Article

Association between childbirth attitudes and fear on birth preferences of a future generation of Australian parents

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Abstract

Background: The reality of childbirth fear is recognised for expectant parents but we lack knowledge about the childbirth attitudes of the next generation of Australian parents. Aim: Examination of adults' attitudes toward childbirth including influencing contributing factors, fear scores, birth preferences and reasons for this preference. Methods: A cross-sectional online study was conducted with 654 Western Australian students attending one tertiary institution. Students (male and female) were eligible to participate if they were less than 40 years of age and did not currently have children but confirmed their intention to become parents. To assess associations or comparison of means, bi-variable analyses (Chi square test, Fisher's Exact test, Independent Student's t-test or one way ANOVA) were used. Factors associated with childbirth fear and birth preferences were assessed with binary logistic regression analysis. Findings: Childbirth attitudes were shaped by family members' (82.0%) and friends' experiences (64.4%) plus media (TV, YouTube, and movies) (63.5%). Furthermore, 15.6% of adults indicated a preference for a caesarean birth, even without obstetric complications. Likewise, 26.1% reported elevated fear; students with elevated fear scores had 2.6 times greater odds of wanting a caesarean birth. Only 23.4% of students felt confident about their childbirth knowledge. Conclusion: Adults reported fear levels that warrant attention prior to a future pregnancy. Although the majority would choose a vaginal birth, they require awareness of benefits and risks for both vaginal and caesarean births to ensure their decisions reflect informed choice rather than influences of inadequate knowledge or fear.

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... Maternal request for planned caesarean birth has been suggested as one explanation [10]. Women's childbirth preferences develop before their first pregnancy, and caesarean birth preference in nulligravid (never pregnant) women already surpasses the WHO recommended rate [11][12][13][14]. ...
... For nulligravid women, who are unlikely to have been exposed to any direct experience, vicarious experience is potentially the most influential factor [17]. Hauck et al. [12] found childbirth attitudes in nulligravid women, such as attitudes towards obstetric technology, physical cost of childbirth or women's ability to choose a how to birth, were informed by vicarious experiences in the form of birth stories from family, friends, and media. Vicarious experience also influences childbirth fear. ...
... Based on findings from qualitative research showing that women identified birth stories as a factor influencing childbirth attitudes in nulligravid women [12], it was hypothesised that exposure to birth stories would provoke a shift in childbirth preference. Since women who express a preference towards caesarean birth report birth stories as focused on negative vaginal experience and positive caesarean birth experiences [26], it was expected that positive caesarean birth and negative vaginal birth stories would lead to an increased preference for caesarean birth. ...
Article
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Objective Preference for caesarean birth is associated with higher fear and lower self-efficacy for vaginal birth. Vicarious experience is a strong factor influencing self-efficacy in nulligravid women, and is increasingly accessible via digital and general media. This study assessed the effect of exposure to different birth stories on nulligravid women’s childbirth preferences and the factors mediating these effects. Methods Nulligravid women ( N = 426) were randomly allocated to one of four conditions exposing them to written birth stories. Stories varied by type of birth (vaginal/caesarean) and storyteller evaluation (positive/negative) in a 2 × 2 design. Childbirth preference, fear of labour and vaginal birth, and self-efficacy for vaginal birth were measured before and after exposure via a two-way between groups analysis of covariance. Hierarchical regression models were used to determine the mediating effects of change in childbirth fear and childbirth self-efficacy. Results Variations in type of birth and storyteller evaluation significantly influenced childbirth preferences ( F (1, 421) = 44.78, p < 0.001). The effect of vaginal birth stories on preference was significantly mediated by fear of labour and vaginal birth and self-efficacy. Effects of exposure to caesarean birth stories were not explained by changes in fear or self-efficacy. Conclusions Childbirth preferences in nulligravid women can be significantly influenced by vicarious experiences. For stories about vaginal birth, the influence of birth stories on women’s fear and self-efficacy expectancy are partly responsible for this influence. The findings highlight the importance of monitoring bias in vicarious experiences, and may inform novel strategies to promote healthy childbirth.
... Researchers have been searching for ways to understanding the pain and fear of childbirth across cultures and demonstrate the complex and varied factors related to fear of childbirth [5,[9][10][11]. When women have an intense fear of childbirth, they are significantly more likely to have a stronger awareness of pain than women who do not have an intense fear of childbirth, and this often contributes to a negative birth experience for them [5,9]. The fears mainly involve worries about the pain of childbirth, anxiety and negative emotions, risks and complications related to birth, body changes after the birth, influences of family birth histories involving pain, confidence in knowledge regarding childbirth, relationships with partners after birth [10,11], disrespect and abuse, and disturbing and embarrassing experiences [12]. ...
... When women have an intense fear of childbirth, they are significantly more likely to have a stronger awareness of pain than women who do not have an intense fear of childbirth, and this often contributes to a negative birth experience for them [5,9]. The fears mainly involve worries about the pain of childbirth, anxiety and negative emotions, risks and complications related to birth, body changes after the birth, influences of family birth histories involving pain, confidence in knowledge regarding childbirth, relationships with partners after birth [10,11], disrespect and abuse, and disturbing and embarrassing experiences [12]. The World Health Organization [13] considers respectful, compassionate care during childbirth a fundamental human right and recognises it as a priority [14]. ...
... Other studies have shown that fear of childbirth is mainly attributed to the fear of pain and may have a substantial social dimension in addition to the histories and perceptions of pregnant women. Therefore, these social dimensions may affect the community that is not currently pregnant but that can be influenced by the social context of women's experience [11]. Furthermore, it can affect women's choices regarding birth, for example, by increasing options for caesarean section and use of medicalisation, despite all the risks involved, including health effects on women and children [43]. ...
Article
Background The pain associated with childbirth is a cause of severe pain, and the literature suggests that it can be influenced by psychosocial influences, the environment, and cognitive processes, creating the overall experience of childbirth. Therefore, the investigation of women's childbirth pain experience is essential. Aim The purpose of this study is to understand women's childbirth pain and determine which influences can contribute to building different experiences. Method A qualitative descriptive approach was adopted to explore the women’s childbirth pain experiences, by understanding the influences on their experiences. Data were collected through in-depth interviews with 21 women in a hospital setting in São Paulo, Brazil, and analysed by thematic analysis. Results Three major themes emerged from the analysis: (1) experiencing childbirth pain, (2) face-to-face with pain, and (3) empowerment needs. Discussion Many factors influence how Brazilian women manage pain and shape their experience during childbirth. The findings suggest that when women had a positive experience, they asked for minimal support, demonstrated balance, and expressed that the pain was manageable; when they had unfavourable experiences, they regarded pain as a threat and a punishment and associated it with unpleasant emotions. Conclusion The results outlined concerns that should be addressed in the provision of specific, appropriate care for women, to support them in improving their experience during childbirth.
... This link between attitudes, fear of birth and preferred birth choices was also found among childless college students. 17 ...
... They seem to form long before women are pregnant, as was shown in students' attitudes toward caesarean births. 17 Thus, it may not be easy to affect these attitudes, which may be deeply rooted in cultural agendas. Such agendas give rise to women's perceptions of birth as a natural or a medical event, 29 which may then be reflected in the attitudes to medicalization. ...
Article
Problem: Rates of medical interventions in childbirth have greatly increased in the Western world. Background: Women's attitudes affect their birth choices. Aim: To assess women's attitudes towards the medicalization of childbirth and their associations with women's background as well as their fear of birth and planned and unplanned modes of birth. Methods: This longitudinal observational study included 836 parous woman recruited at women's health centres and natural birth communities in Israel. All women filled in questionnaires about attitudes towards the medicalization of childbirth, fear of birth, and planned birth choices. Women at <28 weeks gestation when filling in the questionnaire were asked to fill in a second one at ∼34 weeks. Phone follow-up was conducted ∼6 weeks postpartum to assess actual mode of birth. Findings: Attitudes towards medicalization were more positive among younger and less educated women, those who emigrated from the former Soviet Union, and those with a more complicated obstetric background. Baseline attitudes did not differ by parity yet became less positive throughout pregnancy only for primiparae. More positive attitudes were related to greater fear of birth. The attitudes were significantly associated with planned birth choices and predicted emergency caesareans and instrumental births. Discussion: Women form attitudes towards the medicalization of childbirth which may still be open to change during the first pregnancy. More favourable attitudes are related to more medical modes of birth, planned and unplanned. Conclusion: Understanding women's views of childbirth medicalization may be key to understanding their choices and how they affect labour and birth.
... Likewise, other studies have reported that sociodemographic characteristics were not associated with negative perceptions and FOC (Antic, Rados & Jokic-Begic, 2019;Thomson et al. 2017). However, some studies have reported that factors such as being a student in health sciences, ethnicity, delivery method, and source of information about delivery and pregnancy affected students' preferences for either vaginal or C-section delivery and their level of fear related to childbirth (Edmonds, Cwiertniewicz & Stoll, 2015;Hauck et al. 2016;Knobel et al. 2016;Stoll et al. 2015;Weeks, Sadler & Stoll, 2020). ...
... (7). Hauck et al.(27) yaptıkları çalışmada, Avustralyalı genç kadınların %84.4'ünün vajinal doğumu tercih ettiği bildirilmektedir. Kadınların vajinal doğum tercihi olarak en fazla bildirdikleri üç sebep sırasıyla; doğum için normal bir yol olması (%78.3), ...
... Health care-related factors usually include policies and laws, and a dominant physician-patient relationship [12,13]. Individual and cultural-related factors include fear of labor pain, poor knowledge, women's socioeconomic status, previous experiences, negative attitudes and beliefs towards vaginal birth, misconceptions, social norms, and pressure from certain people, friends and family, rumors, and false complications attributed to vaginal birth [4,[14][15][16]. Thus, improving knowledge and modifying women's attitudes toward vaginal birth are recognized as important strategies for controlling unnecessary CS and maternal requests to have a CS delivery [17,18]. ...
Article
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Introduction Improvement of women’s knowledge and attitude toward vaginal birth is recognized as an important strategy to control caesarean sections (CS) on maternal request. This study aimed to evaluate the effectiveness of a mass-media campaign in improving knowledge, attitude and intention of women for vaginal birth. Methods This was a population-based study carried out in Tehran, Iran. A national ‘No to unnecessary caesarean sections’ campaign was launched in April 2016 and was televised for ten days. A random sample of pregnant women from all defined geographical areas of Tehran were recruited and assessed for knowledge about the benefits of vaginal birth and the risk of CS, attitude and intention toward mode of delivery at two points in time: before and after the campaign. A comparison was made to evaluate outcome measures among those who had seen the campaign and those who had not. Results In all, 37 public and private maternity care centers were selected randomly and 702 eligible pregnant women attending these centers were entered in the study. Pre- and post-intervention data for 466 women were available for analysis. Of these, 194 women indicated that they had seen the campaign and the remaining 272 women said that they had not. A comparison of the outcome measures between the two study groups showed that there were significant differences between those who had seen the campaign and those who had not. Those who had seen the campaign reported increased knowledge, had a more positive attitude and indicated increased behavioral intention toward vaginal birth. Conclusions In general, the findings indicated that the mass-media campaign improved pregnant women’s knowledge, attitude and intention towards vaginal birth. However, the long-term effects of such campaigns need further investigation.
... Mediante investigações realizadas no âmbito desta problemática junto de população não-grávida, os níveis elevados de medo associam-se ao parto realizado pela via vaginal. Tais resultados justificam-se pela conceptualização da intensidade de dor elevada por parte dos estudantes universitários, conduzindo à preferência pela via transabdominal como forma de escapatória dolorosa (Hauck, Stoll, Hall, & Downie, 2016;Nilsson et al., 2018;Stoll & Hall, 2013;Stoll et al., 2016). Deste modo, o medo do parto contribui para o aumento das cesarianas eletivas e da medicalização, capaz de proporcionar sentimentos de dúvida e incerteza sobre a capacidade de dar à luz uma criança (Størksen, Garthus-Niegel, Adams, Vangen, & Eberhard-Gran, 2015). ...
Article
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Background: Childbirth is feared by both women and men, leading to increased elective caesarean section rates and medicalization. Although it is most feared during pregnancy, its assessment in non-pregnant populations contributes to an early intervention. Objective: To translate, adapt, and test the psychometric properties of an instrument to measure childbirth fear prior to pregnancy in non-pregnant populations. Methodology: Methodological study, forward-backward translation, and psychometric analysis (reliability and validity) of the Portuguese version of the Childbirth Fear Prior to Pregnancy Scale (EMPAG). Both the EMPAG and the Portuguese version of the 21-item Anxiety, Depression and Stress Scale (EADS-21) were applied. Results: The adapted version of the scale, which was applied to 327 university students, met the criteria of semantic, idiomatic, experiential, and conceptual equivalence and had good internal consistency (a = 0.88) and temporal stability. It consists of 10 items and is explained by 3 factors, without correlation with the EADS-21. Conclusion: The preliminary study of the EMPAG showed good psychometric qualities. It is suggested that the sample should be larger to support the results obtained in this study.
... Several studies have investigated maternity care preferences and attitudes of young women and men who plan to have children in the future. [5][6][7][8][9][10][11][12][13] These studies typically focus on attitudes of young people in a single country or region. For example, Stoll et al surveyed Western Canadian university students about their attitudes toward birth in 2006. ...
Article
Introduction: Midwifery care is associated with positive birth outcomes, access to community birth options, and judicious use of interventions. The aim of this study was to characterize and compare maternity care preferences of university students across a range of maternity care systems and to explore whether preferences align with evidence-based recommendations and options available. Methods: A cross-sectional, web-based survey was completed in 2014 and 2015 by a convenience sample of university students in 8 high-income countries across 4 continents (N = 4569). In addition to describing preferences for midwifery care and community birth options across countries, this study examined sociodemographic characteristics, psychological factors, knowledge about pregnancy and birth, and sources of information that shaped students' attitudes toward birth in relation to preferences for midwifery care and community birth options. Results: Approximately half of the student respondents (48.2%) preferred midwifery-led care for a healthy pregnancy; 9.5% would choose to give birth in a birthing center, and 4.5% preferred a home birth. Preference for midwifery care varied from 10.3% among women in the United States to 78.6% among women in the United Kingdom. Preferences for home birth varied from 0.3% among US women to 18.3% among Canadian women. Women, health science students, those with low childbirth fear, those who learned about pregnancy and birth from friends (compared with other sources, eg, the media), and those who responded from Europe were significantly more likely to prefer midwifery care and community birth. High confidence in knowledge of pregnancy and birth was linked to significantly higher odds of community birth preferences and midwifery care preferences. Discussion: It would be beneficial to integrate childbirth education into high school curricula to promote knowledge of midwifery care, pregnancy, and childbirth and to reduce fear among prospective parents. Community birth options need to be expanded to meet demand among the next generation of maternity service users.
... Among pregnant Iranian women, 70% of those who opt for CS delivery do so for reasons other than medical needs, including personal request, spouse's priorities, and sometimes, inducement by physicians, so the mother's decision is one of the main factors for the increase in CS deliveries (4) . Evidence suggests that training women to develop skills of overcoming a fear of normal vaginal delivery (NVD), reducing labor pain (5) , raising women's awareness regarding the advantages and disadvantages of a given delivery method (6,7) , and engaging them in the process of decision-making on delivery method (8) are effective ways of reducing CS-favoring decisions. The effectiveness of health education programs is substantially related to applied educational theories and models (9) . ...
Article
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Objective The incidence of cesarean section (CS) was estimated as about 48% between 2000 and 2012 in Iran. This study was conducted to assess the effects of reviewing written childbirth scenarios on the selection of delivery method. Materials and Methods This randomized controlled trial was conducted in Shohada Women’s Hospital in Behshahr, Mazandaran, Iran, from May to December 2015. A total of 223 women at 28 to 32 weeks of gestation were randomly allocated into three groups; the standard care (control), theory of planned behavior (TPB)-based education, and TPB education plus additional support via written childbirth scenarios (scenario). Participants were assessed at baseline (weeks 28-32) and intervention (week 37 of pregnancy) periods. Both intervention groups (TPB and scenario groups) participated in three learning sessions that were based on TPB, whereas the control group received routine care service. Results The frequencies of normal vaginal delivery (NVD) in the scenario, TPB, and control groups were 73.2%, 58.5%, and 45.7%, respectively (p=0.004). The results showed that the relative risks of CS decision in the scenario and TPB groups in comparison with the control group were both 0.87 and statistically significant (p=0.018 and p=0.013, respectively). The relative risk of choosing CS after the removal of obligatory CS cases in the scenario group compared with the control was 0.85. Conclusion Written childbirth scenarios that contain information on NVD and CS as additional support are effective educational tools for reducing CS rates.
... 21 Friends and family tell their birth stories, thereby creating an environment or a norm that suggests what birth is and how it should be handled. 7,20,22 The way a woman herself was born and the way her family members birthed could influence her birth-related choices and perceptions. 11,23,24 These factors, together with sociodemographic factors, will represent the social dimensions of our model. ...
Article
Background: Women perceive what birth is even before they are pregnant for the first time. Part of this conceptualization is the basic belief about birth as a medical and natural process. These two separate beliefs are pivotal in the decision-making process about labor and birth. Adapting Engel's biopsychosocial framework, we explored the importance of a wide range of factors which may contribute to these beliefs among first-time mothers. Method: This observational study included 413 primiparae ≥24 weeks' gestation, recruited in medical centers and in natural birth communities in Israel. The women completed a questionnaire which included the Birth Beliefs Scale and a variety of biopsychosocial characteristics such as obstetric history, birth environment, optimism, health-related anxiety, and maternal expectations. Results: Psychological dispositions were more related to the birth beliefs than the social or biomedical factors. Sociodemographic characteristics and birth environment were only marginally related to the birth beliefs. The basic belief that birth is a natural process was positively related to optimism and to conceiving spontaneously. Beliefs that birth is a medical process were related to pessimism, health-related anxiety, and to expectations that an infant's behavior reflects mothering. Expectations about motherhood as being naturally fulfilling were positively related to both beliefs. Conclusion: Psychological factors seem to be most influential in the conceptualization of the beliefs. It is important to recognize how women interpret the messages they receive about birth which, together with their obstetric experience, shape their beliefs. Future studies are recommended to understand the evolution of these beliefs, especially within diverse cultures.
... The prevalence of C-section is increasing worldwide, despite WHO recommendations to the contrary, being this increase most acute in Latin America. This phenomenon may be due to several factors, such as: low maternal self-efficacy; a fear of childbirth, which is related to the social construction of this event; fear of labor pain; and a predisposition by the medical team to perform the surgery (110)(111)(112). It is therefore important to implement public health programs focused on reversing this trend, being C-section is now considered as a significant risk factor for a several number of immune and metabolic diseases, whose incidences are currently growing worldwide. ...
Article
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The current recommendation of the World Health Organization (WHO) regarding cesarean section (C-section) is that this clinical practice should be carried out only under specific conditions, when the health or life of the mother/newborn dyad is threatened, and that its use should not exceed 10–15% of the total deliveries. However, over the last few decades, the frequency of C-section delivery in medium- and high-income countries has rapidly increased worldwide. This review describes the evolution of this procedure in Latin American countries, showing that today more than half of newborns in the region are delivered by C-section. Given that C-section delivery is more expensive than vaginal delivery, its use has increased more rapidly in the private than the public sector; nevertheless, the prevalence of C-section deliveries in the public sector is higher than the WHO’s recommendations and continues to increase, representing a growing challenge for Latin America. Although the medium- and long-term consequences of C-section delivery, as opposed to vaginal delivery, on the infant health are unclear, epidemiological studies suggest that it is associated with higher risk of developing asthma, food allergy, type 1 diabetes, and obesity during infancy. These findings are important, as the incidence of these diseases in the Latin American pediatric population is also increasing, particularly obesity. Although the link between these diseases and delivery mode remains controversial, recent studies indicate that the establishment of the gut microbiota is delayed in infants born by C-section during the postnatal period, i.e., during a critical developmental window for the maturation of the newborn’s immune system. This delay may favor the subsequent development of inflammatory and metabolic disorders during infancy. Accordingly, from a public health perspective, it is important to slow down and eventually reverse the pattern of increased C-section use in the affected populations.
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Problem: Birth preferences, such as mode and place of birth and other birth options, have important individual and societal implications, yet few studies have investigated the mechanism which predicts a wide range of childbirth options simultaneously. Background: Basic beliefs about birth as a natural and as a medical process are both predictive factors for childbirth preferences. Studies investigating birth beliefs, preferences, and actual birth are rare. Aim: To test a predictive model of how these beliefs translate into birth preferences and into actual birth related-options. Methods: Longitudinal observational study including 342 first-time expectant mothers recruited at women's health centres and natural birth communities in Israel. All women filled out questionnaires including basic birth beliefs and preferred birth options. Two months postpartum, they filled out a questionnaire including detailed questions regarding actual birth. Findings: Stronger beliefs about birth being natural were related to preferring a more natural place and mode of birth and preferring more natural birth-related options. Stronger beliefs about birth being medical were associated with opposite options. The preferences mediated the association between the birth beliefs and actual birth. The beliefs predicted the preferences better than they predicted actual birth. Discussion: Birth beliefs are pivotal in the decision-making process regarding preferred and actual birth options. In a medicalized obstetric system, where natural birth is something women need to actively seek out and insist on, the predictive powers of beliefs and of preferences decrease. Conclusion: Women's beliefs should be recognized and birth preferences respected.
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The childbirth preferences and attitudes of young women prior to pregnancy (N = 758) were explored in a cross-sectional survey. Sources of influential childbirth information and self-reported childbirth learning needs were described. Young women’s attitudes about childbirth, including the degree of confidence in coping with a vaginal birth, whether birth is considered a natural event, and expectations of labor pain were associated with their mode of birth preference. Conversations with friends and family were the most influential source of childbirth information. Gaps in knowledge about pregnancy and birth were identified. An improved understanding of women’s preferences and attitudinal profiles can inform the structure and content of educational strategies that aim to help the next generation of maternity care consumers participate in informed decision making.
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AIHW In 2012, 307,474 women gave birth to 312,153 babies in Australia. This was an increase of 10,343 births (3.4%) from that reported in 2011, and a total increase of 21.5% since 2003. Nationally, the proportion of teenage mothers (younger than 20) declined from 3.7% in 2011 to 3.6% in 2011, compared with 4.6% in 2003.
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Background Childbirth fear is associated with increased obstetric interventions and poor emotional and psychological health for women. The purpose of this study is to test an antenatal psycho-education intervention by midwives in reducing women's childbirth fear.Methods Women (n = 1,410) attending three hospitals in South East Queensland, Australia, were recruited into the BELIEF trial. Participants reporting high fear were randomly allocated to intervention (n = 170) or control (n = 169) groups. All women received a decision-aid booklet on childbirth choices. The telephone counseling intervention was offered at 24 and 34 weeks of pregnancy. The control group received usual care offered by public maternity services. Primary outcome was reduction in childbirth fear (WDEQ-A) from second trimester to 36 weeks’ gestation. Secondary outcomes were improved childbirth self-efficacy, and reduced decisional conflict and depressive symptoms. Demographic, obstetric & psychometric measures were administered at recruitment, and 36 weeks of pregnancy.ResultsThere were significant differences between groups on postintervention scores for fear of birth (p < 0.001) and childbirth self-efficacy (p = 0.002). Decisional conflict and depressive symptoms reduced but were not significant.Conclusion Psycho-education by trained midwives was effective in reducing high childbirth fear levels and increasing childbirth confidence in pregnant women. Improving antenatal emotional well-being may have wider positive social and maternity care implications for optimal childbirth experiences.
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Background Childbirth fear is reported to affect around 20% of women. However reporting on levels of symptom severity vary. Unlike Scandinavian countries, there has been limited focus on childbirth fear in Australia. The aim of this paper is to determine the prevalence of low, moderate, high and severe levels of childbirth fear in a large representative sample of pregnant women drawn from a large randomised controlled trial and identify demographic and obstetric characteristics associated with childbirth fear. Method Using a descriptive cross-sectional design, 1,410 women in their second trimester were recruited from one of three public hospitals in south-east Queensland. Participants were screened for childbirth fear using the Wijma Delivery Expectancy/Experience Questionnaire Version A (WDEQ-A). Associations of demographic and obstetric factors and levels of childbirth fear between nulliparous and multiparous women were investigated. Results Prevalence of childbirth fear was 24% overall, with 31.5% of nulliparous women reporting high levels of fear (score ≥66 on the WDEQ-A) compared to 18% of multiparous women. Childbirth fear was associated with paid employment, parity, and mode of last birth, with higher levels of fear in first time mothers (p < 0.001) and in women who had previously had an operative birth (p < 0.001). Conclusion Prevalence of childbirth fear in Australian women was comparable to international rates. Significant factors associated with childbirth fear were being in paid employment, and obstetric characteristics such as parity and birth mode in the previous pregnancy. First time mothers had higher levels of fear than women who had birthed before. A previous operative birth was fear provoking. Experiencing a previous normal birth was protective of childbirth fear.
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In our secondary analysis of a cross-sectional survey, we explored predictors of childbirth fear for young women (n = 2,676). Young women whose attitudes toward pregnancy and birth were shaped by the media were 1.5 times more likely to report childbirth fear. Three factors that were associated with reduced fear of birth were women's confidence in reproductive knowledge, witnessing a birth, and learning about pregnancy and birth through friends. Offering age-appropriate birth education during primary and secondary education, as an alternative to mass-mediated information about birth, can be evaluated as an approach to reduce young women's childbirth fear.
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The caesarean section rates have been rising in the developed world for over two decades. This study assessed the involvement of the public and private health sectors in this increase. Population-based, retrospective cohort study. Public and private hospitals in Western Australia. Included in this study were 155 646 births to nulliparous women during 1996-2008. Caesarean section rates were calculated separately for four patient type groups defined according to mothers' funding source at the time of birth (public/private) and type of delivery hospital (public/private). The average annual per cent change (AAPC) for the caesarean section rates was calculated using joinpoint regression. Overall, there were 45 903 caesarean sections performed (29%) during the study period, 24 803 in-labour and 21 100 prelabour. Until 2005, the rate of caesarean deliveries increased most rapidly on average annually for private patients delivering in private hospitals (AAPC=6.5%) compared with public patients in public hospitals (AAPC=4.3%, p<0.0001). This increase could mostly be attributed to an increase in prelabour caesarean deliveries for this group of women and could not be explained by an increase in breech deliveries, placenta praevia or multiple pregnancies. Our results indicate that an increase in the prelabour caesarean delivery rate for private patients in private hospitals has been driving the increase in the caesarean section rate for nulliparous women since 1996. Future research with more detailed information on indication for the prelabour caesarean section is needed to understand the reasons for these findings.
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To compare the risk profile of women giving birth in private and public hospitals and the rate of obstetric intervention during birth compared with previous published rates from a decade ago. Population-based descriptive study. New South Wales, Australia. 691 738 women giving birth to a singleton baby during the period 2000 to 2008. Risk profile of women giving birth in public and private hospitals, intervention rates and changes in these rates over the past decade. Among low-risk women rates of obstetric intervention were highest in private hospitals and lowest in public hospitals. Low-risk primiparous women giving birth in a private hospital compared to a public hospital had higher rates of induction (31% vs 23%); instrumental birth (29% vs 18%); caesarean section (27% vs 18%), epidural (53% vs 32%) and episiotomy (28% vs 12%) and lower normal vaginal birth rates (44% vs 64%). Low-risk multiparous women had higher rates of instrumental birth (7% vs 3%), caesarean section (27% vs 16%), epidural (35% vs 12%) and episiotomy (8% vs 2%) and lower normal vaginal birth rates (66% vs 81%). As interventions were introduced during labour, the rate of interventions in birth increased. Over the past decade these interventions have increased by 5% for women in public hospitals and by over 10% for women in private hospitals. Among low-risk primiparous women giving birth in private hospitals 15 per 100 women had a vaginal birth with no obstetric intervention compared to 35 per 100 women giving birth in a public hospital. Low-risk primiparous women giving birth in private hospitals have more chance of a surgical birth than a normal vaginal birth and this phenomenon has increased markedly in the past decade.
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At 30 percent, British Columbia has the highest cesarean section rate in Canada. Little is known about the childbirth views and birthing preferences of college-aged women and men. The objectives of this study were to document (a) the prevalence of cesarean versus vaginal delivery as the preferred mode of delivery among nonpregnant university students without a history of childbirth, (b) the reasons for reported childbirth preferences, and (c) confidence in vaginal birth as a predictor of childbirth preference. A cohort of 3,680 male and female university students without a history of childbirth participated in an online survey of childbirth preferences. The study used a mixed methods approach (quantitative thematic analysis and logistic regression modeling). Prevalence of, and reasons for, preferred mode of delivery were analyzed separately for male and female respondents. Most men and women responded that they preferred vaginal delivery, with 9 percent stating a preference for cesarean delivery. Reasons for preferred mode of delivery were similar for men and women. For women, confidence in vaginal birth emerged as a significant predictor of childbirth preference. Results indicate that a preference for cesarean section is linked to fear of childbirth and driven by low confidence in vaginal birth. Educational strategies targeting university-aged men and women may be helpful in alleviating fears of vaginal birth and providing evidence-based information about different birth options.
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Objectives—This report presents preliminary 2014 data on U.S. births. Births are shown by age, live-birth order, race, and Hispanic origin of mother. Data on marital status, cesarean delivery, preterm births, and low birthweight are also presented. Methods—Data are based on 99.71% of 2014 births. Records for the few states with less than 100% of records received are weighted to independent control counts of all births received in state vital statistics offices in 2014. Comparisons are made with final 2013 data and earlier years. Results—The 2014 preliminary number of U.S. births was 3,985,924, an increase of 1% from 2013. The number of births increased for women in all race and Hispanic origin groups in 2014 except for American Indian or Alaska Native women, for whom births decreased. The general fertility rate was 62.9 births per 1,000 women aged 15–44, up 1% from 2013, and the first increase in the fertility rate since 2007. The birth rate for teenagers aged 15–19 decreased 9% in 2014 to 24.2 births per 1,000 women, yet another historic low for the nation; rates decreased for both younger and older teenagers to record lows. The birth rate for women in their early 20s declined to 79.0 births per 1,000 women, another record low. Birth rates for women in their 30s and early 40s increased in 2014. The nonmarital birth rate declined 1% in 2014, to 44.0 births per 1,000 unmarried women aged 15–44, dropping for six consecutive years. The cesarean delivery rate was down 2%, and the low-risk cesarean delivery rate was down 3%, in 2014. The preterm birth rate (based on a change in measure) was down in 2014 to 9.57%. The low birthweight rate was essentially unchanged in 2014 at 8.00%. © 2015, National Center for Health Statistics. All rights reserved.
Article
Objectives-This report presents prelimina ry data for 2013 on births in the United States. U.S. data on births are shown by age, live-birth order, race, and Hispanic origin of mother. Data on marital status, cesarean delivery, preterm births, and low birthwe ight are also presented. Methods-Data in this report are based on 99.85% of 2013 births. Records for the few states with less than 100% of records received are weighted to independent control counts of all births received in state vital statistics offices in 2013. Comparisons are made with final 2012 data and earlier years. Results- The 2013 preliminary number of births for the United States was 3,957,577, slightly more births (4,736) than in 2012. The number of births increased or were unchanged for most race and Hispanic origin groups from 2012 to 2013; however, the number of births for Asian or Pacific Islander women declined 2% in 2013. • The general fertility rate was 62.9 births per 1,000 women age 15-44 years, down slightly from 2012 and a record low. • The birth rate for teens aged 15-19 declined 10% in 2013 to 26.6 births per 1,000 women, yet another historic low for the nation, with rates declining for both younger and older teenagers to record lows. • The birth rate for women in their early twenties also declined in 2013, to a record low of 81.2 births per 1,000 women. • Birth rates for women in their thirties and forties rose in 2013. • The nonmarita l birth rate was down 1% in 2013 to 44.8 births per 1,000 unmarried women aged 15-44; the number of births to unmarried women declined slightly, as did the percentage of births to unmarr ied women (40.6% in 2013). • A small decline was seen in the cesarean delivery rate (32.7%). • The preterm birth rate fell for the seventh year in a row to 11.38% in 2013. • The low birthweight rate was essentially unchanged at 8.02%.
Article
AIM: To determine the association between mode of birth and physical and psychological health problems reported at 10 weeks postpartum. METHODS: A cross-sectional, self-report survey was completed by 2,699 Western Australian women at 10 weeks postpartum. Information on birth mode and physical and psychological health was sought. Descriptive statistics and frequency distributions were performed to describe the sample. Logistic regression was used to determine the association between mode of birth and the reported number of physical health problems (two or more and three or more) and two psychological health problems. RESULTS: The occurrence of physical health problems for all women were incontinence (11.5%), no bowel control (2.6%), backache (41%), heavy bleeding (14.1%), and excessive fatigue or tiredness (35.7%). A significant association was found between all cesarean sections (elective and emergency) and the number of physical health problems compared to spontaneous vaginal births. Women who had an emergency cesarean were most likely (OR = 3.15, CI = 2.40–4.13, p < 0.0005) to report two or more physical problems, whereas women who had an elective cesarean were more likely (OR = 2.75, CI = 2.08–3.63, p < 0.0005) to report three or more physical problems. Nearly 15% of women reported being unhappy for more than a few days. This was highest in women having an emergency cesarean (16.4%) and lowest in women giving birth spontaneously (13.5%). Some 6.4% of women stated they were constantly reliving negative thoughts of birth and/or labor. Women who had an emergency cesarean were more likely (OR = 3.10, CI = 1.96–4.89, p < 0.0005) to choose this item and they were also more likely (OR = 2.04, CI = 1.01–4.13, p < 0.047) to experience both psychological health items. CONCLUSION: Women's reports of health problems within the first 10 weeks postpartum are concerning and warrant ongoing attention. The prevalence of health problems was higher in women who had experienced a cesarean. This information on morbidity postbirth is essential for women and their care providers in making informed decisions around available birth options.
Article
Immune diseases such as asthma, allergy, inflammatory bowel disease, and type 1 diabetes have shown a parallel increase in prevalence during recent decades in westernized countries. The rate of cesarean delivery has also increased in this period and has been associated with the development of some of these diseases. Mature children born by cesarean delivery were analyzed for risk of hospital contact for chronic immune diseases recorded in the Danish national registries in the 35-year period 1977-2012. Two million term children participated in the primary analysis. We studied childhood diseases with a suspected relation to a deviant immune-maturation and a debut at young age. The effect of cesarean delivery on childhood disease incidences were estimated by means of confounder-adjusted incidence rate ratios with 95% confidence intervals obtained in Poisson regression analyses. Children delivered by cesarean delivery had significantly increased risk of asthma, systemic connective tissue disorders, juvenile arthritis, inflammatory bowel disease, immune deficiencies, and leukemia. No associations were found between cesarean delivery and type 1 diabetes, psoriasis, or celiac disease. Cesarean delivery exemplifies a shared environmental risk factor in early life associating with several chronic immune diseases. Understanding commonalities in the underlying mechanisms behind chronic diseases may give novel insight into their origin and allow prevention. Copyright © 2015 by the American Academy of Pediatrics.
Article
Objective: To estimate the cost of 'the cascade' of obstetric interventions introduced during labour for low risk women. Design: A cost formula derived from population data. Setting: New South Wales, Australia. Population: All 171,157 women having a live baby during 1996 and 1997. Methods: Four groups of interventions that occur during labour were identified. A cost model was constructed using the known age-adjusted rates for low risk women having one of three birth outcomes following these pre-specified interventions. Costs were based on statewide averages for the cost of labour and birth in hospital. Main outcome measures: The outcome measure is an 'average cost unit per woman' for low risk women, predicted by the level of intervention during labour. Obstetric care is classified as either private obstetric care in a private or public hospital, or routine public hospital care. Results: The relative cost of birth increased by up to 50% for low risk primiparous women and up to 36% for low risk multiparous women as labour interventions accumulated. An epidural was associated with a sharp increase in cost of up to 32% for some primiparous low risk women, and up to 36% for some multiparous low risk women. Private obstetric care increased the overall relative cost by 9% for primiparous low risk women and 4% for multiparous low risk women. Conclusions: The initiation of a cascade of obstetric interventions during labour for low risk women is costly to the health system. Private obstetric care adds further to the cost of care for low risk women
Article
Little is known if couples hold similar or different attitudes towards birth or what impact these have on the actual mode of birth. The aim of this study was to compare couples' personal and general attitudes towards birth. An additional aim was to study the relationship between attitudes, birth preferences, and fear of birth in relation to mode of birth. This study is part of a longitudinal cohort study of 1074 pregnant women and their partners recruited during one year in three hospitals in the middle-north part of Sweden. Data was collected by questionnaires. Chi-square test, t-tests and multinominal regression analysis were used in the analyses. Women held stronger attitudes about the importance of a safe and less stressful birth for the baby, while their partners were most concerned about the woman's health. Women who preferred a caesarean section and reported childbirth fear often prioritized a safe and stressful birth for themselves, wanted to avoid pain, plan the date, and decide about birth themselves and did not view birth as natural. Some of these attitudes were also found in partners who preferred a caesarean section. Birth preference and fear were strongly associated with mode of birth. Special attention should be directed towards parents with a caesarean section preference and parents with childbirth related fear as they have certain attitudes to birth and are more likely to have caesarean section for the birth of the baby.
Article
to compare self-rated health and perceived difficulties during pregnancy as well as antenatal attendance, birth experience and parental stress in fathers with and without childbirth related fear. a longitudinal regional survey. Data were collected by three questionnaires. three hospitals in the middle-north part of Sweden. 1047 expectant fathers recruited in mid-pregnancy and followed up at two months and one year after birth. childbirth fear was assessed using the Fear of Birth Scale (FOBS). Self-rated physical and mental health and perceived difficulties were assessed in mid pregnancy. Two months after birth antenatal attendance, mode of birth and the birth experience were investigated. Parental stress was measured using the Swedish Parental Stress Questionnaire (SPSQ). Crude and adjusted odds ratios were calculated between expectant fathers who scored 50 and above (childbirth fear) and those that did not (no fear). expectant fathers with childbirth related fear (13.6%) reported poorer physical (OR 1.8; 95% CI 1.2-2.8) and mental (OR 3.0; 1.8-5.1) health than their non-fearful counterparts. The fearful fathers were more likely to perceive difficulties in pregnancy (OR 2.1; 1.4-3.0), and the forthcoming birth (OR 4.3; 2.9-6.3) compared to fathers without childbirth fear. First-time fathers with fear attended fewer antenatal classes. Fathers with high fear reported higher mean scores in four of the five subscales of the SPSQ. Childbirth related fear was not associated with mode of birth or fathers' birth experience. expectant fathers with childbirth related fear had poorer health, viewed the pregnancy, birth and the forthcoming parenthood with more difficulties. They were less often present during antenatal classes and had higher parental stress. this study provides insight into the health of expectant fathers during pregnancy and highlights the importance of understanding how childbirth fear may affect expectant fathers in both the short and longer term.
Article
to examine attitudes towards birth that may be common among young adults who have been socialised into a medicalised birth culture. Specifically, we were interested in examining factors that might be associated with fear of birth and preferences for elective obstetric interventions among the next generation of maternity care consumers. secondary analysis of an online survey of university students. British Columbia, Canada. students from the University of British Columbia (n=3680). A quarter of the sample comprised Asian students, which allowed for analysis of cultural differences in attitudes towards birth. Both male and female students participated in the study; results are reported for the full sample, and by gender. a six item fear of childbirth scale was developed, as well as a 4 item index that measures students' concerns over physical changes following pregnancy and birth and a 2 item scale that assesses students' attitudes towards obstetric technology. as we hypothesised, students who were more fearful of birth preferred epidural anaesthesia and birth by CS. Worries over physical changes following pregnancy and birth, favourable attitudes towards obstetric technology, and exposure to pregnancy and birth information via the media were also significantly associated with a preference for CS. Fear of birth scores were highest among students who reported that the media had shaped their attitudes towards pregnancy and birth. Asian students had significantly higher fear of birth scores and were more likely to prefer CS, compared to Caucasian students. young adults are contemplating pregnancy and birth in an increasingly technology-dependent society. Educational programmes aimed at reducing fear of childbirth and concerns over physical changes following pregnancy and childbirth might contribute to vaginal birth intentions among young adults. Midwives may use the findings to identify and counsel nulliparas who exhibit fear of birth and other childbirth attitudes that may predispose them to choose elective obstetric interventions.
Article
To explore if antenatal fear of childbirth in men affects their experience of the birth event and if this experience is associated with type of childbirth preparation. Data from a randomized controlled multicenter trial on antenatal education. 15 antenatal clinics in Sweden between January 2006 and May 2007. 762 men, of whom 83 (10.9%) suffered from fear of childbirth. Of these 83 men, 39 were randomized to psychoprophylaxis childbirth preparation where men were trained to coach their partners during labor and 44 to standard care antenatal preparation for childbirth and parenthood without such training. Experience of childbirth was compared between men with and without fear of childbirth regardless of randomization, and between fearful men in the randomized groups. Analyses by logistic regression adjusted for sociodemographic variables. Self-reported data on experience of childbirth including an adapted version of the Wijma Delivery Experience Questionnaire (W-DEQ B). Men with antenatal fear of childbirth more often experienced childbirth as frightening than men without fear: adjusted odds ratio 4.68, 95% confidence interval 2.67–8.20. Men with antenatal fear in the psychoprophylaxis group rated childbirth as frightening less often than those in standard care: adjusted odds ratio 0.30, 95% confidence interval 0.10–0.95. Men who suffer from antenatal fear of childbirth are at higher risk of experiencing childbirth as frightening. Childbirth preparation including training as a coach may help fearful men to a more positive childbirth experience. Additional studies are needed to support this conclusion.
Article
Objective: to investigate the prevalence of childbirth related fear in Swedish fathers and associated factors. Design: a regional cohort study. Data was collected by a questionnaire. Setting: three hospitals in the middle-north part of Sweden Participants: 1047 expectant fathers recruited in mid-pregnancy during one year (2007) who completed the Fear of Birth Scale (FOBS). Measurements: prevalence of childbirth fear and associated factors. Crude and adjusted odds ratios were calculated between men who scored 50 and above (childbirth fear) and those that did not (no fear). Logistic regression analysis was used to assess which factors contributed most to childbirth fear in fathers. Findings: the prevalence of childbirth fear in men was 13.6%. Factors associated with childbirth related fear were as follows: Less positive feelings about the approaching birth (OR 3.4; 2.2-5.2), country of birth other than Sweden (OR 2.8; 1.3-6.1), a preference for a caesarean birth (OR 2.1; 1.7-4.1), childbirth thoughts in mid-pregnancy (OR 1.9; 1.1-2.0) and expecting the first baby (OR 1.8; 1.2-2.6). Key conclusions: high levels of fear were associated with first time fathers and being a non-native to Sweden. Men with fear were more likely to experience pregnancy and the coming birth as a negative event. These men were also more likely to identify caesarean section as their preferred mode of birth. Implications for practice: engaging expectant fathers in antenatal conversations about their experiences of pregnancy and feelings about birth provides health-care professionals with an opportunity to address childbirth fear, share relevant information and promote birth as a normal but significant life event.
Article
The interactions of the hormones of pregnancy, labour and birth are complex and subtle and their effects are far reaching. Within these complex interactions beta endorphin (beta-end) has a key balancing function, being a hormone of relationship and a stress hormone. As well as helping the mother cope with labour, beta-end enhances relationships with the newborn and the initiation of breastfeeding. Both too much endorphin and too little can create problems in labour. Optimising endorphin levels is therefore more complex than simply enhancing them and calls for midwifery skills to relieve fear so that women feel safe.
Article
To assess the association between fear of childbirth and duration of labour. A prospective study of women from 32 weeks of gestation through to delivery. Akershus University Hospital, Norway. A total of 2206 pregnant women with a singleton pregnancy and intended vaginal delivery during the period 2008-10. Fear of childbirth was assessed by the Wijma Delivery Expectancy Questionnaire (W-DEQ) version A at 32 weeks of gestation, and defined as a W-DEQ sum score ≥ 85. Information on labour duration, use of epidural analgesia and mode of delivery was obtained from the maternal ward electronic birth records. Labour duration in hours: from 3-4 cm cervical dilatation and three uterine contractions per 10 minutes lasting ≥ 1 minute, until delivery of the child. Fear of childbirth (W-DEQ sum score ≥ 85) was present in 7.5% (165) of women. Labour duration was significantly longer in women with fear of childbirth compared with women with no such fear using a linear regression model (crude unstandardized coefficient 1.54; 95% confidence interval 0.87-2.22, corresponding to a difference of 1 hour and 32 minutes). After adjustment for parity, counselling for pregnancy concern, epidural analgesia, labour induction, labour augmentation, emergency caesarean delivery, instrumental vaginal delivery, offspring birthweight and maternal age, the difference attenuated, but remained statistically significant (adjusted unstandardized coefficient 0.78; 95% confidence interval 0.20-1.35, corresponding to a 47-minute difference). Duration of labour was longer in women with fear of childbirth than in women without fear of childbirth.
Article
Concurrent with the trend of increasing cesarean delivery numbers, there has been an epidemic of both autoimmune diseases and allergic diseases. Several theories have emerged suggesting that environmental influences are contributing to this phenomenon, most notably, the hygiene hypothesis. This article provides background about the human microbiota and its relationship to the developing immune system as well as the relationship of mode of delivery on the colonization of the infant intestine, development of the immune system, and subsequent childhood allergies, asthma, and autoimmune diseases.
Article
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.
Article
research, conducted predominately in Scandinavian countries, suggests that a substantial number of women experience high levels of fear concerning childbirth which can impact on birth outcomes, the mother-infant relationship and the ongoing mental health of the mother. The prevalence of childbirth-related fear (CBRF) is not well known outside of the Nordic nations. This study aimed to examine the prevalence of CBRF in two rural populations (Sweden and Australia) and to pilot a short, easy-to-administer measurement tool. a questionnaire assessing a range of childbirth-related issues was administered to women in the first trimester across two rural populations in Sweden (n = 386) and Australia (n = 123). CBRF was measured using the Fear of Birth Scale (FOBS) a two-item visual analogue scale. close to 30% of women from the Australian and Swedish samples reported elevated levels of CBRF in the first trimester. A previous negative birth experience and less than positive attitudes to their current pregnancy and birth were predictive of high levels of fear. Swedish women with high levels of fear indicated a preference for caesarean section as the mode of birth in this pregnancy. A higher proportion (19%) of Australian women indicated that they would prefer an elective caesarean section, compared with only 8.8% of the Swedish sample; however, this was not related to high levels of fear. Preference for caesarean section was related to CBRF in the Swedish sample but not in the Australian sample. the high proportion of women identified with CBRF suggests a need for monitoring of women during pregnancy, particularly those with a previous negative birth experience. The FOBS developed for this study could be used as a screening tool to identify women who require further investigation. Further cross-cultural research is needed to explore the role of fear in women's preference for caesarean section.
To explore women's levels of childbirth fear, sleep deprivation, anxiety, and fatigue and their relationships during the third trimester of pregnancy. A cross-sectional descriptive survey of a community sample. Six hundred and fifty English-speaking nulliparous and multiparous women, 17 to 46 years of age and between 35 and 39 weeks gestation, with uncomplicated pregnancies. Wijma Delivery Expectancy/Experience Questionnaire, Spielberger State Anxiety Inventory, Mindell's Sleep Questionnaire, and the Multidimensional Assessment of Fatigue Questionnaire. Twenty-five percent of women reported high levels of childbirth fear and 20.6% reported sleeping less than 6 hours per night. Childbirth fear, fatigue, sleep deprivation, and anxiety were positively correlated. Fewer women attending midwives reported severe fear of childbirth than those attending obstetricians. Women with high childbirth fear were more likely to have more daily stressors, anxiety, and fatigue, as well as less help. Higher levels of anxiety predicted higher levels of childbirth fear among women. One fourth of women reported high childbirth fear. Women's fear of childbirth was related to fatigue, available help, stressors, and anxiety. Fear of childbirth appears to be part of a complex picture of women's emotional experiences during pregnancy.
Article
To investigate Swedish women's level of antenatal fear of childbirth at various gestational ages, and factors associated with intense fear and with preference for cesarean section. A cross-sectional study. All antenatal clinics in four geographical areas. Thousand six hundred and thirty-five pregnant women at various gestational ages recruited during September-October 2006. A questionnaire completed at the antenatal clinic. The women reported their appraisal of the approaching delivery according to the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). The level of fear of childbirth and preferred mode of delivery. Mean W-DEQ score was 62.8. The prevalence of intense fear of childbirth (W-DEQ score > or =85) was 15.8% and very intense fear (tocophobia) (W-DEQ score > or =100) 5.7%. Nulliparous women had a higher mean score than parous women, but more parous women reported an intense fear. Preference for cesarean section was associated with fear of childbirth (OR 11.79, 6.1-22.59 for nulliparous and OR 8.32, 4.36-15.85 for parous women) and for parous women also with a previous cesarean section (OR 18.54, 9.55-35.97), or an instrumental vaginal delivery (OR 2.34, 1.02-5.34). The level of fear of childbirth was not associated with the gestational age. When a woman requests a cesarean section, both primary fear of birth and traumatic childbirth experiences need to be considered and dealt with. The W-DEQ can be used at any time during pregnancy in order to identify pregnant women who suffer from intense fear of childbirth.
Article
Aim: To investigate pre- and postpartum levels of childbirth fear in a cohort of childbearing women and explore the relationship to birth outcomes. Background: While results are mixed, there is evidence that fear of childbirth is associated with mode of birth. Limited theoretical work around childbirth fear has been undertaken with Australian women. Design: A prospective correlation design. Method. Women (n = 401) completed the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) version A at 36 weeks gestation, with 243 (61%) women also completing version B at six weeks postpartum. Scores were summarised with means and standard deviations. Content analysis of the free statements identified nine issues of concern. Results: Twenty-six per cent of pregnant women reported low levels of childbirth fear, 48% were moderately fearful and 26% were highly fearful. Fear decreased after birth for those women in the high antenatal fear group, however surgical intervention at birth (n = 238, anova, F(1,230) = 12.39, p = 0.001) and suspected fetal compromise (F(1,230) = 4.33, p = 0.039) increased levels of postpartum fear. Univariately, high antenatal fear was associated with emergency caesarean delivery (n = 324, Wald 5.05, p = 0.025) however after adjustment for nulliparity and fetal compromise the association disappeared. Australian-born women were more likely to report higher levels of fear and experience higher rates of caesarean section than participants of non-Australian origin. Conclusions: Results support those from earlier studies in showing that nulliparous women experience more fear than parous women before birth and that there is no difference in levels of postpartum fear between these two groups. Fear levels were higher in Australian women when compared to a Swedish sample. Relevance to clinical practice: The results of this study add to our preliminary understanding of the phenomena of childbirth fear within an Australian context and are particularly useful in profiling women for whom secondary fear of childbirth is more likely to occur.
Article
To estimate the cost of "the cascade" of obstetric interventions introduced during labour for low risk women. A cost formula derived from population data. New South Wales, Australia. All 171,157 women having a live baby during 1996 and 1997. Four groups of interventions that occur during labour were identified. A cost model was constructed using the known age-adjusted rates for low risk women having one of three birth outcomes following these pre-specified interventions. Costs were based on statewide averages for the cost of labour and birth in hospital. The outcome measure is an "average cost unit per woman" for low risk women, predicted by the level of intervention during labour. Obstetric care is classified as either private obstetric care in a private or public hospital, or routine public hospital care. The relative cost of birth increased by up to 50% for low risk primiparous women and up to 36% for low risk multiparous women as labour interventions accumulated. An epidural was associated with a sharp increase in cost of up to 32% for some primiparous low risk women, and up to 36% for some multiparous low risk women. Private obstetric care increased the overall relative cost by 9% for primiparous low risk women and 4% for multiparous low risk women. The initiation of a cascade of obstetric interventions during labour for low risk women is costly to the health system. Private obstetric care adds further to the cost of care for low risk women.
Article
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.
Article
To compare the outcomes and costs associated with primary cesarean births with no labor (planned cesareans) to vaginal and cesarean births with labor (planned vaginal). Analysis was based on a Massachusetts data system linking 470,857 birth certificates, fetal death records, and birth-related hospital discharge records from 1998 and 2003. We examined a subset of 244,088 mothers with no prior cesarean and no documented prenatal risk. We then divided mothers into two groups: those with no labor and a primary cesarean (planned primary cesarean deliveries-3,334 women) and those with labor and either a vaginal birth or a cesarean delivery (planned vaginal-240,754 women). We compared maternal rehospitalization rates and analyzed costs and length of stay. Rehospitalizations in the first 30 days after giving birth were more likely in planned cesarean (19.2 in 1,000) when compared with planned vaginal births (7.5 in 1,000). After controlling for age, parity, and race or ethnicity, mothers with a planned primary cesarean were 2.3 (95% confidence interval [CI] 1.74-2.9) times more likely to require a rehospitalization in the first 30 days postpartum. The leading causes of rehospitalization after a planned cesarean were wound complications (6.6 in 1,000) (P<.001) and infection (3.3 in 1,000). The average initial hospital cost of a planned primary cesarean of US dollars 4,372 (95% C.I. US dollars 4,293-4,451) was 76% higher than the average for planned vaginal births of US dollars 2,487 (95% C.I. US dollars 2,481-2,493), and length of stay was 77% longer (4.3 days to 2.4 days). Clinicians should be aware of the increased risk for maternal rehospitalization after cesarean deliveries to low-risk mothers when counseling women about their choices. II.
Preventable obstetrical interventions: how many caesarean sections can be prevented in Canada?
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