Fear and Anxiety Disorders Related to Childbirth: Epidemiological and Therapeutic Issues

Psychological, educational, and alternative interventions for reducing fear of childbirth in pregnant women: A systematic review

“…According to Nilsson et al (2018), these differences could be due to general ignorance about the concept of fear of childbirth (FoC) and its risk factors, which leads to the use of different measuring instruments or even different cut‐off points within the same tool. FoC is usually understood as a continuum whose lowest level is the usual worries, and the highest one is tocophobia (Badaoui et al, 2019). Moreover, many studies distinguish between primary and secondary FoC: the former exists before giving birth for the first time, and the latter starts after a negative childbirth experience (O'Connell et al, 2015).…”

“…However, there is very little literature on most of them, thus it is difficult to clarify their validity and reliability (Brunton et al, 2015; Richens et al, 2018). For a couple of decades, the most used tool for measuring FoC has been the Wijma's Delivery Expectancy/Experience Questionnaire (W‐DEQ), which has two versions, A and B, that aim to measure fear experienced before and during birth, respectively (Badaoui et al, 2019; Nilsson et al, 2018; O'Connell et al, 2017; Richens et al, 2018; Wijma et al, 1998). Now, nevertheless, its validity has been criticized for proving to be a multidimensional instrument and being difficult to adapt to other cultures (Pallant et al, 2016; Richens et al, 2018); furthermore, its length makes it inadequate for clinical practice (Nilsson et al, 2018; Richens et al, 2018).…”

“…There are not many studies that have collected the risk factors associated with FoC. Some sociodemographic variables, such as age, educational level, civil status, and living in rural areas or being a foreigner, correlate with FoC (Badaoui et al, 2019; Deliktas & Kukulu, 2019; Dencker et al, 2019; O'Connell et al, 2019; Salomonsson et al, 2013; Ternström et al, 2015); however, it is not possible to come to clear conclusions because studies are scarce, findings are contradictory, and concepts and methods are heterogeneous (Dencker et al, 2019). Another group of factors is obstetric variables, such as parity, the birth mode, and the subjective experience of it.…”

“…According to Badaoui et al (2019), cesarean sections are usually followed by an increase of postnatal fear, which turns spontaneous vaginal birth into a protective factor. It is generally accepted that fear levels are lower for multiparous women than for nulliparous (Geissbuehler & Eberhard, 2002; Nilsson et al, 2018; O'Connell et al, 2017, 2019; Ternström et al, 2015), except for mothers with negative experiences in previous births (Badaoui et al, 2019; Dencker et al, 2019; Sheen & Slade, 2018). This is logical as phobias subside more effectively with the exposure to the feared stimulus (Moriana et al, 2017).…”

“…These observations could mean that parity is not so important, and both groups feel the same level of fear, but for different reasons. Other variables, such as unwanted pregnancy, the length of labor, and infertility disorders, may also correlate with tocophobia (Badaoui et al, 2019; Dencker et al, 2019). Finally, certain psychological and social variables, such as the presence of mental disorders or pain catastrophization thoughts, just like PrA as it has been said above, may be considered as risk factors, while others such as social support, sense of control and security during birth, or childbirth self‐efficacy have shown to be, to a greater or lesser extent, protective factors (Badaoui et al, 2019; Bayrampour et al, 2016; Finfgeld‐Connett, 2005; Lyberg et al, 2018; O'Connell et al, 2019; Rondung et al, 2016; Salomonsson et al, 2013; Sheen & Slade, 2018; Wijma & Wijma, 2017).…”