Fear of childbirth and mode of delivery in six European countries: the BIDENS study


Objectives: To investigate the association between fear of childbirth and mode of delivery in six European countries. Furthermore, we explored the association of physical, emotional and/or sexual abuse and depressive symptoms with fear of childbirth.

Methods: In this cohort study, pregnant women were recruited at antenatal clinics in 6 European countriesfrom March 2008 to August 2010.A total of 7200 women completed the questionnaire, mode of delivery was reported for 6724 women. The abuse questions were based on a questionnaire developed in a previous Nordic study (NorAq). Fear of childbirth was measured through the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). Data on mode of delivery were retrieved through hospital records. Depressive symptoms were measured by means of the 5-item Edinburgh Depression Scale (EDS).

Results: Prevalence of intense fear of childbirth was 11.0% (W-DEQ score ≥ 85) and extreme fear 4.2% (W-DEQ score ≥ 100). The prevalence of intense and extreme fear of childbirth differs significantly between countries (p<0.05), 6.3% to 14.2%, and 1.9% to 6.6%, respectively. The overall prevalence of spontaneous vaginal delivery was74.9%, vacuum extraction 8.3%, forceps delivery 0.3% and Caesarean Section (CS)16.5%. Women with fear of childbirth (W-DEQ score ≥ 85) have a significantly higher chance of delivering by CS, odds ratio (OR)1.6(95% CI 1.4,2.0). The association between fear of childbirth and a CS, remains significant after correction for age, marital status, mother tongue and education (p<0.005, adjusted odds ratio 1.6, 95% CI 1.3, 2.0). Furthermore, women with fear of childbirth more often prefer a CS, OR 3.9 (95% CI 3.0,4.8). Fear of childbirth seems influenced by abuse and depressive symptoms (EDS score > 7). Women who were  physically, emotionally and/or sexually abused at any point during life and women with depressive symptoms have a significant higher chance of developing fear of childbirth, respectively OR1.9 (95% CI 1.7,2.2) and OR 3.8 (95% CI 3.1,4.6).

Conclusion: The prevalence of ‘fear of childbirth’ appears to be different in the participating countries. Women with fear of childbirth have a significant higher risk of delivering by CS. Abuse during lifetime and depressive symptoms are factors associated with fear of childbirth.

Authors & affiliation: 
the Bidens study group: Marleen Temmerman (UGent Belgium), An-Sofie Van Parys (UGent Belgium); Iceland: Thora Steingrímsdóttir, Hildur Krisjansdottir, Denmark: Ann Tabor, Anne-Mette Schroll; Estonia: Helle Karro, Made Laanpere; Norway: Berit Schei, Mirjam Lukasse; Sweden: Elsa Lena Ryding, Anne-Marie Wangel
Published In: 
22nd European congress of Obstetrics and Gynaecology (EBCOG 2012) Tallinn, Estonia
Publication date: 
Wednesday, May 9, 2012