Fear of childbirth in nulliparous and multiparous women: a population-based analysis of all singleton births in Finland in 1997-2010.
OBJECTIVE
To identify risk factors for fear of childbirth (FOC) according to parity and socioeconomic status, and to evaluate associations between FOC and adverse perinatal outcomes.


METHODS
A cohort study.


METHODS
The Finnish Medical Birth Register.


METHODS
All 788 317 singleton births during 1997-2010 in Finland.


METHODS
Fear of childbirth was defined according to the International Classification of Diseases code O99.80, and its associations with several risk factors and perinatal outcomes were analysed by multivariable logistic regression.


METHODS
Prevalence of, risk factors for and outcomes of FOC.


RESULTS
Fear of childbirth was experienced by 2.5% of nulliparous women and 4.5% of multiparous women. The strongest risk factors for FOC in nulliparous women were depression [adjusted odds ratio (aOR), 6.35; 95% confidence interval (CI), 5.25-7.68], advanced maternal age (aOR, 3.78; 95% CI, 3.23-4.42) and high or unspecified socioeconomic status. In multiparous women, the strongest risk factors for FOC were depression (aOR, 5.47; 95% CI, 4.67-6.41), previous caesarean section (CS) (aOR, 3.02; 95% CI, 2.93-3.11) and high or unspecified socioeconomic status. Among both nulliparous and multiparous women, FOC was associated with higher rates of CS (3.3-fold and 4.5-fold higher, respectively) and a lower incidence of low birthweight (<2500 g), small for gestational age babies, preterm birth and low Apgar scores at 1 minute.


CONCLUSIONS
High and unspecified socioeconomic status, advanced maternal age and depression are predisposing factors for FOC regardless of parity. Among multiparous women, a previous CS increases vulnerability to FOC. FOC is associated with increased rates of CS, but does not adversely affect other pregnancy outcomes.
Department of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio, Finland.
S
S
Räisänen
S M
SM
Lehto
H S
HS
Nielsen
M
M
Gissler
M R
MR
Kramer
S
S
Heinonen
D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D002585:Cesarean Section; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000523:psychology* / Q000706:statistics & numerical data; D003863:Depression / Q000150:complications; D005239:Fear / Q000523:psychology; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D008423:Maternal Age; D016017:Odds Ratio; D010298:Parity; D036801:Parturition / Q000523:psychology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012307:Risk Factors; D018571:Sentinel Surveillance; D012923:Social Class; D012944:Social Support; D011795:Surveys and Questionnaires
Birth; childbirth; fear of childbirth; population register; pregnancy outcome; register; socioeconomic status