RESUMEN
Social support is an important factor in reducing fear of childbirth (FOC). Recently, the Internet and Social Networking Services (SNS) have become new forms of social support. However, it is unclear whether such support can reduce pregnant women's fear. This study aimed to investigate the association between FOC and social support through the Internet and SNS in pregnant women. A cross-sectional study using a web-based questionnaire including questions about FOC, social support, the Internet and SNS usage, psychological variables, and sociodemographic variables was conducted. Data from 111 participants were analyzed. A greater number of social support from people who are often seen during pregnancy, and becoming relieved by interaction with others through the Internet and SNS were negatively associated with FOC. This study showed that face-to-face social support was associated with lower FOC, while social support through the Internet and SNS was not. Further research is needed on how to use Internet and SNS to reduce FOC in pregnant women.
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Parto , Mujeres Embarazadas , Embarazo , Femenino , Humanos , Mujeres Embarazadas/psicología , Parto/psicología , Estudios Transversales , Miedo/psicología , Apoyo Social , Encuestas y Cuestionarios , Parto Obstétrico/psicologíaRESUMEN
OBJECTIVE: This study was conducted to determine the prevalence of fear of childbirth and affecting factors in pregnant women in Turkey. MATERIALS AND METHODS: This was a cross-sectional study and included a total of 2025. Pregnant Women Assessment, some variables related to previous and current perinatal processes and Wijma Delivery Expectancy/Experience Questionnaire (version A) were used for data collection. FINDINGS: In this sample, 42.4% of the women reported fear of childbirth. What the women were afraid of most was the development of unwanted conditions at childbirth, obscurity/uncertainty, and negative attitudes of health professionals. The factors causing fear of childbirth were the low education level, unemployment status, low financial status, stillbirth, unplanned pregnancy, indecisiveness about the type of delivery, not attending prenatal education programs, negative effects of other people, insufficient social support, confiding in the healthcare centre and health professional, negative, and indecisive birth perceptions, prior negative birth experiences and not feeling ready for childbirth (p < 0.001). CONCLUSIONS: The prevalence of fear of childbirth in this Turkish sample, especially in the multipara is higher than in Western countries. Causes of fear of childbirth can vary with countries and even with each region of a country.
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Parto Obstétrico , Mujeres Embarazadas , Embarazo , Femenino , Humanos , Turquía , Prevalencia , Estudios Transversales , Parto , MiedoRESUMEN
AIM: The aim of the study was to determine the prevalence of severe fear of childbirth in a group of pregnant women, to determine the risk factors, and to prove the impact of the fear of childbirth on various obstetrics outcomes in this group. MATERIALS AND METHODS: The study population consists of pregnant women who gave birth at the 2nd Gynecology and Obstetrics Department of the Faculty of Medicine, Comenius University and University Hospital Bratislava, from January 1st, 2022, until April 31st, 2022. After signing an informed consent, the pregnant women were given a Slovak version of the Wijma Delivery Expectancy Questionnaire (S-WDEQ), which is a psychometric tool to evaluate the prevalence of severe fear of childbirth. They were given the S-WDEQ during the 36th and 38th week of gestational age. The childbirth data were collected from the hospital information system after the delivery of the baby. RESULTS AND CONCLUSION: The studied group consists of 453 pregnant women who fulfilled the inclusion criteria. Extreme fear of childbirth was identified using S-WDEQ in 10.6% (48) of them. Level of education and age were not considered to be significant predictors of fear of childbirth. Statistically significant difference was not found in terms of the age groups and groups with different levels of education. At the edge of the statistical significance were primiparas, who made up 60.4% (RR: 1.29; 95% CI: 1.00-1.68; P = 0.0525) of all women with severe fear of childbirth. Women with a history of cesarean section were significantly more frequent in the group of women with serious concerns about childbirth (RR: 3.83; 95% CI: 1.56-9.40; P = 0.0033). Women who gave birth by cesarean section due to the indication of non-progressive labour were also more often represented in the group of women with serious concerns about childbirth (RR: 3.01; 95% CI: 1.07-8.42; P = 0.0358). A higher S-WDEQ score at the 36th week of gestational age in a group of primiparous women increased the statistical probability of cesarean delivery (P = 0.0030). The statistical results are not showing the impact of fear of childbirth on the induction success and the duration of the first stage of labour in primiparous women. The fear of childbirth prevalence is relatively high and it has impact on the outcome of childbirth. The use of a validated questionnaire as a screening tool to search for women with childbirth fear could positively influence their concerns by following psychoeducational interventions in clinical care settings.
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Cesárea , Parto , Femenino , Embarazo , Humanos , Prevalencia , Mujeres Embarazadas , Encuestas y Cuestionarios , Factores de RiesgoRESUMEN
BACKGROUND: Fear of childbirth (FOC) is a common psychological problem in Chinese pregnant women. FOC can influence both maternal health and infants' wellness. Special assessment tools for FOC in Mandarin Chinese are currently lacking. The aim of this study was to evaluate the psychometric properties of the Mandarin Chinese of the Wijma Delivery Expectancy/Experience Questionnaire Version A (W-DEQ-A). METHODS: We recruited 364 Chinese pregnant women from April 2021 to July 2021. Translation and cultural adaptation, as well as reliability and validity testing were conducted. Analyses included the content validity, structural validity, criterion-related validity, convergent validity and reliability. The content validity indices were used to assess the content validity of the tool. The structural validity was tested through exploratory factor analysis and confirmatory factor analysis. The Cronbach's alpha coefficient was used to evaluate the reliability of the W-DEQ-A Chinese version. RESULTS: The Chinese translation showed excellent similarities and equivalence to the original version, with the satisfactory content validity. Factor analysis indicated 5 factors, accounting for 57% of the total variance. Both criterion-related validity and convergent validity proved to be acceptable. The reliability was tested with a Cronbach's alpha coefficient of 0.911 for the total scale. CONCLUSION: The W-DEQ-A Chinese version is a reliable and valid tool to identify FOC in Mandarin Chinese-speaking populations.
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Mujeres Embarazadas , Femenino , Embarazo , Humanos , Estudios Transversales , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Psicometría , Mujeres Embarazadas/psicología , ChinaRESUMEN
BACKGROUND: Fear of childbirth is common both before and after childbirth, often leading to complications in mother and new-born. The Wijma Delivery Expectancy/Experience Questionnaires (W-DEQ) are commonly used to measure fear of childbirth among women before (version A) and after childbirth (version B). The tools are not yet validated in the Tanzanian context. This study aimed to validate the reliability, validity, and factorial structure of their Kiswahili translations. METHODS: A longitudinal study was conducted in six public health facilities in the Pwani region, Tanzania. In all, 694 pregnant and 625 postnatal women were concurrently selected and responded to W-DEQ-A and W-DEQ-B. Validation involved: translating the English questionnaires into Kiswahili; expert rating of the relevancy of the Kiswahili versions' items; computing content validity ratio; piloting the tools; data collection; statistical analysis with reliability evaluated using Cronbach's alpha and the intraclass correlation coefficient. Tool validity was assessed using factor analysis, convergent and discriminant validity. Exploratory factor analysis and confirmatory factor analysis were conducted on data collected using W-DEQ-A and W-DEQ-B, respectively. RESULTS: Exploratory factor analysis revealed seven factors contributing to 50% of the total variation. Four items did not load to any factor and were deleted. The factors identified were: fear; lack of self-efficacy; lack of positive anticipation; isolation; concerns for the baby; negative emotions; lack of positive behaviour. The factors correlated differently with each other and with the total scores. Both Kiswahili versions with 33 items had good internal consistency, with Cronbach's alphas of .83 and .85, respectively. The concerns for the baby factor showed both convergent and discriminant validity. The other six factors showed some problems with convergent validity. The final model from the confirmatory factor analysis yielded 29 items with good psychometric properties (χ2/df = 2.26, p = < .001, RMSEA = .045, CFI = .90 and TLI = .81). CONCLUSIONS: The Kiswahili W-DEQ-A-Revised and W-DEQ-B-Revised are reliable tools and measure fear of childbirth with a multifactorial structure, encompassing seven factors with 29 items. They are recommended for measuring fear of childbirth among pregnant and postnatal Tanzanian women. Further studies are needed to address the inconsistent convergent validity in the revised versions and assess the psychometric properties of W-DEQ-A among pregnant women across gestational ages.
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Miedo , Embarazo , Lactante , Femenino , Humanos , Tanzanía , Estudios Longitudinales , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
INTRODUCTION: Fear of childbirth has a significant impact on women's well-being post-birth. It can affect the women's relationships, future reproductive choices, and their decision on their future mode of birth. The Wijma Delivery Expectancy/Experience Questionnaire (Version B) is a comprehensive instrument for the assessment of postnatal fear of childbirth. METHODS: Hong Kong Chinese women at a postnatal ward of a tertiary hospital completed the translated questionnaire, Edinburgh Postpartum Depression Scale, and State-trait Anxiety Inventory. Exploratory factor analysis was performed. Pearson's correlation between the Wijma Delivery Expectancy/Experience Questionnaire (Version B) and the State-trait Anxiety Inventory or Edinburgh Postpartum Depression Scale scores were used to determine the convergent validity. Cronbach's alpha coefficient and intraclass correlation coefficient were used to determine the reliability of the translated Wijma Delivery Expectancy/Experience Questionnaire (Version B). RESULTS: 136 postnatal mothers completed the study. 21.3% of women experienced fear of childbirth using the standard cut-off of 85/165. The Cronbach's alpha coefficient and test-retest reliability of the Chinese version were 0.910 and 0.741 respectively. Convergent validity was demonstrated with other psychological measures at expected moderate levels. Exploratory factor analysis revealed 4 factors. CONCLUSION: The Chinese version of the Wijma Delivery Expectancy/Experience Questionnaire (Version B) is a valid and reliable instrument to measure fear of childbirth amongst Chinese postpartum women. The questionnaire can be used to assess the severity of women's fear throughout their postpartum period, and to monitor the response of any medical or psychological interventions for women experiencing postnatal fear of childbirth.
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Depresión Posparto , China , Miedo/psicología , Femenino , Humanos , Parto/psicología , Embarazo , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
OBJECTIVES: Determine whether the Fear of Birth Scale (FOBS) is a useful screening instrument for Fear of Childbirth (FoC) and examine the potential added value of screening by analyzing how often pregnant women discuss their FoC during consultation. METHODS: This cross-sectional survey study included nulliparous pregnant women of all gestational ages, recruited via the internet, hospital and midwifery practices. The online questionnaires included the FOBS and Wijma Delivery Expectations Questionnaire version A (W-DEQ A). The latter was used as golden standard for assessing FoC (cutoff: ≥85). RESULTS: Of the 364 included women, 67 (18.4%) had FoC according to the W-DEQ A. Using the FOBS with a cutoff score of ≥49, the sensitivity was 82.1% and the specificity 81.1%, with 111 (30.5%) women identified as having FoC. Positive predictive value was 49.5% and negative predictive value 95.3%. Of the women with FoC (FOBS ≥49), 68 (61.3%) did not discuss FoC with their caregiver. CONCLUSION: The FOBS is a useful screening instrument for FoC. A positive score must be followed by further assessment, either by discussing it during consultation or additional evaluation with the W-DEQ A. The majority of pregnant women with FoC do not discuss their fears, underscoring the need for screening.
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Parto , Trastornos Fóbicos , Femenino , Embarazo , Humanos , Masculino , Estudios Transversales , Miedo , Derivación y ConsultaRESUMEN
INTRODUCTION: Fear of childbirth causes significant distress and impact on women's wellbeing. It contributed to the rising trend of non-medically indicated Caesarean births worldwide. The objective of this study was to translate and validate the Chinese version of the Wijma Delivery Expectancy/Experience Questionnaire (Version A) (W-DEQ-A), which is a comprehensive instrument for the assessment of fear of childbirth among antenatal women. METHODS: The translated questionnaire was finalised after back-translation and review by an expert panel. Hong Kong Chinese women at an antenatal clinic completed the translated questionnaire, Edinburgh Postpartum Depression Scale (EPDS), and State-trait Anxiety Inventory (STAI). The reliability of the translated questionnaire was analysed using Cronbach's alpha coefficient and intraclass correlation coefficient. Convergent validity was measured by Pearson's correlation between the W-DEQ-A and STAI or EPDS scores. The subscales of the questionnaire were determined using exploratory factor analysis. RESULTS: One hundred and fifty women completed the study. The Cronbach's alpha coefficient and test-retest reliability of the Chinese version were 0.907 and 0.867, respectively. Convergent validity was demonstrated by the moderate correlation between the translated W-DEQ-A and STAI or EPDS. Exploratory factor analysis of the W-DEQ-A revealed a multi-dimensional structure with four factors: sense of isolation, moment of birth, negative emotion, and lack of positive self-evaluation. Using a standard cut-off of 85, 11.3% of women were found to suffer from fear of childbirth. CONCLUSION: The Chinese version of the Wijma Delivery Expectancy/Experience Questionnaire (Version A) is a reliable and valid instrument to measure antenatal fear of childbirth among Chinese women.
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Miedo , Parto , China , Femenino , Humanos , Embarazo , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
BACKGROUND: Several tools measuring fear of childbirth (FOC) have been developed in the last three decades, however concerns about their readability have been raised. AIM: To explore the fear of childbirth in a sample of women of reproductive age by evaluating the readability of Wijma Delivery Expectancy/Experience Questionnaire version A (W-DEQ-A). METHODS: The Flesch Reading Ease Formula, the Flesch-Kincaid Grade Level, the FOG Scale, the SMOG Index, the Coleman-Liau Index, the Automated Readability Index, and the Linsear Write Formula were used to evaluate the readability of the W-DEQ-A. Also, focus group discussions were held to validate the findings of the readability scales mentioned above. FINDINGS: The SMOG Index (score = 7.6), Coleman-Liau Index (score = 7.6), and the Linsear Write Formula (score = 9.4) were easily readable by women of reproductive age who had at least secondary school education (grade 12). Concerns were raised over some terms used such as desolate and deserted, which were rarely used in day to day English language conversations. CONCLUSIONS: In this study, participants observed that W-DEQ- A was readable if administered to expectant women with a basic secondary school certificate; but there is a need to simplify some words. It was emphasized that societal dynamics play an important role in the fear of childbirth and therefore the questionnaire should address all aspects contributing to fear of childbirth and not merely the feelings and thoughts women may have at the prospect of labor and delivery.
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Comprensión , Miedo , Femenino , Humanos , Kenia , Lenguaje , Encuestas y CuestionariosRESUMEN
BACKGROUND: Prenatal distress and fear of childbirth negatively affect the health of the mother and the fetus. Sociodemographic and pregnancy related characteristics may influence prenatal distress and fear of childbirth. AIM: This study aimed to explore the relationship between fear of childbirth and prenatal distress levels with accompanying factors. SUBJECTS AND METHODS: The study was designed as a cross-sectional survey study and conducted in the outpatient clinic of Obstetrics and Gynecology Department of Pamukkale University Hospital, Denizli, Turkey, between April 2017 and January 2018. Survey data were collected from 103 third-trimester pregnant women who had admitted to the hospital for routine prenatal examination. Sociodemographic Information Form, the Revised Prenatal Distress Questionnaire (NUPDQ), and the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) were used to collect data. Sociodemographics, obstetrics, and other variables were summarized by descriptive statistics. Mann-Whitney U-test, Chi-squared test, and Fisher's exact test were used for comparison of data between groups. RESULTS: The mean score of NUPDQ was 7.58 (SD 4.09) in the nulliparous group and 8.17 (SD 5.16) in the multiparous group (P = 0.68). The mean W-DEQ score was 40.46 (SD 21.80) in nulliparous women and 45.55 (SD 26.72) in multiparous women (P = 0.38). The W-DEQ and NUPDQ scores were moderately correlated with a Spearman correlation co-efficient of 0.58 (P < 0.001). CONCLUSIONS: The results of this study revealed that fear of childbirth and prenatal distress were moderately and positively correlated. NUPDQ and W-DEQ can be used during pregnancy to understand if pregnant women have fear or distress. This could help to give a better support to pregnant women.
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Ansiedad/psicología , Parto Obstétrico/psicología , Miedo/psicología , Parto/psicología , Mujeres Embarazadas/psicología , Adulto , Estudios Transversales , Femenino , Humanos , Paridad , Embarazo , Atención Prenatal , Estrés Psicológico , Encuestas y Cuestionarios , Turquía , Adulto JovenRESUMEN
The aims of this study were to determine prevalence of childbirth fear among uncomplicated pregnant women in Siriraj Hospital and possible associated factors. A total of 305 uncomplicated, singleton pregnant women were enrolled during early third trimester. All participants were interviewed regarding baseline demographic, social, economic, family, and obstetric characteristics. Fear of childbirth (FOC) was evaluated by Thai version of Wijma Delivery Expectancy/Experience Questionnaire Version A (W-DEQ). W-DEQ scores and level of FOC were compared between various characteristics to determine possible associated factors. Mean W-DEQ score was 51.9. Prevalence of low, moderate, high, and severe FOC were 18.4%, 64.9%, 16.1%, and 0.7%, respectively. Mean FOC score was significantly higher in women with unplanned than planned pregnancy (p = .033). Women with high to severe FOC were significantly less likely to have adequate income (p = .03), have family support (p = .02), have been told about delivery (p = .03), and have witnessed delivery (p = .01). IMPACT STATEMENT What is already known on this subject? Prevalence of fear of childbirth (FOC) in Western countries varies from 8 to 27%. FOC have been related to several unwanted conditions, including obstetrics complications, operative vaginal delivery, increased analgesic use in labour, elective caesarean section, postpartum depression, and impaired maternal-infant relation. Several factors related to FOC have been reported, including maternal age, parity, gestational age, history of a vacuum or forceps extraction, previous caesarean section, previous adverse perinatal outcome, low education, low socio-economic level, psychiatric problems, personality, lack of social support, and low self-esteem. What do the results of this study add? Prevalence of low, moderate, high, and severe FOC in Siriraj Hospital were 18.4%, 64.9%, 16.1%, and 0.7%, respectively. This was relatively lower than those reported from Western countries. Mean FOC score was significantly higher in women with unplanned than planned pregnancy. High to severe FOC was significantly related to low financial and family support and less understandings on delivery process. Differences in the results might be partly due to the differences in study population characteristics of Thais, including ethnics, religions, beliefs, perceptions, social structures, and social norms. What are the implications of these findings for clinical practice and/or further research? Future researches are suggested to explore and understand more about social and cultural factors associated with FOC. Identification of women with high or severe degree of FOC could help in preparing the women at risk before or during pregnancy to lessen FOC in order to improve their childbirth experiences. In addition, effective interventions to reduce FOC should be developed, evaluated, and implemented in the future.
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Miedo/psicología , Parto/psicología , Adulto , Parto Obstétrico/psicología , Femenino , Edad Gestacional , Humanos , Renta , Paridad , Educación del Paciente como Asunto , Embarazo , Embarazo no Planeado/psicología , Apoyo Social , Encuestas y Cuestionarios , TailandiaRESUMEN
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.
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Parto Obstétrico/psicología , Miedo , Mujeres Embarazadas/psicología , Adulto , Estudios Transversales , Femenino , Humanos , Irlanda , Embarazo , Prevalencia , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
Background: Culture is an important factor to determine fear of childbirth which is shaped by social learning processes. The purpose of this study is to determine the level of fear of childbirth among Turkish healthy pregnant women. Method: The researchers reviewed the eight databases considering inclusion criteria and 14 studies were included. The data analysis was conducted using meta-analysis. Results: Pregnant women experienced severe levels of fear, 67.26 ± 4.08, 95% confidence interval [59.26, 75.26], and 21 out of every 100 women experienced clinical level of fear. Between study variance was significant for parity (Qb = 6.40, p = .04) and region (Qb = 19.14, p = .00) moderators. Conclusions: The high level of FOC, particularly in the Eastern region, suggests that some of the cultural factors in the Eastern region in Turkey negatively affect the birth expectations. In a country like Turkey with a multicultural population, the health care professional should provide culturally sensitive care.
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Parto Obstétrico/psicología , Miedo/psicología , Parto/psicología , Mujeres Embarazadas/psicología , Adulto , Femenino , Humanos , Embarazo , Autoeficacia , TurquíaRESUMEN
BACKGROUND: Fear of childbirth (FOC) could have significant impact on women's childbearing choices and experience. Culture affects the way women conceptualize childbirth, influencing the fears and expectations they may hold in relation to it. In the current study, we examined differences in childbirth preferences of cesarean section and use of epidural analgesia between Norwegian and Israeli pregnant women. Later, we used the Norwegian six-factor solution of the widely-used Wijma Delivery Expectancy Questionnaire (W-DEQ-A) to compare levels of the different FOC factors. Finally, we investigated differences in the associations between FOC and childbirth preferences between the two countries. METHODS: Secondary analysis of two large surveys. Women from Israel (n = 490) and Norway (n = 2918) were recruited during prenatal check-ups in community clinics and a university hospital. At around 32 weeks of gestation, all participants filled out questionnaires, including the W-DEQ-A. Statistical analysis included exploratory factor analysis, confirmatory factor analysis, M/ANOVA, Spearman's Rho and Fisher's Z tests for the significance of the difference between independent correlations. RESULTS: The Norwegian six-factor solution of the W-DEQ fit well with the Israeli data. Norwegian women were more concerned about loneliness, feeling less self-efficacy, negatively appraising birth, and lacking positive anticipation. Israeli women were more concerned about negative outcomes for the child and experienced greater general fear and fear of pain. Norwegian women preferred more cesarean sections compared to Israeli women, who preferred more epidural use than Norwegians. FOC factors were more strongly related to childbirth preferences among Norwegians. CONCLUSIONS: Cultural differences between Israel and Norway are reflected by the differences seen in the levels of fear reported across the six factors. In Israel, birth culture is very medicalized, motherhood is highly revered, and there is an emphasis on having "perfect babies". In contrast, Norwegian women have fewer children, and birth is considered more natural. This could explain why Israeli women were more concerned that their child might be harmed during birth, while Norwegian women were more concerned with the physical and emotional expectations of birth.
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Miedo/psicología , Parto/psicología , Mujeres Embarazadas/psicología , Adulto , Comparación Transcultural , Parto Obstétrico/psicología , Femenino , Humanos , Israel , Noruega , Embarazo , Encuestas y CuestionariosRESUMEN
BACKGROUND: Fear of childbirth may reduce the womens' pain tolerance during labour and may have impact on the mother-infant interaction. We aimed to assess (1) the association between fear of childbirth antepartum and subsequent request for pharmacological pain relief, and (2) the association between the used method of pain relief and experienced fear of childbirth as reported postpartum in low risk labouring women. METHODS: Secondary analysis of the RAVEL study, a randomised controlled trial comparing remifentanil patient controlled analgesia (PCA) and epidural analgesia to relieve labour pain. The RAVEL study included 409 pregnant women at low risk for obstetric complications at 18 midwifery practices and six hospitals in The Netherlands (NTR 3687). We measured fear of childbirth antepartum and experienced fear of childbirth reported postpartum, using the Wijma Delivery Expectancy/Experience Questionnaire. RESULTS: Women with fear of childbirth antepartum more frequently requested pain relief compared to women without fear of childbirth antepartum, but this association did not reach statistical significance (adjusted odds ratio (aOR2.0; 95% confidence interval (CI) 0.8-4.6). Women who received epidural analgesia more frequently reported fear of childbirth postpartum compared to women who did not receive epidural analgesia (aOR3.5; CI 1.5-8.2), while the association between remifentanil-PCA and fear of childbirth postpartum was not statistically significant (aOR1.7; CI 0.7-4.3). CONCLUSIONS: Women with fear of childbirth antepartum more frequently requested pain relief compared to women without fear of childbirth antepartum, but this association was not statistically significant. Women who received pharmacological pain relief more frequently reported that they had experienced fear of childbirth during labour compared to women who did not receive pain relief. Based on our data epidural analgesia with continuous infusion does not seem to be preferable over remifentanil-PCA as method of pain relief when considering fear of childbirth postpartum. TRIAL REGISTRATION: Netherlands Trial Register 3687 ; Register date: 5 Nov 2012.
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Analgesia Obstétrica/psicología , Miedo , Dolor de Parto/psicología , Complicaciones del Trabajo de Parto/psicología , Satisfacción del Paciente/estadística & datos numéricos , Adulto , Analgesia Obstétrica/estadística & datos numéricos , Femenino , Humanos , Dolor de Parto/terapia , Países Bajos , Complicaciones del Trabajo de Parto/terapia , Embarazo , Adulto JovenRESUMEN
BACKGROUND: Fear of Childbirth (FOC) is a common problem affecting women's health and wellbeing, and a common reason for requesting caesarean section. The aims of this review were to summarise published research on prevalence of FOC in childbearing women and how it is defined and measured during pregnancy and postpartum, and to search for useful measures of FOC, for research as well as for clinical settings. METHODS: Five bibliographic databases in March 2015 were searched for published research on FOC, using a protocol agreed a priori. The quality of selected studies was assessed independently by pairs of authors. Prevalence data, definitions and methods of measurement were extracted independently from each included study by pairs of authors. Finally, some of the country rates were combined and compared. RESULTS: In total, 12,188 citations were identified and screened by title and abstract; 11,698 were excluded and full-text of 490 assessed for analysis. Of these, 466 were excluded leaving 24 papers included in the review, presenting prevalence of FOC from nine countries in Europe, Australia, Canada and the United States. Various definitions and measurements of FOC were used. The most frequently-used scale was the W-DEQ with various cut-off points describing moderate, severe/intense and extreme/phobic fear. Different 3-, 4-, and 5/6 point scales and visual analogue scales were also used. Country rates (as measured by seven studies using W-DEQ with ≥85 cut-off point) varied from 6.3 to 14.8%, a significant difference (chi-square = 104.44, d.f. = 6, p < 0.0001). CONCLUSIONS: Rates of severe FOC, measured in the same way, varied in different countries. Reasons why FOC might differ are unknown, and further research is necessary. Future studies on FOC should use the W-DEQ tool with a cut-off point of ≥85, or a more thoroughly tested version of the FOBS scale, or a three-point scale measurement of FOC using a single question as 'Are you afraid about the birth?' In this way, valid comparisons in research can be made. Moreover, validation of a clinical tool that is more focussed on FOC alone, and easier than the longer W-DEQ, for women to fill in and clinicians to administer, is required.
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Miedo/psicología , Parto/psicología , Trastornos Fóbicos/epidemiología , Complicaciones del Embarazo/epidemiología , Mujeres Embarazadas/psicología , Femenino , Humanos , Trastornos Fóbicos/psicología , Periodo Posparto/psicología , Embarazo , Complicaciones del Embarazo/psicología , PrevalenciaRESUMEN
BACKGROUND: Psycho-education can reduce childbirth fear and caesarean section numbers. This study determines the cost-effectiveness of a midwife-led psycho-education intervention for women fearful of birth. METHOD: One thousand four hundred ten pregnant women in south-east Queensland, Australia were screened for childbirth fear (W-DEQ A ≥ 66). Women with high scores (n = 339) were randomised to the BELIEF Study (Birth Emotions and Looking to Improve Expectant Fear) to receive psycho-education (n = 170) at 24 and 34 weeks of pregnancy or to the control group (n = 169). Women in both groups were surveyed 6 weeks postpartum with total cost for health service use during pregnancy calculated. Logistic regression models assessed the odds ratio of having vaginal birth or caesarean section in the study groups. RESULT: Of 339 women randomised, 184 (54%) women returned data at 6 weeks postpartum (Intervention Group n = 91; Control Group n = 93). Women receiving psycho-education had a higher likelihood of vaginal birth compared to controls (n = 60, 66% vs. n = 54, 58%; OR 2.34). Mean 'treatment' cost for women receiving psycho-education was AUS$72. Mean cost for health services excluding the cost of psycho-education, was less in the intervention group (AUS$1193 vs. AUS$1236), but not significant (p = 0.78). For every five women who received midwife counselling, one caesarean section was averted. The incremental healthcare cost to prevent one caesarean section using this intervention was AUS$145. CONCLUSION: Costs of delivering midwife psycho-education to women with childbirth fear during pregnancy are offset by improved vaginal birth rates and reduction in caesarean section numbers. TRIAL REGISTRATION: Australian New Zealand Controlled Trials Registry ACTRN12612000526875 , 17th May 2012 (retrospectively registered one week after enrolment of first participant).
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Análisis Costo-Beneficio , Partería/economía , Educación del Paciente como Asunto/economía , Mujeres Embarazadas/psicología , Atención Prenatal/economía , Adulto , Cesárea/economía , Cesárea/psicología , Parto Obstétrico/economía , Parto Obstétrico/psicología , Miedo , Femenino , Humanos , Partería/métodos , Parto/psicología , Educación del Paciente como Asunto/métodos , Embarazo , Atención Prenatal/métodos , QueenslandRESUMEN
INTRODUCTION: Tocophobia is defined as a severe fear of pregnancy and childbirth. There is increasing evidence that tocophobia may have short-term and long-term adverse effects on mother and baby. We performed a systematic review and meta-analysis to determine the global prevalence of tocophobia in pregnancy. MATERIAL AND METHODS: Relevant articles were identified through searching six relevant databases: MEDLINE, CINAHL, Pubmed, PsycINFO, Maternity & Infant Care and Scopus between 1946 and April 2016. We used search terms for tocophobia prevalence in pregnant women that we agreed on with a medical librarian. There were no language restrictions. Two review authors independently assessed data for inclusion, extracted data and assessed quality using a standardized appraisal tool. Meta-analysis was performed to determine the overall pooled-prevalence of tocophobia. Several subgroup and sensitivity analyses were conducted. RESULTS: Thirty-three studies were included in the systematic review from 18 countries of which data from 29 studies were used in the meta-analysis of 853 988 pregnant women. Definition of tocophobia varied, whereas prevalence rates ranged between 3.7 and 43%. The overall pooled prevalence of tocophobia, using a random-effects model, was 14% (95% CI 0.12-0.16). Significant heterogeneity was observed (I2 = 99.25%, p = 0.00), which was not explained in subgroup analyses including tocophobia definition used, screening trimester and parity. CONCLUSION: The prevalence of tocophobia is estimated at 14% and appears to have increased in recent years (2000 onwards). Considerable heterogeneity (99.25%) was noted that may be attributed to lack of consensus on the definition of tocophobia, so our results should be interpreted with caution.
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Miedo , Parto/psicología , Trastornos Fóbicos/epidemiología , Complicaciones del Embarazo/epidemiología , Femenino , Salud Global , Humanos , Salud Materna , Trastornos Fóbicos/etiología , Embarazo , Complicaciones del Embarazo/etiología , PrevalenciaRESUMEN
INTRODUCTION: The objective of this study was to calculate costs associated with severe fear of childbirth (FOC) during pregnancy and peripartum by comparing two groups of women expecting their first child and attending an ordinary antenatal program; one with low FOC and one with severe FOC. MATERIAL AND METHODS: In a prospective case-control cohort study one group with low FOC [Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) sum score ≤60, n = 107] and one with severe FOC (W-DEQ ≥85, n = 43) were followed up till 3 months postpartum and included in the analysis. Medical records were assessed and medical parameters were mapped. Mean costs for healthcare consumption and sick leave during pregnancy were calculated and compared. RESULTS: When means were compared between the groups, the group with severe FOC had more visits for psychosocial reasons (p = 0.001) and more hours on sick leave (p = 0.03) during pregnancy, and stayed longer at the maternity ward (p = 0.04). They also more seldom had normal spontaneous deliveries (p = 0.03), and more often had an elective cesarean section on maternal request (p = 0.02). Postpartum, they more often than the group with low FOC paid visits to the maternity clinic because of complications (p = 0.001) and to the antenatal unit because of adverse childbirth experiences (p = 0.001). The costs for handling women with severe FOC was 38% higher than those for women with low FOC. CONCLUSION: Women with severe FOC generate considerably higher perinatal costs than women with low FOC when handled in care as usual.