Health, obstetric outcomes and reproduction in women with vulvar pain or primary fear of childbirth

Abstract

Fear of childbirth (FOC) is common and affects approximately 5-20 % of all pregnant women. FOC is associated with giving birth by caesarean section on maternal request (CSMR). The rate of caesarean sections (CS) and CSMR has increased during the last decades. To decrease these women's fear, the rate of CSMR and to promote a more positive birth experience, many treatments for FOC have been evaluated. In Sweden, the treatment is individualized and given by obstetricians, midwives, psychologists or psychotherapists in the specialist care. Women with FOC suffer more often from psychiatric illness and rate their general health as less good, which is important to consider when counselling these women and deciding on mode of delivery. Little is known about the long term obstetric and reproductive outcomes for women with FOC. Therefore, the aim of the studies on which this thesis is based was to compare psychiatric care before and after childbirth in women giving birth by CSMR to women giving birth by other modes of delivery and to follow the subsequent obstetric and reproductive outcomes in women receiving counselling for FOC in their first childbirth. Furthermore, we hypothesized that women with localized provoked vulvodynia (LPV) and/or vaginismus might fear vaginal childbirth and little is known about their reproduction and obstetric outcomes which is why we investigated the parity and obstetric outcomes in women diagnosed with LPV/vaginismus before first childbirth. Based on data linked from several Swedish National registers, the prevalence of psychiatric in-and outpatient care before (paper I) and after first childbirth (paper II) was compared in primiparae giving birth by CSMR to primiparae giving birth by other modes of delivery. The prevalence of psychiatric disorders was found to be significantly higher in women giving birth by CSMR, indicating a severe burden of psychiatric illness in these women. In paper III, also based on data from several Swedish National registers, a diagnosis of LPV/vaginismus before childbirth was shown to decrease the odds of giving birth. When giving birth these women had an increased risk of CS, especially CSMR. This could possibly indicate FOC in these women. Further, women with vaginismus had an increased risk of pelvic floor injuries. Paper IV was a follow-up study of women who received counselling for FOC in their first pregnancy leading to parturition. It was based on data from medical records and a questionnaire. The women were followed 7-14 years after their first childbirth. Women treated for FOC more often gave birth by CS, rated their first birth experience as less positive 4 and more often required counselling for FOC in their subsequent pregnancies compared to women without FOC in their first pregnancy. There were no significant differences in the rate of complications during pregnancy and childbirth compared to the other women. Women treated for FOC less often gave birth more than twice. Despite being given counselling and being exposed to childbirth almost one in five ...

The effect of the personality traits of pregnant women on the fear of childbirth

“…Pregnant women who consulted an antenatal polyclinic at a related hospital between 01 May 2016 and 01 August 2016 were included in this study. To determine the sample size, a power analysis was conducted (sample error: 0.01 and power: 95%), and the prevalence of childbirth fear was estimated as 20%. The minimal number of people to be included in the study sample was calculated as 318.…”

“…Severe FOC is an amount of worry that diminishes the woman's courage to have a baby or have a baby through vaginal delivery, or even it may result in a mental illness. Phobic FOC means that the fear is so much that the woman avoids becoming pregnant or vaginal childbirth, and sometimes it causes the woman to abort pregnancy . It has been reported that 20% of pregnant women are afraid of childbirth, including 10% of women who experience severe fear and 2.5% of women who experience fear at the phobic level …”

The Relationship between Fear of Childbirth and the Desire to Avoid Pregnancy among Young Unmarried Women

“…The researchers created this form to collect information on some sociodemographic characteristics of the participants (e.g., age, education status, income status). 2,[4][5][6] Desire to Avoid Pregnancy (DAP) Scale DAP was developed by Rocca et al (2019) and tested for validity and reliability in Turkish by Karataş Okyay et al 5,7 It is a 14-item scale that measures the preferences, thoughts, and feelings of women regarding a future pregnancy and childbirth. Items 3, 7, 9, 11, 12, 13, and 14 are inversely scored, while items 1, 2, 4, 5, 6, 8, and 10 are directly scored.…”

“…Tokophobia is the case where the fear experienced by the woman drives her towards avoiding pregnancy or childbirth or sometimes terminating her pregnancy. 2,3 While studies have focused on the fear of childbirth among pregnant women, less is known about the fear of childbirth among unmarried women. The prevalence of fear of childbirth was found among 13.6% of unmarried university students in Canada.…”