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

Relationship between dyadic coping, resilience and fear of childbirth in expectant couples: An actor-partner interdependence model approach

BACKGROUND

Fear of childbirth is a common concern in pregnant women and their spouses due to the unpredictability of the process and outcome of a delivery, which results in adverse effects on mental health, birth outcomes and family intimacy. However, there is a lack of studies that explore the influencing factors of fear of childbirth among expectant couples from a dyadic perspective. The aim of this study is to explore the correlation of dyadic coping, resilience and fear of childbirth in pregnant couples and to construct an actor-partner interdependence model to verify dyadic effects.

METHODS

This cross-sectional survey included 420 couples and was conducted between November 2022 and March 2023 in the obstetric department at two hospitals in China. Convenience sampling and an actor-partner interdependence model was used.

FINDINGS

The prevalence of fear of childbirth among pregnant women and their spouses is 37.4 % and 33.1 %, respectively. Women's resilience and dyadic coping had a partner effect on spouses' fear of childbirth, in addition to an actor effect on their own fear of childbirth. Spouses' resilience and dyadic coping had only actor effects on themselves, and no partner effect was found on the pregnant women.

CONCLUSION

Women's fear of childbirth was positively associated with spouses' fear of childbirth. Interventions for fear of childbirth should include improving resilience and enhancing dyadic stress support and coping. This study provides empirical evidence for future clinical research and interventions on the psychological status of pregnant women and their partners during pregnancy.

Fear of childbirth and its associated factors among pregnant women in East Africa: Systematic review and meta-analysis

BACKGROUND

Tokophobia is a mild to extreme fear of pregnancy and/or childbirth that may cause a woman to avoid giving birth. It is a common obstetrical problem that affects women's health. Some studies have found that fear of childbirth is common in East African countries. However, there was inconsistency across those studies, and no study was undertaken to report the pooled prevalence of fear of childbirth and its associated factors. As a result, the purpose of this systematic review and meta-analysis is to identify the pooled prevalence of fear of childbirth and its associated factors in Eastern Africa.

METHODS

We conducted a systematic review and meta-analysis of studies on the prevalence and associated factors of childbirth fear using Pub Med, Hinari, Google Scholar, and East African University archives. Data were extracted using a data extraction format developed in Microsoft Excel, and the analysis was carried out with STATA 14 statistical software. Each article's quality was assessed using the Joanna Briggs Institute's critical appraisal tool for prevalence studies. The Cochrane Q statistics and I2 test were used to examine heterogeneity between studies. Subgroup analysis was done by country and sample size. To assess publication bias, a funnel plot, and Egger's regression test were used.

RESULTS

This systematic review and meta-analysis included eleven studies. The pooled prevalence of the fear of childbirth among pregnant women in East Africa was 27.86 %. A history of labor and delivery complications (OR = 5.41, 95 %CI = 2.20, 8.63), poor social support (OR = 4.50, 95 %CI = 1.70, 11.92), primiparity (OR = 1.91, 95 %CI = 1.17, 3.12), no ANC follow-up (AOR=2.65, 95 %CI=1.48, 4.74), and unplanned pregnancy (AOR=4.88, 95 %CI=1.23, 19.31) were statistically associated with the fear of childbirth.

CONCLUSION

The pooled prevalence of fear of childbirth was high. Previous labor and delivery complications, poor social support, primiparity, a lack of antenatal care follow-up, and unplanned pregnancy were all statistically associated with fear of childbirth. To address this, healthcare providers should focus on individualized psychological support for pregnant women who experience tokophobia. Furthermore, encouraging comprehensive antenatal care and strengthening social networks can reduce the fear of childbirth and promote maternal well-being.

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.

A comparison of childbirth self-efficacy, fear of childbirth, and labor pain intensity between primiparas and multiparas during the latent phase of labor: a cross-sectional study

BACKGROUND

Childbirth is a long-lasting physiological stress. As one of the main stressors, labor pain exists throughout the whole process. Childbirth self-efficacy is the confidence, or belief that they can manage pain during childbirth. This sense of self-efficacy determines how pregnant women deal with labor pain and enables them to regulate their behavior and actively deal with childbirth. However, the difference in pain sensitivity between single births (primiparas) and multiple births (multiparas) has rarely been investigated.

OBJECTIVES

This study is aimed at investigating self-efficacy, fear of childbirth, labor pain of primiparas and multiparas and exploring factors related to the perceived labor pain intensity of pregnant women.

DESIGN

Prospective cross-sectional study.

SETTING(S)

Labour and delivery in a large academic specialized hospital in Guangzhou, China.

PARTICIPANTS

A total of 347 women, (182 primiparas and 165 multiparas) were enrolled in the data analysis. Pain was assessed before cervical dilatation (cervical dilatation ≤ 3 cm for the first delivery and ≤ 2 cm for the second delivery).

METHOD

The general information of participants was obtained by questionnaire and obstetrical records of the subjects were obtained from the electronic medical records extracted from the electronic medical record system (EMRS). Childbirth self-efficacy, fear of childbirth (FOC) and labor pain were compared between primiparas and multiparas. Paired t-test, chi-square test, Mann-Whitney test, univariate and multivariate regression analysis were used to analyze labor pain between the two groups and investigate factors related perceived labor pain intensity.

RESULTS

The total scores related to fear of childbirth, fetal health, self-control, and labor pain injury of multiparas were notably reduced compared with primiparas (all P < 0.05). The perceived labor pain intensity and duration of the first stage of labor was reduced in the multipara group compared with the primipara group. The childbirth control sense of the multipara was better than that of the primipara. The perceived labor pain intensity was negatively correlated with advanced age (age ≥ 35 years), self-efficacy score, family support, and education (all P < 0.05). In contrast, the perceived labor pain intensity was positively correlated with tension, severe fear of childbirth, and anxiety (P < 0.05). Self-efficacy, gravidity, delivery cognition, and fear of childbirth were independent risk factors for the perceived labor pain intensity in the latent period (all P < 0.05).

CONCLUSIONS

Fear of childbirth is a predictor of perceived labor pain intensity. The extent of labor pain (minimum and maximum) can be predicted by the level of fear the expectant mother has. During the latent phase of labor, self-efficacy, fear of childbirth and labor pain are different between primiparas and multiparas.

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.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Embracing Motherhood: Impact of Nurse Led Fear and Apprehension Related to Labour or Childbirth Improving Intervention (FALCI) in Reducing Childbirth Fear Among Pregnant Women

Objective

Childbirth is a complex process with various dimensions including physical, psychological, emotional, social, and cultural aspects. The study intended to assess the effectiveness of Nurse led FALCI (Fear and Apprehension related to Labour or Childbirth Improving) Intervention in reducing childbirth fear among pregnant women.

Materials and methods

A quasi-experimental study was conducted among 115 pregnant women (selected through purposive sampling) at antenatal OPD of tertiary care hospital of Bhopal. Data was collected using Wijma Delivery Expectancy Questionnaire (DEQ) and self-structured questionnaire on socio-demographic and clinical variables. The intervention (FALCI) was carried out in two phases, each lasting for 30 minutes conducted at week 3-4 and week 5-6 and information booklet was provided for reinforcement. The data was analysed using two-way repeated measures mixed ANOVA (within group and between groups).

Results

Findings revealed that most of the pregnant women in both experimental (68.5%) and control (90.2%) group had high level of childbirth fear. Post-intervention data revealed mean of pretest, posttest 1 and posttest 2 were 73.85, 46.94 and 37.90 in experimental group and the mean of pretest, posttest 1 and posttest 2 were 75.49, 72.59 and 72.67 in control group respectively and found that there is significant difference in childbirth fear (within group, F value=114.69, p<0.001 in experimental group and F =0.575, p=0.564 in control group) and between groups (F value= 81.52, p value <0.001). However, no significant association was found between childbirth fear and sociodemographic/clinical variables.

Conclusion

The study findings revealed that Nurse led FALCI intervention was effective in reducing childbirth fear among the pregnant women and it is recommended that such intervention must be planned at all levels and implemented as routine protocol in maternity services.

Discrepancy in parental fear of childbirth: A scoping review

BACKGROUND

Fear of childbirth is a prevalent clinical psychological issue for both mother and father; however, there is a lack of research comparing and summarizing discrepancies in parental fear of childbirth.

AIM

This study aimed to explore differences in parental fear of childbirth, identify gaps in related research area, and provide directions for future studies.

METHODS

Original references were searched from six databases by using subject terms associated with fear of childbirth. The guideline of the scoping review framework proposed by Arksey and O' Malley were applied.

RESULTS

The review covered 203 publications in all. Of them, 181 were maternal studies and 22 were paternal studies. 105 articles examined prevalence and influencing factors ranging from 0.7 % to 89.3 % in mothers and 5 % to 54.3 % in fathers. The current study included 84 influencing factors, 9 of which were common to parents and 75 of which were different, containing fathers' specific influences on fear of childbirth are perceived pregnancy difficulties, perceived birth difficulties, feelings about the upcoming birth, more frequent thoughts of birth in the middle of pregnancy and not attending parent education classes. 12 articles dealt with the experience of fear of childbirth, and the parents' fear of childbirth had 5 common themes, including fear of the birthing process, fear related to the baby, fear of lack of support, fear of postnatal health and life, and adverse psychological problems. But they have different sub-themes. 61 articles on fear of childbirth interventions, including 8 mother-specific approaches and 4 identical approaches for parents, and all of these methods were effective in reducing the prevalence of parental fear of childbirth.

CONCLUSION

Factors such as marital status, personality, etc., that are specific to mothers can also be applied to paternal fear of childbirth. Cognitive-behavioral therapy and group discussion, which are unique to maternal fear of childbirth, may be attempted for paternal fear of childbirth. In addition, future research should be devoted to developing a specific measurement tool for fathers, studying paternal fear of childbirth in depth from various aspects.

Exploring the Relationship Between Childbirth Expectations and Fear Among Primigravida Women in Saudi Arabia

Background Childbirth is a significant life event that is accompanied by fear, particularly among primigravida mothers. However, little is known about the expectations and fears of childbirth of primigravida women in Saudi Arabia. Aim This study aimed to explore expectations and fears of childbirth among primigravidas. Methods An exploratory, descriptive, cross-sectional study involving 369 primigravidas was conducted at antenatal outpatient clinics at the Maternity and Children's Hospital in Tabuk, Saudi Arabia. Results In the current study, most participants were aged 25-34 years 204 (55.3%), married 355 (96.2%), and had secondary or higher education 279 (75.6%). A majority of participants 265 (71.8%) reported financial difficulties and 244 unplanned pregnancies (66.1%), while most were pregnant beyond 30 weeks 254 (66.4%). The results showed that the mean total score on the Wijma Delivery Expectancy Questionnaire (W-DEQ) fear of childbirth scale was 57.56, indicating moderate levels of fear on average among primigravida women, with the highest subscale score for the moment of birth. The mean total score on the Childbirth Expectations Questionnaire (CEQ) childbirth expectations scale was 108.15, also indicating moderate expectations on average, with other significant expectations having the highest subscale score. A significant negative correlation was found between the fear and expectations scales (r=-0.775, p<0.001). Sociodemographic factors such as older age, higher education, income, employment, and planned pregnancy were associated with higher expectations and lower fear, whereas younger age, lower education, income, employment, unplanned pregnancy, and medical issues were associated with higher fear. Conclusions The findings of this study provide valuable insights into the expectations and fears of childbirth of primigravida women in Saudi Arabia. The results could inform healthcare providers and policymakers about the predictors of fear and effective interventions to reduce fear and improve birth experience in primiparous women.

Evaluation of childbirth self-efficacy and associated factors among pregnant women

BACKGROUND

Increasing the rate of Normal Vaginal Delivery (NVD) and reducing elective cesarean section is one of the important concerns, especially in Iran. Childbirth self-efficacy can play an important role in managing the fear of childbirth and increasing the rate of NVD. The aim of this study was to determine demographic, fertility, and social factors related to childbirth self-efficacy.

MATERIALS AND METHODS

The present study was a single-group, single-stage, multivariate, cross-sectional study that assessed childbirth self-efficacy and associated factors in 358 eligible pregnant women with gestational age of 37 weeks and over in Guilan (North Iranian province) from November 2018 to July 2019. Data collection was performed based on consecutive sampling method from the pregnant women referring to the prenatal clinic. Data collection tools included a demographic and reproductive characteristics questionnaire; Lowe's childbirth self-efficacy Inventory and Zimet's perceived social support multidimensional questionnaire.

RESULTS

There was a significant relationship between the educational level of pregnant women and Outcome Expectancy (OE) and Self-efficacy Expectancy (EE) and also between the spousal level of education and OE (P < 0.05). Parity, previous experience of birth, participation in pregnancy preparation classes, access to information sources about childbirth, and birth preference were significantly related to OE and EE (P < 0.05). There was a significant relationship between the two domains of perceived social support, spouse and friends, and the OE and EE (P < 0.05). The multivariate logistic regression model revealed that birth preference was a predictor for OE and EE, while a pregnant woman's education level and perceived social support in the domain of significant others were predictors for OE. Spousal age, mean family income, and participation in the prenatal preparation classes were predictors for EE.

CONCLUSIONS

Regarding the importance of self-efficacy in childbirth in encouraging pregnant women to perform NVD, pregnancy and childbirth preparation classes with an emphasis on concepts including self-efficacy of childbirth should be focused by midwives and other health-care workers in order to improve pregnant women's knowledge regarding the benefits of NVD and to strengthen their belief in the benefits of pain-compatible actions.

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.

Fear of childbirth among pregnant women in Eastern Ethiopia: A community-based study

INTRODUCTION

Fear of childbirth refers to feelings of uncertainty and anxiety before, during, or after childbirth by thinking about future labor and birth or experience of others. Evidence on burden of fear of childbirth and its associated factors is limited in Ethiopia. In this study, we assessed magnitude of fear of childbirth and its associated factors among pregnant women in Eastern Ethiopia.

METHODS

A community-based cross-sectional study was conducted among randomly selected pregnant women recruited from Kersa Health and Demographic Surveillance System-an open cohort consisting of continuous registry of health and demographic conditions in eastern Ethiopia. Women were interviewed and fear of childbirth was assessed using the Wijma Delivery Expectancy Questionnaire. Data were entered using EpiData 3.1 and analyzed using SPSS 20. Factors associated with fear of childbirth were identified using binary and multiple logistic regression and described using adjusted odds ratio (aOR) along with 95% confidence interval (CI). Finally, statistical significance was set at p < 0.05 in the multiple logistic regression.

RESULTS

Of a total of 476 pregnant women included in the study, 111(23.3%; 95% CI 19.3-26.9) had fear of childbirth. Fear of childbirth was more likely among women who had no antenatal care (aOR = 2.6; 95% CI:1.22-5.50), no husband support (aOR = 5.7; 95% CI: 2.32-13.10), unplanned pregnancy (aOR = 7.8; 95% CI: 3.92-15.42), and had history of complication in labor and pregnancy (aOR = 10.4; 95% CI: 5.20-20.81).

CONCLUSION

A quarter of pregnant women in eastern Ethiopia had fear of childbirth. Helping women to have positive pregnancy experience requires strengthening antenatal care, partner support, and prevention of unwanted pregnancy.

Psychometric properties of the Chinese version of the fathers' fear of childbirth scale: A cross-sectional study

BACKGROUND AND AIM

Fear of childbirth (FOC) is one of the most common mental health concerns among expectant fathers, which can cause adverse consequences for themselves and their families. A valid and accurate tool is the key to the identification of FOC. This study aimed to translate and culturally adapt the fathers' fear of childbirth scale (FFCS) into simplified Chinese and test the scale's psychometric properties among expectant fathers in mainland China.

METHODS

Researchers obtained translation permission and followed the multiphase translation guidelines to develop the Chinese version of the fathers' fear of childbirth scale (C-FFCS). Relevant psychometric properties were selected for the scale's psychometric validation on the basis of the Consensus-based Standards for the Selection of Health Status Measurement Instruments checklist. In this cross-sectional study, two samples of expectant fathers were collected in a university-affiliated hospital in Hangzhou between September and October 2022.

RESULTS

A total of 381 expectant fathers completed the C-FFCS, resulting in an effective response rate of 95.6%. The C-FFCS is a 3-factor structure consisting of 16 items, which explained 66.374% of the total variance. The content validity index of items ranged from 0.833 to 1.00, and the scale-level content validity index was 0.931. The confirmatory factor analysis confirmed the scale's 3-factor structure. Evidence of convergent validity (average variance extracted = 0.508-0.780) as well as discriminant validity offered excellent psychometric support. The Cronbach's α coefficient, McDonald's ω coefficient, intraclass correlation coefficient, Spearman-Brown coefficient, and Guttman split-half coefficient are within the satisfactory range (> 0.80). Significant correlations between the scores of the C-FFCS and Childbirth Attitude Questionnaire (r = 0.658, p < 0.01) and Fear of Birth Scale (r = 0.555, p < 0.01) both revealed good concurrent validity. The structure of C-FFCS was invariant across different parity groups, with no floor and ceiling effect.

CONCLUSION

The C-FFCS was demonstrated to be a sound instrument with good reliability and validity for measuring Chinese expectant fathers' FOC levels. However, further studies are advocated to verify the C-FFCS among a larger sample that is more representative of the Chinese expectant father population.

Validating the use of the Wijma Delivery Expectancy/Experience Questionnaire in Mainland China: a descriptive, cross-sectional study

BACKGROUND

Fear of childbirth (FOC) is a common psychological problem in Chinese pregnant women. FOC can influence both maternal health and infants' wellness. Special assessment tools for FOC in Mandarin Chinese are currently lacking. The aim of this study was to evaluate the psychometric properties of the Mandarin Chinese of the Wijma Delivery Expectancy/Experience Questionnaire Version A (W-DEQ-A).

METHODS

We recruited 364 Chinese pregnant women from April 2021 to July 2021. Translation and cultural adaptation, as well as reliability and validity testing were conducted. Analyses included the content validity, structural validity, criterion-related validity, convergent validity and reliability. The content validity indices were used to assess the content validity of the tool. The structural validity was tested through exploratory factor analysis and confirmatory factor analysis. The Cronbach's alpha coefficient was used to evaluate the reliability of the W-DEQ-A Chinese version.

RESULTS

The Chinese translation showed excellent similarities and equivalence to the original version, with the satisfactory content validity. Factor analysis indicated 5 factors, accounting for 57% of the total variance. Both criterion-related validity and convergent validity proved to be acceptable. The reliability was tested with a Cronbach's alpha coefficient of 0.911 for the total scale.

CONCLUSION

The W-DEQ-A Chinese version is a reliable and valid tool to identify FOC in Mandarin Chinese-speaking populations.

Experiencing Pregnancy during the COVID-19 Lockdown in Poland: A Cross-Sectional Study of the Mediating Effect of Resiliency on Prenatal Depression Symptoms

The COVID-19 pandemic in Poland brought uncertainty, not only to the general population but also to women preparing for childbirth, which increased the risk of mental health illnesses during this special period of life. Resilience, which refers to positive adaptation or the ability to maintain good mental health, can be a protective factor against the development of psychiatric problems such as depressive symptoms. This study aimed to assess the protective role of resilience in the relationship of such risk factors as traumatic childbirth perception and pandemic-related pregnancy stress with prenatal depressive symptoms. The study was performed at the end of the first wave of the COVID-19 pandemic. A total of 80 pregnant women took part. A mediation analysis, an independent t-test, and a Pearson correlation analysis were conducted. The lower resilience group declared the inclusion of slightly more participants (n = 41; 51.2%); 39 women (48.8%) demonstrated a higher risk of prenatal depression. The analysis revealed a significant direct effect between pandemic-related stress and prenatal depression (βc = 0.285, SE = 0.05, t = 2.63, p < 0.05) as well as between pandemic-related stress and resilience (βa = −0.283, SE = 0.07, t = −2.61, p < 0.05) and between resilience and prenatal depression (βb = −0.585, SE = 0.07, t = −6.34, p < 0.001). After the introduction of resilience as a mediator, the strength of the relationship not only decreased, but also ceased to be statistically significant (βc′ = 0.120, SE = 0.04, t = 1.29, p = 0.19), which indicates that it was in a full mediation state (R2 = 0.39, F = 25.31, p < 0.001; Z = 2.43, p < 0.05). The results indicate that in pregnant women, a high level of resilience protects them from the effects of pandemic-related stress on perinatal depression symptoms.

The Prevalence of Fear of Childbirth and Its Association With Intolerance of Uncertainty and Coping Styles Among Pregnant Chinese Women During the COVID-19 Pandemic

Background

Fear of childbirth (FOC) is one of the most common psychological symptoms among pregnant women and significantly relates to cesarean section, anxiety, and depression. However, it is not clear the prevalence and risk factors of FOC among Chinese pregnant women since the outbreak of the COVID-19 pandemic.

Aims

The objective of this study was to examine the associations between coping styles, intolerance of uncertainty, and FOC.

Method

From December 2021 to April 2022, a cross-sectional survey was conducted in two hospitals in China through convenient sampling. The cross-sectional survey was conducted among 969 pregnant women, which included the Childbirth Attitude Questionnaire (CAQ), Intolerance of Uncertainty Scale-12 (IUS-12), and Simplified Coping Style Questionnaire (SCSQ).

Results

The total prevalence of FOC was 67.8%. The percentages of women with mild (a score of 28-39), moderate (40-51), and severe FOC (52-64) were 43.6, 20.2, and 4.0%, respectively. The regression results indicated that primiparas, unplanned pregnancy, few spousal support, intolerance of uncertainty, and negative coping styles were significant risk factors of FOC. Women who adopt positive coping strategies experienced a lower level of childbirth fear.

Conclusion

These findings suggest that cultivating positive coping styles and obtaining sufficient childbirth information may be helpful for mothers' mental health. Regular screening assessment of perinatal psychological symptoms, such as the high level of intolerance of uncertainty and negative coping styles, should be adopted to reduce the risk of fear of childbirth.

Associations among fear of childbirth, resilience and psychological distress in pregnant women: A response surface analysis and moderated mediation model

INTRODUCTION

Prenatal psychological distress is prevalent during pregnancy. This study aimed to estimate the associations among fear of childbirth, resilience and psychological distress.

METHODS

A total of 1,060 Chinese pregnant women were enrolled from Be Resilient to Postpartum Depression (ChiCTR2100048465) and the following instruments were administered to them: Childbirth Attitudes Questionnaire, Connor-Davidson Resilience Scale, Perceived Social Support Scale, General Self-Efficacy Scale, Adverse Childhood Experience scale and Hospital Anxiety and Depression Scale. A dominance, a response surface analysis and a moderated mediation analysis were performed.

RESULTS

In terms of psychological distress, resilience and fear of childbirth could explain 41.6% (0.148/0.356) and 33.1% (0.118/0.356), respectively. Pregnant women with high resilience-low fear of childbirth had significantly lower levels of psychological distress than those with low resilience-high fear of childbirth. The indirect effects of fear of childbirth on psychological distress through resilience was significantly (B = 0.054, 95% CI 0.038 to 0.070). The interactions between fear of childbirth and adverse childhood experiences (β = 0.114, 95% CI -0.002 to 0.231, p = 0.054) and between resilience and adverse childhood experiences (β = -0.118, 95% CI -0.222 to -0.012, p < 0.05) were significant.

CONCLUSION

Resilience, fear of childbirth and adverse childhood experiences may be three important factors to psychological distress in Chinese pregnant women.