Women’s experiences of fear of childbirth: a metasynthesis of qualitative studies

Figures & data

Figure 1. Flow Diagram

Table I. Characteristics of included studies and quality assessment

Reference, Author, year, country	Study aims	Methodology and theoretical perspective	Sample	Quality assessment
Fenwick, Staff, Gamble, Creedy, & Bayes, (2010) Australia	To describe Australian women’s request for CS in the absence of medical indicators in their first pregnancy	Interviews Thematic analysis	8 primiparous and 6 multiparous women who requested CS without any known medical indication, all had experienced CS within the past 5 years	M:35
Fisher, Hauck, & Fenwick, (2006) Australia	To explore in detail the childbirth experiences of women identified as fearful of birth	Interviews Constant comparison	8 primiparous and 14 multiparous women who expressed fear, 19 woman were interviewed after childbirth and 3 women before	M:32
Melender, (2002) Finland	To describe the causes of fear associated with preg-nancy and childbirth and to describe coping stra-tegies of preg-nant woman who have fears	Interviews Content analysis	10 primiparous and 10 multiparous women interviewed 2–3 days after childbirth	M:31
Faisal, Matinnia, Hejar, & Khodakarami, (2014) Iran	To gain a deeper understanding of why Iranian primigravidae request CS without any medical indication	Interviews Thematic analysis	14 nulliparous women who requested CS without any medical indication, interviewed in the third trimester	M:38
Lyberg & Severinsson, (2010) Norway	To illuminate mothers’ fear of childbirth and their experiences of the team-midwifery care model during pregnancy, child-birth and the postnatal period	Interviews Hermeneutical analysis	4 primiparous and 9 multiparous women interviewed 1–1,5 year after childbirth	M:33
Ramvi & Tangerud, (2011) Norway	To investigate women requesting CS, but gave vaginal birth in spite of fear of childbirth	Interview Narrative approach	2 primiparous and 3 multiparous women interviewed 1 year after the childbirth	M:35
Eriksson, Jansson, & Hamberg, (2006) Sweden	To investigate and describe how intense fear related to childbirth is experienced, dealt with and communicated from the perspective of the women themselves	Interviews Grounded theory	6 primiparous and 14 multiparous women with experiences of intense fear, interviewed after childbirth	M:36
Nilsson, Bondas, & Lundgren, (2010) Sweden	To describe the meaning of previous experiences of childbirth in pregnant woman who have exhibited intense fear of childbirth such that it has an impact on their daily lives	Interviews Phenomeno-logical analysis	9 pregnant multiparous women who sought help for fear of childbirth	M:32
Nilsson & Lundgren, (2009) Sweden	To describe woman’s lived experience of fear of childbirth.	Interviews Phenomeno-logical analysis	2 pregnant primiparous and 6 pregnant multiparous women who sought help for fear	M:33
Nilsson, Robertson, & Lundgren, (2012) Sweden	To describe the meaning of fear of childbirth and of birth in women who earlier had experienced intense fear of childbirth after a previous negative childbirth experience	Interviews Phenomeno-logical analysis	6 multiparous women who sought help for fear of childbirth about 10 years earlier	M:34
Ryding, Wijma, & Wijma, (1998) Sweden	To describe women’s thoughts and feelings during the delivery process ending in ECS.	Interviews Phenomeno-logical analysis	29 primiparous and 24 multiparous women interviewed 1–5 days after elective CS	M:37
Salomonsson, Bertero, & Alehagen, (2013) Sweden	To apply and test the concept of self-efficacy to expectations of the up-coming birth in the context of severe fear of childbirth	Interviews Content analysis	17 pregnant primiparous women with fear at 25–26 gestational week, interviews between 32–38 gestation week	M:31
Wahlbeck, Kvist, & Landgren, (2018) Sweden	To describe women’s experience of undergoing art therapy with severe fear of childbirth.	Interviews Phenomeno-logical hermeneutical analysis	19 women who had undergone art therapy for severe fear of childbirth 10 multiparous and 10 primiparous, interviews 3 months after childbirth	M:36
Roosevelt & Kane Low, (2016) USA	To explore woman’s experiences while completing the W-DEQ, an instrument used to measure fear of childbirth.	Focus groups Interviews Content analysis	22 women who were pregnant or had given birth in the last 5 years, have self-identified fear of childbirth	M:31

Assessment for quality using the COREQ 32-items checklist, M = Moderate quality, 31–38 scores.

Table II. Main theme, themes and subthemes

Main theme	Being at a point of no return
Themes	Subthemes	Articles
To suffer consequences from traumatic births	To live with terrible birth experiences	35,36,38,39,41–44,46,47
	To live with stories of terrible childbirth	34–37,39–42,46
To lack warranty and understanding	To lose control	34–44,42,45–47
	To lack understanding	35,39,40,42,46,47
	To fear pain and injury	34–37,39,41–44 46,47
To face the fear	To manage the fear	35,36,40,42 45,46
	To seek support	34,35,38–40,43,45,46
	To have caesarean section as an emergency exit	34,37–39,44

Table

#1	“Qualitative Research"[Mesh] OR “Grounded Theory"[Mesh] OR “Focus Groups"[Mesh] OR “Interviews as Topic"[Mesh] OR “Narration"[Mesh]	104250
#2	narrative*[tiab] OR narration[tiab] OR interview*[tiab] OR “focus group”[tiab] OR “focus groups”[tiab] OR grounded[tiab] OR qualitative[tiab] OR ethnograph*[tiab]	473522
#3	#1 OR #3	495110
#4	((((fear OR anxiety OR “birth trauma” OR PTSD OR stress disorders))) AND ((birth OR childbirth OR “post partum” OR postpartum OR “post natal” OR postnatal OR puerperium OR antenatal OR prenatal OR perinatal OR parturition OR delivery, obstetric OR cesarean section OR Extraction, Obstetrical OR labor, induced))) AND (("Randomized Controlled Trial"[Publication Type] OR “Observational Study"[Publication Type] OR “Clinical Trial"[Publication Type] OR “Randomized Controlled Trials as Topic"[Mesh Terms] OR “Placebos"[Mesh Terms] OR (random* AND trial*[tiab]) OR “randomized"[tiab] OR “randomly"[tiab] OR placebo* OR “Review” OR “meta-analysis” OR questionnaire OR interview OR survey OR cohort study OR focus group))	8838
#5	#3 AND #4	1870
	Filters activated: English, Swedish	1808
	Publication date from 2015/01/01 to 2018/12/31	537

Table

S1	MAINSUBJECT.EXACT.EXPLODE("Interviews”) OR MAINSUBJECT.EXACT("Narratives”) OR MAINSUBJECT.EXACT.EXPLODE("Grounded Theory”) OR MAINSUBJECT.EXACT.EXPLODE("Qualitative Research”)	39999
S2	ti,ab(narrative* OR narration OR interview* OR “focus group” OR “focus groups” OR grounded OR qualitative OR ethnograph*)	439979
S3	1 OR 2	442548
S4	((ti(Childbirth OR Perinatal OR Postnatal OR Primipara OR Birth) AND ti(Anxiety OR Fear OR “birth trauma”)) OR (ab(Childbirth OR Perinatal OR Postnatal OR Primipara OR Birth) AND ab(Anxiety OR Fear OR “birth trauma”)) OR ((SU.EXACT("Labor (Childbirth)”) OR SU.EXACT("Perinatal Period”) OR SU.EXACT("Postnatal Period”) OR SU.EXACT("Primipara”) OR SU.EXACT("Birth”)) AND (SU.EXACT("Anxiety”) OR SU.EXACT("Birth Trauma”) OR SU.EXACT("Fear”))) AND me.exact("Empirical Study” OR “Quantitative Study” OR “Longitudinal Study” OR “Interview” OR “Followup Study” OR “Literature Review” OR “Prospective Study” OR “Qualitative Study” OR “Clinical Case Study” OR “Treatment Outcome/Clinical Trial” OR “Retrospective Study” OR “Systematic Review” OR “Meta Analysis” OR “Focus Group”))	5593
S5	4 AND 3	909
S5	Limit language English	846
S6	Limit 2015-01-01 - 2018-12-31	214

Table

#1	Qualitative studies[MH] OR Discourse Analysis[MH] OR Meta Synthesis[MH] OR Thematic analysis[MH] OR Focus Groups[MH] OR Interviews[MH] OR Narratives[MH] OR Self Report[MH]	→ 89 740
#2	TI (narrative* OR narration OR interview* OR “focus group” OR “focus groups” OR grounded OR qualitative OR ethnograph*) OR AB (narrative* OR narration OR interview* OR “focus group” OR “focus groups” OR grounded OR qualitative OR ethnograph*)	→52 954
#3	#1 AND #2	→96 268
#4	(birth OR childbirth OR “post partum” OR postpartum OR “post natal” OR postnatal OR puerperium OR antenatal OR prenatal OR perinatal OR parturition OR delivery, obstetric OR cesarean section OR labor OR Vacuum Extraction, Obstetrical OR Dystocia) AND (fear OR anxiety OR “birth trauma” OR PTSD OR stress disorders)	→1 396
#5	#3 AND #4	→524
#6	Limit English	(fanns inga svenska)
#7	Limit 2015–2018

Table

#1	((fear or anxiety or “birth trauma” or PTSD or stress disorders) and (birth or childbirth or “post partum” or postpartum or “post natal” or postnatal or puerperium or antenatal or prenatal or perinatal or parturition or delivery, obstetric or cesarean section or Extraction, Obstetrical or labor, induced)):ti,ab,kw	1098
#2	narrative* or narration or interview* or “focus group” or “focus groups” or grounded or qualitative or ethnograph*:ti,ab,kw	30455
#3	#1 AND #2	155
#3	Limit 2015–2018	58

Table

#1	(TITLE-ABS-KEY (birth OR prenatal OR perinatal OR parturition) OR TITLE-ABS-KEY (“delivery, obstetric” OR “cesarean section” OR “extraction, obstetrical”) OR TITLE-ABS-KEY (“labor, induced” OR antenatal OR puerperium OR postnatal OR “post natal”) OR TITLE-ABS-KEY (postpartum OR “post partum” OR childbirth))	→896 885
#2	TITLE-ABS-KEY (fear OR anxiety OR “birth trauma” OR ptsd OR “stress disorders”)	→474 308
#3	(TITLE-ABS-KEY (“Randomized Controlled Trial” OR “Observational Study” OR “Clinical Trial” OR placebo*) OR TITLE-ABS-KEY (random* OR review OR “meta-analysis”) OR TITLE-ABS-KEY (questionnaire OR interview OR survey OR cohort AND study OR “focus group”))	→8 610 503
#4	#1 AND #2 AND #3	→9 421
#5	TITLE-ABS-KEY (narrative* OR narration OR interview* OR “focus group” OR “focus groups” OR grounded OR qualitative OR ethnograph*)	→1 295 507
#6	#4 AND #5	→2 371
#7	Limit English Swedish	→2 228
#8	Limit 2015–2018	→671

Fenwick, J., Staff, L., Gamble, J., Creedy, D. K., & Bayes, S. (2010). Why do women request caesarean section in a normal, healthy first pregnancy? Midwifery, 26(4), 394–400.

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Fisher, C., Hauck, Y., & Fenwick, J. (2006). How social context impacts on women’s fears of childbirth: A Western Australian example. Social Science & Medicine, 63(1), 64–75.

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Melender, H. L. (2002). Fears and coping strategies associated with pregnancy and childbirth in Finland. Journal of Midwifery & Women’s Health, 47(4), 256–263.

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Faisal, I., Matinnia, N., Hejar, A. R., & Khodakarami, Z. (2014). Why do primigravidae request caesarean section in a normal pregnancy? A qualitative study in Iran. Midwifery, 30(2), 227–233.

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Lyberg, A., & Severinsson, E. (2010). Fear of childbirth: Mothers’ experiences of team-midwifery care - a follow-up study. Journal of Nursing Management, 18(4), 383–390.

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Ramvi, E., & Tangerud, M. (2011). Experiences of women who have a vaginal birth after requesting a cesarean section due to a fear of birth: A biographical, narrative, interpretative study. Nursing & Health Sciences, 13(3), 269–274.

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Nilsson, C., Robertson, E., & Lundgren, I. (2012). An effort to make all the pieces come together: Women´s long-term perspectives on their experiences of intense fear of childbirth. Internationa Journal of Childbirth, 2, 255–268.

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Ryding, E. L., Wijma, K., & Wijma, B. (1998). Experiences of emergency cesarean section: A phenomenological study of 53 women. Birth, 25(4), 246–251.

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Salomonsson, B., Bertero, C., & Alehagen, S. (2013). Self-efficacy in pregnant women with severe fear of childbirth. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 42(2), 191–202.

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Wahlbeck, H., Kvist, J. L., & Landgren, K. (2018). Gaining hope and self-confidence-An interview study of women´s experience of treatment by art therapy for severe fear of childbirth. Women and Birth, 31(4), 299–306.

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Roosevelt, L., & Kane Low, L. (2016). Exploring fear of childbirth in the USA through a qualitative assessment of the wijma delivery expectancy questionnaire. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 45, 28.

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