The influence of women's fear, attitudes and beliefs of childbirth on mode and experience of birth

Women's fears and attitudes to childbirth may influence the maternity care they receive andthe outcomes of birth. This study aimed to develop profiles of women according to theirattitudes regarding birth and their levels of childbirth related fear.

The association of theseprofiles with mode and outcomes of birth was explored.

Methods: Prospective longitudinal cohort design with self report questionnaires containing a set ofattitudinal statements regarding birth (Birth Attitudes Profile Scale) and a fear of childbirthscale. Pregnant women responded at 18-20 weeks gestation and two months after birth from aregional area of Sweden (n = 386) and a regional area of Australia (n = 123).

Cluster analysiswas used to identify a set of profiles. Odds ratios (95% CI) were calculated, comparing cluster membership for country of care, pregnancy characteristics, birth experience andoutcomes.

Results: Three clusters were identified - 'Self determiners'(clear attitudes about birth includingseeing it as a natural process and no childbirth fear), 'Take it as it comes'(no fear of birth andlow levels of agreement with any of the attitude statements) and 'Fearful'(afraid of birth,with concerns for the personal impact of birth including pain and control, safety concerns andlow levels of agreement with attitudes relating to women's freedom of choice or birth as anatural process).

At 18 -20 weeks gestation, when compared to the 'Self determiners', womenin the 'Fearful'cluster were more likely to: prefer a caesarean (OR = 3.3 CI: 1.6-6.8), holdless than positive feelings about being pregnant (OR = 3.6 CI: 1.4-9.0), report less thanpositive feelings about the approaching birth (OR = 7.2 CI: 4.4-12.0) and less than positivefeelings about the first weeks with a newborn (OR = 2.0 CI 1.2-3.6). At two months postpartum the 'Fearful'cluster had a greater likelihood of having had an elective caesarean (OR= 5.4 CI 2.1-14.2); they were more likely to have had an epidural if they laboured (OR = 1.9CI 1.1-3.2) and to experience their labour pain as more intense than women in the otherclusters.

The 'Fearful'cluster were more likely to report a negative experience of birth (OR =1.7 CI 1.02- 2.9). The 'Take it as it comes'cluster had a higher likelihood of an electivecaesarean (OR 3.0 CI 1.1-8.0).

Conclusions: In this study three clusters of women were identified.

Belonging to the 'Fearful'cluster had anegative effect on women's emotional health during pregnancy and increased the likelihoodof a negative birth experience. Both women in the 'Take it as it comes'and the 'Fearful'cluster had higher odds of having an elective caesarean compared to women in the 'Selfdeterminers'.

Understanding women's attitudes and level of fear may help midwives anddoctors to tailor their interactions with women.

Published on: 2012-06-25

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