ABSTRACT
BACKGROUND: Several psychological and obstetric predictors of a negative childbirth experience and traumatic response to delivery have been identified. However, the influence of antepartum physiological stress parameters has not been elucidated. OBJECTIVE: The study includes an exploratory analysis of the associations of fear of delivery, antenatal basal and reactive activity of the hypothalamic-pituitary-adrenal axis, and obstetric outcomes, with childbirth experience and posttraumatic avoidance in the postpartum period. DESIGN: This was a prospective study with two antenatal measurements and a final assessment during the first week postpartum. An experimental condition with a standardized stressor (Trier Social Stress Test) was included in the design to study psychobiological stress response as a predictor of traumatic birth and posttraumatic avoidance. RESULTS: Linear regression analyses show independent associations of fear of delivery and more pronounced antenatal cortisol awakening response with a more negative childbirth experience. Fear of delivery was mediated by state anxiety after stress exposure, which, together with cortisol awakening response, explained 16% of the variance in the outcome of a more negative childbirth experience. Finally, antenatal fear of delivery and a negative childbirth experience both predicted higher avoidance scores during the first week postpartum. CONCLUSIONS: The associations found in this study can improve identification during pregnancy of women at risk for negative psychological response to childbirth. For these women, the provision of supportive care during pregnancy should be evaluated.