No relationship between fear of childbirth and pregnancy-/delivery-outcome in a low-risk Dutch pregnancy cohort delivering at home or in hospital

Abstract

Objective: To examine the relationship of fear of childbirth (FOC), general anxiety and depression during pregnancy and postpartum with birth complications. Methods: For this prospective cohort study 105 healthy women with low-risk pregnancies (until at least 30 weeks gestation) completed the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) and the Hospital Anxiety and Depression Scale (HADS) at 30 weeks gestation and 6 weeks postpartum. These results were related with delivery characteristics. Results: FOC during pregnancy was not related to complications during labour and delivery. In a regression analysis, both multiparity and medical interventions were predictors for higher postpartum FOC. A positive correlation was found between FOC during pregnancy and FOC at six weeks postpartum, corrected for complications during childbirth (r = 0.45, p < 0.001). Conclusions: The birth giving process was not related to FOC during pregnancy, but the pre-partum level of FOC certainly is predictive of the level of postpartum FOC, suggesting that FOC as measured during gestation may influence the interpretation of the birth experience itself. We did find a positive relationship between both parity and medical interventions during childbirth and FOC postpartum.

Keywords::

• Fear of childbirth
• pregnancy
• postpartum
• depression
• anxiety

Acknowledgements

We would like to thank the participating women and the midwifery practices for their cooperation in this study, and Y. Beuger and R.J. Meerman for their support with data management.

Declaration of Interests: The authors report no declarations of interest.

Current knowledge on this subject

• Till now, most studies found a relation of FOC during pregnancy with emergency CS and prolonged labour, but not all studies have confirmed these findings.

• High FOC postpartum is more common in women who had an instrumental vaginal delivery, emergency CS or a fetal compromise during delivery. Such deliveries can lead to trauma anxiety such as seen in women with Post Traumatic Stress Disorder (PTSD) and to FOC in subsequent pregnancies.

• There appears to be a vicious cycle phenomenon: women experience during labour what they already feared, and this in turn influences their FOC postpartum.

What this study adds

• To minimise the possibility of confounding factors, we were interested in studying the relationship between FOC and delivery characteristics in a low-risk sample. No relation was found between FOC during pregnancy in a low-risk sample and delivery complications.

• We did find a relationship between postpartum FOC and the combination of multiparity and medical intervention. This could be due to a higher unexpectedness of complications in this low risk group.

• In this low-risk sample, we could confirm the vicious cycle, found in other studies, of a positive correlation of FOC during pregnancy and at 6 weeks postpartum, irrespective of problems during childbirth.