Dalarna University's logo and link to the university's website

OBJECTIVE:

to investigate the prevalence of childbirth related fear (CBRF) in early pregnancy among both Swedish born and foreign born women living in Sweden.

DESIGN:

a cross sectional prevalence study. Data was collected by a questionnaire, which was available in Swedish and eight other languages.

SETTING:

a university hospital in the middle of Sweden.

PARTICIPANTS:

the recruitment took place during a two month period where the participating women completed the Fear of Birth Scale (FOBS) in mid-pregnancy.

MEASUREMENTS:

prevalence of CBRF, the cut-point of 60 and above. Odds ratios with a 95% confidence interval were calculated between women born in Sweden and women born in a foreign country. Stratified analyses were also performed separately for Swedish born and foreign born women.

FINDINGS:

in total 606 women completed the survey, 78% were born in Sweden and 22% were born in a foreign country. About 22% of the total sample scored 60 or more on the FOBS-scale. Almost 18% (n=85) of the women born in Sweden reported CBRF whereas 37 % (n=49) of the foreign born women reported CBRF. Being born outside Sweden (OR 2.7; CI 1.7-4.0) and expecting the first baby (OR 1.9; CI 1.3-2.8) were associated with CBRF. There were no differences in age, civil status or level of education between women with or without FOBS≥60. However, a stratified analysis showed that primiparas born in a foreign country (OR 3.8; CI 1.8-8.0) were more likely to score 60 or more on the FOBS-scale compared to multiparas born in a foreign country.

KEY CONCLUSIONS:

childbirth related fear was almost three times as common among foreign born women when compared to Swedish women. Foreign born childbearing women are an extremely vulnerable group who need culturally sensitive and targeted support from caregivers. Further research is needed to clearly identify the components of women׳s childbirth related fear in various ethnic groups.

BACKGROUND:

Fear of childbirth is common during pregnancy but rarely assessed in clinical practice. The Fear of Birth Scale has been proposed as a valid measure suitable for assessing fear of birth in an antenatal clinical context. To make sure that the scale makes sense in relation to the known constructs of fear of birth, it is important to find out what women think when responding to the Fear of Birth Scale.

AIM:

To report what women in mid-pregnancy think when assessing fear of birth on the Fear of Birth Scale.

METHODS:

A qualitative design using semi-structured interviews with a think aloud technique was used. Thirty-one women were recruited in gestational week 17-20. Content analysis was conducted to describe the different dimensions of fear of birth.

FINDINGS:

Worry was described as unspecific feelings and thoughts, often with a negative loading. Fear was described as a strong feeling connected to something specific. Furthermore, the women thought about aspects that influence their worries and fears and explained the strategies that helped them to cope with their fear of birth.

CONCLUSION:

Women could clearly assess, describe, and discuss fear of birth using the Fear of Birth Scale. This supports the use of the Fear of Birth Scale in clinical settings as a starting point for further dialogue about women's fear of birth. The dialogue may identify women's need for information, treatment, and referral when necessary.

Fear of birth is a concern that requires evidence based treatment. The aim of this study is to present the protocol of a randomized controlled multi-center trial to compare internet-based cognitive therapy with counseling as standard care for pregnant women reporting fear of birth. Participants will be recruited in mid-pregnancy. Women who score 60 or above on the Fear of Birth Scale will be offered to participate in this study. Data will be collected by questionnaires including validated instruments at baseline and follow-ups at gestational weeks 30 and 36, two months and one year after birth. The primary outcome will be level of fear of birth measured with the Fear of Birth Scale at 36 weeks of gestation. Secondary outcome measures are level of fear of birth at two months and one year after giving birth, preferences for mode of birth, requests for elective cesarean section, compliance and satisfaction with treatment and birth outcomes. A power calculation based on a 20% reduction of fear implies that approximately 200 will be included in the trial. The study outlined in this protocol will be the first randomized controlled trial comparing internet-based cognitive therapy with counseling for women reporting fear of birth. An effective treatment may result in better overall health for women with fear of birth and a reduction in cesarean sections for non-medical reasons. Evidence regarding treatment options of fear of birth will also provide a greater choice for women.