Definitions, measurements and prevalence of fear of childbirth: a systematic review

A cluster analysis of reasons behind fear of birth among women in Sweden

BACKGROUND

Fear of birth is common and complex, caused by a variety of reasons. The aim was to investigate the prevalence of pre-established reasons in relation to fear, and to identify profiles of women based on their reported reasons behind fear of birth.

METHODS

A cross-sectional Swedish study of women with self-reported fear of birth who completed an online survey. Descriptive statistics, chi-square test, crude and adjusted odds ratios with 95% confidence intervals were used in the analysis of pre-established reasons in relation to self-reported severe fear. A Kappa-means cluster analysis was performed in order to group reasons, that were further investigated in relation to women's background variables.

RESULTS

A total of 1419 women completed the survey. The strongest reason behind fear of birth was to be forced to give birth vaginally. Four clusters were identified and labeled: minor complexity (reference group), relative minor complexity, relative major complexity, and major complexity. Cesarean section preference, previous mental health problems, being younger, primiparity, and exposure to domestic violence were factors related to cluster grouping.

CONCLUSIONS

Women with fear of birth have various reasons and diverse complexities behind their fear. Health care providers need to investigate these reasons and support pregnant women with childbirth fear, based on their needs.

Prevalence and determinants of fear of childbirth among pregnant women in Egypt: A cross-sectional study

PROBLEM

Fear of childbirth (FOC) is a significant public health concern, and understanding its determinants is crucial for developing effective interventions to support women during pregnancy and childbirth.

BACKGROUND

Fear of childbirth (FOC) is increasingly recognized as an essential psychological health concern among pregnant women globally. However, research elucidating the prevalence and multifaceted determinants of FOC in the Egyptian context remains scarce. This knowledge is pivotal to informing maternal health practices.

AIM

This study aimed to investigate FOC prevalence and its determinants among pregnant women in Egypt.

METHODS

A cross-sectional study was conducted among 460 low-risk pregnant women attending antenatal clinics in El-Beheira Governorate, Egypt, from February 2023 to July 2023. Data were collected using structured questionnaires on sociodemographic and obstetric profiles, the Childbirth Attitude Questionnaire, the Childbirth Self-Efficacy Inventory, and the Multidimensional Scale of Perceived Social Support.

RESULTS

The prevalence of FOC ranged from mild to severe, with 70.4% of women displaying some degree of fear and 11.3% exhibiting severe FOC. Key determinants associated with greater FOC were younger age, nulliparity, unplanned pregnancy, negative previous birth experiences, and preference for cesarean delivery. An inverse relationship was found between FOC and childbirth self-efficacy.

CONCLUSIONS

This study reveals a high FOC prevalence among Egyptian pregnant women, necessitating the need for systematic screening and tailored interventions to mitigate this concern, especially among high-risk groups like young, nulliparous mothers. Fostering childbirth self-efficacy may aid in reducing FOC. These findings can inform the enhancement of holistic maternal health practices in Egypt.

A group intervention for pregnant multiparas with fear of childbirth: A protocol of a feasibility study of the MOTIVE trial

BACKGROUND

Although research interest in fear of childbirth has increased, interventions targeting especially multiparas with fear of childbirth have been overlooked, although untreated fear can cause serious adverse effects on the mother and the whole family. Thus MOTIVE (Multiparas overcoming Childbirth Fear Through Intervention and Empowerment), an intervention for pregnant multiparas with fear of childbirth, was designed.

METHODS

This is a protocol of a single-arm non-randomized feasibility study of the MOTIVE trial with a mixed-methods design. The primary aim of the intervention is to assist pregnant multiparas with fear of childbirth, with the desired outcome to alleviate fear. MOTIVE consists of four group sessions (2 h each); three during pregnancy and one after giving birth and in addition of a phone call after birth. The intervention is provided by a midwife and a psychiatric nurse at the maternity hospital. Quantitative data will be gathered via self-report questionnaires at three time points, at baseline, at 4 weeks post-baseline and post-intervention. Qualitative data will be gathered by diaries, open-ended questions from post-intervention questionnaires, and individual interviews. The target is to assemble four groups of four multiparas over a 12-month period.

DISCUSSION

The findings will provide insights into the feasibility and acceptability of the intervention and will inform revisions to it. The results will guide the development of a definitive, larger-scale trial evaluation to further examine the efficacy of the refined intervention.

Pregnancy and Childbirth Fear of Women from Poland, Greece, Turkey, Belarus, and Russia

Background/Objectives: Pregnancy and childbirth in many women cause various situations, from physical to emotional. The analysis of selected factors affecting pregnancy and childbirth in a group of women from Poland, Greece, Turkey, Belarus, and Russia and self-assessment of their impact on fear of pregnancy and childbirth. Material and Methods: A total of 2017 women were surveyed, including 584 pregnant women, 528 postpartum women, and 906 non-pregnant and never-pregnant women. The study used an original questionnaire, including questions on socio-demographics and the history of pregnancy and childbirth. The material status of the respondents was assessed using the Family Affluence Scale. Results: The age range of respondents was 19-50. The surveyed women most often reported (p < 0.001) fear (n = 928) and excitement (n = 901). A positive correlation was found between anemia, infections, and fear in women from Belarus. No correlation was found between low, average, or high material status and the perception of pregnancy in women from the studied countries. Significantly (p < 0.001), women from Turkey had more children (p < 0.001) than women from other countries. With the exception of Russia, statistical correlations were shown between the feeling of fear of pregnancy and childbirth and the way the previous/current pregnancy was delivered and the experience of an artificial/natural miscarriage in the past. In general, 630 women had given birth vaginally, and 283 women had given birth by cesarean section. In the group of currently pregnant women, 22 women had had natural miscarriages in Belarus, 37 in Poland, 27 in Greece, 29 in Turkey, and 9 in Russia. Conclusions: When thinking about pregnancy, respondents in all groups most often felt joy and excitement, as well as fear and excitement, about childbirth. Natural miscarriage was experienced most frequently by women in Poland and Greece and induced in Belarus. The largest number of women who had cesarean section were from Poland and Belarus.

Spiritual Health, Anxiety and Fear of Childbirth in Iran: Is there Any Relationship?

The most common reason for mothers' request for a cesarean section is fear of childbirth. The present study was conducted to determine the relationship between spiritual health and anxiety and fear of childbirth in pregnant women. This correlational cross-sectional study was performed on 426 pregnant women who were referred to Yahyanejad Hospital in Babol, Iran, during 2018-2021. These pregnant women were hospitalized in the maternity ward for vaginal delivery. Convenience sampling bases on inclusion criteria were done to select the subjects. The questionnaires used in this study included Demographic and Obstetric Questionnaire, Anxiety and Fear of Childbirth Questionnaire by Pirdel et al., and Palutzian & Ellison Spiritual Well-being Scale. Data were analyzed using SPSS version 16 using descriptive and analytical indicators and linear and multiple correlation tests. The results of the study showed that all pregnant women experienced moderate (23.1) or severe (76.9) fear and anxiety, and none of the women had low fear and anxiety. Moreover, all women in this study had moderate (50.5) or high (49.5) spiritual health. The results of linear regression test showed that there is a significant and inverse relationship between spiritual health and anxiety and fear of childbirth (R: - 0.12, CI - 0.14, - 0.019, P = 0.011). Furthermore, the results of multivariate linear regression test after adjustments for intervening demographic and midwifery variables showed a significant relationship between spiritual health (R: - 0.12, CI - 0.14, - 0.02, P = 0.009), education level and number of pregnancies, and anxiety and fear of childbirth. The results of the study showed that with the increase in spiritual health, anxiety and fear of childbirth decreases. Therefore, it can be inferred that women need spiritual care in addition to medical care to deal with fear and anxiety during pregnancy and childbirth.

The effect of non-pharmacological prenatal interventions on fear of childbirth: an overview of systematic reviews and meta-analysis

BACKGROUND

During pregnancy and childbirth, alongside positive feelings, women undergo feelings such as fear of childbirth (FoC) and worry about its consequences, which could leave negative effects on the mother and her child during pregnancy, delivery, and postpartum. The study was carried out to determine the effectiveness of prenatal non-pharmacological interventions on reducing the FoC.

METHODS

The protocol of the study was registered in PROSPERO (ID: CRD42023468547). PubMed, Web of Science, Cochrane, Scopus, SID (Scientific Information Database) and Google Scholar search engine databases were systematically searched until July 27, 2023 with no limitation of time and limited to Persian and English studies in order to perform this overview. Certainty of evidence was assessed using GRADE, methodological quality using AMSTAR 2 and reporting quality using PRISMA score. Meta-analysis was performed on the data extracted from the original trials to evaluate the effect of different interventions on reducing the FoC. Sub-group analysis and meta-regression models were used to examine high heterogeneity, and sensitivity analysis was used to eliminate the effect of high risk of bias studies on the study findings.

RESULTS

Overall, 15 systematic reviews (SRs) were included in the overview, among which meta-analysis was performed in 9 studies. Considering methodological quality, these SRs were in low to critically low status and had relatively complete reports regarding reporting quality. Meta-analysis findings indicated that psychological interventions (SMD -2.02, 95% CI -2.69 to -1.36, 16 trials, 1057 participants, I2 = 95%) and prenatal educations (SMD -0.88, 95% CI -1.16 to -0.61, 4 trials, 432 participants, I2 = 72.8%) cause a significant reduction in FoC relative to prenatal usual cares with low certainty of evidence. Distraction techniques lead to a significant reduction in FoC relative to prenatal usual care with high certainty of evidence (SMD -0.75, 95% CI -1.18 to -0.33, 4 trials, 329 participants, I2 = 69%), but enhanced cares do not result in a significant decrease FoC relative to prenatal usual care with very low certainty of evidence (SMD -1.14, 95% CI -2.85 to 0.58, 3 trials, 232 participants, I2 = 97%).

CONCLUSIONS

Distraction techniques are effective in reducing FoC. Regarding the effect of psychological interventions and prenatal educations on the reduction of FoC, the findings indicated that the interventions may result in the reduction of FoC. Very uncertain evidence showed that enhanced cares are not effective in reducing the FoC.

Validation of the Chinese version of the Fear of Birth Scale among pregnant women

AIM

Adapt Fear of Birth Scale (FOBS) for the Chinese context, evaluate psychometric properties and determine optimal cutoff point for pregnant women in 3rd trimester.

DESIGN

This is a descriptive cross-sectional study. Cultural guidelines informed the development of the Chinese version of FOBS (FOBS-C) incorporating validation on translation, equivalence index, content validity index, and cognitive debriefing. Thirty pregnant women took a test-retest survey and another 1019 took three cross-sectional surveys. Convergent validation of the FOBS-C involved comparison with Childbirth Attitudes Questionnaire (CAQ), Wijma Delivery Expectancy Questionnaire (WDEQ-A), Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder Scale (GAD-7), and physiological indicators. Cutoff points for FOBS-C were identified using receiver operating characteristic analysis against medical indicators.

FINDINGS

FOBS-C demonstrated high translation equivalence (0.833-1), content validity (0.800-0.933), internal consistency (0.897), and test-retest reliability (0.860). Convergent validity was supported by statistically significant correlations between FOBS scores, heart rate, skin conductance changes, as well as scores from WDEQ-A, CAQ, EPDS, and GAD-7. Known-group validity was observed with different medical indicators. FOBS-C cutoff points indicating severe fear of childbirth were identified as 65, 68, 71, and 56, respectively, against WDEQ-A ≥ 85, CAQ ≥ 52, preference for C-section birth, and preference for analgesia, demonstrating known-group validity. A cutoff point of 65 showed the FOBS-C's strongest known-group validity.

CONCLUSION

The FOBS-C exhibits robust psychometric properties, making it a valid screening tool for identifying severe fear of birth. Establishing a cutoff point at 65 facilitates effective screening.

The Fathers' Fear of Childbirth Scale: a Turkish validity and reliability study

PURPOSE

Fathers' Fear of Childbirth Scale (FFCS) was developed specifically to measure fathers' fear of childbirth. The aim of this study was to investigate the Turkish validity and reliability of the FFCS.

DESIGN

This study used a cross-sectional and methodological design.

METHODS

The population of the study consists of 315 pregnant spouses who were registered at a hospital in Ankara, Turkey, between August 11 and 5 November 2021. The mean age of expectant fathers are 31.57 (5.88). After translating the FFCS to Turkish, a confirmatory factor analysis was conducted to examine its construct validity. Concurrent validity was established by examining the correlation between the FFCS-Turkish with the Fear of Birth Scale (FOBS) and the male version of the Childbirth Fear-Prior to Pregnancy scale (M-CFPP). Both internal consistency and test-retest reliability were examined for the FFCS-Turkish. Results: The scope validity index of the scale was found to be 0.96. Based on the results of confirmatory factor analysis, a two-factor structure with 17 items was verified. The fit indices were found to be χ2 = 309.610, χ2/df = 2.76, root mean square error = 0.075, goodness of fit index = 0.89, comparative fit index = 0.93, and adjusted goodness of fit index = 0.86. All fit indices were at good levels. A strong correlation was found between the FFCS and the FOBS and M-CFPP scales within the scope of concurrent validity. Cronbach's alpha reliability coefficient for the entire scale was 0.93. The test-retest reliability was also high.

CONCLUSIONS

The FFCS is a valid and reliable scale and measurement tool that can be used on Turkish expectant fathers.

Pre- and postpartum fear of childbirth and its predictors among rural women in China

BACKGROUND

Fear of childbirth (FOC) can influence both maternal and child health. Research on FOC in China is scarce, especially on rural women. This study aimed to assess pre- and postpartum FOC and its predictors among Chinese rural women.

METHODS

This was a prospective correlation study. A total of 569 women completed the prenatal questionnaire in the third trimester, and 477 of them completed the postpartum questionnaire within three days after childbirth. Maternal socio-demographic information, clinical information, childbirth self-efficacy and prenatal and postpartum FOC were investigated. FOC was evaluated using the Wijma Childbirth Expectancy/ Experience Questionnaire (WDEQ). Descriptive, bivariate, multivariate linear regression analysis, univariate and multivariate logistic regression analyses were performed.

RESULTS

The mean pre- and postpartum FOC scores were 64.5 (standard deviation: 25.1) and 64.3 (standard deviation: 23.9), respectively, with 20.8% of women reporting severe fear before childbirth and 18.2% after childbirth. Multivariate linear regression analysis revealed predictors for higher levels of prenatal FOC including higher education level, nullipara, higher monthly household income, lower family support, and lower childbirth self-efficacy (p < 0.05) and the predictors for higher levels of postpartum FOC included unemployed status, lower childbirth self-efficacy, and higher prenatal FOC (p < 0.05). Multivariate logistic regression showed that higher childbirth self-efficacy reduced the likelihood of severe prenatal FOC (OR: 0.99, p < 0.001), while severe prenatal FOC increased the likelihood of severe postpartum FOC (OR: 3.57, p < 0.001).

CONCLUSION

The rural women have high levels of FOC before and after childbirth, with approximately 20% experiencing severe FOC during both periods. Higher education level, nullipara, higher monthly household income, lower family support, and lower childbirth self-efficacy are predictors of heightened prenatal FOC. Unemployed status, lower childbirth self-efficacy, and higher prenatal FOC are predictors of heightened postpartum FOC. Notably, enhancing childbirth self-efficacy emerges as crucial in mitigating severe prenatal FOC, while severe prenatal FOC significantly increases the likelihood of severe postpartum FOC. The development of targeted intervention strategies for the above factors can help reduce women's FOC level and improve their overall pregnancy and childbirth experience.

A multilevel developmental psychopathology model of childbirth and the perinatal transition

Despite recent applications of a developmental psychopathology perspective to the perinatal period, these conceptualizations have largely ignored the role that childbirth plays in the perinatal transition. Thus, we present a conceptual model of childbirth as a bridge between prenatal and postnatal health. We argue that biopsychosocial factors during pregnancy influence postnatal health trajectories both directly and indirectly through childbirth experiences, and we focus our review on those indirect effects. In order to frame our model within a developmental psychopathology lens, we first describe "typical" biopsychosocial aspects of pregnancy and childbirth. Then, we explore ways in which these processes may deviate from the norm to result in adverse or traumatic childbirth experiences. We briefly describe early postnatal health trajectories that may follow from these birth experiences, including those which are adaptive despite traumatic childbirth, and we conclude with implications for research and clinical practice. We intend for our model to illuminate the importance of including childbirth in multilevel perinatal research. This advancement is critical for reducing perinatal health disparities and promoting health and well-being among birthing parents and their children.

Subjective Experiences of Pregnancy, Delivery, and Nursing in Transgender Men and Non-Binary Individuals: A Qualitative Analysis of Gender and Mental Health Concerns

Studies of how gender-diverse individuals experience pregnancy, childbirth, and nursing remain few, mainly focus on the US and contain scarce information about mental health concerns peri-partum. This hinders informed reproductive health decisions and counseling. We used in-depth interviews to examine how gestational gender-diverse individuals in Sweden experience the process of planning and undergoing pregnancy, delivery, and nursing. In total, 12 participants, identifying on the masculine side of the gender spectrum or as non-binary, who had attended Swedish antenatal care and delivered a live birth, were included in the study. Data were analyzed using qualitative thematic content analysis. The analysis resulted in one overarching theme: sustaining gender congruence during pregnancy and three main categories: (1) considering pregnancy; (2) undergoing pregnancy and childbirth; and (3) postnatal reflections. The association between childbearing and being regarded as female permeated narratives. Participants renegotiated the feminine connotations of pregnancy, accessed gender-affirming treatment, and concealed their pregnancy to safeguard their gender congruence. Mis-gendering and breast enlargement triggered gender dysphoria. Social judgment, loneliness, information shortages, hormonal influence and cessation of testosterone increased gender dysphoria and strained their mental health. Depression exacerbated gender dysphoria and made it harder to claim one's gender identity. Dissociation was used to handle a feminized body, vaginal delivery, and nursing. Pregnancy was easier to envision and handle after masculinizing gender-affirming treatments. The results deepen the understanding of gender dysphoria and may be used to inform reproductive counseling and healthcare development. Research outcomes on mental health concerns provide a basis for further research.

The comparison of the effect of non-pharmacological pain relief and pharmacological analgesia with remifentanil on fear of childbirth and postpartum depression: a randomized controlled clinical trial

INTRODUCTION

Childbirth may be associated with psychological, social, and emotional effects and provide the background for women's health or illness throughout their life. This research aimed at comparing the impact of non-pharmacological pain relief and pharmacological analgesia with remifentanil on childbirth fear and postpartum depression.

MATERIALS AND METHOD

This randomized clinical trial with two parallel arms was conducted on 66 women with term pregnancy referred to Taleghani Hospital in Tabriz for vaginal delivery during September 2022 to September 2023. First, all of the eligible participants were selected through Convenience Sampling. Then, they were randomly assigned into two groups of pharmacological analgesia with remifentanil and non-pharmacological analgesia with a ratio of 1:1 using stratified block randomization based on the number of births. Before the intervention, fear of childbirth (FOC) was measured using Delivery Fear Scale (DFS) between 4 and 6 cm cervical dilatation. Pain and fear during labor in dilatation of 8 cm were measured in both groups using VAS and DFS. After delivery, FOC was assessed using Delivery Fear Scale (W DEQ Version B) and postpartum depression using the Edinburgh's postpartum depression scale (EPDS). Significance level was considered 0.05. Mean difference (MD) was compared with Independent T-test and ANCOVA pre and post intervention.

RESULTS

The mean score of FOC in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group after the intervention by controlling the effect of the baseline score (MD: -6.33, 95%, Confidence Interval (CI): -12.79 to -0.12, p = 0.04). In the postpartum period, the mean score of FOC in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group after controlling the effect of the baseline score (MD: -21.89; 95% CI: -35.12 to -8.66; p = 0.002). The mean score of postpartum depression in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group (MD: -1.93, 95% CI: -3.48 to -0.37, p = 0.01).

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT): IRCT20170506033834N10. Date of registration: 05/07/2022 Date of first registration: 05/07/2022. URL: https://www.irct.ir/trial/61030; Date of recruitment start date05/07/2022.

CONCLUSION

The study results indicated a reduction in FOC and postpartum depression among parturient women receiving non-pharmacological strategies with active participation in childbirth compared to women receiving pharmacological analgesia. Owing to the possible side effects of pharmacological methods for mother and fetus, non-pharmacological strategies with active participation of the mother in childbirth are recommended to reduce the FOC and postpartum depression.

The effect of interventions in vaginal birth on fear of childbirth: A multicentre study

AIM

This cross-sectional multicentre study aimed to determine the effect of interventions during vaginal birth for fear of childbirth.

METHODS

In this cross-sectional and analytical study, 852 women who had a vaginal birth between 2019 and 2020 were enrolled. Data were collected using the Descriptive Questionnaire and Wijma Birth Expectation/Experience Scale Version B.

RESULTS

The mean total Wijma Birth Expectation/Experience Scale Version B score of the women was 97.00 ± 24.24, indicating severe and clinical levels of fear of childbirth. Moreover, 69.4% of the women had clinical, 18.6% had severe and 12% had moderate levels of fear of childbirth. During birth, women who had close supporters, who were allowed to move and who did not undergo amniotomy, enema, perineal shaving and electronic foetal monitoring had a low level of fear of childbirth. As the number of pregnant women in the labour room, frequency of vaginal examinations, duration of delivery/hour, severity of labour pain and negative perception of the approach of health professionals increased, the women's fear of childbirth increased. Fear of childbirth decreased as the frequency of antenatal follow-ups, number of births and satisfaction levels of the women increased (p < 0.05). Low income perception, irregular prenatal follow-up, severe labour pain and a long duration of labour were strong predictors of increased fear of childbirth. Increasing number of births, high birth satisfaction level and positive perception of the approach of health professionals were strong predictors of reduced fear of childbirth.

CONCLUSIONS

The reduction of interventions in vaginal delivery and support from health care providers during delivery can be effective in reducing fear of childbirth.

Fear of giving birth alone: Experiences of psychological distress, symptoms of anxiety and depression, and coping- strategies of childbearing women during COVID-19

BACKGROUND

Psychological distress during pregnancy is a well-documented risk factor for adverse maternal outcomes. Distress related to the COVID-19 pandemic may further increase the vulnerability of pregnant women to negative mental health outcomes.

AIM

To explore the mental health experiences of pregnant women, focusing on mental health outcomes, challenges related to the pandemic, coping strategies, and factors buffering mental health factors during the restricted COVID-19 lockdown period.

METHODS

A mixed-methods survey study was conducted, examining symptoms of anxiety, depression, and burnout among 21 pregnant women. Qualitative data were gathered through open-ended questions about participants' experiences of challenges, coping strategies and buffering factors amid the pandemic. Symptoms of anxiety, depression and burnout were calculated, and qualitative data was thematically analyzed.

RESULTS

Approximately one-third (24 %) of the respondents reported clinically significant levels of depression, 19 % reported clinically significant levels of anxiety, and 43 % reported experiencing burnout. All participants reported distress and emotional burden, including fear, worry, stress and anxiety related to the pandemic. Specific concerns such as fear of giving birth alone, fear of the consequences due to lockdown restrictions, insufficient information, disruption of prenatal healthcare services, and fear of miscarriage were prevalent among the participants. Social support, financial stability, stable relationships, adherence to daily routines, reduced stress and social demands, a calmer daily life, physical activity, and less work-related stress including working from home, emerges as buffering factors that aided women in coping with pandemic-related distress.

CONCLUSION

Healthcare providers should prioritize stability, predictability, and minimizing disruptions to prenatal care. Broad-based screening is crucial to identify women at risk of depression, anxiety, and burnout. Recommendations for clinical pathways aimed at pregnant women are discussed.

Validity and reliability of the Greek version of Wijma delivery expectancy/experience questionnaire (Version A) among low-risk pregnant women

BACKGROUND

Fear of childbirth is a frequent health issue for pregnant women. The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) is a widely used instrument to measure the fear of childbirth during the antenatal period. The aim of the study was to assess the psychometric properties of the W-DEQ (version A) in a sample of Greek pregnant women.

METHODS

Low-risk pregnant women in the second or third trimester of pregnancy (N = 201) were invited to participate in the study and to complete a booklet of questionnaires including the Greek versions of W-DEQ-A, State-Trait Anxiety Inventory (STAI), Coping Orientations to Problems Experienced (Brief COPE), Perceived Stress Scale (PSS-10) and Edinburgh Postnatal Depression Scale (EPDS). Exploratory (EFA) and confirmatory factor analysis (CFA) was performed.

RESULTS

The mean age of participants was 34.2 years (SD = 4.3 years). EFA yielded six factors ("Lack of self-efficacy", "Lack of positive anticipation", "Lack of feeling lonely", "Concerns about delivery and losing control", "Calmness", and "Concern for the child") of 33 items of W-DEQ-A. CFA confirmed the multidimensionality of the instrument. All Cronbach's alpha were over 0.7, indicating acceptable reliability of the factors. All factors were significantly correlated with each other, and convergent validity was demonstrated by a significant association with stress, anxiety, and depression among low-risk pregnant women.

CONCLUSION

The Greek version of W-DEQ-A proved to be a valid and reliable instrument of fear of childbirth among Greek low-risk pregnant women.

Fear of childbirth and influencing factors of expectant fathers in China: a cross-sectional study

Fear of childbirth not only brings negative psychological experiences to expectant fathers and affect their ability to prepare for parenthood but can even affect children's emotional and cognitive development. It is essential to identify men with a more severe fear of birth and its related risk factors for the better transition of fathers' role. The objective of this study was to investigate the prevalence of fear of childbirth among Chinese expectant fathers, identify its contributing factors and explore the association among fear of childbirth, resilience and dyadic coping. A cross-sectional survey was conducted in the obstetric department of two tertiary hospitals in Wuhan, China. The socio-demographic questionnaire, the father's version of the Wijma Delivery Expectancy/Experience Questionnaire version A (W-DEQ A), the Connor-Davidson Resilience Scale-10 (CD-RISC), and the Dyadic Coping Inventory (DCI) were used to explore the correlation of fear of childbirth, resilience and dyadic coping of participants. Ultimately, a total of 1176 expectant fathers were included in this study. The prevalence of fear of childbirth was 32.1%. Gestational weeks of pregnant women, monthly income, adverse birth experience, gravidity and parity of pregnant women were considered risk factors for the expectant fathers with fear of childbirth. Furthermore, there was a weak negative correlation between fear of childbirth and resilience and dyadic coping. In conclusion, the prevalence of fear of childbirth in expectant fathers in China was high. Adequate identification of factors influencing the fear of childbirth among expectant fathers is necessary to reduce the fear of childbirth and to develop appropriate interventions in preparing fathers for their new parenting role.

Fear of childbirth prolongs interpregnancy interval: A nationwide register-based quantile logistic regression analysis

Introduction

It is not well studied how fear of childbirth (FOC) influences the interpregnancy interval (IPI). Thus, we aimed to analyze the association between FOC and the length of the IPI.

Methods

All women having their first and second pregnancies during the study period (2004-2018) were gathered from the Finnish Medical Birth Register. A logistic regression model was used to assess the association between the FOC and subsequent length of the IPI. The length of the IPI was assessed separately for women with FOC in the first pregnancy, and for women who developed the FOC in the second pregnancy. IPIs with a length in the lower quartal were considered short IPIs, and length in the upper quartal as long IPIs. Adjusted odds ratios (aOR) with 95% CIs were compared between the groups.

Results

A total of 52 709 women with short IPI (<1.05 years), 105 604 women with normal IPI, and 52 889 women with long IPI (>2.57 years) were included. A total of 3606 women had FOC in the first pregnancy, and a total of 11 473 had their first FOC diagnosis in the second pregnancy. Women with FOC in the first pregnancy had lower odds for short IPI (aOR 0.88, CI 0.81-0.95) and higher odds for long IPI (aOR 1.30, CI 1.21-1.40). Women with the first FOC diagnosis in the second pregnancy had higher odds for long IPI (aOR 1.68, CI 1.61-1.75), When only vaginal deliveries in the first pregnancy were included, women with FOC in the second pregnancy had lower odds for long IPI (aOR 0.71, CI 0.66-0.75) and higher odds for long IPI (aOR 1.52, CI 1.41-1.62), when only cesarean section was included.

Conclusion

The main finding of this study was that women with FOC had notably higher odds for long IPI. The etiologic and background factors behind FOC should be better recognized and prevented, and FOC should not only be considered as a complicating factor for pregnancy and delivery but also a factor that strongly affects the desire of women to get pregnant again.

Kaleidoscope of emotions in hospital childbirth: A phenomenological study

The childbirth process represents a moment of transition in the life of each woman, and is a source of complex and dynamic emotions. The aim of this study was to describe the emotions women experience during hospital childbirth and to determine the conditioning factors. A qualitative prospective study with a phenomenological approach was conducted using semi-structured interviews with 42 women. The negative emotions the women highlighted were fear, anguish, suffering, concern and nervousness, and they were related to factors such as: the evolution of childbirth, the appearance of complications, pain, the doubt about the ability to give birth and poor communication. The positive emotions highlighted were joy, satisfaction, security, confidence and tranquillity, and they were related to the first skin-to-skin contact, effective communication, partner support and participation in decisions. The findings may contribute to the development of policies aimed at achieving the women and newborns' maximum health and life potential.

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.

Neglected medium-term and long-term consequences of labour and childbirth: a systematic analysis of the burden, recommended practices, and a way forward

Over the past three decades, substantial progress has been made in reducing maternal mortality worldwide. However, the historical focus on mortality reduction has been accompanied by comparative neglect of labour and birth complications that can emerge or persist months or years postnatally. This paper addresses these overlooked conditions, arguing that their absence from the global health agenda and national action plans has led to the misconception that they are uncommon or unimportant. The historical limitation of postnatal care services to the 6 weeks after birth is also a contributing factor. We reviewed epidemiological data on medium-term and long-term complications arising from labour and childbirth beyond 6 weeks, along with high-quality clinical guidelines for their prevention, identification, and treatment. We explore the complex interplay of human evolution, maternal physiology, and inherent predispositions that contribute to these complications. We offer actionable recommendations to change the current trajectories of these neglected conditions and help achieve the targets of Sustainable Development Goal 3. This paper is the third in a Series of four papers about maternal health in the perinatal period and beyond.

Experiences of success and failure in childbirth

AIMS

To determine what kinds of birth-related experiences of success and failure are described by the participants, and whether there are differences according to fear of childbirth and parity. Studying these experiences is important for understanding the psychological mechanisms behind different childbirth experiences and their impact on maternal mental well-being.

METHODS

This was a longitudinal mixed methods study. Descriptions of the birth experiences of 113 Finnish participants were gathered in a survey at 4-8 weeks postpartum and analysed with content analysis. Fear of childbirth was determined antenatally with the Wijma Delivery Expectations scale (W-DEQ A).The number of success and failure expressions were compared between people with FOC and others and between primiparous and multiparous people.

RESULTS

The contents of the childbirth-related experiences of success and failure were categorised into 12 subcategories, organised under three higher-order categories that were named personal factors, course of childbirth, and support. The most typical expressions of success were in the categories of mode of birth, staff, and mental factors, and the most typical expressions of failure in the categories of staff and mental factors. Experiences of failure were more often expressed by primiparous than multiparous people, but there were no statistically significant differences by FOC. Expressions of success were equally common regardless of parity or FOC.

CONCLUSION

Postpartum people categorise aspects of their birth experiences in terms of success and failure. Primiparous people are more susceptible to experiencing failure at childbirth, but possible differences between people with FOC and other people warrant further investigation.

Stress is not so bad-cortisol level and psychological functioning after 8-week HIIT program during pregnancy: a randomized controlled trial

Background

Amid extensive pregnancy exercise research, the impact of High Intensity Interval Training (HIIT) on pregnant women's mental health is underexplored. Despite exercise benefits, it can trigger stress responses like elevated cortisol. This study fills the gap by investigating correlations between hair cortisol levels, mental health, and HIIT effects in pregnant women.

Methods

We conducted a randomized control trial among 38 Caucasian women in uncomplicated, singleton pregnancy (age 31.11 ± 4.03 years, 21.82 ± 4.30 week of gestation; mean ± SD). The experimental group comprised 22 women engaged in an 8-week high-intensity interval training program (HIIT). The comparative group consisted of 16 pregnant women undergoing an 8-week educational program (EDU). Before and after the interventions, all women were evaluated using the following tools: Hair cortisol level measurements, Beck Depression Inventory - II for depressive symptoms assessment, Childbirth Attitudes Questionnaire for childbirth fear measurement, 12-item Short Form Health Survey to gage health-related quality of life, International Physical Activity Questionnaire for physical activity level estimation, and a Progressive maximal exercise test to evaluate maternal exercise capacity.

Results

The key finding of our study reveals that women engaged in the HIIT intervention exhibited a distinct cortisol production pattern in contrast to the EDU group practicing standard moderate intensity physical activity. In the HIIT group, there was an increase in hair cortisol levels, while the EDU group showed a notable decrease. Remarkably, HIIT stimulated cortisol production without adversely impacting fear of childbirth and psychophysical condition during pregnancy. In fact, only the HIIT group showed a significant enhancement in mental health.

Conclusion

No links were discovered between hair cortisol levels and the severity of depressive symptoms, psychophysical well-being, or fear of childbirth. Hence, based on our research, employing cortisol levels during pregnancy as an indicator of negative stress or depression risk appears unwarranted.

The prevalence and associated factors of fear of childbirth among Turkish pregnant women

OBJECTIVE

This study was conducted to determine the prevalence of fear of childbirth and affecting factors in pregnant women in Turkey.

MATERIALS AND METHODS

This was a cross-sectional study and included a total of 2025.    Pregnant Women Assessment, some variables related to previous and current perinatal processes and Wijma Delivery Expectancy/Experience Questionnaire (version A) were used for data collection.

FINDINGS

In this sample, 42.4% of the women reported fear of childbirth. What the women were afraid of most was the development of unwanted conditions at childbirth, obscurity/uncertainty, and negative attitudes of health professionals. The factors causing fear of childbirth were the low education level, unemployment status, low financial status, stillbirth, unplanned pregnancy, indecisiveness about the type of delivery, not attending prenatal education programs, negative effects of other people, insufficient social support, confiding in the healthcare centre and health professional, negative, and indecisive birth perceptions, prior negative birth experiences and not feeling ready for childbirth (p < 0.001).

CONCLUSIONS

The prevalence of fear of childbirth in this Turkish sample, especially in the multipara is higher than in Western countries. Causes of fear of childbirth can vary with countries and even with each region of a country.

Anxiety and depression in pregnancy: associated variables during the COVID-19 pandemic period

OBJECTIVE

To assess the association between age, parity, nationality, educational level, employment and partner support with depression and anxiety during pregnancy. To determine the impact of the evolution of the COVID-19 pandemic on the anxiety and depression levels of the participants.

METHOD

Cross-sectional descriptive correlational study carried out in the Osakidetza/Basque Health Service, Primary Care, Bizkaia (Spain). A total of 295 pregnant women between 8 and 41 weeks participated. The association between age, parity, nationality, educational level, employment, partner support and COVID-19 incidence rates during the study period and depression (measured with the Edinburgh Postnatal Depression Scale) and anxiety (measured with the State-Anxiety Inventory/STAI-S subscale) scores during pregnancy was measured. A logistic regression model was constructed and odds ratios and their 95% confidence intervals were estimated.

RESULTS

The mean score was 18.75 points for anxiety (SD=8.69) and 6.45 points for depression (SD=4.32). Women expecting their second or later child had higher scores for depression (OR 2.51[95%IC: 1.26-5.01)) and anxiety (OR 1.98 [95%IC: 1.01-3.89]). Having completed university studies was associated with lower scores in depression (OR 0.28 [95%IC: 0.11-0.77]) and in anxiety (OR 0,2 [95%IC: 0.08-0.54]). A good relationship with the partner was associated with lower levels of anxiety (OR 0.45 [95%IC: 0.24-0.81]). The mean anxiety and depression scores are related to the incidence of COVID-19 cases; the anxiety score was significantly higher in periods of higher incidence.

CONCLUSIONS

Greater emotional care for pregnant women with low educational level, multiparous and with weak support from their partner, would reduce anxiety and depression in pregnancy. Health emergency situations affect mental health during gestation.

The effect of interventions in alleviating fear of childbirth in pregnant women: a systematic review

BACKGROUND

The Fear of Childbirth (FOC) is regarded as a general problem, which affects women's health and well-being, justifying demanding caesarean section. Several primary studies have been performed in relation to the interventions performed to reduce the fear of childbirth, which show contradictions between the results of these studies.

OBJECTIVE

This review aims to provide a comprehensive review of the different types of interventions used to reduce the fear of childbirth in pregnant mothers.

METHODS

In this study, systematic review of study information related to the effect of different therapies on reducing the fear of childbirth using subject-related keywords and validated with MeSH in SID, MagIran, IranMedex, IranDoc, Embase, ProQuest, Scopus, PubMed, Web of Science (ISI) databases and Google Scholar Search Engine were extracted without any time limit until February 2021.

RESULTS

After removing duplicates and irrelevant works from among the 5396 articles found, 63 articles remained in the study. The participants in these 63 articles were 5415 cases and 5770 controls. In addition, three studies were on epidural anesthesia, 33 on the effects of psychotherapy, 19 on the effects of education, and eight on the influence of other interventions on alleviating FOC. As shown by the results, psychotherapy intervention and education decreased FOC significantly.

CONCLUSION

According to the results of this study, to prevent the fear of childbirth, pregnancy training and prenatal preparation courses are recommended to empower pregnant women. It also seems beneficial to use psychotherapy approaches for women who are afraid of childbirth.

Cost-Effectiveness of the Mindfulness-Based Childbirth and Parenting Program for Pregnant Women With Fear of Childbirth

OBJECTIVE

To examine the cost-effectiveness of the Mindfulness-Based Childbirth and Parenting (MBCP) program compared with enhanced care as usual (ECAU).

DESIGN

Randomized controlled trial.

SETTING

Midwifery settings in the Netherlands, April 2014 to July 2017.

PARTICIPANTS

Subset of pregnant women with high levels of fear of childbirth (N = 54: randomized to MBCP, n = 32, or to ECAU, n = 22) who were selected from the parent study because they completed all four cost questionnaires.

METHODS

We measured self-reported health care and non-health care costs. A subset of participants from the parent study completed the questionnaires at all four assessment points. We used the Wijma Delivery Expectancy Questionnaire to measure fear of childbirth and used the EuroQol-5D to measure quality of life. We used these measures of effect together with societal costs in the primary cost-effectiveness analyses. In the secondary cost-effectiveness analyses, we used different estimates of effects and costs to test the robustness of the primary analyses.

RESULTS

In all but one scenario, MBCP was more effective and cost less than ECAU. As indicated by the acceptability curves, the likelihood of MBCP being cost-effective varied within a range of 70% to 98%.

CONCLUSION

Our findings indicate that MBCP is a cost-effective intervention to reduce fear of childbirth in pregnant women. Important next steps are to replicate the study in countries with different health care systems and to explore the potential for further integration of MBCP into midwifery care.

Determinants of Prenatal Childbirth Fear during the Third Trimester among Low-Risk Expectant Mothers: A Cross-Sectional Study

BACKGROUND

Fear of Childbirth (FOC) can significantly impact women's physical and psychological health; therefore, healthcare providers must provide proactive care, which means they have to intervene before FOC becomes tokophobia. This study's purpose is to evaluate the determinants of prenatal childbirth fear during the third trimester among low-risk expectant mothers.

METHODS

A cross-sectional comparative study was conducted at the Maternal and Children Hospital's outpatient clinics in Najran City, Saudi Arabia, from April to July 2023. The study involved 377 nulliparous and multiparous women, using a systemic random sampling technique. The data were collected using an interview schedule composed of questions related to demographic and obstetrics characteristics, the FOC questionnaire, and a multidimensional scale of perceived social support. Significant FOC predictors were examined using a binary logistic regression model.

RESULTS

There was a statistically significant difference between nulliparous and multiparous participants concerning FOC; 80.0% of nulliparous participants had significant FOC compared to 67.8% of multiparous participants (p = 0.011). A binary logistic regression clarified that regular antenatal care and family and spousal support were significantly negatively correlated with significant FOC among multiparous and nulliparous women (p < 0.05). For multiparas, FOC was associated with pregnancy planning and previous labor-related complications. In addition, friends' support was an important predictor of significantly lower FOC among nulliparous women (p < 0.05).

CONCLUSIONS

Significant FOC was higher in nulliparous women when compared to multiparous women. Numerous obstetric variables and different types of social support play important roles in significant FOC. Special attention and support should be provided to high-risk women for proper FOC management during prenatal classes to improve their childbirth experiences.

Beyond Fear: Unveiling the Relationship Between Fear of Childbirth and Pharmacological Pain Relief

BACKGROUND

Pharmacological analgesia is the dominant method for pain relief in labor. Fear of childbirth (FOC) may significantly affect women's preferences for and usage of pharmacological analgesia.

AIM

This study aimed to investigate the relationship between FOC in late pregnancy and preferences for, as well as actual use of, pharmacological analgesia among nulliparous and multiparous women, accounting for confounding factors.

METHODS

A total of 1,300 women participated in the study, completing questionnaires assessing preferences for pharmacological analgesia, FOC, perception of labor pain, social support, coping styles, and demographic variables. The actual use of pharmacological analgesia was followed up. The data were analyzed using univariate and multivariate regression analyses.

RESULTS

Univariate analysis revealed that women with moderate to severe FOC had a stronger preference for pharmacological analgesia compared to those with none to mild FOC. However, multivariate analysis showed no direct association between FOC and actual usage of pharmacological analgesia. Instead, a stronger preference for pharmacological analgesia increased the likelihood of its actual usage during labor.

CONCLUSIONS

Our study underscores the effect of FOC on preferences for pharmacological analgesia and its potential influence on actual usage during labor. Healthcare providers should consider women's FOC and preferences when evaluating pain management options. Targeted interventions focusing on promoting non-pharmacological techniques should be implemented to optimize labor pain management for women, particularly nulliparous women.

Expecting the uncertain: The applicability of the intolerance of uncertainty model on fear of childbirth

A considerable number of pregnant women experience fear of childbirth (FOC), characterized by worries and fear of the unpredictable. Despite this, the psychological processes in FOC have received notably little attention. The aim of this study was to advance the understanding by exploring the applicability of the Intolerance of Uncertainty (IU) model on FOC. Anonymous data was collected in a sample of pregnant women (N = 357) with varying levels of FOC. Analyses supported the associations between FOC and all proposed psychological processes: IU, negative problem orientation, positive beliefs about worry and avoidance of inner experiences. The exploration of potential mediators of the relation between IU and FOC revealed that, of the three processes from the model, only positive beliefs about worry were a mediator, and more specifically, a partial mediator between IU and FOC. These findings add to the theoretical understanding of FOC, by indicating that the role of IU may be similar to other conditions inflicted by worry and anxiety, which may inform treatment development.

The effect of continuous intrapartum supportive care on maternal mental health: a randomized controlled trial

Supportive care during labor is the primary role of intrapartum nurses and midwives and provides comfort for women allowing them to have a positive experience. It is argued that supportive care during labor reduces fear and resultant side effects. However, evidence for different parameters of mental health is insufficient. The aim of this study was to evaluate the effect of continuous intrapartum supportive care on the fear of childbirth, perceived control and support at birth, birth trauma and maternal attachment. This is a randomized controlled study with an intervention group and a control group. The intervention group included 40 women receiving continuous intrapartum supportive care and the control group included 40 women receiving routine care. Thirty women in the intervention group and 29 women in the control group completed the study. No significant differences were detected between the two groups at baseline (p > .05). Continuous intrapartum supportive care significantly decreased fear of birth and birth trauma, and significantly increased perceived intrapartum control and support and postpartum maternal attachment (p < .01). Results from this evidence-based study suggest that continuous intrapartum supportive care could protect and maintain perinatal mental health.

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.

Investigating Factors Influencing Prenatal Stress, Anxiety, and Fear of Childbirth During the COVID-19 Pandemic in Germany and Switzerland: An Online Survey

OBJECTIVES

Pregnant women are likely to experience high levels of stress during the COVID-19 pandemic. However, the factors that might influence the extent of experienced emotional distress are poorly understood. Therefore, we aimed to investigate potential correlates of prenatal emotional distress during the COVID-19 pandemic.

METHODS

In total, N = 1437 pregnant women from Germany and Switzerland participated in an online study during the first wave of the COVID-19 pandemic (May-August 2020). The survey assessed prenatal distress, pandemic-related pregnancy stress, general anxiety, fear of childbirth, and several socio-demographic, pregnancy- and COVID-19-related factors. Linear multivariate regression models were the main analytical strategy.

RESULTS

The results highlight that several factors such as full-time employment, nulliparity, high-risk pregnancy, emotional problems, cancelled prenatal appointments, and stating that COVID-19 affected the choice of birth mode were significantly associated with elevated prenatal distress, anxiety, pandemic-related pregnancy stress, and fear of childbirth. Conversely, access to an outdoor space was a protective factor for pandemic-related pregnancy stress and prenatal distress.

CONCLUSIONS FOR PRACTICE

Overall, the study highlights significant correlates influencing the levels of emotional distress pregnant women experienced during the COVID-19 pandemic. These findings may contribute to the improvement of maternal prenatal medical and psychological care during a public health crisis of international concern, such as the COVID-19 pandemic.

Cognitive processing biases associated with fear of childbirth

Fear of childbirth (FOC) is a phobic-like response concerning the prospect of giving birth. FOC can have negative implications for women during pregnancy and can impact their birthing experience. Cognitive processing biases (e.g., difficulty disengaging from threatening information, interpreting ambiguous information as threatening, and preferentially recalling threatening content) have previously been found to maintain general anxiety and low mood. To date, there has been no research assessing these attention, interpretation, and memory biases and their relationship with FOC in pregnant women. Accordingly, in this cross-sectional study, participants who were at least 12 weeks pregnant (n = 116), recruited through a local hospital trust, completed tasks assessing attention (emotional Stroop task), interpretation (scrambled sentences test), and explicit memory (recognition task) biases with materials including FOC-related content. They also completed three separate measures of FOC and measures of low mood, general anxiety, worry, and rumination. We found that a negative interpretation bias (but not attention or explicit memory biases) was associated with higher levels of FOC. These findings indicate that women presenting with higher FOC are more likely to demonstrate negative interpretation biases for ambiguous information relating to childbirth, which may inform research developing interventions to support women presenting with FOC.

Fear of childbirth: prevalence and associated factors in pregnant women of a maternity hospital in southern Brazil

BACKGROUND

The fear of childbirth (FOC) harms maternal and fetal health, however it has been little studied in Brazil. This research aimed to determine the prevalence of FOC in a maternity hospital in southern Brazil and identify its associated factors.

METHODS

The Wijma Delivery Expectancy Questionnaire - W-DEQ(A) was used to assess the prevalence of FOC, and its relationship with sociodemographic variables, gestational history, aspects of the current pregnancy, knowledge about childbirth, anxiety symptoms (Beck Anxiety Inventory), depressive symptoms (Edinburgh Postnatal Depression Scale), and perception of social support (Multidimensional Scale of Perceived Social Support) was investigated. Questionnaires about the content of FOC and information sources regarding childbirth were also applied.

RESULTS

We interviewed 125 pregnant women between 28 and 36 weeks of pregnancy between July and September of 2021, and 12% of them scored ≥ 85 on the W-DEQ(A), indicating severe FOC. There was a significant correlation between FOC and anxiety symptoms (r = 0.50, p < 0.001), depressive symptoms (r = 0.34, p < 0.001), and poor social support (r = -0.23, p = 0.008). FOC was lower in pregnant women with complete elementary education when compared to those with higher education (p = 0.003), however, those with negative experiences in previous deliveries had more FOC than those who had had positive experiences (p = 0.001). More than 85% of them fear fetal distress.

CONCLUSIONS

FOC is a prevalent condition that impacts the mental health of pregnant women. Therefore, health professionals should recognize and address it during prenatal care to provide integral maternal-fetal care and improve the childbirth experience.

Measuring Fear of Childbirth Among a Diverse Population in the United States: A Revised Wijma Delivery Expectancy/Experience Scale (WDEQ-10)

INTRODUCTION

The current gold standard instrument used to measure fear of childbirth is the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ). However, the existing scale is long, has translational challenges, and lacks data specific to experiences of a diverse population in the United States, making it challenging to assess how fear of childbirth impacts perinatal health care disparities. The objective of this study was to revise the WDEQ and analyze its reliability and validity for use in the United States.

METHODS

The questionnaire was revised using qualitative data from a previously published study of fear of childbirth within a racially, ethnically, and economically diverse group of pregnant or postpartum people in the United States. Psychometric properties were analyzed in terms of construct validity, reliability, and factor analysis from a group of 329 participants.

RESULTS

The revised and shortened 10 item WDEQ-10 comprises 3 subscales: fear of environmental factors, fear of death or injury, and fear of how they feel. The results indicate that the WDEQ-10 demonstrates good reliability and validity and confirmed the multidimensionality of fear of childbirth through a 3-factor solution.

DISCUSSION

The WDEQ-10 is a readable and accessible instrument that will allow health care providers and researchers to accurately measure complex components of how pregnant people experience fear of childbirth.

A Systematic Review of Tocophobia Rate Before and During the COVID-19 Pandemic

Introduction: Childbirth is a phenomenon that causes stress to future mothers. The fear of childbirth is complemented by the fear that prevails all over the world due to the COVID-19 pandemic. Childbirth alone entails many risks; adding to them the COVID-19 outbreaks lead to a considerable amount of uncertainty that affects the psychology of pregnant women. Aim:The present study aims at comparing the rate of tocophobia before and during the COVID-19 pandemic through a systematic review of studies published before and during the COVID-19 pandemic. Methods:The methodology used in this study comprised an advanced search in several scientific databases and the recovery of relevant quantitative studies. Results:The review included a total of 18 research papers published in English from January 2009 to April 2023, which examined the phenomenon of tocophobia before and during the COVID-19 pandemic. Conclusion:This systematic review shows that tocophobia was more prevalent after the outbreak of the COVID-19 pandemic (ranging from 4.8%-20.8% before the COVID-19 pandemic and 10.6%-62% during the COVID-19 pandemic). It seems that the increase in tocophobia rate after the onset of the COVID-19 pandemic ranged from 6.4% to 54.3%. According to our review, tocophobia constitutes a major source of anxiety, especially during the COVID-19 pandemic. Therefore, governments should take appropriate action, especially in times of the COVID-19 pandemic, to ensure a more secure and friendly hospital setting for pregnant women.

Norwegian midwiveś experiences of encounter and support women with fear of childbirth during birth

OBJECTIVE

To describe midwiveś experiences of encountering and supporting women with fear of childbirth (FOC) during the birth.

METHOD

Qualitative study with a phenomenological approach, using 10 individual semi-structured interviews with midwives who had cared for women with FOC during the birth. All midwives worked in birth clinics or maternity wards. The data was analysed using Malterud́s systematic text condensation (STC).

RESULTS

The findings present in three main themes: taking on a professional role as a midwife to take care of women; time matters for safety and trust; and to encounter and see women without prejudices. Themes to describe a 'professional midwife' included self-confidence, control, competence/experience, independence, promoting normal birth, and motivation. Time played a crucial role in enabling a calm approach and a relationship built on trust, as well as in creating a sense of continuity and being present. Individual care and equality among the women was of importance to prevent prejudices, as was having control of the term FOC. Self-awareness was also important for evaluating the quality of the relationship, and the midwives' wanted clear guidelines for handling women with FOC.

CONCLUSION

Aspects related to professional midwifery skills, organisational factors such as time to establish safety and trust, and use of the concept of FOC, are all important for midwives when encountering and supporting women with FOC at birth. All these aspects need to be improved in the care of women with FOC, and clearly defined guidelines for handling such cases need to be developed.

Optimising maternity care for a subsequent pregnancy after a psychologically traumatic birth: A scoping review

BACKGROUND

Psychological birth trauma is recognised as a significant and ubiquitous sequelae from childbirth, with the incidence reported as up to 44%. In a subsequent pregnancy, women have reported a range of psychological distress symptoms from anxiety, panic attacks, depression, sleep difficulties and suicidal thoughts.

AIM

To summarise evidence on optimising a positive pregnancy and birth experience for a subsequent pregnancy following a psychologically traumatic pregnancy and identify research gaps.

METHODS

This review followed the Joanna Briggs Institute methodology for scoping reviews and the PRISMA-ScR check list. Six databases were searched using key words relating to psychological birth trauma and subsequent pregnancy. Utilising agreed criteria, relevant papers were identified, and data were extracted and synthesised.

RESULTS

A total of 22 papers met the inclusion criteria for this review. All papers addressed different aspects of what was important to women in this cohort, summarised as women wanting to be at the centre of their care. Pathways of care were diverse ranging from free birth to elective caesarean. There was no systematic process for identifying a previously traumatic birth experience and no education to enable clinicians to understand the importance of this.

CONCLUSION

For women who have experienced a previous psychologically traumatic birth, being at the centre of their care, in their subsequent pregnancy, is a priority. Embedding woman-centred pathways of care for women with this experience, as well as multidisciplinary education on the recognition and prevention of birth trauma, should be a research priority.

Fear of childbirth and use of labor analgesia: A nationwide register-based analysis in Finland

OBJECTIVE

To calculate the rates of labor analgesia among women with fear of childbirth (FOC) in multiparous and nulliparous women, because FOC might be associated with higher rates of labor analgesia.

METHODS

In this retrospective register-based cohort study, data from the National Medical Birth Register was used to evaluate the usage of labor analgesia in pregnancies with FOC, when compared with those without. The analgesia methods were stratified into neuraxial analgesia, pudendal, paracervical, nitrous oxide, other medical, other non-medical, and no analgesia.

RESULTS

A total of 19 285 pregnancies with diagnosed maternal FOC were found during our study period. The control group consisted of 757 997 pregnancies without diagnosed maternal FOC. Nulliparous women with diagnosed FOC had a higher rate of epidural analgesia (70.2% vs 67.1%), spinal analgesia (12.3% vs 7.6%), and pudendal block (17.6% vs 9.6%). Multiparous women with FOC had a notably higher rate for epidural analgesia (47.0% vs 29.0%).

CONCLUSION

The main finding in this study was that women with diagnosed FOC had a higher rate of labor analgesia. The results of this study can be used by midwives, obstetricians, and anesthesiologists to provide optimal pain relief for mothers with FOC.

Early-stage pregnancy recognition on microblogs: Machine learning and lexicon-based approaches

Pregnancy carries high medical and psychosocial risks that could lead pregnant women to experience serious health consequences. Providing protective measures for pregnant women is one of the critical tasks during the pregnancy period. This study proposes an emotion-based mechanism to detect the early stage of pregnancy using real-time data from Twitter. Pregnancy-related emotions (e.g., anger, fear, sadness, joy, and surprise) and polarity (positive and negative) were extracted from users' tweets using NRC Affect Intensity Lexicon and SentiStrength techniques. Then, pregnancy-related terms were extracted and mapped with pregnancy-related sentiments using part-of-speech tagging and association rules mining techniques. The results showed that pregnancy tweets contained high positivity, as well as significant amounts of joy, sadness, and fear. The classification results demonstrated the possibility of using users' sentiments for early-stage pregnancy recognition on microblogs. The proposed mechanism offers valuable insights to healthcare decision-makers, allowing them to develop a comprehensive understanding of users' health status based on social media posts.

Fear of childbirth and its determinants in pregnant women in the third trimester: a cross-sectional study

BACKGROUND

Fear of childbirth (FOC) is a prevalent issue among pregnant women and significantly relates to adverse outcomes for the mother and child. However, it is not clear the prevalence and risk factors of FOC among pregnant women in a region with a moderate level of economic development in China. The aim of this study was to investigate the prevalence and risk factors of FOC among pregnant women in the third trimester of pregnancy in Lianyungang city, Eastern China.

METHODS

A cross-sectional survey was conducted from December 2022 to February 2023 among pregnant women in the third trimester who met the inclusion criteria and visited Lianyungang Maternal and Child Health Hospital in Jiangsu Province, Eastern China. A structured questionnaire including sociodemographic characteristics, clinical characteristics, FOC, family function, doctor-patient communication, social support, general self-efficacy, anxiety, depression, insomnia symptoms, and quality of life was used to collect data. A multiple linear regression model was used to identify predictors of FOC.

RESULTS

This study included 535 pregnant women in the third trimester. The mean score of FOC was 30.67 ± 10.18, and the median score was 29.00. The prevalence of FOC was 56.64%. Multiple linear regression analysis revealed that pregnant women with electronic screen exposure time more than 5 h per day (β = 2.02, 95%CI: 0.50-3.53, P < 0.05), no history of cesarean section (β = 2.66, 95%CI: 0.61-4.71, P < 0.05), likes sour food or hates greasy food (β = 1.75, 95%CI: 0.00-3.50, P < 0.05), anxiety (β = 0.50, 95%CI: 0.21-0.80, P < 0.05) and depression (β = 0.30, 95%CI: 0.04-0.57, P < 0.05) were more likely to have a greater level of FOC than their counterparts. However, a significantly lower level of FOC was observed in pregnant women who were multipara (β=-1.64, 95%CI: -3.27-0.01, P < 0.05), not worrying about delivery without family members (β=-3.75, 95%CI: -5.26-2.25, P < 0.001), had good family function (β=-0.32, 95%CI: -0.64-0.00, P < 0.05) and doctor-patient communication (β=-0.33, 95%CI: -0.64-0.02, P < 0.05).

CONCLUSIONS

The prevalence of FOC was high in Lianyungang city, Eastern China. FOC is influenced by multiple factors. There is an urgent need to develop interventions to reduce the prevalence of FOC in the third trimester of pregnancy, and to pay attention to pregnant women with risk factors for FOC.

Validation of the Iranian version of the Postpartum Specific Anxiety Scale 12-item research short-form for use during global crises (PSAS-IR-RSF-C)

BACKGROUND

Due to its high pervasiveness and adversarial consequences, postpartum anxiety has been one of the most worrying public health concerns in the last decade. According to previous research, the occurrence of mental disorders among women in the postpartum period upsurges significantly in the course of universal disasters. The Postpartum Specific Anxiety Scale - Research Short Form - for use in global Crises [PSAS-IR-RSF-C] has not been used in Iran for postpartum women during a health system shock. Consequently, this study was conducted to determine the validity and reliability of the Persian version (PSAS-IR-RSF-C) during the COVID-19 pandemic.

METHODS

This cross-sectional study was performed with 180 women who were between six weeks and six months after delivery, by random sampling method from December 2021 to June 2022. The validity of the PSAS-RSF-C in terms of face, content, was analyzed, and the construct validity was assessed using exploratory and confirmatory factor analyses. Internal consistency and test-retest reliability of the questionnaire were measured using (Cronbach's alpha, McDonald's ω) and intraclass correlation coefficient (ICC), respectively.

RESULTS

The content validity index and content validity ratio of the Persian version of the PSAS-IR-RSF-C were 0.96 and 0.98, respectively. A three-factor structure was extracted during the exploratory factor analysis process, and model validity was confirmed by the values of fit indices. Cronbach's alpha coefficient, McDonald's ω and intra-cluster correlation coefficient (95% confidence interval) were 0.74, 0.92 (0.78 to 0.93) and 0.97 (0.93 to 0.98), respectively.

CONCLUSIONS

For the specific assessment of postpartum anxiety among Iranian women during crises, the Persian version of the PSAS-IR-RSF-C is a valid and reliable tool.

Prenatal wellbeing of mothers, their partners, and couples: a cross-sectional descriptive study

BACKGROUND

Prenatal posttraumatic stress symptoms (PTSS), fear of childbirth (FOC), and depressive symptoms have been related to various negative effects during pregnancy, childbirth, and in the postnatal period. This study evaluates the prevalence of PTSS, FOC, depressive symptoms, and health-related quality of life (HRQoL) among pregnant women, their partners, and as couples.

METHODS

In a cohort of 3853 volunteered, unselected women at the mean of 17th weeks of pregnancy with 3020 partners, PTSS was evaluated by Impact of Event Scale (IES), FOC by Wijma Delivery Expectancy Questionnaire (W-DEQ-A), depressive symptoms by Edinburgh Postnatal Depression Scale (EPDS), and HRQoL by 15D instrument.

RESULTS

PTSS (IES score ≥ 33) was identified among 20.2% of the women, 13.4% of the partners, and 3.4% of the couples. Altogether, 5.9% of the women, but only 0.3% of the partners, and 0.04% of the couples experienced symptoms suggestive of phobic FOC (W-DEQ A ≥ 100). Respectively, 7.6% of the women, 1.8% of the partners, and 0.4% of the couples reported depressive symptoms (EPDS ≥ 13). Nulliparous women and partners without previous children experienced FOC more often than those with previous children, but there was no difference in PTSS, depressive symptoms, or HRQoL. Women's mean 15D score was lower than partners' and that of age- and gender-standardized general population, while partners' mean 15D score was higher than that of age- and gender-standardized general population. Women whose partners reported PTSS, phobic FOC, or depressive symptoms, often had the same symptoms (22.3%, 14.3%, and 20.4%, respectively).

CONCLUSIONS

PTSS were common in both women and partners, as well as in couples. FOC and depressive symptoms were common in women but uncommon in partners, thus they rarely occurred simultaneously in couples. However, special attention should be paid to a pregnant woman whose partner experiences any of these symptoms.

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.

Effect of lifestyles on fear of pregnancy: Development and psychometric testing of the fear of pregnancy scale

OBJECTIVE

Pregnancy may be a cause of fear for some women. Fear of pregnancy is a woman's belief that her health or life may get worse due to pregnancy. This study aimed to develop a valid and reliable instrument to measure fear of pregnancy in women, and determine the effect of lifestyle on fear of pregnancy.

METHODS

This study was conducted in three phases. For the first phase, item generation and selection were made through qualitative interviews and literature review. In the second phase, items were administered to 398 women of reproductive age. The scale development phase was completed with exploratory factor analysis and internal consistency analysis. In the third phase, the Fear of Pregnancy Scale was developed, and was administered, together with the Lifestyle Scale, to women of reproductive age (n = 748).

RESULTS

The Fear of Pregnancy Scale was found to be a valid and reliable instrument for women of reproductive age. Perfectionism, control and self-esteem lifestyles were found to influence fear of pregnancy. Furthermore, fear of pregnancy was significantly more common in primiparous women and women with insufficient information about pregnancy.

CONCLUSION

This study found that fear of pregnancy was moderate and varied with lifestyle. Factors associated with fear of pregnancy that remain unspoken, and how they affect women's lives are not yet known. Evaluation of fear of pregnancy in women can be an important step in showing adaptation to future pregnancy, and revealing its effects on reproductive health.

The effectiveness of mindfulness-based interventions on self-efficacy and fear of childbirth in pregnant women: A systematic review and meta-analyses

BACKGROUND

Mindfulness-based interventions are a relatively new and potentially useful psychological approach in prenatal care. This study aimed to determine the effect of mindfulness-based programs on pregnant women's fear of childbirth FOC and self-efficacy.

METHODS

The systematic search of PubMed, Scopus, Web of Science, Cochrane Library, Google Scholar, SID, and Magiran databases began on 11 November 2021 and ended on 17 December 2021 to obtain studies published in English and Persian without date constraints. Another search was conducted in March 2023. The Cochrane handbook tool was used to evaluate selected studies and their risk of bias.

RESULTS

From a total of 316 records obtained, after removing duplicate items, 16 full texts were evaluated for eligibility; and finally, 10 studies were included in the study and meta-analysis. Based on the results of meta-analyses, mindfulness-based exercises may improve childbirth self-efficacy (SMD = 1.34, 95 % CI: 0.39 to 2.30; P < 0.00001; 5 studies, 304 women; low-certainty evidence) and probably reduce the level of FOC (SMD = -0.71, 95 % CI: -1.14 to -0.27; P = 0.001; 5 studies, 424 women; moderate-certainty evidence) in the intervention group compared to the control group.

LIMITATIONS

Different duration of interventions across studies, different gestational ages at the time of enrollment, and large heterogeneity in the meta-analysis of results were the limitations of this study.

CONCLUSION

Mindfulness-based interventions probably reduce FOC and may promote self-efficacy. More randomized controlled trials with stronger designs and adequate power samples are required to verify the effectiveness of mindfulness-based interventions, especially on self-efficacy in pregnant women.

PROSPERO ID

CRD42021294056.

Midwives' Perception Regarding Conditions Influencing the Implementation of the Natural Childbirth Promotion Program in Iran: A Qualitative Study

Background

In Iran, the Natural Childbirth Promotion Program (NCPP) has been implemented as a component of the Health Transformation Plan (HTP) since 2014 and as an attempt to encourage natural childbirth practices and reduce cesarean section rates. The purpose of this qualitative study was to explore the perceptions of midwives about conditions influencing the implementation of NCPP.

Methods

In this qualitative study, data were collected through 21 in-depth semi-structured individual interviews with expert midwives who were selected using purposive sampling mainly from one medical university in Eastern Iran from October 2019 to February 2020. Based on the framework method as a thematic analysis approach, the data were analyzed manually. To enhance the rigor of the study, we followed Lincoln and Guba's criteria.

Results

Data analysis yielded 546 open codes. After the codes were reviewed and similar codes were removed, there remained 195 codes. Further analysis led to extraction of 81 sub-sub themes, 19 sub-themes, and eight main themes. These themes included: Responsive staff; Characteristics of the parturient; Recognition of midwifery role; Teamwork; The birthing environment; Effective management; Institutional and social context; and Social education.

Conclusion

Based on the perceptions of the studied midwives, the success of the NCPP is guaranteed by a set of conditions identified in this study. In practice, these conditions are complementary and interrelated, and they cover a wide range of staff and parturient characteristics to the social context. It seems that effective implementation of the NCPP also calls for the accountability of all stakeholders, from policymakers to maternity care providers.

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.

The importance of high-quality partner support for reducing stress during pregnancy and postpartum bonding impairments

The current study investigated the extent to which interparental support reduced pregnancy stress and subsequent postpartum bonding impairments with infant. We hypothesized that receiving higher quality partner support would be associated with decreased maternal pregnancy-related concerns, and less maternal and paternal pregnancy stress which, in turn, would predict fewer parent-infant bonding impairments. One hundred fifty-seven cohabiting couples completed semi-structured interviews and questionnaires once during pregnancy and twice postpartum. Path analyses with tests of mediation were employed to test our hypotheses. Higher quality support received by mothers was associated with lower maternal pregnancy stress which, in turn, predicted fewer mother-infant bonding impairments. An indirect pathway of equal magnitude was observed for fathers. Dyadic pathways also emerged such that higher quality support received by fathers was associated with lower maternal pregnancy stress which reduced mother-infant bonding impairments. Similarly, higher quality support received by mothers reduced paternal pregnancy stress and subsequent father-infant bonding impairments. Hypothesized effects reaching statistical significance (p < .05) were small to moderate in magnitude. These findings have important theoretical and clinical implications in demonstrating the critical role of both receiving and providing high-quality interparental support to reduce pregnancy stress and subsequent postpartum bonding impairments for mothers and fathers. Results also highlight the utility of investigating maternal mental health in the couple context.

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.