title: Fear of childbirth and elective caesarean section: a population-based study.
abstract: BACKGROUND
  This population-based cohort study aimed to investigate the demographic and psychosocial characteristics associated with fear of childbirth and the relative importance of such fear as a predictor of elective caesarean section.
  
  
  METHODS
  A sample of 1789 women from the Akershus Birth Cohort in Norway provided data collected by three self-administered questionnaires at 17 and 32 weeks of pregnancy and 8 weeks postpartum. Information about the participants' childbirths was obtained from the hospital records.
  
  
  RESULTS
  Eight percent of the women reported fear of delivery, defined as a score of ≥85 on the Wijma Delivery Expectancy Questionnaire. Using multivariable logistic regression models, a previous negative overall birth experience exerted the strongest impact on fear of childbirth, followed by impaired mental health and poor social support. Fear of childbirth was strongly associated with a preference for elective caesarean section (aOR 4.6, 95% CI 2.9-7.3) whereas the association of fear with performance of caesarean delivery was weaker (aOR 2.4, 95% CI 1.2-4.9). The vast majority (87%) of women with fear of childbirth did not, however, receive a caesarean section. By contrast, a previous negative overall birth experience was highly predictive of elective caesarean section (aOR 8.1, 95% CI 3.9-16.7) and few women without such experiences did request caesarean section.
  
  
  CONCLUSIONS
  Results suggest that women with fear of childbirth may have identifiable vulnerability characteristics, such as poor mental health and poor social support. Results also emphasize the need to focus on the subjective experience of the birth to prevent fear of childbirth and elective caesarean sections on maternal request. Regarding the relationship with social support, causality has to be interpreted cautiously, as social support was measured at 8 weeks postpartum only.
authors.affiliation: Health Services Research Centre, Akershus University Hospital, Post Box 1000, 1478, Lørenskog, Norway. hegeth@gmail.com.|Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway. hegeth@gmail.com.
authors.forename: Hege Therese
authors.initials: HT
authors.lastname: Størksen
authors.affiliation: Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, TU Dresden, Dresden, Germany. susanniegel@gmail.com.|Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway. susanniegel@gmail.com.
authors.forename: Susan
authors.initials: S
authors.lastname: Garthus-Niegel
authors.affiliation: Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway. samsalad@hotmail.com.
authors.forename: Samantha S
authors.initials: SS
authors.lastname: Adams
authors.affiliation: Norwegian Resource Centre for Women's Health, Women and Children's Division, Oslo University Hospital, Rikshospitalet, Oslo, Norway. sirvan@ous-hf.no.|Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway. sirvan@ous-hf.no.
authors.forename: Siri
authors.initials: S
authors.lastname: Vangen
authors.affiliation: Health Services Research Centre, Akershus University Hospital, Post Box 1000, 1478, Lørenskog, Norway. malin.eberhard.gran@fhi.no.|Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway. malin.eberhard.gran@fhi.no.|Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway. malin.eberhard.gran@fhi.no.
authors.forename: Malin
authors.initials: M
authors.lastname: Eberhard-Gran
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000523:psychology; D017558:Elective Surgical Procedures / Q000523:psychology; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D001523:Mental Disorders / Q000523:psychology; D008875:Middle Aged; D009664:Norway; D007744:Obstetric Labor Complications / Q000523:psychology*; D036801:Parturition / Q000523:psychology*; D057240:Patient Preference / Q000523:psychology; D011247:Pregnancy; D011446:Prospective Studies; D012944:Social Support; D011795:Surveys and Questionnaires; D055815:Young Adult