title: Fear of Childbirth and Preference for Cesarean Delivery Among Young American Women Before Childbirth: A Survey Study.
abstract: BACKGROUND
  Fear of birth and mode of delivery preferences are similar among pregnant and nonpregnant women, suggesting that attitudes toward birth are formed in young adulthood or earlier. Understanding why some young women fear birth and prefer obstetric interventions can inform public health initiatives aimed at reducing fear and promoting birth as a normal life event.
  
  
  METHODS
  We conducted an online survey with 752 American nulliparous young women to assess their preferences and attitudes toward childbirth. We identified explanatory variables associated with reported fear of childbirth and cesarean delivery (CD) preferences.
  
  
  RESULTS
  A preference for CD was reported by 14 percent of young women and 27 percent had scores indicating elevated fear of birth. Fear of birth increased the likelihood of cesarean preference (adjusted relative risk (ARR) 3.84 [95% CI 2.49-5.95]) as did a family history of CD (ARR 1.65 [95% CI 1.13-2.42]). The likelihood of reporting elevated childbirth fear was increased among young women who reported concerns about the physical changes pregnancy and birth have on women's bodies (ARR 2.04 [95% CI 1.50-2.78]). Young women who reported a high degree of confidence in their knowledge about childbirth were significantly less likely to report childbirth fear (ARR 0.61 [95% CI 0.42-0.87]). Access to childbirth information was also associated with a decreased likelihood of fear of birth (ARR 0.75 [95% CI 0.59-0.95]).
  
  
  CONCLUSIONS
  Young women reporting high levels of childbirth fear are nearly four times more likely to prefer a CD. Specific fears, such as worries over the influence of pregnancy and birth on the female body, need to be addressed before pregnancy.
authors.affiliation: School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Stoll
authors.affiliation: Boston College, School of Nursing, Chestnut Hill, MA, USA.
authors.forename: Joyce Katherine
authors.identifier: http://orcid.org/0000-0002-0465-9043
authors.initials: JK
authors.lastname: Edmonds
authors.affiliation: School of Nursing, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Hall
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety; D001290:Attitude; D002585:Cesarean Section / Q000523:psychology*; D003430:Cross-Sectional Studies; D005239:Fear; D005260:Female; D006801:Humans; D008404:Massachusetts; D010298:Parity; D036801:Parturition / Q000523:psychology*; D011247:Pregnancy; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: attitudes; cesarean delivery; childbirth; fear of birth; online survey; young women