title: Severe fear of childbirth indicates high perinatal costs for Swedish women giving birth to their first child.
abstract: BACKGROUND
  The objective of this study was to calculate costs associated with severe fear of childbirth (FOC) during pregnancy and peripartum by comparing two groups of women expecting their first child and attending an ordinary antenatal program; one with low FOC and one with severe FOC.
  
  
  METHODS
  In a prospective case-control cohort study one group with low FOC [Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) sum score ≤60, n = 107] and one with severe FOC (W-DEQ ≥85, n = 43) were followed up till 3 months postpartum and included in the analysis. Medical records were assessed and medical parameters were mapped. Mean costs for healthcare consumption and sick leave during pregnancy were calculated and compared.
  
  
  RESULTS
  When means were compared between the groups, the group with severe FOC had more visits for psychosocial reasons (p = 0.001) and more hours on sick leave (p = 0.03) during pregnancy, and stayed longer at the maternity ward (p = 0.04). They also more seldom had normal spontaneous deliveries (p = 0.03), and more often had an elective cesarean section on maternal request (p = 0.02). Postpartum, they more often than the group with low FOC paid visits to the maternity clinic because of complications (p = 0.001) and to the antenatal unit because of adverse childbirth experiences (p = 0.001). The costs for handling women with severe FOC was 38% higher than those for women with low FOC.
  
  
  CONCLUSIONS
  Women with severe FOC generate considerably higher perinatal costs than women with low FOC when handled in care as usual.
authors.affiliation: Unit of Medical Psychology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.|Department of Obstetrics and Gynecology, Vrinnevisjukhuset, Region Council of Östergötland, Norrköping, Sweden.
authors.forename: Katri
authors.identifier: http://orcid.org/0000-0002-6014-4327
authors.initials: K
authors.lastname: Nieminen
authors.affiliation: Unit of Medical Psychology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Klaas
authors.initials: K
authors.lastname: Wijma
authors.affiliation: Unit of Medical Psychology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Sanna
authors.initials: S
authors.lastname: Johansson
authors.affiliation: Unit of Medical Psychology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Emelie K
authors.initials: EK
authors.lastname: Kinberger
authors.affiliation: Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Elsa-Lena
authors.initials: EL
authors.lastname: Ryding
authors.affiliation: Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden.|Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Andersson
authors.affiliation: Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Bernfort
authors.affiliation: Unit of Gender and Medicine, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Barbro
authors.initials: B
authors.lastname: Wijma
mesh_terms: D000293:Adolescent; D000328:Adult; D003365:Costs and Cost Analysis; D036861:Delivery, Obstetric / Q000191:economics / Q000523:psychology*; D005239:Fear; D005260:Female; D006801:Humans; D008427:Maternal Health Services / Q000191:economics; D007744:Obstetric Labor Complications / Q000191:economics / Q000523:psychology*; D010298:Parity; D018743:Perinatal Care / Q000191:economics*; D011247:Pregnancy; D011594:Psychometrics; D011795:Surveys and Questionnaires; D013548:Sweden; D055815:Young Adult
keywords: Costs; W-DEQ; severe fear of childbirth