Fear of Childbirth and Risk of Cesarean Delivery: A Cohort Study in Six European Countries
This is the accepted version of the following article: schroll, a. m., karro, h., lukasse, m., van parys, a. s., wangel, a. m., schei, b., ... & kristjansdottir, h. (2014). fear of childbirth and risk of caesarean section: a cohort study in six european countries., which has been published in final form at http://dx.doi.org/10.1111/birt.12147.
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Original versionSchroll, A. M., Karro, H., Lukasse, M., Van Parys, A. S., Wangel, A. M., Schei, B., ... & Kristjansdottir, H. (2014). Fear of childbirth and risk of caesarean section: a cohort study in six European countries. http://dx.doi.org/10.1111/birt.12147
Background: Few studies have examined mode of birthamong women with fear of childbirth, and the results are conflicting.The objective of this study was toassess the association between fear of childbirthandcesarean sectionin North European women.Methods: A longitudinal cohort study was conducted of 6,422 unselected pregnant women from Belgium, Iceland, Denmark, Estonia, Norway, and Sweden. Fear of childbirthwas 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 childbirthwere more likely to give birth by elective cesarean, Odds Ratio (OR)1.66 (1.05–2.61). Among 3,233 multiparous women, severe fear of childbirthincreased the risk of elective cesarean, OR 1.87 (1.30–2.69). Reporting lack of positive anticipation, one of six dimensions of fearof 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 cesareanin both primiparous and multiparous women. Indications for cesareanwere 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 severe fear of childbirthincreases the risk of elective cesarean, especially among multiparous women. Lack of positive anticipation of the upcoming childbirthseems to be an important dimension of fear associated with cesarean. Counseling forwomen who do not look forward to vaginal birth shouldbe further evaluated.