Fear of Childbirth and Elective Cesarean Section
Fear of Childbirth and Elective Cesarean Section
Childbirth is one of the most important events in a woman's life. Parturition is the transition to motherhood and delivery has substantial physical and emotional impacts. Approximately 6 to 10 % of all pregnant women experience severe fear of childbirth. This fear may be the dominant emotion during pregnancy and may complicate and prolong labour. Moreover, severe fear of childbirth may lead to increased risk of postnatal depression, and posttraumatic stress disorder. Numerous factors have been associated with that fear, including low self-esteem, pre-existing psychological problems, lack of social support, a history of abuse, or a previous negative birth experience. It is conceivable that demographic and psychosocial factors may increase stress related to impending childbirth and are connected with the ways women anticipate and experience various life events. Consequently, those characteristics could be predictive of fear of childbirth. However, few studies have focused on the relative importance of both demographic and psychosocial factors, and several studies of fear of childbirth and its association with these factors have been limited by a small sample size or use of non-validated questions or other unspecific measurements.
Another important issue is the increasing number of women who deliver by caesarean section (CS) in almost all countries in the western world over the last 30 years. Although Norway has a relatively low caesarean section rate compared to other European countries, rates have increased from 2.5 % in 1972 to 17 % in 2011 (Norwegian Institute of Public Health website, 2014). Currently, the proportion of all caesarean deliveries that are elective in Norway varies between 30 and 47 % (Norwegian Institute of Public Health website, 2014). The majority of caesarean sections are performed for medical reasons; however, an increasing number are performed as a result of maternal request without a medical indication. This development is concerning because a caesarean section without medical indication may not confer health gain, can result in dangerous side effects, and is more costly than vaginal deliveries. When categorized by cause, 14–22 % of all elective caesareans in Norway are performed upon maternal request.
Several studies has shown that fear of childbirth often is an underlying factor for a mother's request for caesarean section. Hence, childbirth-related anxiety has been suggested to be a main reason for the increase in elective caesarean sections. Fear of childbirth might affect women in such a way that they begin to doubt themselves and feel uncertain of their ability to bear and give birth to a child. Although an association between fear of childbirth and a request for caesarean section has previously been shown, few studies have assessed the association between fear of childbirth and performance of elective caesarean section. In particular, no previous study has assessed the independent effect of fear on the elective caesarean section rate taking medical risk factors and previous overall birth experiences into account.
The aim of this study was to investigate (a) the demographic and psychosocial characteristics associated with fear of childbirth and (b) the relative importance of such fear on both caesarean delivery preference and delivery by elective caesarean section among 1789 pregnant Norwegian women.
Background
Childbirth is one of the most important events in a woman's life. Parturition is the transition to motherhood and delivery has substantial physical and emotional impacts. Approximately 6 to 10 % of all pregnant women experience severe fear of childbirth. This fear may be the dominant emotion during pregnancy and may complicate and prolong labour. Moreover, severe fear of childbirth may lead to increased risk of postnatal depression, and posttraumatic stress disorder. Numerous factors have been associated with that fear, including low self-esteem, pre-existing psychological problems, lack of social support, a history of abuse, or a previous negative birth experience. It is conceivable that demographic and psychosocial factors may increase stress related to impending childbirth and are connected with the ways women anticipate and experience various life events. Consequently, those characteristics could be predictive of fear of childbirth. However, few studies have focused on the relative importance of both demographic and psychosocial factors, and several studies of fear of childbirth and its association with these factors have been limited by a small sample size or use of non-validated questions or other unspecific measurements.
Another important issue is the increasing number of women who deliver by caesarean section (CS) in almost all countries in the western world over the last 30 years. Although Norway has a relatively low caesarean section rate compared to other European countries, rates have increased from 2.5 % in 1972 to 17 % in 2011 (Norwegian Institute of Public Health website, 2014). Currently, the proportion of all caesarean deliveries that are elective in Norway varies between 30 and 47 % (Norwegian Institute of Public Health website, 2014). The majority of caesarean sections are performed for medical reasons; however, an increasing number are performed as a result of maternal request without a medical indication. This development is concerning because a caesarean section without medical indication may not confer health gain, can result in dangerous side effects, and is more costly than vaginal deliveries. When categorized by cause, 14–22 % of all elective caesareans in Norway are performed upon maternal request.
Several studies has shown that fear of childbirth often is an underlying factor for a mother's request for caesarean section. Hence, childbirth-related anxiety has been suggested to be a main reason for the increase in elective caesarean sections. Fear of childbirth might affect women in such a way that they begin to doubt themselves and feel uncertain of their ability to bear and give birth to a child. Although an association between fear of childbirth and a request for caesarean section has previously been shown, few studies have assessed the association between fear of childbirth and performance of elective caesarean section. In particular, no previous study has assessed the independent effect of fear on the elective caesarean section rate taking medical risk factors and previous overall birth experiences into account.
The aim of this study was to investigate (a) the demographic and psychosocial characteristics associated with fear of childbirth and (b) the relative importance of such fear on both caesarean delivery preference and delivery by elective caesarean section among 1789 pregnant Norwegian women.
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