Experiences of Fears Associated with Pregnancy and Childbirth: A Study of 329 Pregnant Women
Abstract
Background: Women may experience a variety of fears in association with pregnancy and childbirth. The purpose of this study was to describe their objects, causes, and manifestations, and to identify factors associated with the fears. Methods: The study sample comprised 481 pregnant women in western Finland, of whom 329 (response rate 69%) completed a questionnaire. It was developed on the basis of semi‐structured interviews and previous studies and had a 4‐point scale and a dichotomous scale. Data were subjected to rotated factor analysis, and sum variables were produced. The effects of various demographic variables were calculated using the Kruskal‐Wallis and Mann‐Whitney U tests. Results: Of the 329 respondents, 78 percent expressed fears relating to pregnancy, to childbirth, or to both. Specific fears concerned childbirth, the child's and mother's well‐being, health care staff, family life, and cesarean section. Causes of fears were negative mood, negative stories told by others, alarming information, diseases and child‐related problems, and, in multiparas, negative experiences of previous pregnancy, childbirth, and baby's health and care; causes were significantly related to occupation. Fears were manifested as symptoms of stress, effects on everyday life, and a wish to have a cesarean section or to avoid pregnancy and childbirth; employment situation and elective cesarean section were the most important factors related to manifestation of fears. Parity and antenatal training were the most important variables related to objects of fears. Conclusions: Women's fears that are associated with pregnancy and childbirth can be explained by different factors. It is important for perinatal health caregivers to ask pregnant women about their feelings related to the current pregnancy, childbirth, and future motherhood, and to give women who express fears an opportunity to discuss them, paying special attention to primiparas and to multiparas with negative experiences of earlier pregnancies. (BIRTH 29:2 June 2002)
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Women fearing birth vary with regard to fear acquisition, fear objects, symptom severity, and comorbidity.
“Many other variations exist among women fearing birth with regard to fear acquisition, fear objects, symptom severity, and comorbidity [20-23].”
From Comparing internet-based cognitive behavioral therapy with standard care for women with fear of birth: Randomized controlled trial (2018) · cites this paper as [21]
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“Melender [10] found a similar figure in a study on pregnant women.”
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“Melender 2002 Melender HL. Experiences of fears associated with pregnancy and childbirth: a study of 329 pregnant women.”
BackgroundComparing the effects of ice massage and acupressure on labor pain reduction
Hajiamini, Z., Masoud, S. N., Ebadi, A., Afzali, M., & Ali-Asgari, M. (2012) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2012.05.003 · Cited by 76 · see citing works
What characterizes women in Norway who wish to have a caesarean section?
Kringeland, T., Daltveit, A., & Møller, A. (2009) · Scandinavian Journal of Public Health · doi:10.1177/1403494809105027 · Cited by 84 · see citing works
Denis, A., Parant, O., & Callahan, S. (2010) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2010.513048 · Cited by 72 · see citing works
“Although not previously identified with PTSD in the literature, previous studies note that increased pain perception during birth was associated with a negative birth experience (Boudou et al., 2007; Melender, 2002; Soet et al., 2003).”
BackgroundResultInfluentialMatinnia, N., Faisal, I., Juni, M. H., Herjar, A. R., Moeini, B., & Osman, Z. J. (2014) · Maternal and Child Health Journal · doi:10.1007/s10995-014-1610-0 · Cited by 69 · see citing works
“The unsatisfactory treatment and unfriendly behaviour by the maternity ward staff can be both a cause and a consequence of women’s childbirth related fears, including lack of trust maternity staff [2, 5, 22, 40].”
BackgroundResultFear of Childbirth, Tocophobia, and Mental Health in Mothers: The Obstetric–Psychiatric Interface
Hofberg, K., & Ward, M. R. (2004) · Clinical Obstetrics & Gynecology · doi:10.1097/01.grf.0000132527.62504.ca · Cited by 69 · see citing works
Malmquist, A., Jönsson, L., Wikström, J., & Nieminen, K. (2019) · Midwifery · doi:10.1016/j.midw.2019.102551 · Cited by 72 · see citing works
“Persons with severe FOC can be afraid of coping with pain, of being injured themselves or that the offspring is injured or dies (Eriksson et al. 2006; Melender, 2002).”
BackgroundResultInfluentialUndone by fear? Deluded by trust?
Dahlen, H. G. (2010) · Midwifery · doi:10.1016/j.midw.2009.11.008 · Cited by 67 · see citing works
“, 2005), with nearly one-quarter of women experiencing an intense or significant fear of childbirth (Areskog et al., 1981; Zar et al., 2001; Melender, 2002).”
BackgroundRisk and risk assessment in pregnancy – do we scare because we care?
Stahl, K., & Hundley, V. A. (2003) · Midwifery · doi:10.1016/s0266-6138(03)00041-x · Cited by 67 · see citing works
Psychosocial Correlates of Depression Symptoms During the Third Trimester of Pregnancy
Records, K., & Rice, M. J. (2007) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1111/j.1552-6909.2007.00140.x · Cited by 67 · see citing works
Swedish midwives’ perceptions of fear of childbirth
Salomonsson, B., Wijma, K., & Alehagen, S. (2008) · Midwifery · doi:10.1016/j.midw.2008.07.003 · Cited by 67 · see citing works
“Several studies show that FOC also exists in nulliparous women (Ryding, 1993; Geissbuehler and Eberhard, 2002; Melender, 2002; Saisto and Halmesmäki, 2003; Waldenström et al., 2006), and that it is even more intense in nulliparous than multiparous women (Wijma et al.”
BackgroundHaptotherapy as a new intervention for treating fear of childbirth: a randomized controlled trial
Klabbers, G. A., Wijma, K., Paarlberg, K. M., Emons, W. H. M., & Vingerhoets, A. J. J. M. (2017) · Journal of Psychosomatic Obstetrics & Gynecology · doi:10.1080/0167482x.2017.1398230 · Cited by 67 · see citing works
What Constitutes a Good Childbirth? A Qualitative Study of Pregnant Finnish Women
Melender, H. (2006) · Journal of Midwifery & Women s Health · doi:10.1016/j.jmwh.2006.02.009 · Cited by 65 · see citing works
LUKASSE, M., VANGEN, S., ØIAN, P., & SCHEI, B. (2011) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/j.1600-0412.2010.01024.x · Cited by 61 · see citing works
The initial development of the Pregnancy-related Anxiety Scale
Brunton, R. J., Dryer, R., Saliba, A., & Kohlhoff, J. (2019) · Women and Birth · doi:10.1016/j.wombi.2018.05.004 · Cited by 73 · see citing works
Pregnant women's thoughts when assessing fear of birth on the Fear of Birth Scale
Ternström, E., Hildingsson, I., Haines, H., & Rubertsson, C. (2016) · Women and Birth · doi:10.1016/j.wombi.2015.11.009 · Cited by 60 · see citing works
“Lack of trust in staff has earlier been described as a prevalent source of fear of birth.(19,21) In the present study, women stated that having trust in the staff was a strategy that helped them to cope with their own worries and fears.”
BackgroundZhou, X., Liu, H., Li, X., & Zhang, S. (2021) · Psychology Research and Behavior Management · doi:10.2147/prbm.s309889 · Cited by 60 · see citing works
Dahlen, H. G., & Caplice, S. (2014) · Women and Birth · doi:10.1016/j.wombi.2014.06.008 · Cited by 60 · see citing works
O’Connell, M. A., Khashan, A. S., & Leahy‐Warren, P. (2020) · Women and Birth · doi:10.1016/j.wombi.2020.05.008 · Cited by 58 · see citing works
“Studies included in this meta-analysis [4] were all undertaken in first world countries, however, there has since been a prevalence study performed in Kenya which indicates a similar prevalence of 14% in primigradas in this developing country, while FOC prevalence was lower in multigravidas (8%) [8].”
BackgroundMethodInfluentialJomeen, J., Martin, C., Jones, C., Marshall, C. A., Ayers, S., Burt, K., Frodsham, L., Horsch, A., Midwinter, D., O’Connell, M. A., et al. (2020) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2020.1843908 · Cited by 58 · see citing works
“Melender (2002) reported that almost a fifth of women will experience some degree of pregnancy-and childbirth-related fear or both.”
A Birth Education Program for Expectant Fathers in Taiwan: Effects on Their Anxiety
Li, H., Lin, K., Chang, S., Kao, C., Liu, C., & Kuo, S. (2009) · Birth · doi:10.1111/j.1523-536x.2009.00356.x · Cited by 58 · see citing works
Trillingsgaard, T., Elklit, A., Shevlin, M. E., & Maimburg, R. D. (2011) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2011.611937 · Cited by 57 · see citing works
“Transition to motherhood begins with pregnancy, a phase of profound physical, biological and neuro-endocrinological changes that have been associated with increases in fear and anxiety (Melender, 2002).”
BackgroundKlabbers, G. A., van Bakel, H. J. A., van den Heuvel, M. M. A., & Vingerhoets, A. J. J. M. (2016) · Research portal (Tilburg University) · Cited by 56 · see citing works
Interventions to treat fear of childbirth in pregnancy: a systematic review and meta-analysis
Webb, R., Bond, R., Romero‐Gonzalez, B., Mycroft, R. H., & Ayers, S. (2021) · Psychological Medicine · doi:10.1017/s0033291721002324 · Cited by 56 · see citing works
“Research also suggests that vicarious experiences such as viewing a live birth is associated with a reduction in fear (Stoll & Hall, 2013) and research also suggests that the transmission of information such as negative childbirth stories (Melender, 2002; Tsui et al., 2007) and public discourses of birth (Fenwick, Hau…”
BackgroundInfluentialMasoumi, S. Z., Kazemi, F., Oshvandi, K., Jalali, M., Vardanjani, A. E., & Rafiei, H. (2016) · PubMed Central · Cited by 55 · see citing works
Aromatherapy and massage for antenatal anxiety: Its effect on the fetus
Bastard, J., & Tiran, D. (2005) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2005.07.001 · Cited by 52 · see citing works
Farrell, R. M., Collart, C., Craighead, C., Pierce, M., Chien, E. K., Frankel, R., Edmonds, B. T., Perni, U. C., Coleridge, M. B., Ranzini, A. C., et al. (2021) · JMIR Formative Research · doi:10.2196/32791 · Cited by 198 · see citing works
Factors influencing maternal distress among Dutch women with a healthy pregnancy
Kuipers, Y., Ausems, M., Budé, L. M., van Limbeek, E. B. M., Vries, R. G. D., & Nieuwenhuijze, M. J. (2015) · Women and Birth · doi:10.1016/j.wombi.2015.02.002 · Cited by 51 · see citing works
“It's All the Rage These Days”: University Students' Attitudes Toward Vaginal and Cesarean Birth
Stoll, K., Fairbrother, N., Carty, E., Jordan, N., Miceli, C., Vostrcil, Y., & Willihnganz, L. (2009) · Birth · doi:10.1111/j.1523-536x.2009.00310.x · Cited by 62 · see citing works
Takegata, M., Haruna, M., Matsuzaki, M., Shiraishi, M., Murayama, R., Okano, T., & Severinsson, E. (2013) · Nursing and Health Sciences · doi:10.1111/nhs.12036 · Cited by 49 · see citing works
Maternal Fear Associated with Pregnancy and Childbirth in Hong Kong Chinese Women
Tsui, M. H. Y., Pang, M. W., Melender, H., Xu, L., Lau, T. K., & Leung, T. N. (2007) · Women & Health · doi:10.1300/j013v44n04_05 · Cited by 49 · see citing works
“The causes of fear in our population were also similar to those identified in the Finnish population (Melender 2002), although “negative stories from others” featured more strongly in our population than “negative attitude or mood.””
BackgroundMethodResultInfluentialReconceiving Pregnancy and Childcare: Ethics, Experience, and Reproductive Labor
Mullin, A. (2005) · DigitalGeorgetown (Georgetown University Library) · doi:10.1017/cbo9780511814280 · Cited by 48 · see citing works
SARS: pregnant women's fears and perceptions
Ng, J. W. Y., Sham, A., Tang, P. L., & Fung, S. Y. (2004) · British Journal of Midwifery · doi:10.12968/bjom.2004.12.11.16710 · Cited by 48 · see citing works
Haapio, S., Kaunonen, M., Arffman, M., & Åstedt-Kurki, P. M. (2016) · Scandinavian Journal of Caring Sciences · doi:10.1111/scs.12346 · Cited by 48 · see citing works
Rondung, E., Ternström, E., Hildingsson, I., Haines, H. M., Sundin, Ö., Ekdahl, J., Karlström, A., Larsson, B., Segeblad, B., Baylis, R., et al. (2018) · JMIR Mental Health · doi:10.2196/10420 · Cited by 47 · see citing works
Tokophobia: A dread of pregnancy
Bhatia, M., & Jhanjee, A. (2012) · Industrial Psychiatry Journal · doi:10.4103/0972-6748.119649 · Cited by 47 · see citing works
“[4,5] However, 13% of non‑gravid women report fear of childbirth sufficient to postpone or avoid pregnancy.”
Pregnancy related risk perception in pregnant women, midwives & doctors: a cross-sectional survey
Lee, S., Holden, D., Webb, R., & Ayers, S. (2019) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-019-2467-4 · Cited by 47 · see citing works
Women's needs from antenatal care in three European countries
Luyben, A. G., & Fleming, V. E. M. (2005) · Midwifery · doi:10.1016/j.midw.2004.11.001 · Cited by 45 · see citing works
Karlsdóttir, S. I., Sveinsdóttir, H., Kristjánsdóttir, H., Aspelund, T., & Olafsdottir, O. (2017) · Women and Birth · doi:10.1016/j.wombi.2017.09.007 · Cited by 37 · see citing works
Fear of childbirth in nulliparous women: A cross-sectional multicentre study in China
Qiu, L., Sun, N., Shi, X., Zhao, Y., Feng, L., Gong, Y., & Yin, X. (2019) · Women and Birth · doi:10.1016/j.wombi.2019.04.005 · Cited by 45 · see citing works
- Authors
- Hanna‐Leena Melender, R.
- Venue
- Birth
- Publisher
- Wiley
- Published
- 2002-05-16
- Volume
- 29
- Issue
- 2
- Pages
- 101-111
- ISSN
- 0730-7659 (ISSN-L)
- 1523-536X
- OpenAlex
- W2153268917
- Cited by
- 399
- References
- 28
- Citations by year
- 2026: 13 · 2025: 12 · 2024: 17 · 2023: 18 · 2022: 20 · 2021: 31 · 2020: 27 · 2019: 17 · 2018: 21 · 2017: 18 · 2016: 18 · 2015: 15 · 2014: 15 · 2013: 22 · 2012: 18
- FWCI
- 9.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Birth (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- fear of childbirth, pregnant women, causes of fear, cesarean section, parity, primiparous women, multiparous women, maternal stress, perinatal care, working conditions
- MeSH terms
- Adolescent, Adult, Family, Fear, Female, Finland, Humans, Interpersonal Relations, Labor, Obstetric, Negativism, Pain, Pregnancy, Pregnancy Complications, Surveys and Questionnaires, Stress, Physiological, Delivery, Obstetric
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