Identifying women who are afraid of giving birth: A comparison of the fear of birth scale with the WDEQ-A in a large Australian cohort.

BACKGROUND: The WDEQ-A is the most widely used measure of childbirth fear in pregnant women; however there is increasing discussion in the literature that simpler, more culturally transferrable tools may offer a better solution to identifying fearful women in clinical practice. AIM: To compare the two item Fear of Birth Scale (FOBS) with the 33 item WDEQ-A in a large cohort of Australian pregnant women. METHOD: Self-report questionnaires during second trimester including Wijma Delivery Expectancy Questionnaire (WDEQ-A) and Fear of Birth Scale (FOBS). Correlation of FOBS and WDEQ-A was tested using Spearman's correlation coefficients. Receiver operating characteristic (ROC) curve assessed the sensitivity and specificity of possible cut-points on the FOBS against WDEQ-A cut-point of ≥85. Sensitivity, specificity, positive and negative predictive values were determined. Fearful and non-fearful women as classified by both instruments were compared for differences in demographic, psycho-social and obstetric characteristics. RESULTS: 1410 women participated. The correlation between the instruments was strong (Spearman's Rho = 0.66, p < 0.001). The area under the ROC was 0.89 indicating high sensitivity with a FOBS cut-point of 54. Sensitivity was 89%, specificity 79% and Youden index 0.68. Positive predictive value was 85% and negative predictive value 79%. Both instruments identified high fear as significantly associated with first time mothers, previous emergency caesarean and women with self-reported anxiety and/or depression. Additionally FOBS identified a significant association between fearful women and preference for caesarean. CONCLUSION: This study supports the use of the FOBS in clinical practice to identify childbirth fear in pregnant women.

Maternal and infant outcome after caesarean section without recorded medical indication: findings from a Swedish case-control study.

OBJECTIVE: To compare maternal complications and infant outcomes for women undergoing elective caesarean sections based on a maternal request and without recorded medical indication with those of women who underwent spontaneous onset of labour with the intention to have a vaginal birth. DESIGN: Retrospective register study. SETTING: Sweden; Medical Birth Register used for data collection. METHODS: A case-control study of 5877 birth records of women undergoing caesarean sections without medical indication and a control group of 13 774 women undergoing births through spontaneous onset of labour. The control group was further divided into women who actually had a vaginal birth and women who ended up with an emergency caesarean section. RESULTS: Maternal complications occurred more frequently among women undergoing caesarean section with odds ratios (OR) for bleeding complications of 2.5 (95% CI 2.1-3.0) in the elective caesarean group and 2.0 (95% CI 1.5-2.6) in the emergency caesarean group. The OR for infections was 2.6 in both groups. Breastfeeding complications were most common in women having an elective caesarean section: 6.8 (95% CI 3.2-14.5). Infant outcomes showed a higher incidence of respiratory distress with an OR of 2.7 (95% CI 1.8-3.9) in the elective caesarean section group compared with infants born by emergency caesarean section. The risk of hypoglycaemia was at least twice as high for infants in the caesarean group. CONCLUSIONS: Caesarean sections without medical indication as well as emergency caesarean sections were associated with higher risks for maternal and infant morbidity.

First-time mothers' wish for a planned caesarean section: deeply rooted emotions.

BACKGROUND: international estimates suggest that caesarean section on maternal request range from 4% to 18% of all caesarean section. An increasing number of surveys have investigated women's reasons for a caesarean section in the absence of a medical indication but few studies have solely studied first-time mothers motivation for this request. OBJECTIVE: to describe the underlying reasons for the desire for a caesarean section in the absence of medical indication in pregnant first-time mothers. METHOD: a qualitative descriptive study, with content analysis of interviews with 12 first-time mothers. FINDINGS: the overarching theme formulated to illustrate the central interpreted meaning of the underlying desire for a planned caesarean section was based on deeply rooted emotions'. Four categories were identified as related to the request for a caesarean section on maternal request. The categories was identified as 'always knowing that there are no other options than a caesarean section', 'caesarean section as a more controlled and safe way of having a baby', own negative experiences of health care and having problems dealing with other people's reaction about their mode of delivery. CONCLUSION: the results show that for these first-time mothers deeply rooted emotions described as stronger than fear of birth were behind their wish for a planned caesarean section.

Few fathers-to-be prefer caesarean section for the birth of their baby.

The objective of this study was to investigate prospective fathers' preferences for caesarean section and associated factors. Data were collected by means of a questionnaire given in mid-pregnancy to 1105 fathers-to-be in northern Sweden. In total, 6.4% of fathers preferred a caesarean section. The factors associated with a preference for caesarean section were a wish to plan the date of the baby's birth [prevalence ratio (PR) 6.0], a previous negative birth experience (PR 8.6) and previous experience of a caesarean section (PR 5.7).

Antenatal fear of childbirth and its association with subsequent caesarean section and experience of childbirth.

OBJECTIVE: To investigate the prevalence of fear of childbirth in a nationwide sample and its association with subsequent rates of caesarean section and overall experience of childbirth. DESIGN: A prospective study using between-group comparisons. SETTING: About 600 antenatal clinics in Sweden. SAMPLE: A total of 2,662 women recruited at their first visit to an antenatal clinic during three predetermined weeks spread over 1 year. METHODS: Postal questionnaires at 16 weeks of gestation (mean) and 2 months postpartum. Women with fear of childbirth, defined as 'very negative' feelings when thinking about the delivery in second trimester and/or having undergone counselling because of fear of childbirth later in pregnancy, were compared with those in the reference group without these characteristics. MAIN OUTCOME MEASURES: Elective and emergency caesarean section and overall childbirth experience. RESULTS: In total 97 women (3.6%) had very negative feelings and about half of them subsequently underwent counselling. In addition, 193 women (7.2%) who initially had more positive feelings underwent counselling later in pregnancy. In women who underwent counselling, fear of childbirth was associated with a three to six times higher rate of elective caesarean sections but not with higher rates of emergency caesarean section or negative childbirth experience. Very negative feelings without counselling were not associated with an increased caesarean section rate but were associated with a negative birth experience. CONCLUSIONS: At least 10% of pregnant women in Sweden suffer from fear of childbirth. Fear of childbirth in combination with counselling may increase the rate of elective caesarean sections, whereas fear without treatment may have a negative impact on the subsequent experience of childbirth.

Midwives' lived experiences of being supportive to prospective mothers/parents during pregnancy.

OBJECTIVE: To elucidate midwives' narrated experiences of being supportive to prospective mothers or parents during pregnancy. DESIGN: Phenomenological hermeneutic analysis of transcribed text from seven tape-recorded interviews. SETTING: Midwifery clinics in five health centres in the context of Swedish primary health care. PARTICIPANTS: Seven midwives working in antenatal care. FINDINGS: The interpretation of the text showed that through perception and intuition the midwives seemed to become aware that some women needed increased support. The situations of these prospective mothers were often characterised by difficult social problems or fears. The prospective fathers were mostly absent in the narratives. The midwives acted on both a personal and a professional level with ethical perspectives in mind, when they were advocating their clients' rights to receive proper care. The comprehensive understanding of the interpretation revealed that the midwife sometimes perceived herself as being metaphorically 'The Good Mother'. KEY CONCLUSIONS: Having the role of 'The Good Mother' could be understood as a way for the midwife to establish a fruitful relationship with prospective mothers/parents. IMPLICATIONS FOR PRACTICE: The findings provide a basis for reflection on the mothering and supportive function of midwives when providing antenatal care.