Childhood abuse and fear of childbirth--a population-based study

The Consequences of A History of Violence on Women's Pregnancy and Childbirth in the Nordic Countries: A Scoping Review

Violence against women (VAW) is a global challenge also in the childbearing period. Despite high gender equality, there is a high prevalence of VAW in the Nordic countries. This scoping review aims to explore predictors for and consequences of a history of violence on women's pregnancy and childbirth in the Nordic countries, including women's experience of the impact of violence and the interventions used to detect, address consequences, and prevent further violence. The framework by Arksey and O'Malley was followed, and English, Finnish, Icelandic, Norwegian, Danish, and Swedish literature was included. The population was women aged ≥18 residing in the Nordic countries during the perinatal period. Eight databases were searched: MEDLINE, CINAHL, PubMed, PsycINFO, Web of Science, ASSIA, Social Services-, and Sociological abstracts. There was no limitation of the search time frame. The initial screening resulted in 1,104 records, and after removing duplicates, 452 remained. Finally, 61 papers met the inclusion criteria. The results covering the past 32 years indicated that childbearing women with a history of violence are at greater risk of common complaints and hospitalization during pregnancy, fear of childbirth, Cesarean section, breastfeeding difficulties, and physical and mental health problems. While extensive research was found on the associations between a history of and current violence and outcomes related to pregnancy, there was a lack of intervention studies and studies from Finland. Efforts must be made to scientifically test the methods used to reduce and treat the adverse effects of a history of violence and prevent further violence.

Childhood abuse and perinatal outcomes for mother and child: A systematic review of the literature

Childhood abuse can have long-term adverse outcomes in adulthood. These outcomes may pose a particular threat to the health and well-being of perinatal women; however, to date, this body of knowledge has not been systematically collated and synthesized. This systematic review examined the child abuse literature and a broad range of perinatal outcomes using a comprehensive search strategy. The aim of this review was to provide a clearer understanding of the distinct effect of different abuse types and areas where there may be gaps in our knowledge. Following PRISMA guidelines, EBSCO, PsychInfo, Scopus, Medline, CINAHL, PubMed, and Google Scholar databases and gray literature including preprints, dissertations and theses were searched for literature where childhood abuse was associated with any adverse perinatal outcome between 1969 and 2022. Exclusion criteria included adolescent samples, abuse examined as a composite variable, editorials, letters to the editor, qualitative studies, reviews, meta-analyses, or book chapters. Using an assessment tool, two reviewers extracted and assessed the methodological quality and risk of bias of each study. From an initial 12,384 articles, 95 studies were selected, and the outcomes were categorized as pregnancy, childbirth, postnatal for the mother, and perinatal for mother and child. The prevalence of childhood abuse ranged from 5-25% with wide variability (physical 2-78%, sexual 2-47%, and emotional/psychological 2-69%). Despite some consistent findings relating to psychological outcomes (i.e., depression and PTSD), most evidence was inconclusive, effect sizes were small, or the findings based on a limited number of studies. Inconsistencies in findings stem from small sample sizes and differing methodologies, and their diversity meant studies were not suitable for a meta-analysis. Research implication include the need for more rigorous methodology and research in countries where the prevalence of abuse may be high. Policy implications include the need for trauma-informed care with the Multi-level Determinants of Perinatal Wellbeing for Child Abuse Survivors model a useful framework. This review highlights the possible impacts of childhood abuse on perinatal women and their offspring and areas of further investigation. This review was registered with PROSPERO in 2021 and funded by an internal grant from Charles Sturt University.

Midwife-led psycho-education intervention to reduce childbirth fear: a quasi-experimental study

This quasi-experimental study aimed to assess the impact of a midwife-led psycho-education intervention on reducing fear of childbirth (FOC) and perceived stress (PS) in pregnant women. The present study involved 96 pregnant women. The intervention group received three 30-45 min telephone sessions using 'BELIEF' (Birth Emotion-Looking to Improve Expectant Fear) psycho-education approach. The outcomes were assessed using questionnaires on childbirth attitudes and PS. Data analysis was performed using Stata version 17. In the intervention group, the mean score for FOC decreased from 39.41 ± 7.02 to 29.91 ± 5.60 (9.5; 24.1%). The mean difference (MD) of 28.22% was statistically significant (adjusted MD: -10.51, 95% CI: -11.60, -9.41, P < 0.001). In the intervention group, mean scores for PS decreased from 22.77 ± 6.94 to 18.23 ± 5.69 (4.54; 19.93%). In the control group, scores increased from 22.68 ± 6.76 to 24.82 ± 6.58 (2.14; 9.43%). The 29.36% MD was statistically significant (aMD: -6.95, 95% CI: -8.73, -5.18, P < 0.001). The findings of this study indicate that the midwife-led psycho-education intervention, utilizing the 'BELIEF' protocol over the telephone, has a significant effect on reducing FOC and PS, as well as increasing the preference for vaginal birth.

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.

"Women Friendly": A Childbirth Preparation Intervention in Israel for Women with Symptoms of Post-Traumatic Stress Disorder

Pregnant women with symptoms of post-traumatic stress disorder (PTSD), who have experienced traumatic events such as sexual abuse and traumatic births, are particularly vulnerable to experiencing extreme fear of childbirth complications during labor and traumatic deliveries. In this commentary, we review the literature on this group of women and their specific needs during pregnancy and childbirth. We present a childbirth preparation intervention for pregnant women with PTSD symptoms, "Women Friendly", designed in Israel and gradually becoming available in the community and Israeli hospitals. This intervention is intended for women with high levels of fear of childbirth who are unmotivated or unable to undergo traditional psychotherapy that focuses on exposure to and processing of past traumatic event(s). It is based on birth-oriented thinking, principles of positive psychology, and trauma-informed care. In addition to the five sessions offered to pregnant women, medical staff are provided with 19 training sessions on the "Women Friendly" approach. Qualitative and quantitative research should examine the effectiveness of this intervention. Should results be encouraging, this intervention could be more widely implemented in Israel and abroad and applied in broader contexts, such as gynecological check-ups and medical examinations, interventions, and surgery.

Childhood trauma and fear of childbirth: findings from a birth cohort study

The aim of this study is to investigate if experiencing childhood trauma (emotional abuse, emotional neglect, physical abuse, physical neglect, or sexual abuse) or a greater total burden of childhood trauma increase the risk of fear of childbirth (FOC). This study included 2556 women living in Southwest Finland. Women were recruited during routine ultrasound visits at gestational week (gwk) 12. Experiencing childhood trauma was assessed in retrospect with the Trauma and Distress Scale (TADS) questionnaire completed at gwk 14. Information on the diagnosis of FOC (ICD-10 diagnosis O99.80) was obtained from the Finnish Medical Birth Register. Associations between childhood trauma (domains and total TADS score) and FOC were analyzed with logistic regression in unadjusted and adjusted models. Emotional abuse (aOR 1.25, 95% CI 1.10-1.42), emotional neglect (aOR 1.26, 95% CI 1.08-1.46), and a greater total burden of trauma (TADS total score) (aOR 1.06, 95% CI 1.02-1.10) increased the risk for FOC. We found no evidence for physical abuse (aOR 1.15, 95% CI 1.00-1.32), physical neglect (aOR 1.06, 95% CI 0.92-1.22), and sexual abuse (aOR 1.24, 95% CI 0.99-1.56) associating with FOC. Childhood emotional abuse, emotional neglect, and a greater total burden of childhood trauma increase the risk for FOC. However, the childhood traumatic events were inquired in retrospect, which could distort the events.

The Effect of Intimate Partner Violence on Fear of Childbirth Among Pregnant Women

This study was conducted to determine the effect of intimate partner violence on childbirth fear of pregnant women. This descriptive and cross-sectional study included 335 pregnant women who applied to pregnant outpatient clinics. The data of the study were collected with Questionnaire Form and Wijma Birth Expectation/Experience Scale A Version (W-DEQ-A). Descriptive statistical methods, t-test, one-way ANOVA, Mann-Whitney U-test, and Kruskal-Wallis test were used in the analysis of the data. W-DEQ-A scale score of pregnant women was found to be 69.34 ± 29.37. It was found that 15.2% of pregnant women experienced "mild level" childbirth fear, 28.4% had "moderate level" childbirth fear, 26.6% had "severe level" childbirth fear, and 29.9% had "clinical level" childbirth fear. It was determined that 49.3% of pregnant women were exposed to any type of violence by their partners. It was found that pregnant women were exposed to 46% verbal violence, 23.9% emotional violence, 13.7% economic violence, 8.7% physical violence, and 2.1% sexual violence. When pregnant women experiencing any type of violence (p = .000), verbal violence (p = .000), emotional violence (p = .000), and economic violence (p = .000) were compared with pregnant women who did not experience violence, W-DEQ-A scores were higher and differences were statistically significant. It was determined to be statistically significant differences of W-DEQ-A scores according to the age of the pregnant women (p = .044), family type (p = .004), place of residence (p = .026), and psychological problems before pregnancy (p = .026). As a result, the rate of violence exerted by their intimate partners against pregnant women was high. In addition, intimate partner violence during pregnancy had negative effects on the fear of childbirth of pregnant women.

“I shut it out”: expectant mothers’ fear of childbirth after a traumatic birth—a phenomenological study

Purpose

To describe expectant mothers’ experiences of fear of childbirth after a previous traumatic birth.

Method

Qualitative, individual, in-depth interviews were conducted with eight expectant mothers between September and November 2020. Data were analysed using a descriptive phenomenological approach.

Results

We identified four interconnected constituents: Suboptimal midwifery care, loss of control and agency; insufficient time and capacity to process a traumatic birth experience; “The baby has to be delivered!”, and finally, the path to a new childbirth with the hope of mastering fears.

Conclusion

Findings reveal an association between a previous history of traumatic birth and a fear of childbirth in expectant mothers. The trauma they experienced whilst giving birth strongly impacted their subsequent pregnancy, making it difficult for them to deal with the new pregnancy and impending birth. Women who have experienced a traumatic birth need to have the opportunity to process the trauma. Routines must therefore be developed that identify, support and follow up with the women. If these women are identified and given the help they need, this may help prevent and/or alleviate fear of childbirth in their subsequent pregnancy.

Factors of the childbirth fear among nulliparous women in Iran

BACKGROUND

Fear of childbirth is an anxiety associated with childbirth, which manifests itself in physical and concentration problems. It is often associated with requesting a cesarean section, and it is prevalent in nulliparous women. This is a study aimed to summarize the published research on the factors for fear of childbirth in nulliparous women in Iran.

METHODS

This study was conducted based on the PRISMA statement. A literature search was performed on nine electronic databases (Web of Sciences, Since Direct, Scopus, PubMed, Cochrane Library, ProQuest, and Persian databases including Scientific Information Database, Irandoc, and Magiran) using keywords related to fear of childbirth, factors, nulliparous, and Iran from 2000 to 2020. This study included cross-sectional studies with full-text in English or Persian in Iran. The quality of the selected studies was evaluated independently by two authors and via the STROBE checklist.

RESULTS

In this study, 93 articles were identified,13 duplicate articles were excluded, 80 articles were screened by title and abstract, 62 were excluded, and the full-text of 18 articles was assessed for analysis. Of these, 12 were excluded, and six articles were reviewed. Six studies were conducted in different provinces of Iran. Based on the study results, factors of the fear of childbirth in nulliparous women were: biological (the process of labor and childbirth and labor pain, concern for the baby (harm to the baby and baby infirmity), psychological (painful injections during labor and suturing in childbirth), and individual (loss of control during labor).

CONCLUSIONS

This study identified four main factors that affect fear of childbirth status in nulliparous women, and concern for the baby was a more common factor in this study. In conclusion, these factors can be reduced by increasing their assurance about child health, training during pregnancy, talking about positive experiences, and holding workshops.

Prevalence of self-reported emotional, physical, and sexual abuse and association with fear of childbirth in pregnant women with epilepsy: The Norwegian Mother, Father, and Child Cohort Study

OBJECTIVE

This study was undertaken to examine the prevalence of self-reported experiences with abuse in pregnant women with epilepsy and the association between having experienced abuse and childbirth expectations, particularly the fear of childbirth.

METHODS

We performed a cross-sectional study of women with and without epilepsy enrolled in the Norwegian Mother, Father, and Child Cohort Study 1999-2008. Data on epilepsy diagnosis; antiseizure medication (ASM) use; emotional, physical, and sexual abuse; and childbirth expectations were collected from questionnaires completed during gestational Weeks 17-19 and 30.

RESULTS

Our study population included 295 women with ASM-treated epilepsy, 318 women with ASM-untreated epilepsy, and 93 949 women without epilepsy. A total of 115 women (47%) with ASM-treated and 132 women (57%) with ASM-untreated epilepsy reported any emotional, physical, or sexual abuse, compared to 25 100 women (32%) without epilepsy. The adjusted odds ratios (aORs) for having experienced any abuse were 1.8 (95% confidence interval [CI] = 1.4-2.3) and 1.8 (95% CI = 1.4-2.2) for ASM-treated and ASM-untreated epilepsy, respectively. A total of 29 women (11%) with ASM-treated and 34 women (11%) with ASM-untreated epilepsy reported having been raped, compared to 3088 women (4%) without epilepsy (aORs = 2.8 [95% CI = 1.8-4.1] and 2.9 [95% CI = 2.0-4.2], respectively). In nulliparous women with ASM-untreated epilepsy, having experienced abuse was associated with fear of childbirth; 22 women (31%) with abuse experiences reported fear of childbirth compared to five women (7%) with no experience of abuse (aOR = 5.4 [95% CI = 1.7-17.2]). This association was not seen in multiparous women or in women with ASM-treated epilepsy.

SIGNIFICANCE

More women with epilepsy reported emotional, physical, and sexual abuse than women without epilepsy. Such experiences may be associated with childbirth expectations.

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.

Fear of childbirth during pregnancy: associations with observed mother-infant interactions and perceived bonding

Fear of childbirth (FOC) is a common phenomenon that can impair functioning in pregnancy but potential longer term implications for the mother-infant relationship are little understood. This study was aimed at investigating postpartum implications of FOC on the mother-infant relationship. A UK sample of 341 women in a community setting provided data on anxiety, mood and FOC in mid-pregnancy and subsequently completed self-report measures of postnatal bonding in a longitudinal cohort study. Postnatal observations of mother-infant interactions were collected and rated for a subset of 141 women. FOC was associated with maternal perception of impaired bonding, even after controlling for sociodemographic factors, concurrent depression and the presence of anxiety disorders (Coef = 0.10, 95% CI 0.07-0.14, p < 0.001). Observed mother-infant interactions were not associated with FOC (Coef = -0.01-0.03 CI - 0.02 to 0.02, p = 0.46), weakly with concurrent depression (Coef = - 0.10, CI - 0.19 to 0.00, p = 0.06) and not associated with anxiety disorders. The self-efficacy component of FOC was most strongly associated with lower reported bonding (Coef 0.37, 95% CI 0.25-0.49, p < 0.001) FOC makes a distinct contribution to perceived postpartum bonding difficulties but observed mother-infant interaction quality was not affected. This may be due to low self-efficacy impacting psychological adjustment during pregnancy. Targeted interventions during pregnancy focusing both on treatment of key childbirth fears and bonding could help women adjust earlier.

Causes and Grounds of Childbirth Fear and Coping Strategies Used by Kurdish Adolescent Pregnant Women in Iran: A Qualitative Study

BACKGROUND

Fear of childbirth is one of the most common problems among pregnant women that can threaten their and their baby's health. Therefore, the purpose of this study was to explore the causes and grounds of childbirth fear and the strategies used by pregnant adolescent women in Iran to overcome such fears.

METHODS

In this study, which was conducted among primiparous Kurdish women in Iran, conventional qualitative content analysis was used. Data were selected through purposive sampling and semi-structured interviews. Data saturation was reached with 15 participants. The Lincoln and Guba criteria were used to strengthen the research.

RESULTS

After analyzing the data, two main categories were resulted. The first category was fear of childbirth with subcategories of fear of child health, fear of childbirth process, fears about inappropriate medical staff performance, fears about hospital environment, and postpartum fears. The second category was strategies to reduce childbirth fear with subcategories of choosing appropriate medical centers, increasing information on childbirth, avoiding stressful sources, improving self-care, getting prepared for delivery day in advance, and resorting to spirituality.

CONCLUSION

Pregnancy in adult age is better than adolescent age. The women's fear can be reduced by increasing their assurance about child health, providing appropriate training during pregnancy, explaining the whole process of childbirth and making it easier, improving the hospital environment and medical staff specialization, as well as providing appropriate conditions for further care and support after birth.

Child Sexual Abuse and Pregnancy: A Systematic Review of the Literature

BACKGROUND

Child sexual abuse is related to many negative outcomes but less known is the effect on pregnancy and childbirth.

OBJECTIVE

This review critically examined the literature on the occurrence of child sexual abuse and outcomes associated with this abuse during pregnancy and childbirth.

METHODS

Five databases were searched over 50 years using an iterative approach and the terms pregnancy, sexual abuse/assault, childbirth/labour, identifying 49 studies.

RESULTS

The prevalence of child sexual abuse in pregnant women ranged from 2.63% to 37.25 with certain characteristics more common with a higher (e.g., specific questions, low income) or lower (broad questions, higher education) prevalence. Compared to women with no history of abuse, child sexual abuse survivors may have more concerns with their care, greater health complaints, fear childbirth and have difficulties with delivery. They also had a higher likelihood of PTSD symptomology and anxiety, consumed more harmful substances (e.g., alcohol, cigarettes, and drugs) and had greater concerns with their appearance, poorer health, sleep and may also have a higher risk of re-victimisation.

CONCLUSIONS

The balance of evidence suggests that compared to non-abused women, women with a child abuse history have more adverse experiences with pregnancy, childbirth, and care, with their abuse history, likely contributes to harmful behaviours and psychopathology. However, variability in operationalisation and measurement of abuse may contribute to these findings so tentative conclusions are drawn. Future research should examine the generalisability of the findings (relating to scale limitations) and recommendations for screening (e.g., sensitive items, scoring). Clinical implications of the findings point to the need for early identification of women with a child abuse history as such women require trauma-sensitive care and consideration. A useful tool is the Pregnancy-related Anxiety Scale which provides insights into specific areas of concern.

How norms concerning maternity, femininity and cisgender increase stress among lesbians, bisexual women and transgender people with a fear of childbirth

OBJECTIVE

To explore and describe norms concerning maternity, femininity and cisgender in lesbian and bisexual women and transgender people (LBT) assigned female at birth, with an expressed fear of childbirth (FOC).

DESIGN

Semi-structured interviews were conducted with self-identified LBT people with an expressed FOC.

PARTICIPANTS

17 self-identified LBT people participated. 15 had an expressed FOC, and two were non-afraid partners.

FINDINGS

Participants described how their FOC was related to ideals of "the primal woman", including ideals of a natural birth. They also described stress in relation to expectations of gaining a feminine-coded body during pregnancy and of being related to as feminine women.

KEY CONCLUSIONS

Maternity ideals, and the ideal of the "natural" birth, can be particularly stressful on those who fear childbirth. Norms concerning femininity and cisgender can contribute to FOC among those who do not comfortably conform with feminine body ideals or feminine gender expressions.

IMPLICATION FOR PRACTICE

Treatments of FOC must be designed to acknowledge whether and how norms concerning maternity, femininity and cisgender affect the individual's FOC.

The childbirth experience: A systematic review of predictors and outcomes

BACKGROUND

Birth is often viewed as a pathological event, consequently, there has been an increase in literature focusing on predictors, experience and implications of traumatic childbirth and childbirth-related posttraumatic stress. However, to fully understand childbirth experiences a salutogenic perspective is required. This enables an understanding of what facilitates a positive childbirth experience besides what places women at risk of experiencing traumatic childbirth.

OBJECTIVE

To identify the psychosocial factors that could contribute to or be influenced by women's subjective accounts of childbirth.

METHOD

An in-depth literature search across four databases was undertaken. Quality appraisal based on internal and external validity was conducted and a combined numerical summary and categorical description were undertaken.

FINDINGS

Nineteen papers were included in the review and the variables grouped into three categories. The variables relate to 'Measures of labour and birth experience' (discussing the impact of events and perceptions during labour and birth). The second category discusses how 'support and relationships' can potentially shape the birth experience or be altered by it and finally, 'Psychological variables: influence and impact' is examined extensively.

DISCUSSION

The results of the review highlight significant contradictory evidence of what influences birth experiences. The findings confirm the dearth of available literature concerning positive birth experiences and most variables identified were pathogenic. This review suggests that such factors for PTSD may differ from those that influence birth experiences and should be examined separately. An enhanced understanding of the range of experiences is required to support women's rights in achieving a positive birth.

Women's preference for caesarean section and the actual mode of delivery - Comparing five sites in Norway

OBJECTIVES

The caesarean (CS) section rate varies among hospitals in Norway, and little is known about whether this is influenced by women's preferences. The aim of this study was to investigate the differences in women's preferred mode of delivery during pregnancy between five hospitals in Norway, and to relate this to the actual mode of delivery.

STUDY DESIGN

A prospective cohort study of 2,177 unselected pregnant women in five hospitals in Norway. Women were recruited at their standard ultrasound examinations, and data was collected through questionnaires and electronic patient charts. The exposure was a CS preference and the main outcome measure was the actual mode of delivery.

RESULTS

In total, 3.5% of the primiparous women and 9.6% of the multiparous women reported a preference for CS. This was associated with fear of childbirth and education between 10 and 13 years in both groups, symptoms of depression and an age over 35 years old among the primiparous women, and a previous CS and/or negative birth experience among the multiparous. The multiparous women in Drammen and Tromsø were less likely to prefer a CS, and none of the primiparous women in Tromsø preferred a CS. A total of 67.8% of those who preferred a CS gave birth with this mode of delivery.

CONCLUSION

There were significant differences between the hospitals according to the CS preference. This preference was associated with the previous obstetric history and psychological factors. Therefore, creating good birth experiences and offering women counselling may reduce the CS preference rate.

Support for pregnant women identified with fear of childbirth (FOC)/tokophobia - A systematic review of approaches and interventions

BACKGROUND

providing appropriate care for pregnant women with high or severe fear of childbirth (FOC) is a challenge in midwifery care today. FOC is associated with predisposing anamnestic factors, various sociodemographic and psychosocial characteristics, and may result in serious healthrelated consequences. It is therefore important to establish which interventions may increase a woman's faith in her own ability to cope with labour and birth.

AIM

to systematically identify and review studies examining interventions for relief of severe fear of childbirth in pregnancy and their underlying conceptual foundation.

METHODS

a systematic literature search was performed following Cochrane Collaboration and PRISMA Statement recommendations. Inclusion criteria were: studies including pregnant women diagnosed with high or severe FOC or who requested a caesarean section due to severe FOC, studies (regardless of design) observing the effect of an intervention addressing FOC, and studies published in English. Publications addressing anxiety or stress were excluded. 377 references were screened by title and abstract. The risk of bias was assessed.

FINDINGS

19 articles referring to 15 research projects were included in the analysis. The studies show heterogeneity regarding assessment methods, type, conceptualisation and application of interventions. There is evidence that both cognitive therapy sessions and a theory-based group psychoeducation with relaxation are effective interventions.

KEY CONCLUSIONS

despite methodological limitations, single or group psychoeducation sessions for nulliparous women or therapeutic conversation during pregnancy (in group or individual sessions) have the potential to strengthen women's self-efficacy and decrease the number of caesarean sections due to FOC. The theoretical validation of an intervention deepens the understanding of psychological processes in women coping with severe FOC.

IMPLICATIONS FOR PRACTICE

theory-based concepts of care for both antenatal and intrapartum support of pregnant women with high or severe FOC should be developed, piloted, tested, evaluated and implemented within the given healthcare system. Midwives need to be competent to address pregnant women's fears regarding labour and birth in antenatal care. The use of a valid assessment tool to identify the level of FOC in women, even if they do not raise the issue, is recommended in routine antenatal care so that appropriate expert support can be offered. A one-on-one conversation may be feasible for those women unwilling to fill in a questionnaire. Cooperative local networks between midwives, psychologists and obstetricians qualified in psychotherapy should be established to ensure timely and effective care for women with high or severe FOC.

Posttraumatic stress and depression may undermine abuse survivors' self-efficacy in the obstetric care setting

INTRODUCTION

Posttraumatic stress symptoms (PTS) are associated with increased risk of obstetric complications among pregnant survivors of trauma, abuse and interpersonal violence, but little is known about how PTS affects women's actual experiences of obstetric care. This study investigated the rate at which abuse history was detected by obstetricians, whether abuse survivors experienced more invasive exams than is typically indicated for routine obstetric care, and whether psychological distress was associated with abuse survivors' sense of self-efficacy when communicating their obstetric care needs.

METHODS

Forty-one pregnant abuse survivors completed questionnaires about abuse history, current psychological distress and self-efficacy for communicating obstetric care needs and preferences. Electronic medical records (EMRs) were reviewed to examine frequency of invasive prenatal obstetric procedures (e.g. removal of clothing for external genital examination, pelvic exams and procedures) and to examine the detection rate of abuse histories during the initial obstetric visit.

RESULTS

The majority of participants (83%) reported at least one past incident of violent physical or sexual assault. Obstetricians detected abuse histories in less than one quarter of cases. Nearly half of participants (46%) received invasive exams for non-routine reasons. PTS and depression symptoms were associated with lower self-efficacy in communicating obstetric care preferences.

DISCUSSION

Women most at risk for experiencing distress during their obstetric visits and/or undergoing potentially distressing procedures may also be the least likely to communicate their distress to obstetricians. Results are discussed with implications for improving screening for abuse screening and distress symptoms as well as need for trauma-sensitive obstetric practices.

Negative impressions of childbirth in a North-West England student population

BACKGROUND

Sociocultural childbirth representations can influence the perceptions of childbirth negatively. In this paper we report on a survey study to explore the factors associated with negative impressions of childbirth in a North-West England University student sample. We also explored whether different sources and perceptions of childbirth information were linked to fear of childbirth.

METHODS

All students received a survey link via an online messaging board and/or direct e-mail. Female students who were 18-40 years of age and childless (but planned to have children in the future) were invited to participate. Demographics, birth preferences, a fear of birth and general anxiety measures were included as well as questions about what sources of information shaped students' attitudes toward pregnancy and birth (i.e. visual/written media, experiences of friends/family members, school-based education and other) and impressions of birth from these sources (i.e. positive, negative, both positive and negative and not applicable).

RESULTS

Eligible students (n = 276) completed the online questionnaire. The majority were Caucasian (87%) with a mean age of 22.6 years. Ninety-two students (33.3%) reported negative childbirth impressions through direct or vicarious sources. Students with negative birth impressions were significantly more likely to report higher fear of birth scores. Negatively perceived birth stories of friends/family members, and mixed perceptions of visual media representations of birth were associated with higher fear of birth scores. Having witnessed a birth first-hand and describing the experience as amazing was linked to lower fear scores.

CONCLUSION

First-hand observations of birth, especially positive experiences, had implications for salutary outcomes. Negative or conflicting perceptions of vicarious experiences were associated with increased levels of childbirth fear. While further research is needed, these insights suggest a need for positive birth stories and messages to be disseminated to mitigate any negative effects of indirect accounts.

Psychological perspectives on fear of childbirth

The objective of this narrative review was to examine the literature on fear of childbirth from a psychological perspective, addressing the specificity of childbirth fear, the pathways of fear acquisition, and the physiological, cognitive and behavioral aspects of fear. Systematic procedures for literature search, inclusion and exclusion left 86 original research papers for analysis. Findings summarize the body of knowledge for each area of interest, as well as the number of studies addressing each theme. Overall, few studies adopt a clear-cut psychological perspective, leaving the psychological mechanisms of childbirth fear largely unexplored. Although methodological limitations make conclusions difficult, results give a hint of etiological diversity and possible psychological mechanisms commonly described as transdiagnostic features in anxiety. Systematic investigations of psychological mechanisms, longitudinal studies exploring possible vicious circles of fear, and studies comparing psychological characteristics within the group of women fearing childbirth are identified as research areas of high priority.

Lifetime sexual violence and childbirth expectations - A Norwegian population based cohort study

OBJECTIVE

this study aimed to explore the association between lifetime sexual violence and expectations about childbirth.

DESIGN

Norwegian population-based cohort study.

SETTING

women presenting for routine ultrasound examinations were recruited to the Norwegian Mother and Child Cohort Study between 1999 and 2008.

POPULATION

78,660 pregnant women.

METHODS

sexual violence and expectations about childbirth were self-reported during pregnancy using postal questionnaires. Risk estimations were performed using multivariable logistic regression analysis and stratified by parity.

MAIN OUTCOME MEASURES

fear of childbirth, the thoughts about pain relief, worries about the infant's health and looking forward to the arrival of the infant.

FINDINGS

of 78,660 women, 18.4% reported a history of sexual violence and 0.9% were exposed to sexual violence within the last 12 months, including during the current pregnancy. We found that nulliparous women who reported previous or recent sexual violence had a decrease in the odds of looking forward to the arrival of the infant with an AOR of 0.8 (95% CI 0.7-0.9) and 0.4 (95% CI 0.3-0.6), respectively, compared to non-abused women. The same pattern was observed among multiparous women and they were more likely to report worries about the infant's health. Severe sexual violence (rape) was associated with concerns about childbirth, especially for nulliparous women that were more likely to express fear of birth, a hope for a pain-free birth, a desire for caesarean section and worries about the infant's health than non-exposed women.

CONCLUSIONS

women with a lifetime exposure to sexual violence, both past experiences and within the last 12 months, were less likely to look forward to the arrival of the infant than non-exposed women, and they were more likely to worry about the infant's health. Women with experiences of severe sexual violence (rape) had more concerns about childbirth than women without this experience. This finding shows that exploring women's attitudes toward childbirth may work as an approach when examining exposure to violence.

Birth experiences in adult women with a history of childhood sexual abuse

OBJECTIVE

Although childhood sexual abuse (CSA) may seriously impair childbirth experiences, few systematic evaluations on associations, mediating influences, risk and protective factors are available. As such information is mandatory to improve obstetric care, the present study aimed to provide such data.

METHODS

The study compared childbirth experiences from 85 women after CSA and at least one pregnancy resulting in a life birth with those from 170 control women matched for nationality, personal age and children's age. Trained specialists from support centers investigated CSA. Obstetrical data were collected from the official personal clinical record of each pregnancy (Mutterpass) and data on CSA as well as childbirth experiences were examined by questionnaires.

RESULTS

Childbirth was more often highly frightening (24.7 vs. 5.3%; p<0.01) and a negative experience (40.7 vs. 19.6%, p<0.01) in women with a history of CSA than in controls. Multivariate regression models support the hypothesis that at least part of this association was mediated by covariates (specifically, birth preparation classes, presence of a trusted person, participation in medical decision-making, pain relief, emergency during labor and extreme duration of labor), which represent important resources in improving obstetric care. In 41% of women with CSA, memories of traumatic experiences intruded during childbirth, whereas about 58% experienced dissociation. While dissociation may result in loss of contact with obstetric staff, it was also used to reduce labor pain.

CONCLUSION

Childbirth following a history of CSA is associated with particular challenges. Creating a trusting environment by evaluating and integrating individual needs could ameliorate birth experiences.

Prevalence of Child Sexual Abuse in the Nordic Countries: A Literature Review

This review examined child sexual abuse in the Nordic countries focusing on prevalence rates and victims' age and relationship to the perpetrator. The results show a prevalence of child sexual abuse (broadly defined) between 3-23% for boys and 11-36% for girls. The prevalence rates for contact abuse were 1-12% for boys and 6-30% for girls, while 0.3-6.8% of the boys and 1.1-13.5% of the girls reported penetrating abuse. The findings suggest an increased risk of abuse from early adolescence. In adolescence, peers may constitute the largest group of perpetrators. The results highlight the need for preventive efforts also targeting peer abuse. Future research should include cross-national and repeated studies using comparable methodology.

Group psychoeducation with relaxation for severe fear of childbirth improves maternal adjustment and childbirth experience--a randomised controlled trial

BACKGROUND

Previous studies on the treatment of women with fear of childbirth have focused on the delivery mode. Women with fear of childbirth often suffer from anxiety and/or depression, and treatment therefore also needs to target postnatal psychological well-being and the early mother-infant relationship.

METHODS

Three hundred and seventy-one nulliparous women out of 4575 scored ≥100 in prospective screening (Wijma Delivery Expectancy Questionnaire, W-DEQ-A), indicating severe fear of childbirth. These women were randomised to psychoeducative group intervention with relaxation (n = 131; six sessions during pregnancy, one postnatal) or to conventional care (n = 240) by community nurses (referral if necessary). Psycho-emotional and psychosocial evaluations [Edinburgh Postnatal Depression Scale (EPDS), social support, Maternal Adjustment and Attitudes (MAMA), Traumatic Events Scale (TES) and the Wijma Delivery Experience Questionnaire (W-DEQ-B)] were completed twice during pregnancy and/or 3 months postpartum.

RESULTS

Postnatal maternal adjustment (MAMA mean score 38.1 ± 4.3 versus 35.7 ± 5.0, p = 0.001) and childbirth experience (mean W-DEQ-B sum score 63.0 ± 29 versus 73.7 ± 32, p = 0.008) were better in the intervention group compared with controls. In hierarchical regression, social support, participating in intervention, and less fearful childbirth experience predicted better maternal adjustment. The level of postnatal depressive symptoms was significantly lower in the intervention group (mean sum score 6.4 ± 5.4 versus 8.0 ± 5.9 p = 0.04). There were no differences in the frequency of post-traumatic stress symptoms between the groups.

CONCLUSIONS

In nulliparous women with severe fear of childbirth, participation in a targeted psychoeducative group resulted in better maternal adjustment, a less fearful childbirth experience and fewer postnatal depressive symptoms, compared with conventional care.

Fear of childbirth and elective caesarean section: a population-based study

BACKGROUND

This population-based cohort study aimed to investigate the demographic and psychosocial characteristics associated with fear of childbirth and the relative importance of such fear as a predictor of elective caesarean section.

METHODS

A sample of 1789 women from the Akershus Birth Cohort in Norway provided data collected by three self-administered questionnaires at 17 and 32 weeks of pregnancy and 8 weeks postpartum. Information about the participants' childbirths was obtained from the hospital records.

RESULTS

Eight percent of the women reported fear of delivery, defined as a score of ≥85 on the Wijma Delivery Expectancy Questionnaire. Using multivariable logistic regression models, a previous negative overall birth experience exerted the strongest impact on fear of childbirth, followed by impaired mental health and poor social support. Fear of childbirth was strongly associated with a preference for elective caesarean section (aOR 4.6, 95% CI 2.9-7.3) whereas the association of fear with performance of caesarean delivery was weaker (aOR 2.4, 95% CI 1.2-4.9). The vast majority (87%) of women with fear of childbirth did not, however, receive a caesarean section. By contrast, a previous negative overall birth experience was highly predictive of elective caesarean section (aOR 8.1, 95% CI 3.9-16.7) and few women without such experiences did request caesarean section.

CONCLUSIONS

Results suggest that women with fear of childbirth may have identifiable vulnerability characteristics, such as poor mental health and poor social support. Results also emphasize the need to focus on the subjective experience of the birth to prevent fear of childbirth and elective caesarean sections on maternal request. Regarding the relationship with social support, causality has to be interpreted cautiously, as social support was measured at 8 weeks postpartum only.

Maternal history of childhood sexual abuse and preterm birth: an epidemiologic review

BACKGROUND

History of childhood sexual abuse (CSA) is highly prevalent with as many as one in four American women being victims. Exposure to CSA or other early life traumatic experiences has been associated with adverse reproductive and pregnancy outcomes. However, the effects of CSA on preterm delivery (PTB), a leading cause of neonatal mortality, remain poorly understood. The objectives of this review are (i) to synthesize the available research investigating the relationship between maternal history of childhood sexual abuse (CSA) and preterm delivery (PTB); (ii) to provide suggestions for improving future research on this topic; and (iii) to highlight implications for clinical practice and public health.

METHODS

Relevant articles were identified through searches of four electronic databases (PubMed, CINAHL, Web of Science Core Collection and BIOSIS Online) for studies published before March 2014, as well as through reviewing references of published articles.

RESULTS

A total of six studies published from 1992 to 2010 were included in this review. Overall, findings were inconsistent. Three studies reported statistically significant associations of CSA with PTB (<37 weeks gestation) or shorter mean gestational age at birth. Women with a history of CSA had 2.6 to 4.8-fold increased odds of PTB as compared with women without a history of CSA. Three other studies did not observe statistically significant differences in rates of PTB or mean gestational age at birth in relation to a history of CSA.

CONCLUSIONS

Available evidence on this topic is sparse and inconsistent, and limited by a number of methodological challenges. Given the ubiquity of CSA, as well as the clinical and public health significance of PTB, more rigorously designed epidemiologic studies on the association between CSA and PTB are warranted.

Identifying women who are afraid of giving birth: A comparison of the fear of birth scale with the WDEQ-A in a large Australian cohort

BACKGROUND

The WDEQ-A is the most widely used measure of childbirth fear in pregnant women; however there is increasing discussion in the literature that simpler, more culturally transferrable tools may offer a better solution to identifying fearful women in clinical practice.

AIM

To compare the two item Fear of Birth Scale (FOBS) with the 33 item WDEQ-A in a large cohort of Australian pregnant women.

METHOD

Self-report questionnaires during second trimester including Wijma Delivery Expectancy Questionnaire (WDEQ-A) and Fear of Birth Scale (FOBS). Correlation of FOBS and WDEQ-A was tested using Spearman's correlation coefficients. Receiver operating characteristic (ROC) curve assessed the sensitivity and specificity of possible cut-points on the FOBS against WDEQ-A cut-point of ≥85. Sensitivity, specificity, positive and negative predictive values were determined. Fearful and non-fearful women as classified by both instruments were compared for differences in demographic, psycho-social and obstetric characteristics.

RESULTS

1410 women participated. The correlation between the instruments was strong (Spearman's Rho = 0.66, p < 0.001). The area under the ROC was 0.89 indicating high sensitivity with a FOBS cut-point of 54. Sensitivity was 89%, specificity 79% and Youden index 0.68. Positive predictive value was 85% and negative predictive value 79%. Both instruments identified high fear as significantly associated with first time mothers, previous emergency caesarean and women with self-reported anxiety and/or depression. Additionally FOBS identified a significant association between fearful women and preference for caesarean.

CONCLUSION

This study supports the use of the FOBS in clinical practice to identify childbirth fear in pregnant women.

An innovative nursing approach to caring for an obstetric patient with rape trauma syndrome

Rape trauma syndrome (RTS) is a posttraumatic stress disorder that can be triggered by routine procedures experienced during childbirth. An explanation of the signs and symptoms of RTS is provided, including how to avoid retraumatization during intrapartum care. A case report is presented from a provider perspective to illustrate the seriousness of this disorder and the importance of delivering respectful care. A new approach to obstetric routines is warranted to avoid further traumatizing the woman with RTS.

The association between sociodemographic characteristics and postpartum depression symptoms among Arab-Bedouin women in Southern Israel

BACKGROUND

Prevalence rates of postpartum depression (PPD) are 10 to 20% among various populations. Little is known about the characteristics of PPD among populations experiencing cultural transition. This study aimed to assess PPD symptoms (PPDS) prevalence and to identify risk factors unique to Arab-Bedouin women in southern Israel.

METHODS

The sample included 564 women who visited maternal and child health clinics. Sociodemographic characteristics were obtained using in-person interviews. PPDS were assessed using a validated Arabic translation of the Edinburgh Postnatal Depression Scale (EPDS). Prevalence of PPDS was estimated using the cut-off score of EPDS ≥10; a more stringent cut-off score of EPDS ≥13 was used to define women with moderate to severe PPDS.

RESULTS

The prevalence of PPDS among women was 31%, of which 19.1% were assessed as having moderate to severe symptoms (EPDS ≥ 13). In a multivariate logistic regression, the variables associated with EPDS ≥10 were having an ill-infant odds ratio (OR) = 3.9, lack of husband's support (OR = 2.6), history of emotional problems (OR = 3.2), low income (OR = 1.6), low level of education (OR = 1.6), high marital conflicts (OR = 1.5), and an unplanned pregnancy (OR = 1.5).

CONCLUSION

In the generally understudied population of Arab-Bedouin women living in southern Israel, we found a high prevalence of PPDS. The unique risk factors described in our research can inform health care professionals in designing interventions for early detection and prevention of PPD.

Exploring women's fear of childbirth in a high maternal mortality setting on the Arabian Peninsula

BACKGROUND

Few studies from low-income countries have addressed women's fear of childbirth (FOC) although likely to affect women during both pregnancy and childbirth. The aim of this study was to explore FOC in a high maternal mortality setting in the Arab region, Yemen.

METHODS

A multi-stage (stratified-purposive-random) sampling process was used. We interviewed 220 women with childbirth experience in urban/rural Yemen. Answers to the question 'Were you afraid of giving birth?' were analyzed using qualitative content analysis.

RESULTS

Women perceived childbirth as a place of danger. Fear of death and childbirth complications stemming from previous traumatic childbirth and traumatic experience in the community was rampant. Husbands' and in-laws' disappointment in a girl infant constituted a strong sociocultural component of FOC. Women's perception of living in tension 'between worlds' of tradition and modernity reinforced fear of institutional childbirth. Women without FOC gave reasons of faith, social belonging and trust in either traditional or modern childbirth practice, past positive experience of childbirth and the desire for social status associated with children.

CONCLUSIONS

The numerous maternal and infant deaths have a strong impact on women's FOC. Antenatal care has an important role in reducing fear including that of institutional childbirth and in strengthening a couple in welcoming a female infant. Staff should be sensitized to the fears of both husband and wife and women be allowed support during childbirth. Within the scope of the Millennium Development Goals and strengthening of reproductive mental health programs, FOC urgently needs to be addressed.

Cumulative psychosocial stress, coping resources, and preterm birth

Preterm birth constitutes a significant international public health issue, with implications for child and family well-being. High levels of psychosocial stress and negative affect before and during pregnancy are contributing factors to shortened gestation and preterm birth. We developed a cumulative psychosocial stress variable and examined its association with early delivery controlling for known preterm birth risk factors and confounding environmental variables. We further examined this association among subgroups of women with different levels of coping resources. Utilizing the All Our Babies (AOB) study, an ongoing prospective pregnancy cohort study in Alberta, Canada (n = 3,021), multinomial logistic regression was adopted to examine the independent effect of cumulative psychosocial stress and preterm birth subgroups compared to term births. Stratified analyses according to categories of perceived social support and optimism were undertaken to examine differential effects among subgroups of women. Cumulative psychosocial stress was a statistically significant risk factor for late preterm birth (OR = 1.73; 95 % CI = 1.07, 2.81), but not for early preterm birth (OR = 2.44; 95 % CI = 0.95, 6.32), controlling for income, history of preterm birth, pregnancy complications, reproductive history, and smoking in pregnancy. Stratified analyses showed that cumulative psychosocial stress was a significant risk factor for preterm birth at <37 weeks gestation for women with low levels of social support (OR = 2.09; 95 % CI = 1.07, 4.07) or optimism (OR = 1.87; 95 % CI = 1.04, 3.37). Our analyses suggest that early vulnerability combined with current anxiety symptoms in pregnancy confers risk for preterm birth. Coping resources may mitigate the effect of cumulative psychosocial stress on the risk for early delivery.

Fear of childbirth in nulliparous and multiparous women: a population-based analysis of all singleton births in Finland in 1997-2010

OBJECTIVE

To identify risk factors for fear of childbirth (FOC) according to parity and socioeconomic status, and to evaluate associations between FOC and adverse perinatal outcomes.

DESIGN

A cohort study.

SETTING

The Finnish Medical Birth Register.

POPULATION

All 788 317 singleton births during 1997-2010 in Finland.

METHODS

Fear of childbirth was defined according to the International Classification of Diseases code O99.80, and its associations with several risk factors and perinatal outcomes were analysed by multivariable logistic regression.

MAIN OUTCOME MEASURES

Prevalence of, risk factors for and outcomes of FOC.

RESULTS

Fear of childbirth was experienced by 2.5% of nulliparous women and 4.5% of multiparous women. The strongest risk factors for FOC in nulliparous women were depression [adjusted odds ratio (aOR), 6.35; 95% confidence interval (CI), 5.25-7.68], advanced maternal age (aOR, 3.78; 95% CI, 3.23-4.42) and high or unspecified socioeconomic status. In multiparous women, the strongest risk factors for FOC were depression (aOR, 5.47; 95% CI, 4.67-6.41), previous caesarean section (CS) (aOR, 3.02; 95% CI, 2.93-3.11) and high or unspecified socioeconomic status. Among both nulliparous and multiparous women, FOC was associated with higher rates of CS (3.3-fold and 4.5-fold higher, respectively) and a lower incidence of low birthweight (<2500 g), small for gestational age babies, preterm birth and low Apgar scores at 1 minute.

CONCLUSIONS

High and unspecified socioeconomic status, advanced maternal age and depression are predisposing factors for FOC regardless of parity. Among multiparous women, a previous CS increases vulnerability to FOC. FOC is associated with increased rates of CS, but does not adversely affect other pregnancy outcomes.

A history of abuse and operative delivery--results from a European multi-country cohort study

OBJECTIVE

The main aim of this study was to assess whether a history of abuse, reported during pregnancy, was associated with an operative delivery. Secondly, we assessed if the association varied according to the type of abuse and if the reported abuse had been experienced as a child or an adult.

DESIGN

The Bidens study, a cohort study in six European countries (Belgium, Iceland, Denmark, Estonia, Norway, and Sweden) recruited 6724 pregnant women attending routine antenatal care. History of abuse was assessed through questionnaire and linked to obstetric information from hospital records. The main outcome measure was operative delivery as a dichotomous variable, and categorized as an elective caesarean section (CS), or an operative vaginal birth, or an emergency CS. Non-obstetrically indicated were CSs performed on request or for psychological reasons without another medical reason. Binary and multinomial regression analysis were used to assess the associations.

RESULTS

Among 3308 primiparous women, sexual abuse as an adult (≥ 18 years) increased the risk of an elective CS, Adjusted Odds Ratio 2.12 (1.28-3.49), and the likelihood for a non-obstetrically indicated CS, OR 3.74 (1.24-11.24). Women expressing current suffering from the reported adult sexual abuse had the highest risk for an elective CS, AOR 4.07 (1.46-11.3). Neither physical abuse (in adulthood or childhood <18 years), nor sexual abuse in childhood increased the risk of any operative delivery among primiparous women. Among 3416 multiparous women, neither sexual, nor emotional abuse was significantly associated with any kind of operative delivery, while physical abuse had an increased AOR for emergency CS of 1.51 (1.05-2.19).

CONCLUSION

Sexual abuse as an adult increases the risk of an elective CS among women with no prior birth experience, in particular for non-obstetrical reasons. Among multiparous women, a history of physical abuse increases the risk of an emergency CS.

The impact of previous birth experiences on maternal fear of childbirth

OBJECTIVES

This study aimed to assess the relation between fear of childbirth and previous birth experiences.

DESIGN

A prospective study of pregnant women.

SETTING

Akershus University Hospital, Norway.

POPULATION

Parous women (n = 1357) scheduled to give birth at Akershus University Hospital in Norway during 2009-2011.

METHODS

Data were collected using two self-completed questionnaires at pregnancy weeks 17 and 32. Fear of childbirth was assessed by the Wijma Delivery Expectancy Questionnaire. Previous overall birth experience was measured using a numeric rating scale, and previous obstetric complications were assessed using an index of seven obstetric complications: emergency cesarean section, instrumental vaginal delivery, extensive blood loss, retained placenta, serious maternal infection during labor, thrombosis, and anal sphincter tears.

MAIN OUTCOME MEASURE

Fear of childbirth.

RESULTS

The odds ratio of fear of childbirth was 4.8 (95% confidence interval (CI) 2.8-8.3) for a previous negative overall birth experience, 1.9 (95% CI 1.2-3.1) for one obstetric complication and 2.6 (95% CI 1.2-5.5) for two or more complications. The estimates were adjusted for mental health, labor pain, time since last delivery, age, and education. Almost 80% of women who experienced obstetric complications neither considered the birth a negative overall experience nor developed a fear of childbirth.

CONCLUSIONS

The association between a previous subjectively negative birth experience and fear of childbirth was high and was greater than the association between previous obstetric complications and fear of childbirth.