TITLE:
Psycho-Social Predictors of Childbirth Fear in Pregnant Women: An Australian Study
AUTHORS:
Jocelyn Toohill, Jennifer Fenwick, Jenny Gamble, Debra K. Creedy, Anne Buist, Elsa Lena Ryding
KEYWORDS:
Childbirth Fear, Predictors, Pain, Decisional Conflict, Depression, Social Support
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.4 No.9,
June
24,
2014
ABSTRACT: Background: Around 20% of
birthing women report high levels of childbirth fear. Fear potentially impacts
women’s emotional health, preparation for birth, and birth outcomes. Evidence
suggests that personal and external factors contribute to childbirth fear,
however results vary. Aim: To identify pyscho-social factors associated with
childbirth fear and possible antenatal predictors of childbirth fear according
to women’s parity. Method: 1410 women in second trimester and attending one of
three public hospitals in south-east Queensland were screened for childbirth
fear using the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ).
Other measures included the Edinburgh Depression Scale (EPDS), Decisional
Conflict Scale (DCS) and items from the EuroQol (EQ-5D) targeting
Anxiety/Depression and Pain/Discomfort. In addition items measuring a previous
mental health condition, social support and knowledge were used. Preferred mode
of birth was also collected. Psycho-social factors were analysed to determine
associations with childbirth fear. Multivariate analysis was used to determine
predictors of fear. Results: Thirty-one percent (n = 190/604) of nulliparous
and 18% (n = 143/782) of multiparous women reported high fear levels. Having a
mental health history, desiring a caesarean section, reporting moderate to high
pain during pregnancy, having a non-supportive partner and perceiving less
childbirth knowledge than peers, were associated with childbirth fear. Standard
multiple regression analyses by parity determined that depression, decisional
conflict, low social support and less perceived knowledge predicted levels of
childbirth fear. The model explained 32.4% of variance in childbirth fear for
nulliparous and 29.4% for multiparous women. Conclusion: Psychosocial factors
are significantly associated with childbirth fear. The identification of
predictive psychosocial factors for childbirth fear indicates the importance of
observing, assessing, and developing support strategies for women. Such
strategies are required to decrease anxiety and depression for women during
pregnancy, promote normal birth, and build social support to improve women’s
feelings and positive expectations of birth.