Fear of Childbirth and Elective Cesarean Section
Fear of Childbirth and Elective Cesarean Section
The mean age of the women was 31 years (range 18–45 years; SD 4.6 years). Forty-nine percent of the women were primiparas. Ninety-nine percent of the women were married or cohabiting with the child's father. The mean W-DEQ score was 57 (range 2–145; SD 19.5). Eight per cent of the women (134/1789) reported fear of childbirth, defined as W-DEQ score ≥85. In the study sample, 75 % of the women had a normal vaginal delivery, 11 % had an instrumental vaginal delivery, 9 % delivered by emergency caesarean section and 5 % delivered by elective caesarean section.
Fear of childbirth was observed among 16 % (27/169) of women with poor social support, 33 % (24/73) of women with combined anxiety and depression, and 28 % (20/72) of women with a previous negative overall birth experience. Based on binary logistic regression, we found that a previous negative overall birth experience (crude OR 8.4, 95 % CI 4.6–15.5) and combined anxiety and depression (crude OR 8.4, 95 % CI 4.9–14.4) were the most important correlates of the fear of childbirth; these were followed by poor social support (crude OR 6.1, 95 % CI 3.4–11.0) and no previous delivery experience (crude OR 2.1, 95 % CI 1.4–3.2) (Table 1). After mutual adjustment for the other study factors in a logistic regression model, a previous negative overall birth experience remained the strongest factor for fear of childbirth (aOR 7.6, 95 % CI 3.8–15.2), followed by combined anxiety and depression (aOR 6.1, 95 % CI 3.3–11.2) and poor social support (aOR 3.8, 95 % CI 1.9–7.6). Giving birth for the first time and a high educational level were also associated with fear of childbirth (Table 1).
In the study sample, 9.7 % (174/1789) of the women had a preference for caesarean delivery, and 5 % (90/1789) delivered by elective caesarean section. Among women with a fear of childbirth, 32.8 % (44/134) had a preference for elective caesarean section, and 12.7 % (17/134) delivered by elective caesarean section. Fear of childbirth was strongly associated with preference for caesarean delivery (aOR 4.6, 95 % CI 2.9–7.3) whereas the association with delivery by elective caesarean section was weaker (aOR 2.4, 95 % CI 1.2–4.9) (Table 2). Medical risk factors exerted the strongest impact on delivery by elective caesarean section, with an aOR of 14.3 (95 % CI 8.3–24.8) for one medical risk factor and an aOR of 21.6 (95 % CI 9.6–48.7) for two or more medical risk factors. In addition, a previous negative birth experience was strongly associated with delivery by elective caesarean section (aOR 8.1, 95 % CI 3.9–16.7). Interestingly, women with a high educational level were less likely to have a preference for elective caesarean section than women with a low to moderate educational level. Finally, the majority (87 %, 117/134) of women with fear of childbirth did not undergo an elective caesarean section (Fig. 3).
(Enlarge Image)
Figure 3.
The number of women with fear of childbirth (a), preference for caesarean section (b) and delivery by elective caesarean section (c) among 1789 pregnant women in the Akershus Birth Cohort Study
Results
The mean age of the women was 31 years (range 18–45 years; SD 4.6 years). Forty-nine percent of the women were primiparas. Ninety-nine percent of the women were married or cohabiting with the child's father. The mean W-DEQ score was 57 (range 2–145; SD 19.5). Eight per cent of the women (134/1789) reported fear of childbirth, defined as W-DEQ score ≥85. In the study sample, 75 % of the women had a normal vaginal delivery, 11 % had an instrumental vaginal delivery, 9 % delivered by emergency caesarean section and 5 % delivered by elective caesarean section.
Factors Associated With Fear of Childbirth
Fear of childbirth was observed among 16 % (27/169) of women with poor social support, 33 % (24/73) of women with combined anxiety and depression, and 28 % (20/72) of women with a previous negative overall birth experience. Based on binary logistic regression, we found that a previous negative overall birth experience (crude OR 8.4, 95 % CI 4.6–15.5) and combined anxiety and depression (crude OR 8.4, 95 % CI 4.9–14.4) were the most important correlates of the fear of childbirth; these were followed by poor social support (crude OR 6.1, 95 % CI 3.4–11.0) and no previous delivery experience (crude OR 2.1, 95 % CI 1.4–3.2) (Table 1). After mutual adjustment for the other study factors in a logistic regression model, a previous negative overall birth experience remained the strongest factor for fear of childbirth (aOR 7.6, 95 % CI 3.8–15.2), followed by combined anxiety and depression (aOR 6.1, 95 % CI 3.3–11.2) and poor social support (aOR 3.8, 95 % CI 1.9–7.6). Giving birth for the first time and a high educational level were also associated with fear of childbirth (Table 1).
Factors Associated With Elective Caesarean Section
In the study sample, 9.7 % (174/1789) of the women had a preference for caesarean delivery, and 5 % (90/1789) delivered by elective caesarean section. Among women with a fear of childbirth, 32.8 % (44/134) had a preference for elective caesarean section, and 12.7 % (17/134) delivered by elective caesarean section. Fear of childbirth was strongly associated with preference for caesarean delivery (aOR 4.6, 95 % CI 2.9–7.3) whereas the association with delivery by elective caesarean section was weaker (aOR 2.4, 95 % CI 1.2–4.9) (Table 2). Medical risk factors exerted the strongest impact on delivery by elective caesarean section, with an aOR of 14.3 (95 % CI 8.3–24.8) for one medical risk factor and an aOR of 21.6 (95 % CI 9.6–48.7) for two or more medical risk factors. In addition, a previous negative birth experience was strongly associated with delivery by elective caesarean section (aOR 8.1, 95 % CI 3.9–16.7). Interestingly, women with a high educational level were less likely to have a preference for elective caesarean section than women with a low to moderate educational level. Finally, the majority (87 %, 117/134) of women with fear of childbirth did not undergo an elective caesarean section (Fig. 3).
(Enlarge Image)
Figure 3.
The number of women with fear of childbirth (a), preference for caesarean section (b) and delivery by elective caesarean section (c) among 1789 pregnant women in the Akershus Birth Cohort Study
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