Contents of childbirth-related fear among couples wishing the partner's presence at delivery

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.

Influence of diagnosis of gestational diabetes mellitus on fear of childbirth

INTRODUCTION

Considering the relationship between Gestational Diabetes Mellitus and maternal and perinatal adverse outcomes, it's pertinent to investigate whether this diagnosis is a predictor of fear of childbirth. As there is little data about the fear of childbirth in Brazil, it´s necessary to understand better the population, and this way the authors can identify factors that influence this fear as well as propose public health policies to treat it.

OBJECTIVE

The main goal was to compare the prevalence of fear of childbirth between the groups of low-risk pregnancy and gestational diabetes mellitus.

MATERIAL AND METHODS

In this cohort study, the sample consisted of 319 patients divided into low-risk pregnancy group (n = 152) and gestational diabetes mellitus group (n = 167). Patients have undergone a semi-structured interview with epidemiological, obstetric, and anthropometric data and the main cause of fear of childbirth. In addition, the patients have marked an "X" on the scale into the Fear of Birth Scale to describe their fear. After delivery, data have been collected through electronic medical records.

RESULTS

The prevalence of fear of childbirth found was higher for the gestational diabetes mellitus group (46.05%) compared to the low-risk pregnancy group (34.73%) with a cutoff score ≥ 54. In the whole sample, the main cause of fear of childbirth (score ≥ 60) was the pain of labor and delivery (31.58%).

CONCLUSIONS

The prevalence of fear of childbirth in the present study was greater than 30%, highlighting the relevance of implementing this assessment during prenatal care.

Paternal pregnancy-related anxiety: Systematic review of men's concerns and experiences during their partners' pregnancies

BACKGROUND

Up to 25 % of expectant parents experience anxiety symptoms. Pregnancy-related anxiety is characterised by concerns and worries specific to pregnancy, childbirth, and the transition to parenthood. While pregnancy-related anxiety is well-researched in women, the exact nature of this construct in men is unclear. The purpose of the current review was to examine men's concerns, worries, and fears during pregnancy and gain an understanding of their experiences during pregnancy.

METHODS

An integrative review design was adopted, using thematic content analysis to synthesise findings from quantitative and qualitative studies. Quality appraisal of the quantitative studies used the AXIS appraisal tool. The Critical Appraisal Skills Program (CASP) checklist was used for the qualitative studies.

RESULTS

A comprehensive search of nine databases led to inclusion of 14 quantitative and 41 qualitative studies. Ten dimensions of paternal pregnancy-related anxiety were identified: childbirth concerns, attitudes towards childbirth, baby concerns, acceptance of pregnancy, partner concerns, relationship concerns, worry about self, transition to parenthood, attitudes towards health care professionals, and practical and financial concerns. The pregnancy transition was characterised by mixed emotions and conflicted experiences for fathers.

LIMITATIONS

Generalizability of review findings was limited by poor reporting of demographic information by many included studies, exclusion of studies not published in English, and focus on heterosexual relationships.

CONCLUSIONS

Expectant fathers may experience anxiety symptoms characterised by excessive worry across multiple domains of pregnancy-related concerns. Clinicians play an important role in identifying and supporting fathers with pregnancy-related anxiety and addressing the sense of exclusion often experienced by them.

A new scale for fear of childbirth: the Fear of Childbirth Questionnaire (FCQ)

OBJECTIVE

To create a clear and acceptable measure of fear of childbirth with satisfactory content validity for use with English-speaking women in the UK.

BACKGROUND

Fear of childbirth (FOC) can have a significant impact on a woman's view of her pregnancy, birth and her recovery post birth. Early identification is paramount to ensure that women's needs are recognised so that appropriately tailored care can be provided in pregnancy. Availability of reliable and valid measures to assess FOC in an English-speaking population are sparse, mainly due to issues with definitions of FOC or cultural sensitivity after translation. Recent research from phase one of the Fear of Childbirth study (FOCUS), has established key elements for FOC in an English-speaking UK population, and allows for a culturally sensitive measure of FOC to be developed. The aim was to ensure inclusion of all ten FOC elements and to attend to guidance from women in phase two of the FOCUS study about what would ensure clarity and acceptability.

METHOD

A multidisciplinary team developed items in accordance with FOCUS. The measure was then piloted with one reviewer and further refined by the team of perinatal researchers.

RESULTS

The FCQ is a new 20-item fear of childbirth questionnaire, which has been developed and is grounded in fears reported by women in the UK.

CONCLUSION

A new tool to measure FOC in an English-speaking UK population with good content validity has undergone a preliminary phase of development and now needs testing for reliability and other forms of validity.

Transition to Motherhood: A Study on the Association between Somatic Symptoms during Pregnancy and Post-Partum Anxiety and Depression Symptoms

Several authors found that somatic symptoms during pregnancy such as nausea, vomiting, and levels of sleep, and fear of childbirth were associated with women's post-partum psychopathological difficulties. The present study aimed to verify whether fear of childbirth can mediate the relationship between some somatic symptoms experienced during pregnancy (i.e., nausea, vomiting, and daily sleep duration) and the post-partum depressive and anxious symptoms. N = 258 mothers of children between 3 and 6 months of age filled out self-report questionnaires assessing somatic symptoms during pregnancy, fear of childbirth, and anxious and depressive symptoms during post-partum. Results showed that levels of vomiting during pregnancy (but not nausea and daily sleep duration) was associated with post-partum depression and anxiety. Furthermore, findings showed that fear of childbirth partially mediated the relationships between the levels of vomiting during pregnancy and post-partum state anxiety and depression. These results can have several clinical implications, allowing to implement preventive programs for post-partum depression, considering vomiting and fear of childbirth as important risk factors.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Depression remains a neglected public health problem among pregnant women in Northwest Ethiopia

BACKGROUND

Antenatal depression is highly prevalent but a neglected public health problem in low income countries. It has serious effects on the general health of women, birth outcomes and child health. However, there has been limited substantial evidence on the prevalence and predictors of antenatal depression in Ethiopia. This lack of evidence potentiates the consequences of the problem and can limit the attention to intervention. Thus, this study aimed to assess the prevalence and potential predictors of antenatal depression at Debre Tabor and Woreta towns, Northeast Ethiopia.

METHODS

A community-based cross-sectional study was employed on 548 pregnant women recruited by a cluster sampling method. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS). The List of Threatening Experiences Questionnaire (LTE-Q), the Oslo-3 Social Support Scale (OSSS-3), Intimate Partner Violence (IPV) Scale and Fast Alcohol Screening Test (FAST) were also used to measure stressful events, social support, intimate partner violence (IPV) and hazardous alcohol use respectively. Bivariable and multivariable logistic regression analyses were carried out to identify factors associated with antenatal depression.

RESULTS

The prevalence of antenatal depression was found to be 24.45% (95% CI: 21.20, 28.30%). Being single (AOR =3.32, 95% CI = 1.36, 8.09); fear of pregnancy complication (AOR = 3.84, 95% CI = 1.53,9.62); history of chronic illness (AOR = 8.14, 95% CI = 2.14, 30.91); unplanned pregnancy (AOR = 2.99, 95% CI = 1.36,6.55); history of stillbirth (AOR = 3.56, 95% CI = 1.23, 10.29),one or more negative life events (AOR = 4.06, 95% CI = 1.71, 9.66) and intimate partner violence (AOR = 3.91, 95% CI = 1.65, 9.26) were factors significantly associated with antenatal depression.

CONCLUSION

Nearly a quarter of pregnant women suffer from depressive symptoms during pregnancy. Being single; fear of pregnancy complication; history of chronic illness; unplanned pregnancy; history of stillbirth; one or more negative life events and intimate partner violence were important predictors of antenatal depression in this study. Health care workers should consider addressing these risk factors during a routine antenatal care. Also, integrating early screening, detection, and treatment of antenatal depression into routine antenatal care is warranted to improve the quality of life of pregnant women and pregnancy outcomes as well.

Design and psychometric evaluation of the fathers' fear of childbirth scale: a mixed method study

Background

Fear of childbirth is reported in 13% of fathers, and it may have adverse consequences for the fathers’ health as well as their families. To reduce the fear of childbirth in the expectant fathers, an appropriate screening tool is needed. Due to the lack of a valid and reliable questionnaire to measure fathers’ fear of childbirth, this study was conducted to develop the Fathers’ Fear of Childbirth Scale and evaluate its psychometric properties.

Methods

This mixed method study was conducted in two phases. In the qualitative phase (or item generation), semi-structured interviews were conducted with 20 expectant fathers, and a literature review was performed to generate the Fathers’ Fear of Childbirth Scale items pool. In the quantitative phase (or psychometric evaluation), reliability as well as face, content, and construct validity of this scale were evaluated. To establish construct validity, exploratory and confirmatory factor analyses were performed. Reliability was evaluated through internal consistency and composite reliability measures.

Results

The primary version of Fathers’ Fear of Childbirth Scale contained 32 items, which were reduced to 17 items while establishing construct validity. Exploratory factor analysis extracted two factors, namely fear of childbirth process (12 items) and fear of hospital (5 items). These factors explained 50.82% of the total variance. Goodness of fit indices within the confirmatory factor analysis was acceptable. Internal consistency and composite reliability indices of all the factors were greater than 0.70.

Conclusion

The Fathers’ Fear of Childbirth Scale has a suitable validity and reliability for assessing fear of childbirth in fathers. It is a simple report instrument that can be easily implemented by health care professionals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03696-7.

The Paternal Experience of Fear of Childbirth: An Integrative Review

BACKGROUND

It is estimated that approximately 13% of expectant fathers experience a pathological and debilitating fear of childbirth.

OBJECTIVE

The aim of this integrative review was to examine and synthesise the current body of research relating to paternal experience of fear of childbirth.

METHODS

A systematic literature search of five databases-CINAHL, Cochrane Library, MEDLINE, PsycArticles and PsycInfo-identified seventeen papers. Methodological quality of studies was assessed using the Crowe Critical Appraisal Tool.

RESULTS

Thematic data analysis identified three themes: the focus of fathers' childbirth-related fears, the impact of fear of childbirth on health and wellbeing, and fear of childbirth as a private burden.

DISCUSSION

Fear of childbirth is a significant and distressing experience for expectant fathers who may benefit from an opportunity to express their childbirth-related fears in an environment where they feel validated and supported. Antenatal education is recommended to enhance fathers' childbirth-related self-efficacy to reduce fear of childbirth.

CONCLUSIONS

Fear of childbirth may negatively impact the lives of men and consequently their families. Further investigation into methods and models for identifying and supporting men at risk of or experiencing fear of childbirth is required to improve outcomes for this population of men.

Why are first time expectant fathers afraid of birth? : A qualitative study

OBJECTIVE

To determine the fears associated with childbirth among first time expectant fathers and the reasons for these fears.

STUDY DESIGN

A descriptive, phenomenological approach was used. The sampling was composed of 16 men who were first time expectant fathers, who were at least primary school graduates, who were 18 years of age or older, whose partner was in her final trimester week of pregnancy, who did not have any psychiatric problems and who stated that they had a fear of childbirth.

RESULTS

The data were collected under the two main themes of fears about childbirth and the reasons for the fears. It was found that the expectant fathers had fears associated with the complications that could develop during childbirth and with the health personnel.

CONCLUSIONS

There were various fears associated with childbirth among expectant fathers. The reasons for the fears were mostly the negative stories heard. Health personnel have important duties in defining and decreasing the fears of expectant fathers associated with childbirth. It should not be forgotten that expectant fathers are also a part of childbirth in antenatal education.

The affecting factors of childbirth fear for pregnant women admitted to a health center and university hospital in Turkey

Purpose

Fear of birth may cause perinatal complication, increased risk of intervention and need for analgesia, delayed mother–infant attachment process and deterioration of spouse relationship. The purpose of this study was to determine the affecting factors and childbirth fears of Turkish pregnant women.

Design/methodology/approach

This is a descriptive research type. The sample of this study consisted of 78 pregnant women who met the inclusion criteria and agreed to participate in this study. This study was carried out in a family health center and university hospital in a city in Turkey. Data were collected with Personal Information Form and Wijma Expectancy/Experience Scale-A Version (W-DEQ A).

Findings

The mean scores of pregnant women from W-DEQ A version were 75.60 ± 9.48. In 65.4% of pregnant women, fear of severe birth, 20.5% fear of clinical birth and 14.1% of children had a fear of moderate birth. W-DEQ A version, the third trimester, unplanned pregnancies, lack of knowledge of the level of inadequate birth and more than eight pregnancies in pregnancy, the total score of pregnant women was found to be higher (p < 0.05).

Research limitations/implications

The limitation of this study is its small sample size. Further studies with larger sample sizes are needed.

Practical implications

It was determined that one-fifth of the sample group experienced birth fear at the clinical level and childbirth fear level is associated with unplanned pregnancies, lack of knowledge. In antenatal period, the pregnant woman should be encouraged to express her feelings and thoughts about the labor and give information about the labor.

Social implications

Cognitive and behavioral education programs can be structured to cope with fear of birth for pregnant women at risk.

Originality/value

This research is original. This study presents data on Turkish women. The data can also be used to evaluate intercultural differences.

Specific relations of dimensional anxiety and manifest anxiety disorders during pregnancy with difficult early infant temperament: a longitudinal cohort study

Anxiety in the antenatal period is a common experience, associated with adverse consequences for mother and child. Specific types of prenatal anxiety may have unique associations with infant temperament. This study examines the prospective relationships between general prenatal anxiety, fear of childbirth, and specific prenatal anxiety disorders and early infant temperament 8 weeks postpartum. Data were derived from the Akershus Birth Cohort (ABC), a longitudinal cohort study which targeted all women scheduled to give birth at Akershus University Hospital, Norway. Psychometric measures pertained to general prenatal anxiety (Hopkins Symptom Checklist), fear of childbirth (Wijma delivery expectancy questionnaire), screening for manifest prenatal anxiety disorders based on questions from the mini-international neuropsychiatric interview, and difficult infant temperament (Infant Characteristics Questionnaire). The sample for the present study included 2206 women. General prenatal anxiety, fear of childbirth, agoraphobia, generalized anxiety disorder, and specific phobia presented unique significant prospective contributions to difficult infant temperament 8 weeks postpartum. Separate hierarchical regression models indicated that general prenatal anxiety and fear of childbirth provided the strongest unique contributions. Considering the burden on mothers and the potential long-term effects on child development, the findings of this study highlight the importance of screening women for different types of prenatal anxiety in routine obstetric care. Clinical awareness of the condition and its consequences is warranted. Due to the complexity of infant temperament as a construct with various influences, future research should consider mechanisms and influential factors pertaining to the relationship between prenatal anxiety and infant temperament.

A Virtual Reality Video to Improve Information Provision and Reduce Anxiety Before Cesarean Delivery: Randomized Controlled Trial

BACKGROUND

Anxiety levels before cesarean delivery (CD) can lead to a negative birth experience, which may influence several aspects of the woman's life in the long term. Improving preoperative information may lower preoperative anxiety and lead to a more positive birth experience.

OBJECTIVE

This study aimed to determine whether a virtual reality (VR) video in addition to standard preoperative information decreases anxiety levels before a planned CD.

METHODS

Women scheduled to undergo term elective CD were recruited from the outpatient clinic. They were randomized and stratified based on history of emergency CD (yes or no). All participants received standard preoperative information (folder leaflets and counseling by the obstetrician); the VR group additionally watched the VR video showing all aspects of CD such as the ward admission, operating theater, spinal analgesia, and moment of birth. The primary outcome measure was a change in score on the Visual Analogue Scale for Anxiety (ΔVAS-A) measured at admission for CD, compared with the baseline VAS-A score.

RESULTS

A total of 97 women were included for analysis. The baseline characteristics were similar in both groups, except for a significantly higher level of education in the control group. There was no significant decrease in the VAS-A score of the women in the VR group (n=49) compared with those in the control group (n=48; ΔVAS-A=1.0; P=.08; 95% CI -0.1 to 2.0). Subgroup analysis for the group of women with a history of emergency CD showed a trend toward decreased preoperative anxiety, despite the small sample size of this subgroup (n=17; P=.06). Of the 26 participants who provided completed questionnaires, 22 (85%) in the VR group reported feeling more prepared after seeing the VR video; of the 24 participants' partners who completed the questionnaires, 19 (79%) agreed with the participants. No discomfort or motion sickness was reported.

CONCLUSIONS

A VR video may help patients and their partners feel better prepared when planning a CD. This study showed that VR does not lead to a decrease in preoperative anxiety. However, subgroups such as women with a history of emergency CD may benefit from VR videos.

TRIAL REGISTRATION

International Standard Randomised Controlled Trial Number (ISRCTN) 74794447; http://www.isrctn.com/ISRCTN74794447 (retrospectively registered).

Relationship between Spiritual Intelligence with Happiness and Fear of Childbirth in Iranian Pregnant Women

Background:

Spiritual intelligence is a person's ability to feel a connection to a higher power and a sacred entity. With regard to its relation with happiness, it can have an important effect on the mental health of pregnant women. Therefore, this study aimed to investigate the relationship between spiritual intelligence and happiness and fear of childbirth in pregnant women.

Materials and Methods:

This cross-sectional study was conducted on 245 low-risk pregnant women from June till September 2015. Using random cluster sampling method, the subjects were selected among the women who referred to health care centers in Shahroud (Northeast of Iran). After obtaining informed consent, the researchers evaluated the spiritual intelligence, happiness, and fear of childbirth. Data were analyzed using STATA12 and Chi-square test, t-test, analysis of variance, and Strucrural Equation Model.

Results:

In this study, the spiritual intelligence mean (SD) score was 64.43(16.51). Comparison between mothers with and without fear of childbirth showed there was a significant difference between the spiritual intelligence score and happiness mean scores in these two groups. There is a negative correlation between spiritual intelligence and happiness with fear of childbirth (−0.73 and −0.69, respectively).

Conclusions:

Increased level of spiritual intelligence in pregnant women can lead to an increase in their happiness and reduce their fear of childbirth. The fear of childbirth can be prevented via trainings to pregnant women about the components of spiritual intelligence; moreover, training the techniques to achieve more happiness can help mothers to reduce their fear of childbirth and hence promote natural childbirth.

The role of fear of childbirth in pregnancy related anxiety in Iranian women: a qualitative research

Introduction

Anxiety disorders have severe complications for a mother and her developing baby. A few studies have focused on pregnancy related anxiety and its risk factors including fear of childbirth. Therefore, the current study aimed to explore components and dimensions of this kind of anxiety.

Methods

This qualitative study (conventional content analysis) was conducted with mothers who referred to health care centers from May to December, 2015. In order to collect data, purposive sampling and face-to-face semi-structured in-depth interviews were used. Data analysis was conducted using MAXQDA software.

Results

Twenty eight pregnant women from different social backgrounds, educational levels and ethnicities aged 18–41 years old participated in this study and after analysis, fear of childbirth was classified into four categories including the process of delivery (fear of pain, prolonged labor, loss of control, being left alone during delivery, fear of her own incompetency), time of delivery (fear of preterm labor, fear of unknown delivery time, fear of late arrival to hospital), delivery complications (fear of bleeding, fear of death, postpartum depression, delivery accidents, genitalia injuries and fetal health problems) and healthcare quality (hospital facilities, lack of trust in maternity staff and lack of trust in obstetricians).

Conclusions

The results suggest that supporting, reassuring and educating pregnant mothers and giving information about delivery room, labor and strategies for coping with fear of pain and childbirth are critical. Changes in maternity care policies are recommended to promote positive attitudes toward normal delivery.

Antenatal prevalence of fear associated with childbirth and depressed mood in primigravid women

AIM

To investigate the antenatal prevalence of fear of childbirth and its association with depressed mood in low-risk primigravidae in a referral teaching hospital.

SETTINGS AND DESIGN

The study was conducted in a tertiary referral center catering to three districts in the state of Kerala. This was a cross-sectional study with internal comparison of associated factors.

MATERIALS AND METHODS

Malayalam translation (translation back translation) of Edinburgh Postnatal Depression Scale (EPDS) was self-administered by the participants. It was followed by a structured interview based on the International Classification of Diseases 10 (ICD 10) after which the EPDS scale was scored.

STATISTICAL ANALYSIS

Chi-square test was used to compare the presence of fear in women with a EPDS of ≥ 12 and the association of fear and depression.

RESULTS

Fear associated with childbirth was expressed by 17.7% women. The prevalence of depressed mood based on the EPDS (score > 12) was 9.8% but based on the ICD 10 criteria, the prevalence of depression was 8.7%. A significant number of women with depressed mood and clinical depression had fear of childbirth of some sort.

CONCLUSIONS

A significant number of primigravid women with depressed mood and clinical depression had fear of childbirth of some sort.

Use of Music Intervention for Reducing Anxiety and Promoting Satisfaction in First-Time Filipino Fathers

Childbirth is an anxiety-provoking event in a man's life. Therefore, strategies to decrease paternal anxiety during childbirth are necessary. This study determined the effects of music and satisfaction of first-time Filipino fathers during childbirth. In the study, a prospective quasi-experimental design was utilized. Ninety-eight purposive samples of first-time fathers were included in the study, 50 were allocated in the experimental group (music group) and 48 in the control group (nonmusic group) during the months of August to October 2013. Paternal anxiety and satisfaction were measured using the State Trait Anxiety Inventory and the Visual Analogue Scale for Satisfaction, respectively. Results revealed that the first-time fathers in the experimental group had lower State Trait Anxiety Inventory scores (p < .05) and higher Visual Analogue Scale for Satisfaction scores (p < .05) than those in the control group. Findings of the study provide substantial evidence to support the use of music in reducing anxiety and promoting satisfaction among first-time fathers during childbirth.

The effect of exercise and childbirth classes on fear of childbirth and locus of labor pain control

This study sought to track changes in intensity of fear of childbirth and locus of labor pain control in women attending an exercise program for pregnant women or traditional childbirth classes and to identify the predictors of these changes. The study was longitudinal/non-experimental in nature and run on 109 healthy primigravidae aged from 22 to 37, including 62 women participating in an exercise program for pregnant women and 47 women attending traditional childbirth classes. The following assessment tools were used: two scales developed by the present authors - the Fear of Childbirth Scale and the Control of Birth Pain Scale, three standardized psychological inventories for the big five personality traits (NEO Five Factors Inventory), trait anxiety (State-Trait Anxiety Inventory) and dispositional optimism (Life Oriented Test-Revised) and a questionnaire concerning socioeconomic status, health status, activities during pregnancy, relations with partners and expectations about childbirth. Fear of childbirth significantly decreased in women participating in the exercise program for pregnant women but not in women attending traditional childbirth classes. Several significant predictors of post-intervention fear of childbirth emerged: dispositional optimism and self-rated health (negative) and strength of the belief that childbirth pain depends on chance (positive).

Paternal fears of childbirth: a literature review

To date, most studies on paternal childbirth fears have been exploratory or descriptive, conducted outside of the United States, and focused mainly on White, first-time fathers. Identified fears include harm to the mother or newborn, partner pain, feelings of helplessness, lack of knowledge, and fear of high-risk intervention. Fathers often report that childbirth classes are not helpful and, in some cases, even increase their fears. Some fathers view birth as traumatic, changing their perception of and relationship with their partner. Fathers also voice the need for more information and for reassurance that they are doing the right things for their partner during childbirth. This article summarizes the research findings on paternal childbirth fears and recommends topics for future study.

A qualitative investigation into the pregnancy experiences and childbirth expectations of Australian fathers-to-be

AIM

To explore and describe men's experiences of pregnancy and childbirth expectations.

BACKGROUND

There remains limited work exploring expectant father's perspectives.

DESIGN

Qualitative descriptive design. Twelve Australian expectant fathers participated in between 1 and 2 interviews during pregnancy and 1 after childbirth (32 in total). Six fathers also chose to submit a number of diary entries via e-mail. Thematic analysis was used to analyse the data set.

FINDINGS

Five themes emerged from the data. The themes pregnancy news: heralds profound change adjusting to pregnancy, and birth looming described how men processed the news of pregnancy, worked to accept their changed circumstances and negotiated the final week of the pregnancy. A fourth theme, labelled Feeling sidelined, outlined men's experiences of antenatal care and their feeling of isolation as a result of largely feeling ignored by health care professionals. The fifth theme represents men's childbirth expectations.

CONCLUSION

Adjusting to the news of a pregnancy was a potentially unsettling time for an expectant father that was often associated with increased apprehension and anxiety. Regardless of whether they were a first or once again father most men engaged in a level of emotional work to come to terms with and accept the pregnancy. Understanding men's antenatal experiences and anxieties is an important step in the development of preventative paternal perinatal mental health measures. The significance of this work is situated within the reality that men's wellbeing is associated with maternal psychological well-being, positive peri-natal experiences and child development.

Home Birth: A Story of “Infinite Love and Enormous Rejection”

This article calls for a new way of looking at the home birth debate by challenging the underlying assumptions and beliefs that lead to the polarized discourse. The debate around home birth is about more than place of birth or perinatal mortality. It raises deeper and more complex issues that need to be explored. This article moves the debate about home birth from one about death to one about human nature, from one about statistics, to one about why the statistics will not end the debate. It explores less familiar discourses such as confirmation bias, group polarization, fear, risk, scientific paradigms, and power using insights from disciplines such as philosophy and psychology for guidance as to why “infinite love and enormous rejection” have come to fill the discourse about home birth. If we do not try and understand why the home birth debate is so polarized and develop new strategies to overcome the great divide, we will never make progress with important decisions as how home birth should safely be made available to women.

Content of Childbirth-Related Fear in Swedish Women and Men-Analysis of an Open-Ended Question

The content of childbirth-related fear as described by 308 women and 194 men was analyzed and compared in relation to intensity of fear. The content of fear was similarly described by women and men and concerned the following main categories: the labor and delivery process, the health and life of the baby, the health and life of the woman, own capabilities and reactions, the partner's capabilities and reactions, and the professionals' competence and behavior. Among women, the labor and delivery process was the most frequently reported among the 6 categories of fears, whereas the health and life of the baby was the most frequent among the men. Fears related to own capabilities and reactions were described significantly more often by women with intense fear than by women with mild to moderate fear. The greatest difference between men with intense versus mild to moderate fear was a more frequent expression of concern for the health and life of the woman. Both women and men had fears related to not being treated with respect and not receiving sufficient medical care. This finding suggests that part of the problem with childbirth-related fear is located within the health care system itself.

Satisfaction and use of a spiritually based mantram intervention for childbirth-related fears in couples

This study assessed patient satisfaction with the use of a spiritually based (mantram/sacred word) intervention in expecting couples. A mixed-methods design, experimental repeated measures with interviews at 6-month follow-up was conducted. Satisfaction was moderate to high. Mantram was used for labor pains and uncertainty. Implications include scheduling flexible classes earlier in pregnancy. A larger randomized study is needed to assess intervention effectiveness.

Psychosomatic approaches to obstetrics, gynaecology and andrology--a review

This review aims to clarify the scope and clinical importance of psychosomatic approaches to obstetrics, gynaecology and andrology. This gradually expanding sub-specialty covers a wide domain of complex disease conditions that can be managed more effectively if the various biological, psychological and social aspects are recognised at the start and concurrent treatment initiated. The current need to practise biopsychosocial management of disease conditions is highlighted along with a description of what this would involve. The nine-field psychosomatic approach, which can be applied to everyday clinical encounters, has been illustrated. Clinical applications of the psychosomatic approach are discussed for various conditions including chronic pelvic pain, eating disorders, tokophobia, post-traumatic stress disorder, depression, menstrual disorders, infertility, bereavement and testicular cancer. Cultural considerations and the need for further research are also briefly discussed.

Ethnic Turkish fathers in birth support roles in a Berlin labour and delivery room--motives, preparation and incidence in a 10-year comparison

PURPOSE

Have there been changes among German (G) or ethnic Turkish (T) fathers with respect to birth preparation or motivation to participate in a birth support role? In a 10-year comparison is it possible to identify an increase among ethnic Turkish fathers in birth support roles in Germany?

METHODS

(1) In 1995/96 and 2003, structured interviews were conducted with German and ethnic Turkish fathers on the second or third post-natal day, focusing on the following topics: birth preparation, motives for participating in the birth, anxieties experienced by the father in the labour and delivery room, the father's assessment of his role in the birth, information deficits. (2) In 1995 and 2006, the birth support roles of family members (partners, sisters, mothers-in-law etc.) were documented per 1000 consecutive hospital births and analysed according to parity and ethnicity.

RESULTS

(1) Structured interviews based on guidelines: In comparing 1995/96 (G/T n = 100, in each case) to 2003 (G/ n = 54, T/ n = 42) there is a significant increase among both Germans and ethnic Turks in the number of fathers participating in courses preparing for birth; ethnic Turkish men attended birthing courses noticeably less often (1995/96 and 2003: 8%; G approx. 40%, respectively). During both interview cycles the most common motivation given for providing birth support was 'to solidify the relationship with the partner'. (2) Data on birth support roles: In the comparison between 1995/96 and 2006, more German fathers, as well as more ethnic Turkish fathers, were by the side of their wives/partners in the labour and delivery room; however, in contrast to the Germans, ethnic Turkish men more commonly tended to participate in a birth support role together with female family members, either simultaneously or by turns.

CONCLUSIONS

The birth support role of the father has gained significant ground in the last 10 years, and is now also accepted among ethnic Turkish couples despite cultural differences. This is possibly the result of an acculturation process, in which a phenomenon within the host culture (fathers in the labour and delivery room) mixes with ancestral tradition (the birth support role of women).

Maternal Fear Associated with Pregnancy and Childbirth in Hong Kong Chinese Women

BACKGROUND

Women's fear toward pregnancy and childbirth is a common and important health concern. This study examined the objects, causes, and manifestations of maternal fears and their associated demographic factors in a sample of Hong Kong Chinese pregnant women.

METHODS

Three hundred Chinese pregnant women were recruited in an obstetric unit in Hong Kong in 2003. Data were collected using a 73-item questionnaire. Principal components factor analysis was applied to identify the objects, causes, and manifestations of fear toward pregnancy and childbirth.

RESULTS

The mean maternal age was 30 (SD 5.6) years. All participants reported some degree of fear. The main objects of fear were "fear of childbirth" and "child's and mother's wellbeing." The first factor identified for causes of fear was "negative stories," followed by "negative attitude or mood." Regarding the various manifestations of fear, "stress symptoms" and "wish to avoid pregnancy and childbirth" ranked highest. Twenty-two percent of participants had considered requesting an elective cesarean section due to fear of childbirth.

CONCLUSIONS

Even in a group of low-risk pregnant women, fear toward pregnancy and childbirth was frequently experienced. Better strategies to address women's psychological needs during pregnancy are warranted.

Do women with epilepsy have more fear of childbirth during pregnancy compared with women without epilepsy? A case-control study

BACKGROUND

Although anxiety and depression in populations with epilepsy have been studied, no research on fear of childbirth in women with epilepsy have been conducted. The purposes of this study were to examine whether a significant difference occurred in fear of childbirth between pregnant women with epilepsy and pregnant healthy controls and to evaluate the most common fears.

METHODS

Fifty pregnant women with epilepsy and 50 pregnant women without epilepsy were assessed at a gestational age between 32 and 36 weeks of pregnancy, using two questionnaires for the measurement of fear of childbirth, an open question, and a clinical interview.

RESULTS

We found that during pregnancy, women with epilepsy experienced a significantly higher rate of fear of childbirth when compared with healthy controls, whereas after delivery, the experiences and feelings about childbirth are almost the same as those of women without epilepsy.

CONCLUSIONS

Our findings signify the importance of the assessment of the fear of childbirth, especially in women with epilepsy, and the need to offer professional and ad hoc support to those who suffer from it.

What constitutes a good childbirth? A qualitative study of pregnant Finnish women

The aim of this study was to describe pregnant Finnish women's perceptions of a good childbirth. Data were collected through semistructured interviews in maternity health care clinics and maternity hospitals. Data interpretation was based on content analysis. A purposive sample of 24 pregnant women aged 19 to 45, half of them expecting their first child, were interviewed. Five main issues were seen by informants as important in the course of childbirth: 1) unhurried atmosphere, 2) normality, 3) reasonable duration of labor, 4) security, and 5) control. Participants did not expect much from their birth companions, although some mentioned various tasks for them. The three main issues considered important for the role of staff were the professionals'1) personal characteristics, 2) attitudes toward the childbearing woman, and 3) way they acted. The question about the physical environment was found quite irrelevant by some women, and only a few had special wishes related to the birthing environment. None of the participants voiced opposition to obstetric interventions, but some were willing to avoid them if possible. Informed consent for interventions was seen as very important. These results suggest that health care providers are challenged to provide individualized care for every woman.

How social context impacts on women's fears of childbirth: a Western Australian example

This paper addresses the limited sociological understanding of the phenomena of childbirth fear using data from a qualitative research project conducted in Western Australia. This qualitative study used an exploratory descriptive design, with 22 women identified as being fearful of birth participating in an in-depth interview. Data analysis using the method of constant comparison revealed that social context, explored within the framework of the medicalisation of childbirth, and the intervening circumstances in which the women gave birth, impacted on how and why they experienced fear. As such, this paper argues that fear of childbirth has social as well as personal dimensions and is both a prospective and retrospective phenomena. The analysis identified prospective fear as both social and personal. The social dimensions were labelled as 'fear of the unknown', 'horror stories' and 'general fear for the well-being of the baby'. Personal dimensions included the 'fear of pain', 'losing control and disempowerment' and 'uniqueness of each birth'. Retrospective fear was exclusively personal and was clustered around the themes of 'previous horror birth' and 'speed of birth'. The analysis also revealed two central factors that mediated against childbirth fear: positive relationships formed with midwives, and the support women received from their informal network. Understanding and unpacking the dimensions of women's childbirth fear, and understanding the nature of relationships that mediate women's fear, provides health care professionals with information on which to base potential intervention strategies and support women in ways that lessen rather than heighten their fear.

Experiential factors associated with childbirth-related fear in Swedish women and men: a population based study

The aim of this study was to investigate and compare experiential factors associated with childbirth-related fear in women and in men. A questionnaire was completed by 410 women and 329 men who prior to the study had had a healthy baby at Umeå university hospital, Sweden. The level of fear was estimated, and twenty-nine statements designed to measure experiences and perceptions connected to childbirth and childbirth-related fear, were subjected to exploratory factor analysis. Factor scores were calculated and differences among women and men with intense and mild/moderate fear were estimated. Intense fear was reported by 23% of the women and 13% of the men. The factor analysis identified four factors explaining 52% of the variance in woman and 50% in men. The factors were named 'exposedness and inferiority', 'communicative difficulties', 'norms of harmony' and 'insecurity and danger'. The relative order of the factors varied in relation to gender, and in the women, 'exposedness and inferiority' had the greatest explanatory power, while this was true for 'communicative difficulties' in the men. Most factors were reported to a significantly higher extent by respondents with intense fear. The results are discussed from a gender perspective.

A Model for the HELLP Syndrome: The Maternal Experience

OBJECTIVE

To describe the experience of mothers whose pregnancies were complicated with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) and to determine if such experiences could be clustered by common themes from which a model could emerge.

DESIGN

Retrospective, descriptive, qualitative study utilizing grounded theory analysis.

SETTING

Participants were interviewed in their homes via telephone. Participants were from Kansas, Maine, Maryland, Michigan, Minnesota, Mississippi, South Carolina, Utah, and Wyoming, representing both urban and rural settings.

PARTICIPANTS

Nine self-selected survivors of HELLP syndrome.

RESULTS

The essential structure of the experience of HELLP syndrome can be expressed as a circle of no control and not knowing, which included the five themes of premonition, symptoms, betrayal, whirlwind, and loss. The pervading emotions expressed were fear (of death), frustration, anger, and guilt. HELLP syndrome represents a unique maternal experience that can be expressed in a model.

Fear of pregnancy and childbirth

Pregnancy is a major life event for all women. However, when a psychiatric disorder is added to or exacerbated by the pregnancy then the problem requires expert knowledge from more than one area of medicine. This paper looks at pregnancy and the relationship with depression, eating disorders, and pathological fear of childbirth or tokophobia. It also examines the outcome for these women and their babies. Mental illness is a serious concern. It is now recognised that death from suicide is the leading cause of maternal death overall. Research in these areas is relatively sparse but an attempt is made to collate what is known.

The implications of unfulfilled expectations and perceived pressure to attend the birth on men's stress levels following birth attendance: a longitudinal study

Men's stress and their experiences of reproduction have yet to be fully explored. This study aims to examine the subjective stress experienced by men during their partner's pregnancy, at the time of the birth and six weeks postpartum by means of a longitudinal study of 53 men's reproductive experience. Further, it aims to examine the role birth attendance, unfulfilled expectations and perceived pressure to attend the birth have on levels of stress. Men were measured on the Impact of Event Scale three times during the pregnancy, at the time of the birth and six weeks postpartum. Findings indicate that compared to non-psychiatric norms, overall levels of stress were elevated during the pregnancy, at birth and postpartum. The highest levels of stress were found at the time of the birth in the men who were in birth attendance. Stress levels were particularly high amongst men who felt they did not fulfill their role expectation, or they perceived pressure to be present at the birth. Confirming findings from phenomenological studies, there appears to be some confusion as to the nature and purpose of men's presence at childbirth. Expectant fathers may not anticipate the psychological and emotional realities of childbirth/becoming a father and there remains a possibility that raised stress following childbirth may impact on father/child bonding.

Fears and coping strategies associated with pregnancy and childbirth in Finland

The purpose of this study was to describe the causes of fear associated with pregnancy and childbirth and to describe coping strategies of pregnant women who have fears. Data were collected by using semistructured interviews on the maternity units of two university hospitals in Finland. A convenience sample of 20 women served as participants, and data were analyzed by using content analysis techniques. In most cases, the source of fear was either previous experience and knowledge or uncertainty. In some cases, the source of fear was beliefs about childbirth with no clear origin of the belief. Knowledge was described as a means of dealing with fear, as were talking, writing, and reasoning. When seeking help, many participants relied on their social network and on health care professionals, but some sought information independently from books, magazines, etc. Methods for dispelling or alleviating fear included talking about feelings, increasing knowledge, accessing health care services, referring to positive experiences, receiving reassurance from medical screening, and/or feeling the baby move. Knowledge can be a cause of fear, but its ability to decrease fear is of greater consequence. What seemed to matter most was the way in which information is given.

Experiences of fears associated with pregnancy and childbirth: a study of 329 pregnant women

BACKGROUND

Women may experience a variety of fears in association with pregnancy and childbirth. The purpose of this study was to describe their objects, causes, and manifestations, and to identify factors associated with the fears.

METHODS

The study sample comprised 481 pregnant women in western Finland, of whom 329 (response rate 69) completed a questionnaire. It was developed on the basis of semi-structured interviews and previous studies and had a 4-point scale and a dichotomous scale. Data were subjected to rotated factor analysis, and sum variables were produced. The effects of various demographic variables were calculated using the Kruskal-Wallis and Mann-Whitney U tests.

RESULTS

Of the 329 respondents, 78 percent expressed fears relating to pregnancy, to childbirth, or to both. Specific fears concerned childbirth, the child's and mother's well-being, health care staff, family life, and cesarean section. Causes of fears were negative mood, negative stories told by others, alarming information, diseases and child-related problems, and, in multiparas, negative experiences of previous pregnancy, childbirth, and baby's health and care; causes were significantly related to occupation. Fears were manifested as symptoms of stress, effects on everyday life, and a wish to have a cesarean section or to avoid pregnancy and childbirth; employment situation and elective cesarean section were the most important factors related to manifestation of fears. Parity and antenatal training were the most important variables related to objects of fears.

CONCLUSIONS

Women's fears that are associated with pregnancy and childbirth can be explained by different factors. It is important for perinatal health caregivers to ask pregnant women about their feelings related to the current pregnancy, childbirth, and future motherhood, and to give women who express fears an opportunity to discuss them, paying special attention to primiparas and to multiparas with negative experiences of earlier pregnancies.