A cluster analysis of reasons behind fear of birth among women in Sweden

Figures & data

Table 1. Background of the participants^a.

	Nulliparous women	Parous women	p-value
	n = 711	n = 708
	n (%)	n (%)
Socio-demographic background
Age groups
19–30 years	210 (29.8)	96 (13.7)
31–35 years	350 (50.1)	310 (44.3)
36–53 years	142 (20.2)	294 (42.0)	<0.001
Civil status
Living with a partner	678 (95.5)	672 (95.0)
Not living with a partner	32 (4.5)	35 (5.0)	0.709
Country of birth
Sweden	646 (91.2)	632 (89.4)
Other country	62 (8.8)	75 (10.6)	0.244
Level of education
High school or lower	122 (17.2)	123 (17.4)
University education	588 (82.8)	583 (82.6)	0.944
Residential area
City	518 (73.1)	452 (63.8)
Larger community	106 (15.9)	133 (18.8)
Smaller village	85 (12.0)	123 (17.4)	<0.001
Obstetric characteristics
Obstetric history ^b
Previous live birth		699 (98.7)	na
Previous stillbirth		17 (2.4)	na
Previous miscarriage	136 (19.1)	196 (27.7)	<0.001
Previous abortion	153 (21.5)	144 (20.3)	0.525
Currently pregnant
Yes	679 (95.6)	416 (58.8)
No	31 (4.4)	291 (41.2)	<0.001
Gestational weeks
18 or less	159 (24.5)	104 (25.1)
19–36 weeks	369 (56.8)	222 (53.6)
37 or more	122 (18.8)	88 (21.3)	0.525
Self-reported status of the current pregnancy
Normal	595 (91.1)	364 (87.3)
Not normal	58 (8.9)	53 (12.7)	0.051
Self-reported fear of birth
To a very large extent	93 (25.0)	120 (34.3)	0.002
To a large extent	173 (46.5)	149 (42.6)
To a small extent	104 (28.0)	72 (20.6)
Not at all	2 (0.5)	9 (2.6)
Fear of Birth Scale (FOBS)
Mean, (SD)	62.98 (27.20)	64.44 (30.03)	0.394
FOBS 60 or more	373 (61.9)	350 (67.2)	0.070
Preferred mode of birth
Vaginal	450 (69.1)	282 (67.8)
Cesarean section	104 (16.0)	75 (18.0)
Don’t know	97 (14.9)	59 (14.2)	0.673
Mental health
Previous mental health problems
Yes	382 (60.2)	320 (52.7)	0.008
No	253 (39.8)	287 (47.3)
Current mental health problems
Yes	195 (30.8)	187 (30.8)
No	438 (69.2)	420 (69.2)	1.000
Previous or current exposure to domestic violence
Yes	112 (17.7)	108 (17.9)	1.000
No	520 (82.3)	496 (82.1)

^a Numbers might not reach 100% due to internal missing values.

^b Parous women only.

Table 2. Reported reasons behind fear of birth in women with severe fear^a.

	Reported reasons			Reported reasons
	in women with	Primiparas		in women with	Multiparas
	severe fear	Crude OR	Adjusted OR	severe fear	Crude OR	Adjusted OR
	n (%)	(95% CI)	(95% CI)	n (%)	(95% CI)	(95% CI)
Reasons in relation to labor and birth
Prolonged labor	57 (61.3)	1.07 (0.66–1.74)	1.04 (0.63–1.71)	63 (52.5)	1.22 (0.78–1.90	1.22 (0.78–1.90
Severe ruptures	78 (83.9)	0.84 (0.44–1.61)	0.79 (0.41–1.54)	91 (75.8)	1.37 (0.83–2.71)	1.34 (0.79–2.25)
Risk of dying	51 (54.8)	2.59 (1.60–4.18)***	2.58 (1.57–4.23)***	60 (50.0)	1.87 (1.19–2.93)**	1.92 (1.20–3.09)**
Instrumental vaginal birth	64 (68.8)	2.52 (1.53–4.16)***	2.59 (1.55–4.33)***	60 (50.0)	1.94 (1.24–3.05)**	1.89 (1.19–3.00)**
Cesarean section	29 (31.2)	0.98 (0.59–1.63)	1.15 (0.68–1.94)	35 (29.2)	0.81 (0.50–1.32)	0.85 (0.52–1.40)
Infection	8 (8.6)	1.65 (0.67–4.04)	1.46 (0.58–3.68)	7 (5.8)	1.36 (0.50–3.67)	1.95 (0.68–5.59)
Reasons in relation to inner self
Loneliness	38 (40.9)	1.50 (0.92–2.43)	1.45 (0.87–2.42)	54 (45.0)	1.32 (0.84–2.06)	1.29 (0.81–2.07)
Helplessness	61 (65.6)	1.37 (0.84–2.24)	1.40 (0.84–2.35)	92 (76.7)	3.11 (1.90–5.12)***	3.25 (1.94–5.44)***
Powerlessness	66 (71.0)	1.56 (0.94–2.60)	1.48 (0.87–2.52)	85 (70.8)	1.70 (1.06–2.74)*	1.68 (1.03–2.76)*
Dependency	40 (43.0)	2.34 (1.43–3.83)***	2.27 (1.36–3.78)***	45 (37.5)	2.33 (1.43–3.51)***	2.35 (1.41–3.90)***
Failure	29 (31.2)	0.87 (0.53–1.45)	0.81 (0.47–1.37)	36 (30.0)	1.11 (0.68–1.80)	1.17 (0.70–1.96)
Loss of control	62 (66.7)	1.22 (0.74–2.00)	1.24 (0.74–2.08)	66 (55.0)	1.24 (0.79–1.93)	1.25 (0.78–1.98)
Unbearable pain	60 (64.5)	0.95 (0.58–1.55)	0.94 (0.56–1.56)	65 (54.2)	1.06 (0.68–1.65)	1.08 (0.68–1.71)
Inability to manage labor pain	58 (62.4)	0.84 (0.51–1.37)	0.83 (0.50–1.38)	64 (53.3)	1.22 (0.78–1.90)	1.19 (0.75–1.88)
Inability to give birth	45 (48.4)	1.12 (0.69–1.85	1.13 (0.69–1.85	51 (42.5)	1.65 (1.04–2.61)*	1.78 (1.10–2.68)*
Uncertainty	71 (76.3)	1.48 (0.86–2.55)	1.58 (0.90–2.77)	85 (70.8)	1.64 (1.02–2.64)*	1.64 (1.01–2.68)*
Reasons in relation to the baby
Baby getting infection	15 (16.1)	1.53 (0.79–2.99)	1.61 (0.81–3.19)	15 (12.5)	0.91 (0.47–1.77)	0.89 (0.45–1.77)
Admission to hospital	28 (30.1)	0.65 (0.39–1.07)	0.66 (0.40–1.11)	48 (40.0)	1.32 (0.83–2.09)	1.42 (0.88–2.28)
Baby being sick	47 (50.5)	0.55 (0.34–0.89)*	0.52 (0.31–0.86)*	66 (55.0)	0.90 (0.58–1.41)	0.97 (0.61–1.53)
Birth injuries	78 (83.9)	1.33 (0.71–2.49)	1.39 (0.73–2.66)	90 (75.0)	0.89 (0.53–1.50)	0.90 (0.53–1.53)
Death of the baby	69 (74.2)	1.32 (0.78–2.24)	1.37 (0.79–2.37)	93 (77.5)	1.44 (0.86–2.41)	1.52 (0.89–2.61)
Reasons in relation to encounter with health care providers
Being forced to give birth vaginally	68 (73.1)	6.22 (3.69–10.48)***	7.98 (4.59–13.90)***	79 (65.8)	5.98 (3.69–9.70)***	5.59 (3.40–9.18)***
Unavailable hospital of choice	34 (36.6)	1.13 (0.69–1.85)	1.09 (0.65–1.82)	39 (32.5)	1.42 (0.88–2.31)	1.37 (0.83–2.27)
Stopped from being admitted to hospital	45 (48.4)	0.95 (0.59–1.53)	0.90 (0.55–1.46)	57 (47.5)	1.21 (0.78–1.89)	1.19 (0.75–1.88)
Not receiving pain relief	42 (45.2)	1.06 (0.66–1.69)	1.04 (0.64–1.70)	51 (42.5)	1.17 (0.74–1.83)	1.01 (0.63–1.61)
Not receiving support	61 (65.6)	0.79 (0.48–1.30)	0.75 (0.44–1.27)	87 (72.5)	1.20 (0.73–1.95)	1.19 (0.72–1.98)
Not receiving proper care	61 (65.6)	0.89 (0.54–1.46)	0.87 (0.52–1.45)	74 (61.7)	1.37 (0.87–2.15)	1.40 (0.88–2.24)
Not receiving information	59 (63.4)	0.55 (0.13–0.74)**	0.58 (0.35–0.98)*	78 (65.0)	1.58 (1.00–2.50)	1.52 (0.94–2.45)
Not being involved	63 (67.7)	1.51 (0.92–2.48)	1.40 (0.84–2.33)	75 (62.5)	1.63 (1.04–2.57)*	1.59 (0.99–2.55)
Not being treated with respect	63 (67.7)	1.72 (1.05–2.83)*	1.69 (1.02–2.80)	69 (57.5)	1.50 (0.96–2.34)	1.68 (1.04–2.70)*
Not being taken seriously	72 (77.4)	2.23 (1.29–3.83)**	2.21 (1.26–3.88)**	78 (65.0)	1.61 (1.02–2.34)*	1.64 (1.02–2.63)*
Not being listened to	65 (69.9)	1.58 (0.95–2.61)	1.51 (0.90–2.54)	81 (67.5)	1.87 (1.17–2.96)**	2.08 (1.28–3.39)**
Reasons related to the partner
Not allowed to be present during antenatal visits	26 (28.0)	1.77 (1.02–3.07)*	1.64 (0.91–2.93)	31 (25.8)	1.60 (0.94–2.72)	1.56 (0.90–2.72)
Not allowed to be present during labor and birth	56 (60.2)	1.15 (0.71–1.86)	1.16 (0.76–1.90)	66 (55.0)	1.00 (0.64–1.57)	1.07 (0.68–1.70)
Not receiving support during pregnancy and birth	23 (24.7)	0.64 (0.38–1.10)	0.69 (0.40–1.19)	26 (21.7)	0.60 (0.36–1.01)	0.58 (0.34–0.99)
Not receiving support during parenthood	13 (14.0)	0.69 (0.35–1.33)	0.68 (0.35–1.35)	11 (9.2)	0.69 (0.33–1.45)	0.68 (0.32–1.46)
Partner being fearful	6 (6.5)	0.37 (0.15–0.92)*	0.38 (0.15–0.94)*	8 (6.7)	0.61 (0.26–1.41)	0.59 (0.25–1.40)
Reasons related to other aspects
To see blood	15 (16.1)	1.14 (0.60–2.19)	1.21 (0.61–2.37)	10 (8.3)	1.81 (0.74–4.39)	1.59 (0.62–4.08)
To receive injections	18 (19.4)	0.85 (0.47–1.54)	0.86 (0.47–1.58)	17 (14.2)	1.41 (0.72–2.75)	1.55 (0.77–3.10)
To faint	11 (11.8)	0.63 (0.31–1.26)	0.56 (0.26–1.19)	13 (10.8)	2.98 (1.23–7.19)**	3.09 (1.20–7.90)*
Sex life being affected	45 (48.4)	1.00 (0.62–1.59)	0.90 (0.55–1.47)	47 (39.2)	1.47 (0.92–2.33)	1.38 (0.85–2.22)
Not succeed with breastfeeding	20 (21.5)	0.36 (0.21–0.62)***	0.37 (0.21–0.66)***	26 (21.7)	0.82 (0.48–1.38)	0.94 (0.54–1.64)
Not being a good parent	29 (31.2)	0.86 (0.52–1.42)	0.82 (0.48–1.38)	16 (13.3)	0.91 (0.48–1.74)	0.82 (0.41–1.62)
Others’ stories	46 (49.5)	1.00 (0.62–1.59)	1.04 (0.64–1.70)	34 (28.3)	1.12 (0.68–1.83)	0.95 (0.56–1.60)
Unable to take care of the baby	34 (36.6)	1.04 (0.64–1.70)	1.01 (0.61–1.68)	41 (34.2)	1.43 (0.89–2.31)	1.45 (0.88–2.39)
Don’t know any reason	12 (12.9)	1.57 (0.75–3.28)	1.65 (0.78–3.52)	4 (3.3)	0.43 (0.14–1.31)	0.38 (0.12–1.20)

* =p < 0.05, **=p < 0.01, ***=p < 0.001.

Adjusted for age, residential area, previous miscarriage, previous mental health problems, currently pregnant.

^a Ref = Women assessing fear as not severe.

Figure 1. Cluster based on reported reasons among primiparous women.

Figure 2. Clusters based on reported reasons in multiparous women.