Preferred and actual mode of delivery in relation to fear of childbirth

Figures & data

Figure 1. Flowchart and design of the study. *for this variable n = 492 as 29 reports could be added from medical files.

Table 1. Demographic, obstetric and psychological variables reported at T1 (30 weeks of pregnancy) in relation to preferred mode of delivery (total n: between 534 and 561).

	Preference vaginal delivery	Preference cesarean section
Age (n = 561)
≤25	40 (7%)	4 (6.9%)
26–35	415 (74%)	37 (63.8%)
≥36	106 (17.6%)	17 (29.3%)
Country of origin (n = 561)
The Netherlands	440 (87.5%)	49 (84.5%)
Other	63 (12.5%)	9 (15.5%)
Marital status (n = 560)
Married or cohabiting	493 (98.2%)	57 (98.3%)
Single mother	9 (1.8%)	1 (1.7%)
Education level completed (n = 561)
Elementary/high school	50 (9.9%)	11 (19%)
College	127 (25.2%)	14 (24.1%)
University	326 (64.8%)	33 (56.9%)
Employment status (n = 561)
Fulltime	189 (37.6%)	13 (22.4%)
Part-time	217 (43,1%)	32 (55.2%)
Unemployed/other	97 (19.3%)	13 (22.4%)
Parity (n = 561)**
Nulliparous	247 (49.1%)	17 (29.3%)
Parous	256 (50.9%)	41 (70.7%)
Previous cesarean section^a (n = 297)***
No	230 (89.8%)	11 (26.8%)
Yes	26 (10.2%)	30 (73.2%)
Low-/high-risk pregnancy^b (n = 561)***
Low risk	321 (63.8%)	16 (27.6%)
High risk	182 (36.2%)	42 (72.4%)
Fear of childbirth (n = 548)***
W-DEQ A < 85	449 (91.1)	41 (74.5)
W-DEQ A ≥ 85	44 (8.9)	14 (25.5)
General anxiety (n = 534)*
HADS anxiety <8	417 (87.1%)	45 (81.8%)
HADS anxiety ≥8	62 (12.9%)	10 (18.2%)
Depression (n = 534)
HADS depression <8	453 (94.6%)	51 (92.7%)
HADS depression ≥8	26 (5.4%)	4 (7.3%)
Mental health problems actual or in history (n = 534)
No	387 (80.8%)	46 (83.6%)
Yes	92 (19.2%)	9 (16.4%)

^a Only for parous women. ^bDefinitions. Low risk: taken care of by a community midwife at 30 weeks of pregnancy; high risk: taken care of by an obstetrician/a clinical midwife at 30 weeks of pregnancy.

* p = .05, **p <  .01, ***p < .001.

Table 2. W-DEQ scores in nulliparous and parous women at T1 (30 weeks of gestation, n = 492) and T2 (8 weeks postpartum, n = 455) distributed over four PAC groups, subdivided according to parity and previous obstetric history.

Preferred → actual mode of delivery (PAC)	W-DEQ T1 (Total n = 492)		Severe FOC T1 (W-DEQ ≥ 85) n (%)	W-DEQ T2 (Total n = 455^#)		Severe FOC T2 (W-DEQ ≥ 85) n (%)	PAC Divided for parity/previous mode of delivery	W-DEQ T1 (total n = 492)			W-DEQ T2 (total n = 455^#)			W-DEQ T2 EmCS/ElCS
	n	M/SD		n	M/SD			n	M	Min–max	n	M	Min–max	Em/El CS	n	M	Min–max
VD→VD	386	59.9/18.2	30 (8%)	361	47.4/22.1	15 (4%)	Nulliparous	176	64.7	20–109	166	49.5	10–102	–	–	–	–
							Parous previous VD	198	55.4	12–114	184	44.7	8–118	–	–	–	–
							Parous previous CS	12	64.3	47–77	11	61	29–93	–	–	–	–
VD→CS	56	65.3/16.9	6 (11%)	49	64.6/28.7	7 (15%)	Nulliparous	40	66.0	26–105	35	68.0	15–135	EmCS	26	77.1	34–135
														ElCS	9	53.2	15–96
							Parous previous VD	6	69.2	42–92	4	57	21–111	EmCS	4	57	21–111
														ElCS	0	–	–
							Parous previous CS	10	60.1	29–79	10	45.5	18–85	EmCS	4	52.5	21–85
														ElCS	6	40.8	18–66
CS→VD	21	79.5/21.4	6 (30%)	19	63.6/25.0	3 (16%)	Nulliparous	8	70.9	34–94	8	58.0	20–117	–	–	–	–
							Parous previous VD	10	89.2	56–124	8	68.6	48–92	–	–	–	–
							Parous previous CS	3	70.3	58–84	3	65.3	54–73	–	–	–	–
CS→CS	29	68.3/21.2	7 (24%)	26	57.6/24.6	3 (12%)	Nulliparous	6	85.3	50–112	6	65.3	42–104	EmCS	2	65	60–70
														ElCS	4	65.5	42–104
							Parous previous VD	0			0
							Parous previous CS	23	63.9	39–110	20	55.3	17–108	EmCS	2	52	45–59
														ElCS	18	55.7	17–108

^# n drop outs = 37.

PAC: preferred actual congruence of mode of delivery; VD: vaginal delivery; CS: cesarean section; FOC: fear of childbirth; EmCS: emergency CS; ElCS: elective CS.

Table 3. Logistic regression for variables predicting preferred mode of delivery (VD or CS) (χ²= 100.7, df = 5, p < .001, Nagelkerke R²= 0.36).

	B	S.E.	Wald	df	Exp(B)	95% CI. for EXP(B)
Severe FOC T1 (W-DEQ A ≥85)	1.95	0.44	20.07	1.0	7.04***	3.0–16.5
Parous without previous CS (contrast with nulliparous)	−0.58	0.45	1.71	1.0	0.56	0.2–1.3
Parous with previous CS (contrast with nulliparous)	2.81	0.46	37.11	1.0	16.63***	6.7–41.1
Low-/high-risk pregnancy	0.56	0.40	1.99	1.0	0.16	0.8–3.8
Anxiety T1 (HADS anxiety ≥8)	−0.03	0.44	0.00	1.0	0.95	0.4–2.3

*** p < .001; T1 = 30 weeks of gestation.

Table 4. Three block hierarchical multiple regression analysis for variables predicting W-DEQ score postpartum (F(9,445) = 20.3, p < .001, adjusted R²= 0.28).

	Standardized coefficient beta (after block 3)	t	Partial r after block 1	Partial r after block 2	Partial r after block 3
BLOCK 1: Preferred-Actual mode of delivery-Congruence(PAC)
VD→CS	0.101	2.276	0.224***	0.113*	0.107*
CS→CS	0.005	.114	0.102*	0.048	0.005
CS→VD	0.035	.843	0.139**	0.129**	0.040
BLOCK 2: Obstetric variables
Condition of the newborn (good/needed medical assistance)	−0.160	−3.611	–	−0.182***	−0.169***
Parity (nulliparous/parous)	−0.055	−1.269	–	−0.139**	−0.060
Low-/high-risk pregnancy	0.061	1.421	–	0.104*	0.067
BLOCK 3: Psychological variables
W-DEQ T1	0.362	8.065	–	–	0.357***
HADS anxiety T1	0.131	3.047	–	–	0.143**
Mental health problems at T1 or in past (no/yes)	0.082	2.020	–	–	0.095*
Adjusted R^2	–	–	0.06	0.11	0.28

* p < .05, **p < .01, ***p < .001; T1 = 30 weeks of gestation.