with fear and guilt as they experience their pregnancies as sites of risk and are constituted as failed mothers who are responsible for their large babies.

CONCLUSION

The prediction of a 'large' baby in pregnancy has undeniably negative impacts on women. We encourage midwives to scrutinise the dominant discourses of authoritative scans and problematic large babies, becoming vectors for critical thinking and resistance.

Emotional factors, medical interventions and mode of birth among low-risk primiparous women in Poland

Background and objectives

Birth is a critical event in women's lives. Since humans have evolved to give birth in the context of social support, not having it in modern settings might lead to more complications during birth. Our aim was to model how emotional factors and medical interventions related to birth outcomes in hospital settings in Poland, where c-section rates have doubled in the last decade.

Methodology

We analysed data from 2363 low-risk primiparous women who went into labor with the intention of giving birth vaginally. We used a model comparison approach to examine the relationship between emotional and medical variables and birth outcome (vaginal or c-section), including sociodemographic control variables in all models.

Results

A model with emotional factors better explained the data than a control model (Δ_AIC = 470.8); women with continuous personal support during labor had lower odds of a c-section compared to those attended by hospital staff only (OR = 0.12, 95% CI = 0.09 - 0.16). A model that included medical interventions also better explained the data than a control model (Δ_AIC = 133.6); women given epidurals, in particular, had increased odds of a c-section over those who were not (OR = 3.55, 95% CI = 2.95 - 4.27). The best model included variables for both the level of personal support and the use of epidural (Δ_AIC = 598.0).

Conclusions and implications

Continuous personal support during childbirth may be an evolutionarily informed strategy for reducing complications, including one of the most common obstetrical complications in modern hospital settings, the c-section.

Trends in the epidemiology of fear of childbirth and association with intended mode of delivery: A nationwide register-based cohort study in Finland

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.

Reflection of the mother-daughter relationship on the perception of birth: a qualitative study among pregnant women

This research is conducted to examine the effect of pregnant women's relationships with their mothers on their perception of birth. This is a qualitative analytic study. This research is carried out with 19 pregnant women who received service from a state hospital in a southern province of Turkey between November-December 2020. Pregnant women between the ages of 18-35, at the 32nd gestational week and above, and who had an active relationship with their mother were included in the study. Data were collected by interview method using semi-structured questions. Descriptive analysis was performed for the analysis of the data. All transcripts were evaluated by two researchers and codes were created. The codes formed the subthemes in terms of similarities and differences, themes were created as a result of combining themes. The data obtained consists of three main themes: 1) Mother - daughter relationship, 2) Perception of birth, 3) Perception of maternal support at the moment of birth.

Maternal antenatal depression's effects on child developmental delays: Gestational age, postnatal depressive symptoms, and breastfeeding as mediators

BACKGROUND

Maternal antenatal depression experienced around conception or during pregnancy may adversely affect child development. This study explores three potential mechanisms of the effects of antenatal depression on children's developmental delays at 2-3 years: gestational age of the child, continued depressive symptoms postnatally, and interrupted breastfeeding practices.

METHODS

Mothers (N = 2888) of 3450 children, including 2303 singletons and 1147 multiples from the Upstate KIDS cohort provided data. Linked hospital discharge data was combined with mothers' reports to identify women with moderate to severe antenatal depression. Gestational age was extracted from birth certificates. Mothers completed a depression screener at 4 months postpartum, reported about their breastfeeding practices from 4 to 12 months postpartum, and completed a developmental delay screener when children were 24, 30, and 36 months.

RESULTS

In unadjusted path analysis models, mothers with antenatal depression had more postnatal depressive symptoms and breastfed fewer months, which translated into children being more likely to have developmental delays. Gestational age was not a mediator. Effects were similar across girls and boys and singletons and twins, and largely held when adjusting for covariates.

LIMITATIONS

Main limitations were the relatively advantaged sample and reliance on maternal report.

CONCLUSIONS

Maternal antenatal depression may impact child development through continued depressive symptoms in the postpartum period and through reduced breastfeeding duration suggesting additional targets for intervention.

Birth rate among women with fear of childbirth: a nationwide register-based cohort study in Finland

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.

When complications arise during birth: LBTQ people's experiences of care

OBJECTIVE

To explore the care experiences of lesbian, bisexual, transgender, and queer (LBTQ) people during births where complications have arisen.

DESIGN

Data were collected through semi-structured interviews with self-identified LBTQ people who had experienced obstetrical and/or neonatal complications.

SETTING

Interviews were conducted in Sweden.

PARTICIPANTS

A total of 22 self-identified LBTQ people participated. 12 had experienced birth complications as the birth parent and ten as the non-birth parent.

FINDINGS

Most participants had felt invalidated as an LBTQ family. Separation of the family due to complications elevated the number of hetero/cisnormative assumptions, as new encounters with healthcare professionals increased. Dealing with normative assumptions was particularly difficult in stressful and vulnerable situations. A majority of the birth parents experienced disrespectful treatment from healthcare professionals that violated their bodily integrity. Most participants experienced lack of vital information and emotional support, and expressed that the LBTQ identity made it harder to ask for help.

CONCLUSIONS

Disrespectful treatment and deficiencies in care contributed to negative experiences when complications arose during birth. Trusting care relationships are important to protect the birth experience in case of complications. Validation of the LBTQ identity and access to emotional support for both birth and non-birth parents are crucial for preventing negative birth experiences.

IMPLICATIONS FOR PRACTICE

To reduce minority stress and create conditions for a trusting relationship, healthcare professionals should specifically validate the LBTQ identity, strive for continuity of carer and zero separation of the LBTQ family. Healthcare professionals should make extensive efforts to transfer LBTQ related information between wards.

Antenatal Fear of Childbirth as a Risk Factor for a Bad Childbirth Experience

Giving birth is one of the most impressive experiences in life. However, many pregnant women suffer from fear of childbirth (FOC) and experience labour in very different ways, depending on their personality, previous life experiences, pregnancy, and birth circumstances. The aim of this study was to analyse how fear of childbirth affects the childbirth experience and to assess the related consequences. For this, a descriptive cross-sectional study was carried out in a sample of 414 women between 1 July 2021 and 30 June 2022. The Birth Anticipation Scale (BAS) was used to measure fear of childbirth and the Childbirth Experience Questionnaire (CEQ-E) was applied to measure satisfaction with the childbirth experience. Fear of childbirth negatively and significantly predicted the childbirth experience. In addition, women who were more fearful of childbirth were found to have worse obstetric outcomes and a higher likelihood of having a caesarean delivery (p = 0.008 C. I 95%). Fear behaved as a risk factor for the birth experience, so the greater the fear, the higher the risk of having a worse birth experience (OR 1.1). Encouraging active listening and support strategies may increase pregnant women's confidence, thus decreasing their fear of the process and improving their childbirth experience.

Childbirth fear in the USA during the COVID-19 pandemic: key predictors and associated birth outcomes

Background and objectives

Childbirth fear, which has been argued to have an adaptive basis, exists on a spectrum. Pathologically high levels of childbirth fear is a clinical condition called tokophobia. As a chronic stressor in pregnancy, tokophobia could impact birth outcomes. Many factors associated with tokophobia, including inadequate labor support, were exacerbated by the COVID-19 pandemic.

Methodology

We used longitudinally collected data from a convenience sample of 1775 pregnant persons in the USA to evaluate the association between general and COVID-19 pandemic-related factors and tokophobia using the fear of birth scale. We also assessed associations between tokophobia, low birth weight and preterm birth when adjusting for cesarean section and other covariates among a subset of participants (N = 993).

Results

Tokophobia was highly prevalent (62%). Mothers who self-identified as Black (odds ratio (OR) = 1.90), had lower income (OR = 1.39), had less education (OR = 1.37), had a high-risk pregnancy (OR = 1.65) or had prenatal depression (OR = 4.95) had significantly higher odds of tokophobia. Concerns about how COVID-19 could negatively affect maternal and infant health and birth experience were also associated with tokophobia (ORs from 1.51 to 1.79). Tokophobia was significantly associated with increased odds of giving birth preterm (OR = 1.93).

Conclusions and implications

Tokophobia increases the odds of preterm birth and is more prevalent among individuals who are Black, have a lower income, and have less education. Tokophobia may, therefore, be an underappreciated contributor to inequities in US birth outcomes. The COVID-19 pandemic likely compounded these effects.

'It will dictate how many children I will have"- Women's decision-making in pregnancy following a previous caesarean birth (CB)

Vaginal birth after caesarean (VBAC) is supported in systematic reviews (Wu et al., 2019) and national guidelines (RCOG, 2015) and women are expected to be involved in the decision-making process for either a repeat caesarean birth or planned VBAC.

AIM

To develop a Grounded Theory (GT) of women's decision making of their birth choices in pregnancy following a previous caesarean birth (CB) OBJECTIVE: To explore what determines women's birth choice and their decision making for birth following a previous CB.

DESIGN

Semi structured interviews with pregnant women were undertaken in order to develop a Glasserian Grounded Theory SETTING: Antenatal clinics and wards in a large tertiary level maternity hospital.

FINDINGS

The theory of 'Mentalizing Possibilities' is a substantive theory which explains pregnant women's decision making about their birth choices after a previous CB. Women's main concern is to achieve a positive experience. The core category of 'Mentalizing Possibilities' explains how women process their previous experience, adapt to uncertainty and deal with the decisional conflict. There are behavioural and cognitive strategies which women use to go through this process.

CONCLUSION

Women want a positive birth experience after a previous CB and require support and continuity in decision making to help them decide the optimal birth choice for their current pregnancy.

Midwives' interventions for reducing fear of childbirth in pregnant women: a scoping review

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.

Fear of childbirth: validation of the Kiswahili version of Wijma delivery expectancy/experience questionnaire versions A and B in Tanzania

BACKGROUND

Fear of childbirth is common both before and after childbirth, often leading to complications in mother and new-born. The Wijma Delivery Expectancy/Experience Questionnaires (W-DEQ) are commonly used to measure fear of childbirth among women before (version A) and after childbirth (version B). The tools are not yet validated in the Tanzanian context. This study aimed to validate the reliability, validity, and factorial structure of their Kiswahili translations.

METHODS

A longitudinal study was conducted in six public health facilities in the Pwani region, Tanzania. In all, 694 pregnant and 625 postnatal women were concurrently selected and responded to W-DEQ-A and W-DEQ-B. Validation involved: translating the English questionnaires into Kiswahili; expert rating of the relevancy of the Kiswahili versions' items; computing content validity ratio; piloting the tools; data collection; statistical analysis with reliability evaluated using Cronbach's alpha and the intraclass correlation coefficient. Tool validity was assessed using factor analysis, convergent and discriminant validity. Exploratory factor analysis and confirmatory factor analysis were conducted on data collected using W-DEQ-A and W-DEQ-B, respectively.

RESULTS

Exploratory factor analysis revealed seven factors contributing to 50% of the total variation. Four items did not load to any factor and were deleted. The factors identified were: fear; lack of self-efficacy; lack of positive anticipation; isolation; concerns for the baby; negative emotions; lack of positive behaviour. The factors correlated differently with each other and with the total scores. Both Kiswahili versions with 33 items had good internal consistency, with Cronbach's alphas of .83 and .85, respectively. The concerns for the baby factor showed both convergent and discriminant validity. The other six factors showed some problems with convergent validity. The final model from the confirmatory factor analysis yielded 29 items with good psychometric properties (χ²/df = 2.26, p =  < .001, RMSEA = .045, CFI = .90 and TLI = .81).

CONCLUSIONS

The Kiswahili W-DEQ-A-Revised and W-DEQ-B-Revised are reliable tools and measure fear of childbirth with a multifactorial structure, encompassing seven factors with 29 items. They are recommended for measuring fear of childbirth among pregnant and postnatal Tanzanian women. Further studies are needed to address the inconsistent convergent validity in the revised versions and assess the psychometric properties of W-DEQ-A among pregnant women across gestational ages.

Patterns and predictors of fear of childbirth and depressive symptoms over time in a cohort of women in the Pwani region, Tanzania

BACKGROUND

Fear of childbirth (FoB) and depressive symptoms (DS) are experienced by many women and can negatively affect women during and after pregnancy. This study assessed patterns of FoB and DS over time and associations of postpartum FoB and DS with sociodemographic and obstetric characteristics.

METHODS

We conducted a longitudinal study at six health facilities in Tanzania in 2018-2019. Pregnant women were consecutively assessed for FoB and DS before and after childbirth using the Wijma Delivery Expectancy/Experience Questionnaire versions A & B and the Edinburgh antenatal and postnatal depressive scale. This paper is based on 625 women who completed participation.

RESULTS

The prevalence rates of FoB and DS during pregnancy were 16% and 18.2%, respectively, and after childbirth, 13.9% and 8.5%. Some had FoB (6.4%) and DS (4.3%) at both timepoints. FoB was strongly associated with DS at both timepoints (p < 0.001). Both FoB (p = 0.246) and DS (p < 0.001) decreased after childbirth. Never having experienced obstetric complications decreased the odds of postpartum and persisting FoB (adjusted odds ratio (aOR) 0.44, 95% confidence interval (CI) 0.23-0.83). Giving birth by caesarean section (aOR 2.01, 95% CI 1.11-3.65) and having more than 12 hours pass between admission and childbirth increased the odds of postpartum FoB (aOR 2.07, 95% CI 1.03-4.16). Postpartum DS was more common in women with an ill child/stillbirth/early neonatal death (aOR 4.78, 95% CI 2.29-9.95). Persisting DS was more common in single (aOR 2.59, 95% CI 1.02-6.59) and women without social support from parents (aOR 0.28, 95% 0.11-0.69).

CONCLUSIONS

FoB and DS coexist and decrease over time. Identifying predictors of both conditions will aid in recognising women at risk and planning for prevention and treatment. Screening for FoB and DS before and after childbirth and offering psychological support should be considered part of routine antenatal and postnatal care. Furthermore, supporting women with previous obstetric complications is crucial. Using interviews instead of a self-administered approach might have contributed to social desirability. Also, excluding women with previous caesarean sections could underestimate FoB and DS prevalence rates.

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.

Is it Necessary to Evaluate Fear of Childbirth in Pregnant Women? A Scoping Review

OBJECTIVE

 To review concepts, definitions, and findings about fear of childbirth (FOC).

METHODS

 A bibliographic review was carried out through the main scientific databases in 2020.

RESULTS

 All 32 articles considered potentially relevant were analyzed. A recent study suggests that the global prevalence of FOC can reach up to 14%. Factors such as parity, gestational age, previous birth experience, age and nationality of the woman seem to influence FOC.

CONCLUSION

 Fear of childbirth could be related to an increased risk of adverse obstetric outcomes such as maternal request for cesarean delivery, preterm birth, prolonged labor, postpartum depression, and post-traumatic stress. These evidence highlight the importance of the discussion regarding this topic.

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

Introduction

Fear of childbirth is a well‐known problem during pregnancy and can have implications for childbirth, including prolonged labor, use of epidural analgesia, obstetric complications, presence of traumatic stress symptoms, or request for an elective cesarean section. The coronavirus disease 2019 (COVID‐19) pandemic has affected mental health and therefore could have increased fear of childbirth during the pandemic. The aim of this study was to investigate fear of childbirth during the pandemic in the Netherlands compared with a reference group from before the pandemic.

Material and methods

We conducted a cross‐sectional study to evaluate pregnant women during the first and second waves of COVID‐19 compared with both each other and with pregnant women from before the pandemic. Participants were recruited through social media platforms, hospitals, and midwifery practices. Pregnant women aged ≥18 years who had mastered the Dutch language were eligible to participate. Fear of childbirth was measured with the Wijma Delivery Expectancy Questionnaire online using a cut‐off score of ≥85 to indicate clinically relevant fear of childbirth. The primary outcome was the prevalence of fear of childbirth. We undertook additional analyses to specifically look at possible effect modification.

Results

In total, 1102 pregnant women completed the questionnaire during the first wave of the pandemic, 731 during the second wave, and 364 before the pandemic. Fear of childbirth was present in 10.6%, 11.4%, and 18.4%, respectively. We considered possible effect modification, which indicated that age and parity had a significant influence. In participants during the first wave of COVID‐19, nulliparous women had significantly lower odds (odds ratio [OR] 0.50; 95% confidence interval [CI] 0.34–0.73; p < 0.01) of having a fear of childbirth than did the reference group. Both younger participants in the first wave (OR 0.59; 95% CI 0.37–0.93; p < 0.05) and older participants in the first wave (OR 0.44; 95% CI 0.28–0.71; p < 0.01) and the second wave (OR 0.36; 95% CI 0.21–0.62; p < 0.01) of COVID‐19 had lower odds of fear of childbirth than the reference group.

Conclusions

Pregnant women during the first and second waves of COVID‐19 had lower fear of childbirth scores than pregnant women before the pandemic, indicating less fear of childbirth during the pandemic. This could be explained by an increased level of information, more time to consume information, and better work–life balance with more people working at home during the pandemic.

Fear of childbirth and its predictors in re-pregnant women after cesarean section: a cross-sectional multicenter study in China

Background

Since the implementation of China’s two-child policy in 2016, the number of re-pregnant women after cesarean section has increased significantly. These women are more prone to fear of childbirth compared with primiparas due to their history of scarred uterus leading to a more complicated delivery process, which poses a great threat to their physical and mental health. However, there is currently limited research on the problem in China. The aim of this study was to assess fear of childbirth and its predictors in re-pregnant women after cesarean section in China.

Methods

A cross-sectional multicenter study was conducted in three hospitals from June 7 to December 7, 2020, in Changsha, China. Study hospitals were selected using a random sampling technique. Participants were selected using a convenience sampling technique. Three hundred fifty-eight women during the third trimester of pregnancy who were older than 18 years, having a history of CS(s), and not having major physical or mental health problems were included. Fear of childbirth and its predictors were evaluated using the Childbirth Attitude Questionnaire, the short form of the 32-item Chinese Childbirth Self-Efficacy Inventory, the Social Support Rating Scale, and the demographic-obstetric data sheet. After checking for completeness, data were exported to statistical software for analysis. Both univariate analysis and multiple linear regression analysis were computed to assess fear of childbirth and its predictors. Statistical significance was declared at a P-value of < 0.05.

Results

The average score of fear of childbirth was 43.76 (standard deviation = 5.27, range 17–58). Number of cesarean sections, experience with previous cesarean section, childbirth self-efficacy and social support were significantly associated with fear of childbirth (P < 0.05).

Conclusions

In this study, re-pregnant women after cesarean section in China had moderate fear of childbirth, and the number of cesarean sections, experience with previous cesarean section, childbirth self-efficacy and social support were predictors of fear of childbirth. It is important for healthcare professionals to find re-pregnant women after cesarean section at high risk of fear of childbirth and provide appropriate services during pregnancy.

The Childbirth Fear Questionnaire and the Wijma Delivery Expectancy Questionnaire as Screening Tools for Specific Phobia, Fear of Childbirth

Background: Perinatal anxiety and related disorders are common (20%), distressing and impairing. Fear of childbirth (FoB) is a common type of perinatal anxiety associated with negative mental health, obstetrical, childbirth and child outcomes. Screening can facilitate treatment access for those most in need. Objectives: The purpose of this research was to evaluate the accuracy of the Childbirth Fear Questionnaire (CFQ) and the Wijma Delivery Expectations Questionnaire (W-DEQ) of FoB as screening tools for a specific phobia, FoB. Methods: A total of 659 English-speaking pregnant women living in Canada and over the age of 18 were recruited for the study. Participants completed an online survey of demographic, current pregnancy and reproductive history information, as well as the CFQ and the W-DEQ, and a telephone interview to assess specific phobia FoB. Results: Symptoms meeting full and subclinical diagnostic criteria for a specific phobia, FoB, were reported by 3.3% and 7.1% of participants, respectively. The W-DEQ met or exceeded the criteria for a “good enough” screening tool across several analyses, whereas the CFQ only met these criteria in one analysis and came close in three others. Conclusions: The W-DEQ demonstrated high performance as a screening tool for a specific phobia, FoB, with accuracy superior to that of the CFQ. Additional research to ensure the stability of these findings is needed.

Validation and Psychometric Properties of the Spanish Version of the Fear of Childbirth Questionnaire (CFQ-e)

The fear of childbirth is a topical concern, yet the issue has barely been studied in Spain, and only one fear of childbirth measurement instrument has been validated in the country. The aim of this study was to translate, adapt and validate the Fear of Childbirth Questionnaire (CFQ) for use in Spain, as well as to describe and evaluate the psychometric properties of the Spanish version of this instrument. In a first phase, a methodological study was carried out (translation–backtranslation and cross-cultural adaptation), and pilot study was carried out in the target population. In addition, content validation of the instrument was obtained (CFQ-e) from 10 experts. In the second phase, a cross-sectional study was carried out at several centres in Gran Canaria Island to obtain a validation sample. The evaluation of the psychometric properties of the CFQ-e, including construct validity through exploratory factor analysis and confirmatory factor analysis, the calculation of reliability via factor consistency using the ORION coefficients as well as alpha and omega coefficients were carried out. The CFQ-e showed evidence of content validity, adequate construct validity and reliability. The CFQ-e is composed of 37 items distributed in four subscales or dimensions: “fear of medical interventions”; “fear of harm and dying”; “fear of pain” and “fears relating to sexual aspects and embarrassment”. The CFQ-e constitutes a valid and reliable tool to measure the fear of childbirth in the Spanish pregnant population.

Childbirth fear, birth-related mindset and knowledge in non-pregnant women without birth experience

Background

Childbirth fear and interventions during childbirth might be related to the mindset and knowledge non-pregnant women have regarding childbirth. Non-pregnant women before their first birth experience may be particularly at risk for childbirth fear.

Methods

The present study examined the expressions and associations of birth-related mindset, knowledge, and fear among 316 young, non-pregnant women without birth experience. They participated in a cross-sectional online study and completed the Childbirth Fear Prior to Pregnancy, the Mindset and Birth Questionnaire, and a birth knowledge test.

Results

Most women (44%) had a natural mindset and low fear, 29% had a medical mindset and low fear, 8% natural mindset and higher fear, and 19% medical mindset and higher fear.

There were no differences in knowledge between the four groups. Some gaps in knowledge appeared concerning signs of beginning birth, and non-medical approaches to pain relief. From women with natural mindset and low childbirth fear, a higher percentage (13%) has already watched a birth, as compared to the other groups.

Natural mindset was associated with lower childbirth fear, whereas knowledge was independent from childbirth fear. Higher knowledge was low associated with natural mindset. Mindset and childbirth fear were independent from age and education degree.

Conclusions

Gynecologists, midwifes and other health professionals may develop an awareness for birth as a natural event in their non-pregnant patients, and take birth-related fear into account in their counseling, with focus on women’s self-efficacy and non-medical approaches to pain relief.

Mindful awareness as a mechanism of change for natural childbirth in pregnant women with high fear of childbirth: a randomised controlled trial

BACKGROUND

Mindfulness-Based Childbirth and Parenting (MBCP) is effective in increasing natural childbirth in pregnant women with high fear of childbirth (FOC) as compared to enhanced care as usual (ECAU). We aimed to examine through which pathway of action MBCP reaches this effect, based on a model of approaching or avoiding the challenges related to childbirth.

METHODS

One hundred eleven pregnant women with high FOC were measured pre- and post-intervention on FOC (emotion pathway), catastrophic beliefs about labour pain (cognition pathway) and mindful awareness (attention pathway). A multiple mediation model was used to examine through which pathway the mechanism of change operated in relation to approach (i.e., natural childbirth) versus avoidance (i.e., self-requested caesarean section).

RESULTS

It was found that greater mindful awareness (18% R2 = 0.18, F[1107] = 22.77, p < 0.0001) was the only significant mechanism of change operating through the attentional pathway leading to natural childbirth. More specifically, nonreactivity to inner experience (a facet of mindful awareness) showed to be the strongest mechanism of change. More extensive meditation practice was positively associated with natural childbirth; however, the number of completed MBCP sessions was not associated with the outcome.

CONCLUSIONS

An increase in mindful awareness was the strongest mechanism of change for better adaptation to the challenges of childbirth. Decreases in neither FOC nor catastrophic beliefs about labour pain were identified as mechanisms of change. Additionally, the more one meditated, the more one was inclined towards a natural childbirth. MBCP enhances adaptation to the challenges of childbirth and less use of obstetric interventions in the presence of high FOC.

TRIAL REGISTRATION

The Netherlands Trial Register (NTR; 4302 ).

The influence of maternal psychological distress on the mode of birth and duration of labor: findings from the FinnBrain Birth Cohort Study

Antepartum depression, general anxiety symptoms, and pregnancy-related anxiety have been recognized to affect pregnancy outcomes. Systematic reviews on these associations lack consistent findings, which is why further research is required. We examined the associations between psychological distress, mode of birth, epidural analgesia, and duration of labor. Data from 3619 women with singleton pregnancies, from the population-based FinnBrain Birth Cohort Study were analyzed. Maternal psychological distress was measured during pregnancy at 24 and 34 weeks, using the Pregnancy-Related Anxiety Questionnaire-Revised 2 (PRAQ-R2) and its subscale "Fear of Giving Birth" (FOC), the anxiety subscale of the Symptom Checklist-90 (SCL-90) and the Edinburgh Postnatal Depression Scale (EPDS). Mode of birth, epidural analgesia, and labor duration were obtained from the Finnish Medical Birth Register. Maternal psychological distress, when captured with PRAQ-R2, FOC, and SCL-90, increased the likelihood of women having an elective cesarean section (OR: 1.04, 95% CI 1.01-1.06, p = .003; OR: 1.13, 95% CI 1.07-1.20, p < .001; OR: 1.06, 95% CI 1.03-1.10, p = .001), but no association was detected for instrumental delivery or emergency cesarean section. A rise in both the PRAQ-R2, and FOC measurements increased the likelihood of an epidural analgesia (OR: 1.02, 95% CI 1.01-1.03, p = .003; OR: 1.09, 95% CI 1.05-1.12, p < .001) and predicted longer second stage of labor (OR: 1.01, 95% CI 1.00-1.01, p = .023; OR: 1.03, 95% CI 1.02-1.05, p < .001). EPDS did not predict any of the analyzed outcomes. The results indicate that maternal anxiety symptoms (measured using PRAQ-R2, FOC, and SCL-90) are associated with elective cesarean section. Psychological distress increases the use of epidural analgesia, but is not associated with complicated vaginal birth.

The Impact of Prepartum Depression and Birth Experience on Postpartum Mother-Infant Bonding: A Longitudinal Path Analysis

INTRODUCTION

Negative effects of impaired postpartum mother-infant-bonding on mental health of mothers, their newborn children and subsequent child development are well documented. Previous research demonstrated an association between a negative birth experience and postpartum mental health affecting postpartum mother-infant bonding. This study investigates the extent to which prepartum depression and birth experience influence the postpartum mental health of mothers and their bonding toward their newborns, and whether these influences differ according to parity and self-reported prior mental health problems.

METHOD

Three hundred and fifty-four women (18-43 years; M = 30.13, SD = 5.10) filled in the Edinburgh Postnatal Depression Scale (EPDS), the Maternal-Fetal Attachment Scale (MFAS), Salmon's Item List (SIL) assessing the birth experience, and the Postpartum Bonding Questionnaire (PBQ) at pre- and postpartum; they were also asked about birth complications and parity status.

RESULTS

Primipara reported significantly more birth complications (p = 0.048), with path analysis confirming this result (p < 0.001). Birth complications were associated with a more negative rating of the overall birth experience (p < 0.001). Mothers with self-reported prior mental health problems had higher prepartum depression scores (p < 0.001) but did not differ in other variables from mothers without prior self-reported mental health problems. Differences in depression scores between mothers with self-reported prior mental health problems and those without vanished at postpartum assessment (p > 0.05). Path-analysis highlighted the key role of postpartum depression, which was the only significant predictor of postpartum impairment in maternal-child bonding (p < 0.001). Birth experience and prepartum depression scores exerted an indirect effect on postpartum maternal-child bonding, mediated by postpartum depression.

DISCUSSION

The present study demonstrates the relevance of prepartum mental health of expectant mothers, especially of those who self-report prior mental health problems. The results support that reducing mental health problems of pregnant mothers might contribute to a more positive birth experience and potentially reduce postpartum depressive symptoms. As postpartum depression is associated with impaired parent-child bonding, such targeted interventions could promote child development. Group differences between primiparous and multiparous mothers suggest that the birth experience may be an influential factor for postpartum mental health.

Prevalence and predictive factors for fear of childbirth in pregnant Portuguese women: A cross-sectional study

OBJECTIVE

To measure the prevalence of the fear of childbirth (FOC) and determine which factors predict severe FOC among pregnant Portuguese women.

METHODS

An online cross-sectional study among pregnant Portuguese women aged ≥ 20 years who were recorded using a convenience sampling. Self-administered questionnaires were used for data collection: socio-demographic and obstetric questionnaire and European Portuguese version of Wijma Delivery Expectancy Questionnaire-version A (WDEQ-A). Data of 669 participants were collected successfully from June 9 to October 30, 2019. Predictive factors for severe FOC were investigated using a multivariate logistic regression analysis. Odds ratios (OR) and 95% confidence intervals were calculated.

RESULTS

The prevalence of severe FOC (WDEQ-A ≥ 85) among pregnant Portuguese women was 10%. Severe FOC was significantly associated with lower educational level, single/divorced marital status, and negative previous childbirth experience. Multivariate logistic regression analysis indicated that being single or divorced and having a negative previous childbirth experience were predictive variables for severe FOC.

CONCLUSION

Pregnant Portuguese women have FOC, although with varying severity. The data suggest that marital status and women's perceptions of previous childbirth experience may be useful variables to predict severe FOC. Further research for extending the predictive factors of FOC should be refined. The results are clinically relevant for midwifery care, as they should be used in the sense of early identification of fearful pregnant women to provide adequate support strategies to reduce FOC.

Personality impacts fear of childbirth and subjective birth experiences: A prospective-longitudinal study

Background

Previous research suggests that less emotionally stable, less conscientious, less extraverted, and less agreeable women tend to suffer from higher fear of childbirth and experience their delivery as worse. Moreover, there is evidence that birth characteristics and unexpected incidents during delivery may impact women’s birth experiences. However, it remains unknown whether the role of personality in subjective birth experiences varies between women with different birth characteristics.

Methods

We used data from the Maternal Anxiety in Relation to Infant Development (MARI) Study, a regional-epidemiological study among pregnant women, who were prospectively followed up in multiple waves across the peripartum period. During pregnancy, personality was assessed with the short version of the Big Five Inventory. The Wijma Delivery Expectancy/ Experience Questionnaire was used to measure fear of childbirth (version A) during pregnancy and subjective birth experiences (version B) within the first 10 days after delivery.

Results

Linear regressions revealed that lower levels of emotional stability, agreeableness, and extraversion predicted higher fear of childbirth during pregnancy. Moreover, personality affected subjective birth experiences especially in women with specific birth characteristics: Lower emotional stability predicted worse subjective birth experiences in women with (vs. without) a preterm delivery, and higher conscientiousness predicted worse subjective birth experiences in women with an emergency cesarean section (vs. spontaneous delivery). Subjective birth experiences were also worse in less emotionally stable and less open women with (general) anesthesia (vs. no anesthesia) during delivery. Finally, higher emotional stability predicted a subjective birth experience that was worse than expected, particularly in multiparous women and women without anesthesia during delivery.

Conclusions

These findings suggest that less emotionally stable, less conscientious, and less open women tend to experience their delivery as worse particularly in case of unexpected incidents (i.e., preterm delivery, emergency cesarean section, and necessity of anesthetics) and might thus profit from early targeted interventions.

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

BACKGROUND

Many women experience fear of childbirth (FoB) and depressive symptoms (DS) during pregnancy, but little is known about FoB among Tanzanian women. The current study aimed to assess the prevalence of FoB and DS among pregnant women and determine predictors of each and both, focusing on sociodemographic and obstetric predictors.

METHODS

A cross-sectional study was conducted at six health facilities in two districts in Tanzania between 2018 and 2019. In total, 694 pregnant women with gestational age between 32 and 40 weeks and expecting vaginal delivery were consecutively recruited and assessed for FoB and DS. We collected data through interviews using 6 and 4-points Likert Scale of the Wijma Delivery Expectancy Questionnaire Version A and Edinburgh Postnatal Depression Scale, respectively. Women who scored ≥66 and ≥ 10 were categorised as having FoB and DS, respectively. We performed multivariable logistic regression to investigate the predictors of FoB and DS.

RESULTS

The prevalence rates of FoB and DS among pregnant women were 15.1 and 17.7%, respectively. FoB and DS were more likely in women aged above 30 years [Adjusted Odds Ratio (AOR) 6.29, 95%CI 1.43-27.84] and in single mothers (AOR 2.57, 95%CI 1.14-5.78). Women with secondary education and above (AOR 0.22, 95%CI 0.05-0.99) and those who had given birth previously (AOR 0.27, 95% CI 0.09-0.87) were less likely to have FoB in combination with DS Women who had previous obstetric complications, and those who did not receive any social support from male partners in previous childbirth were more likely to have FoB and DS. FoB was strongly associated with DS (AOR 3.42, 95%CI 2.12-5.53). DS only was more common in women who had inadequate income (AOR 2.35, 95%CI 1.38-3.99) or had previously experienced a perineal tear (AOR 2.32, 95%CI 1.31-4.08).

CONCLUSIONS

Not having a formal education, having only primary education, being aged above 30 years, being single, being nulliparous, having experienced obstetric complications, and having a lack of social support from a male partner during previous pregnancy and childbirth were predictors of FoB and DS during pregnancy. FoB and DS were strongly associated with each other. It is vital to identify at-risk women early, to offer support during pregnancy and childbirth.

Effects of antepartum education on worries about labor and mode of delivery

AIM

This study evaluated the effects of antenatal education, which was provided in a pregnancy education class, on pregnant women's concerns about labor and the mode of delivery.

MATERIALS AND METHODS

Primigravid pregnant women (n = 144) were enrolled into the study between May 2017 and November 2018. Pregnant women received standard education on nutrition during pregnancy, exercise, methods of coping with pain, and breastfeeding. The participants completed the "Introductory Information Form" and "Oxford Worries about Labour Scale" to collect data.

RESULTS

A statistically significant difference was found between the participants' pain, distress, uncertainty, and interventions in the pre-education, post-education, and postpartum periods and mean total score on the Oxford scale (p<.05). However, education had no significant effect on the mode of delivery (p>.05).

CONCLUSION

Education provided during pregnancy significantly decreased women's worries about labor, but it did not lead to a significant difference in the modes of delivery.

Preferred ways of giving birth in non-pregnant and pregnant nulliparous women: the role of control beliefs

PURPOSE

To explore the association between delivery-specific, health-related control beliefs and preferred ways of delivery in nulliparous Hungarian women. Moreover, since data about the delivery-specific control beliefs and delivery-related preferences of non-pregnant nulliparous women are lacking, the present study also seeks to provide descriptive information in this regard.

METHODS

A total of 984 Hungarian nulliparous women (26.45 ± 5.42 years; 660/77.2% non-pregnant and 224/22.8% pregnant) were included in the present study. The online assessment included measures of delivery-specific (internal-, healthcare professional-, and chance-related) health control beliefs, fears of childbirth, self-esteem, as well as preferences regarding delivery setting (i.e. spontaneous vaginal birth in hospital, planned cesarean birth and home birth).

RESULTS

Healthcare professional-related control beliefs were associated with a stronger preference for spontaneous vaginal birth in hospital (OR = 1.87, 95% CI: 1.56-2.23) and planned cesarean birth (OR = 1.96, 95% CI: 1.60-2.40), alongside a weaker preference for home birth (OR = 0.31, 95% CI: 0.25-0.39). In contrast, internal delivery-specific control beliefs predicted a weaker preference for planned cesarean (OR = 0.66, 95% CI: 0.55-0.78) and a stronger preference for home birth (OR = 1.63, 95% CI: 1.33-2.00). A general preference index for medicalized ways of delivery was negatively associated with internal - and positively with healthcare professional - and chance-related control beliefs (βs = -.173, .074 and .445, respectively).

CONCLUSIONS

Delivery-related control beliefs are important psychological characteristics in the prediction of preferences for ways of delivery. Understanding delivery-specific control beliefs may be an important component of supporting women to give birth in a mentally and physically healthy way.

Simulation-based childbirth education for Chinese primiparas: A pilot randomized controlled trial

OBJECTIVE

To evaluate the effectiveness and feasibility of simulation-based childbirth education (SBCE) on reducing fear of childbirth (FOC) of Chinese primiparas.

METHODS

A total of 56 primiparas completed the trial including 26 in the intervention group and 30 in the control group. The intervention group received four sessions of SBCE while the control group received routine prenatal care. Chinese versions of the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ-A) and Childbirth Self-Efficacy Inventory (CBSEI) were used to evaluate FOC and childbirth self-efficacy. Birth outcomes including delivery method, labor duration and Apgar scores were collected.

RESULTS

Scores on the WDEQ-A of the intervention group were statistically lower than those of the control group (P < 0.05). The CBSEI scores of the intervention group were significantly higher than those of the control group (P < 0.05). The cesarean birth rate of the intervention group was lower than that of the control group (34.61% vs 46.67%, P > 0.05).

CONCLUSION

Simulation-based childbirth education alleviates FOC, increases childbirth self-efficacy and improves birth outcomes, providing a new perspective to alleviate FOC of primiparas in the future.

PRACTICE IMPLICATIONS

Simulation-based childbirth education is an effective and feasible method to educate women about childbirth. Its integration into routine prenatal care of Chinese primiparas should be encouraged to reduce FOC.

Severe recalled labor pain and elective cesarean section in a subsequent delivery: a cohort study of Norwegian parous women

INTRODUCTION

Some women keep on recalling intense labor pain experienced at childbirth to a degree that may negatively affect their life during the postpartum period or lead them to request a cesarean section (CS) in the subsequent delivery. This longitudinal study aimed to assess the impact of severe recalled labor pain from the previous birth on the preference for and delivery by an elective CS in the subsequent delivery. Furthermore, we investigated whether co-occurring maternal demographic, somatic and mental health factors related to the previous and subsequent delivery, explain parts of a potential association.

MATERIAL AND METHODS

The study sample comprised 1135 parous women from the Akershus Birth Cohort. Severe recalled labor pain was assessed on a numeric rating scale at pregnancy week 17, and at pregnancy week 32, the preference for an elective CS for the subsequent delivery was assessed. Information on actual delivery by elective CS in the subsequent delivery was retrieved from the electronic birth record. Logistic regression analyses were conducted to examine the impact of severe recalled labor pain on elective CS.

RESULTS

Severe recalled labor pain at the previous birth was associated with a preference for an elective CS (odds ratio [OR] 3.57, 95% confidence interval [CI] 2.25-5.67) and actual delivery by elective CS (OR 4.71, 95% CI 2.32-9.59). This association remained statistically significant for the preference for an elective CS (adjusted OR [aOR] 2.12, 95% CI 1.24-3.62) but diminished for delivery by elective CS (aOR 2.30, 95% CI 0.99-5.35) when adjusting for a variety of covariates. Factors related to previous childbirth such as number of years since previous birth, assisted vaginal delivery, anal sphincter lesions, overall birth experience and fear of childbirth were also linked to preference for and delivery by an elective CS.

CONCLUSIONS

Women with severe recalled labor pain were about twice as likely to prefer an elective CS compared with women without severe recalled pain. For actual delivery, the significant association with severe recalled pain diminished after adjustment for covariates. However, sample size was small and, irrespective of severe recalled labor pain, preference for an elective CS was statistically significantly associated with actual delivery by elective CS.

Polish Adaptation of the Pregnancy-Related Anxiety Questionnaire-Revised 2 for All Pregnant Women

Pregnancy-related anxiety (PrA) is a specific type of anxiety characteristic of the perinatal period. PrA can affect pregnancy and birth. However, no validated tool exists to measure PrA in Polish obstetric practice. The aim of this study was to translate the Pregnancy-Related Anxiety Questionnaire-Revised 2 (PRAQ-R2) into Polish and to evaluate its reliability and factorial and construct validity. This study was conducted in Poland as an online questionnaire in April 2020 and included 175 healthy women. To validate the PRAQ-R2, we used standardized tools for the measurement of general anxiety: the modified Visual Analog Scale (VAS), the Ten-Item Personality Inventory (TIPI), and the Hospital Anxiety and Depression Scale (HADS). Scale reliability was assessed using Cronbach's alpha. Concurrent validity was evaluated by calculating Spearman's rho correlation coefficients. Statistical analyses were performed using R ver. 4.0.2. Values for comparative fit index >0.90, Tucker-Lewis index >0.90, and root mean square error of approximation <0.08 indicated acceptable model fit, confirming the reliability of the three-factor structure of the translation. The subscales and total scores had good consistency (α > 0.7), and convergent validity was demonstrated. The PRAQ-R2 as translated into Polish represents the first validated tool in Poland to measure PrA for all pregnant women.

Psychometric properties of the European Portuguese version of the Wijma Delivery Expectancy/Experience Questionnaire in pregnant women

The researchers' aim is to examine the psychometric properties of the European Portuguese version of the Wijma Delivery Expectancy/Experience Questionnaire version A (WDEQ-A). Data from 669 pregnant Portuguese women was collected between June and October of 2019. From the initial 33-item Portuguese version of the WDEQ-A, a 27-item instrument was developed. Five-factor solution explained 63.8% of the total variance. The factors defined by the researchers were: fear/lack of self-efficacy, loneliness, negative appraisal, lack of positive anticipation and concern for the child. Cronbach's alpha coefficient was 0.934. The European Portuguese version of the WDEQ-A is a reliable and valid tool to measure fear of childbirth on both nulliparous and multiparous women and can be a useful tool for cross-cultural research. Moreover, researchers support the use of this tool in clinical practice to recognize and address fearful women during prenatal period.

Interventions for fear of childbirth including tocophobia

BACKGROUND

Many women experience fear of childbirth (FOC). While fears about childbirth may be normal during pregnancy, some women experience high to severe FOC. At the extreme end of the fear spectrum is tocophobia, which is considered a specific condition that may cause distress, affect well-being during pregnancy and impede the transition to parenthood. Various interventions have been trialled, which support women to reduce and manage high to severe FOC, including tocophobia.

OBJECTIVES

To investigate the effectiveness of non-pharmacological interventions for reducing fear of childbirth (FOC) compared with standard maternity care in pregnant women with high to severe FOC, including tocophobia.

SEARCH METHODS

In July 2020, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies. We contacted researchers of trials which were registered and appeared to be ongoing.

SELECTION CRITERIA

We included randomised clinical trials which recruited pregnant women with high or severe FOC (as defined by the individual trial), for treatment intended to reduce FOC. Two review authors independently screened and selected titles and abstracts for inclusion. We excluded quasi-randomised and cross-over trials.

DATA COLLECTION AND ANALYSIS

We used standard methodological approaches as recommended by Cochrane. Two review authors independently extracted data and assessed the studies for risk of bias. A third review author checked the data analysis for accuracy. We used GRADE to assess the certainty of the evidence. The primary outcome was a reduction in FOC. Secondary outcomes were caesarean section, depression, birth preference for caesarean section or spontaneous vaginal delivery, and epidural use.

MAIN RESULTS

We included seven trials with a total of 1357 participants. The interventions included psychoeducation, cognitive behavioural therapy, group discussion, peer education and art therapy. We judged four studies as high or unclear risk of bias in terms of allocation concealment; we judged three studies as high risk in terms of incomplete outcome data; and in all studies, there was a high risk of bias due to lack of blinding. We downgraded the certainty of the evidence due to concerns about risk of bias, imprecision and inconsistency. None of the studies reported data about women's anxiety. Participating in non-pharmacological interventions may reduce levels of fear of childbirth, as measured by the Wijma Delivery Expectancy Questionnaire (W-DEQ), but the reduction may not be clinically meaningful (mean difference (MD) -7.08, 95% confidence interval (CI) -12.19 to -1.97; 7 studies, 828 women; low-certainty evidence). The W-DEQ tool is scored from 0 to 165 (higher score = greater fear). Non-pharmacological interventions probably reduce the number of women having a caesarean section (RR 0.70, 95% CI 0.55 to 0.89; 5 studies, 557 women; moderate-certainty evidence). There may be little to no difference between non-pharmacological interventions and usual care in depression scores measured with the Edinburgh Postnatal Depression Scale (EPDS) (MD 0.09, 95% CI -1.23 to 1.40; 2 studies, 399 women; low-certainty evidence). The EPDS tool is scored from 0 to 30 (higher score = greater depression). Non-pharmacological interventions probably lead to fewer women preferring a caesarean section (RR 0.37, 95% CI 0.15 to 0.89; 3 studies, 276 women; moderate-certainty evidence).  Non-pharmacological interventions may increase epidural use compared with usual care, but the 95% CI includes the possibility of a slight reduction in epidural use (RR 1.21, 95% CI 0.98 to 1.48; 2 studies, 380 women; low-certainty evidence).

AUTHORS' CONCLUSIONS

The effect of non-pharmacological interventions for women with high to severe fear of childbirth in terms of reducing fear is uncertain. Fear of childbirth, as measured by W-DEQ, may be reduced but it is not certain if this represents a meaningful clinical reduction of fear. There may be little or no difference in depression, but there may be a reduction in caesarean section delivery. Future trials should recruit adequate numbers of women and measure birth satisfaction and anxiety.

Interventions to treat fear of childbirth in pregnancy: a systematic review and meta-analysis

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.

Evaluation of the effect of cognitive behavioral therapy on tocophobia: A systematic review and meta-analysis

Non-medical approaches including cognitive behavioral therapy (CBT) have been proposed for the management of tocophobia. A new method of performing CBT is through internet. The aim of this systematic review and meta-analysis was to evaluate the effect of internet-based and traditional CBT on tocophobia. A literature search was conducted on qualitative and quantitative articles from 2000 to 2019 in Pubmed, Scopus, Web of Science and Cochrane databases using search terms referring to tocophobia and CBT. Identified articles were screened in two steps; 1) title and abstract and 2) full text screening. The quality of the quantitative and qualitative studies was assessed using the quality criteria proposed by the Cochrane Collaboration and Jonna Briggs Institute (JBI) checklist respectively. Out of the 382 relevant studies, 9 studies were eligible for the review. A high level of heterogeneity was observed in the studies (I² = 94%, P < 0.001). The meta-analysis showed that both internet-based, and traditional CBT were effective in reducing tocophobia. CBT was more effective in interventions in the Middle Eastern compared to European countries. More than five CBT sessions could significantly reduce tocophobia. Healthcare providers and midwives should have basic knowledge on physiological interventions to reduce tocophobia.

Mental health problems and fear of childbirth: A cohort study of women in an inner-city maternity service

OBJECTIVES

To estimate the population prevalence of severe fear of childbirth (FOC) during pregnancy and investigate its association with: (a) antenatal common mental disorders (depression and anxiety disorder) and (b) elective cesarean birth.

METHODS

545 participants from an inner-city London maternity population were interviewed soon after their first antenatal appointment (mean gestation: 14 weeks). Current mental disorders were assessed using the Structured Clinical Interview DSM-IV. FOC was measured using the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ-A) at approximately 28 weeks gestation (n = 377), with severe FOC defined using a cutoff of WDEQ-A ≥ 85. Birth mode information was collected at 3 months post-delivery using an adapted Adult Service Use Schedule. Linear regressions were used to model associations, adjusting for the effects of covariates (age, parity, relationship status, education, and planned pregnancy). Sampling weights were used to adjust for bias introduced by the stratified sampling. We also accounted for missing data within the analysis.

RESULTS

The estimated population prevalence of severe FOC was 3% (95% CI: 2%-6%) (n = 377). Depression and anxiety were significantly associated with severe FOC after adjustment for covariates (45% vs 11%; coefficient: 15.75, 95% CI: 8.08-23.42, P < .001). There was a weak association between severe FOC and elective cesarean birth.

CONCLUSIONS

Severe FOC occurs in around 3% of the population. Depression and anxiety are associated with FOC. Pregnant people with depression and anxiety may be at increased risk of experiencing severe FOC. Attitudes toward childbirth should be assessed as part of routine clinical assessment of pregnant people in contact with mental health services.

Preferences of women with low obstetric risk for cesarean or vaginal birth in Poland: Areas for intervention

BACKGROUND

In Poland, the rate of cesarean birth (CB) is 43%, which is much higher than the European average of 27%. Optimizing the CB birth rate is of critical importance, especially among women with low-risk pregnancies. However, the determinants of cesarean preference among low-risk women in Poland have not been well explored.

METHODS

This cross-sectional study included 1011 pregnant women and aimed to identify associations between selected determinants of women's preferences for CB vs. vaginal birth (VB) in Poland. A descriptive questionnaire was distributed online, and a theoretical model was validated against empirically gathered data. Group comparisons were performed using the Welch t test for continuous data or chi-square test for categorical data. All statistical analyses were performed using R (R Core Team, 2018).

RESULTS

The mean age of women preferring CB (30.46 years) was 1.25 years higher than that of women preferring VB (29.21 years). Pregnant women who expressed a preference for CB tended to be multigravid, inhabited cities, and were characterized by higher levels of anxiety and depression. Moreover, the majority of women who underwent a previous CB asserted their intention to repeat the procedure for the current pregnancy.

CONCLUSIONS

The primary factors that were correlated with high CB preference among the low-risk group included age, previous childbirth experiences, and anxiety. The underlying reasons that drive birth preferences remain poorly understood. However, women who have previously undergone difficult childbirth experiences and are afraid of pain require specialized care.

Fear of Childbirth and Preferences for Prevention Services among Urban Pregnant Women in a Developing Country: A Multicenter, Cross-Sectional Study

This study aimed to examine fear of childbirth and willingness to pay for fear-prevention services in pregnant women. A multicenter, cross-sectional study was conducted on pregnant women in two obstetric hospitals in Vietnam. The Fear of Birth Scale was utilized to evaluate fear of childbirth. Multivariable, generalized linear regression and logistic regression models were performed to identify associated factors with fear of childbirth, demand, and willingness to pay for prevention services. Of 900 pregnant women, fear of childbirth was moderately high with a mean score of 18.1 (SD = 2.3). Age of partner; ever having complications of pregnancy; attitudes toward different aspects of childbirth delivery; satisfactions with friends, parents, and siblings' care; and information support were associated with fear of childbirth. Only 33.8% participants had a demand for the prevention service, and 43.7% were willing to pay for this service with an average amount of $US 10.0 per month (SD = 72.0). Our study suggested that individualized psychological counseling and information-seeking guidance should be provided appropriately and differently for multiparous and nulliparous women for reducing fear and improving the acceptability of the prevention services.