title: [Fear of childbirth among nulliparous women: Relations with pain during delivery, post-traumatic stress symptoms, and postpartum depressive symptoms].
abstract: OBJECTIVE
  Fear of childbirth is common in women who are pregnant with their first child and is associated with important consequences such as abortions and miscarriages. Twenty percent of nulliparous women seem to exhibit a mild or moderate fear, while 6% present an excessive and irrational fear known as tocophobia. Tocophobia is suggested to be associated with many negative consequences such as postpartum depression (PPD) and Post-traumatic stress (PTS). However, there is little empirical evidence to support these relationships. Recently, Fairbrother and Woody (2007) did not observe a link between the fear of childbirth and symptoms of PPD and PTS in nulliparous women. Some results, near the significance level, could be explained by a lack of statistical power. The present study focused on the link between the fear of childbirth and the process of delivery, the perception of pain, PPD and PTS. More specifically, it aimed to test three hypotheses: (i) fear of childbirth will be linked to the process of delivery, especially regarding the perception of pain, the use of anaesthesia and the use of Caesarean section; (ii) a high level of fear of childbirth will be associated with more negative postpartum consequences (namely PPD/PTS symptoms); (iii) the process of delivery and pain will also be related to post-delivery symptoms. Mediation effects were tested.
  
  
  METHODS
  Data from a longitudinal study were used to meet the hypotheses. A total of 176 nulliparous pregnant women responded to questionnaires at two time measurements (during pregnancy and at 5weeks postpartum).
  
  
  RESULTS
  Fear of childbirth is related to the perception of pain at birth among women delivering vaginally, in the absence of anaesthesia. It is also linked to symptoms of PPD and PTS, regardless of whether or not anaesthesia was used. Fear of childbirth also appears to be strongly associated to symptoms of PTS in women who have experienced an unplanned caesarean section. Thus, symptoms of postpartum PTS could play a mediating role in the link between fear of childbirth and PPD.
  
  
  CONCLUSIONS
  These results support the relevance of taking into account the fear of childbirth and perception of pain in connection with symptoms of PTS and PPD in nulliparous women. The unplanned caesarean section (including emergency caesarean) also appears to be important in the study of the relationship between fear and symptoms of PTS. Fear of childbirth could render the experience of childbearing more negative and predispose to PTS and PPD. Enabling psychological vulnerabilities could also be an interesting avenue for understanding these links. Limitations are discussed.
authors.affiliation: Département de psychologie, université de Sherbrooke, Institut universitaire de première ligne en santé et services sociaux - Centre intégré universitaire en santé et services sociaux de l'Estrie - CHUS (CIUSSS de l'Estrie - CHUS), Sherbrooke, Canada. Electronic address: Patrick.Gosselin@USherbrooke.ca.
authors.forename: P
authors.initials: P
authors.lastname: Gosselin
authors.affiliation: Département de psychologie, université de Sherbrooke, Institut universitaire de première ligne en santé et services sociaux - Centre intégré universitaire en santé et services sociaux de l'Estrie - CHUS (CIUSSS de l'Estrie - CHUS), Sherbrooke, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Chabot
authors.affiliation: Département de psychologie, université de Sherbrooke, Institut universitaire de première ligne en santé et services sociaux - Centre intégré universitaire en santé et services sociaux de l'Estrie - CHUS (CIUSSS de l'Estrie - CHUS), Sherbrooke, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Béland
authors.affiliation: Département de psychologie, université de Sherbrooke, Institut universitaire de première ligne en santé et services sociaux - Centre intégré universitaire en santé et services sociaux de l'Estrie - CHUS (CIUSSS de l'Estrie - CHUS), Sherbrooke, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Goulet-Gervais
authors.affiliation: Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, Australie.
authors.forename: A J S
authors.initials: AJ
authors.lastname: Morin
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical; D002585:Cesarean Section / Q000523:psychology; D036861:Delivery, Obstetric / Q000523:psychology*; D019052:Depression, Postpartum / Q000523:psychology*; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D010146:Pain / Q000209:etiology*; D058748:Pain Perception; D010298:Parity; D036801:Parturition / Q000523:psychology*; D011247:Pregnancy; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology* / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Douleur; Dépression post-partum; Fear of childbirth; Pain; Peur de l’accouchement; Post-partum depression; Post-traumatic stress; Stress post-traumatique; Tocophobie