Psychological perspectives on fear of childbirth

Introduction There is growing evidence of the considerable impact of fear of childbirth on women's health and well‐being, but prevalence reports of high and severe fear of childbirth and reported risk factors have been inconsistent in various studies. Therefore, this study aimed to determine the prevalence of high and severe fear of childbirth, and to identify risk factors of childbirth fear. Material and methods A cross‐sectional study was conducted among a convenience sample of 882 pregnant women attending antenatal care in Cork, Ireland. Fear of childbirth was assessed using the Wijma Delivery Expectancy Questionnaire version A (W‐DEQ A) using a cut‐off ≥66 to define high fear and ≥85 to define severe fear. Associated risk factors were investigated using univariate and multivariate multinomial logistic regression analyses. Four W‐DEQ A subscales were calculated using a cut‐off ≥2.5 to determine the nature of childbirth fear. Results Overall prevalence of severe fear of childbirth was 5.3% and high fear of childbirth was 36.7%. The prevalence of severe fear of childbirth was 7.4% in nulliparous women and 4.3% in multiparous women; however, the difference was not statistically significant (P < 0.07). The prevalence of high fear of childbirth was 43% in nulliparous women and 33.6% in multiparous women, and this difference was statistically significant (P < 0.005). High fear of childbirth was associated with single marital status when compared with married or co‐habiting women (P < 0.008). In a multivariate analysis, high fear of childbirth was significantly associated with low perceived informational support (adjusted relative risk ratio 2.62, 95% confidence interval [CI] 1.34‐5.13) and possible depression (assessed by the Edinburgh Postnatal Depression Scale) (adjusted relative risk ratio 12.87, 95% CI 6.07‐27.25). In the W‐DEQ A subscales, 35.6% of women scored ≥2.5 in Negative Emotions, 29.4% scored ≥2.5 in Lack of Positive Emotions, 9.9% scored ≥2.5 in Social Isolation and 7.8% scored ≥2.5 in Moment of Birth. Conclusions Fear of childbirth is relatively common, with varying severity, and was more common in first‐time mothers. Using W‐DEQ A subscales provided additional information about the nature of the fear, in addition to severity of fear of childbirth.

Identification of the elements and moderators of FOC provide an insight into the potential mechanisms that contribute to women's fears, which can be used to inform methods of identifying women with FOC or a basis upon which to base supportive strategies to reduce women's fears for giving birth.

Pain catastrophizing and intolerance of uncertainty were the most evident predictors of fear of birth. Although preliminary, the findings suggest that interventions targeting catastrophic cognitions and intolerance of uncertainty might be relevant to psychological treatment for fear, worry, or anxiety relating to giving birth.