Fear of Childbirth and Risk of Cesarean Delivery: A Cohort Study in Six European Countries

Abstract

Background : Few studies have examined mode of birth among women with fear of childbirth , and the results are conflicting . The objective o f this study was to assess the association between fear of childbirth and c esarean section in North European women. Methods : A longitudinal cohort study was conducted of 6,422 unselected pregnant women from Belgium, Iceland, Denmark, Estonia, Norw ay, and Sweden. Fear of childbirth was measured by the Wijma Delivery Expectancy Questionnaire during pregnancy and linked to obstetric information from hospital records . Results: Among 3,189 primiparous women, those reporting severe fear of chi ldbirth were more likely to give birth by elective c esarean , Odds Ratio ( OR ) 1.66 (1.05 – 2.61). Among 3,233 multiparous women, severe fear of childbirth increased the risk of elective cesarean , OR 1.87 (1.30 – 2.69). Reporting lack of positive ant icipation, one of six dimensions of fear of childbirth , was most strongly associated with elective cesarean , OR 2.02 (1.52 – 2.68). A dose - effect pattern was observed between level of fear and risk of emergency cesarean in both p rimiparous and multiparous women. Indications for cesarean were more likely to be reported as ‘non - medical’ among those with severe fear of childbirth ; 16.7% vs 4.6% in primiparous women, and 31.7% vs 17.5% in multiparous women. Conclusion : Having sev ere fear of childbirth increases the risk of elective cesarean , especially among multiparous women. Lack of positive anticipation of the upcoming childbirth seems to be an important dimension of fear associated with cesarean . Counseling for women who do not look forward to vaginal birth should be further evaluated.