Fear of Childbirth and Risk of Cesarean Delivery: A Cohort Study in Six European Countries
Open accessAbstract
Background: Few studies have examined the mode of birth among women with fear of childbirth, and the results are conflicting. The objective of this study was to assess the association between fear of childbirth and cesarean delivery in North European women. Methods: A longitudinal cohort study was conducted among 6,422 pregnant women from Belgium, Iceland, Denmark, Estonia, Norway, and Sweden. Fear of childbirth was measured by the Wijma Delivery Expectancy Questionnaire during pregnancy and linked to obstetric information from hospital records. Results: Among 3,189 primiparous women, those reporting severe fear of childbirth were more likely to give birth by elective cesarean, ( OR , 1.66 [95% CI 1.05–2.61]). Among 3,233 multiparous women, severe fear of childbirth increased the risk of elective cesarean ( OR 1.87 [95% CI 1.30–2.69]). Reporting lack of positive anticipation, one of six dimensions of fear of childbirth, was most strongly associated with elective cesarean ( OR 2.02 [95% CI 1.52–2.68]). A dose–effect pattern was observed between level of fear and risk of emergency cesarean in both primiparous and multiparous women. Indications for cesarean were more likely to be reported as “nonmedical” among those with severe fear of childbirth; 16.7 versus 4.6 percent in primiparous women, and 31.7 versus 17.5 percent in multiparous women. Conclusion: Having severe fear of childbirth increases the risk of elective cesarean, especially among multiparous women. Lack of positive anticipation of the upcoming childbirth seems to be an important dimension of fear associated with cesarean delivery. Counseling for women who do not look forward to vaginal birth should be further evaluated.
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Some studies have suggested a higher number of emergency cesarean births among women with FOB.
“Some studies have suggested a higher number of emergency cesarean births among women with FOB [68-70].”
From Comparing internet-based cognitive behavioral therapy with standard care for women with fear of birth: Randomized controlled trial (2018) · cites this paper as [70]
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- Authors
- Ryding, E. L., Lukasse, M., Parys, A. V., Wangel, A., Karro, H., Kristjansdottir, H., Schroll, A., Schei, B., & the Bidens Group
- Affiliations
- Karolinska Institutet (SE)
- OsloMet – Oslo Metropolitan University (NO)
- Ghent University Hospital (BE)
- Malmö University (SE)
- University of Tartu (EE)
- Faculty of Nursing and Department of Obstetrics and Gynecology Department of Midwifery University of Iceland Landspitalinn University Hospital Reykjavik Iceland
- Rigshospitalet (DK)
- Norwegian University of Science and Technology (NO)
- University of Iceland (IS)
- Corresponding author
- Ryding, Elsa Lena
- Venue
- Birth
- Publisher
- Wiley
- Published
- 2015-02-13
- Volume
- 42
- Issue
- 1
- Pages
- 48-55
- ISSN
- 0730-7659 (ISSN-L)
- 1523-536X
- OpenAlex
- W2019701290
- Cited by
- 218
- References
- 33
- Citations by year
- 2026: 12 · 2025: 14 · 2024: 19 · 2023: 22 · 2022: 29 · 2021: 28 · 2020: 29 · 2019: 19 · 2018: 16 · 2017: 12 · 2016: 12 · 2015: 6
- FWCI
- 17.40
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Birth (publishedVersion)
- PubMed (publishedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- Malmö University Publications (Malmö University) (submittedVersion)
- Funders
- European commision for freedon , security nd justice, Brussels (JLS â„ 2006 â„ DAP-1 â„ 242 â„ W30-CE-0120887 â„ 00-87)
- 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 › Medicine › Surgery › Anesthesia and Pain Management
- Keywords
- fear of childbirth, cesarean section, elective cesarean section, mode of delivery, primiparous women, multiparous women, obstetric indications, Wijma Delivery Expectancy Questionnaire, prenatal counseling
- MeSH terms
- Adolescent, Adult, Cesarean Section, Emergencies, Europe, Fear, Female, Humans, Longitudinal Studies, Middle Aged, Pregnancy, Prospective Studies, Surveys and Questionnaires, Risk Factors, Logistic Models, Elective Surgical Procedures, Parturition, Young Adult
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