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Mental health problems common in women with fear of childbirth: Mental health of women with fear of childbirth
Abstract
OBJECTIVE: To investigate whether women with fear of childbirth have more mental health problems than women of childbearing age in general. DESIGN: Register-based retrospective study. SETTING: The maternity clinic of Helsinki University Central Hospital. POPULATION: In all, 2405 women referred for consultation because of fear of childbirth during 1996-2002 and 4676 comparable control women. METHODS: Data were linked to the Medical Birth Register, the Hospital Discharge Register and the Drug Reimbursement Register 5-12 years before and after the initial childbirth (during 1990-2008). MAIN OUTCOME MEASURES: Prevalence of psychiatric care as evidenced by the use of psychotropic medication, and episodes of either psychiatric inpatient or outpatient care in women with fear of childbirth compared with nonfearful controls. RESULTS: Women with fear of childbirth had significantly more often had psychiatric care (54.0% versus 33.6%, P < 0.001) during the study period. Fearful and nonfearful women differed from each other (P < 0.001) regarding psychiatric inpatient care (7.2% versus 3.6%), outpatient care (19.0% versus 9.8%) and the use of psychotropic medication (51.3% versus 31.3%). Mood and anxiety disorders were the most common psychiatric diagnoses in both groups. The major predictors for a need for psychiatric care after the initial childbirth were previous psychiatric care (adjusted odds ratio 4.5; 95% CI 4.0-5.1) and fear of childbirth (adjusted odds ratio 1.9; 95%CI 1.7-2.1). CONCLUSIONS: A remarkable mental morbidity was seen among women of childbearing age. Mental health problems were twice as common among women with a fear of childbirth as in nonfearful controls. Clinical practice on how to evaluate and treat women fearing childbirth should be developed.
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“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 [22]
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Causes and outcomes in studies of fear of childbirth: A systematic review
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Størksen, H. T., Garthus‐Niegel, S., Adams, S. S., Vangen, S., & Eberhard‐Gran, M. (2015) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-015-0655-4 · Cited by 243
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“Many other variations exist among women fearing birth with regard to fear acquisition, fear objects, symptom severity, and comorbidity [20-23].”
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“Having a trusted carer may also assist in early referral for women requiring additional psychological support given the relationship between childbirth fear and mental health difficulties.(29,56,65)”
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“Namely, while some level of FOC, if present, can be considered a physiological expression of the expectant mother’s feeling that something unknown and uncontrollable is happening [78], SFOC can instead be considered a clinical condition.”
BackgroundNegative impressions of childbirth in a North-West England student population
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“related fear in subsequent pregnancies [7,8].”
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“Mood symptoms, anxiety and depression, co-exist often with the fear of child birth [37], and willingness to undergo a caesarean section among these mothers is common and today fear of giving birth is the leading cause for elective cesarean in Finland.”
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“and 34 for the WDEQ-B in the present study, as the cut-off value to detect severe prenatal and postnatal FoB (Rouhe et al., 2011).”
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“They found women with FOC had an increased risk of requiring psychiatric care 5–12 years after delivery but the risk was even higher among women without FOC [14].”
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“Previous studies have revealed an association between fear of birth and psychiatric illness [2,45], as well as an association among lack of selfefficacy, and subsequent experience with birth [21].”
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Heterogeneity in childbirth related fear or anxiety.
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“This may exclude women with great distress from attempting a vaginal birth and, thus, mitigate any possible effects of distress on an attempted vaginal birth (Rouhe et al. 2011; Saisto and Halmesmäki 2003).”
BackgroundDepressed mood, anxiety, and the use of labor analgesia
Pettersson, F. D., Hellgren, C., Nyberg, F., Åkerud, H., & Poromaa, I. S. (2015) · Archives of Women s Mental Health · doi:10.1007/s00737-015-0572-6 · Cited by 21
“Labor pain in the second stage of labor is caused by a similar mechanism but with contact pressure by the fetus to the nerves, organs, and structures of the pelvic floor (Rowlands and Permezel 1998).”
BackgroundFACTORS ASSOCIATED WITH CHILDBIRTH - RELATED FEAR AMONG SLOVAK WOMEN
Mazúchová, L., Škodová, Z., Kelčíková, S., & Rabárová, A. (2017) · Central European Journal of Nursing and Midwifery · doi:10.15452/cejnm.2017.08.0027 · Cited by 21
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“A remarkable mental morbidity was recently found among women of childbearing age: mental health problems were twice as common among women with a fear of childbirth as in non-fearful controls (Rouhe et al., 2011).”
BackgroundSelf-citationAlizadeh-Dibazari, Z., Maghalian, M., & Mirghafourvand, M. (2025) · BMC Psychology · doi:10.1186/s40359-025-03047-7 · Cited by 18
“These include younger maternal age, being a first-time mother (nulliparity), a history of psychological challenges, previous traumatic experiences, difficult births, and lack of adequate social support [5, 6].”
Ternström, E., Hildingsson, I., Haines, H., Karlström, A., Sundin, Ö., Ekdahl, J., Segeblad, B., Larsson, B., Rondung, E., & Rubertsson, C. (2017) · Sexual & Reproductive Healthcare · doi:10.1016/j.srhc.2017.06.001 · Cited by 17
Women’s experiences of internet-delivered Cognitive Behaviour Therapy (iCBT) for Fear of Birth
Baylis, R., Ekdahl, J., Haines, H. M., & Rubertsson, C. (2019) · Women and Birth · doi:10.1016/j.wombi.2019.05.006 · Cited by 17
Malmquist, A., & Nieminen, K. (2020) · Women and Birth · doi:10.1016/j.wombi.2020.04.005 · Cited by 20
Anxiety and depressive symptoms in women with fear of birth: A longitudinal cohort study
Hildingsson, I., Nilsson, J., Merio, E., & Larsson, B. (2021) · European Journal of Midwifery · doi:10.18332/ejm/138941 · Cited by 16
Iranian women’s perception on the determinants of birth experience: a qualitative study
Mirghafourvand, M., Meedya, S., Mohammadi, E., Mohammad‐Alizadeh‐Charandabi, S., Jafarabadi, M. A., & Ghanbari-Homaie, S. (2022) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-022-05078-z · Cited by 17
“Fear, worry and sense of powerlessness impacted Iranian women’s birth experiences negatively which is supported in other studies [36].”
ResultAiro, R., Korja, R., Saisto, T., Rouhe, H., Muotka, J. S., & Salmela‐Aro, K. (2018) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2018.1462477 · Cited by 21
“However, earlier longitudinal RCTs published results with this same population (Rouhe et al., 2011, 2013, 2015) have already shown positive effects of the group intervention compared to those in the control group.”
MethodResultSelf-citationBeigi, S. M., Valiani, M., Alavi, M., & Mohamadirizi, S. (2019) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_4_19 · Cited by 16
“[1] One of the factors affecting the delivery is the women’s attitude and belief toward labor pain, which is itself influenced by several factors such as previous experiences of pain, ability to adapt to pain, delivery environment, and psychosocial factors.[2] Women’s beliefs about the care they need during various st…”
BackgroundFactors Affecting Fear of Childbirth Among Urban Women in India: A Qualitative Study
Sharma, B., Jungari, S., & Lawange, A. (2022) · SAGE Open · doi:10.1177/21582440221089485 · Cited by 18
“At the same time, past literature shows that the count of women bearing with FOC, requesting for cesarean delivery or elective cesarean delivery has increased (Fuglenes et al., 2011; Hatamleh et al., 2019; Rouhe et al., 2011).”
BackgroundVeringa‐Skiba, I. K., de Bruin, E. I., van Steensel, F. J. A., & Bögels, S. M. (2022) · Birth · doi:10.1111/birt.12571 · Cited by 59
Mei, X., Du, P., Li, Y., Mei, R., Wang, X., Chen, Q., & Ye, Z. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05435-y · Cited by 14
“Prior research supports the current finding by showing that fear of childbirth can lead to the development of psychological distress [18, 45], which subsequently has detrimental effects on the sleep quality of pregnant women [46, 47].”
Psychometric properties of the Persian version of delivery fear scale (DFS) in Iran
Shakarami, A., Iravani, M., Mirghafourvand, M., & Jafarabadi, M. A. (2021) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-021-03634-7 · Cited by 14
“High FOC levels increase the risk of elective and emergency Csections, and bring about abnormal patterns in fetal heart rate, low Apgar score, stillbirths [19], and low birth weight [20].”
BackgroundFear of childbirth and use of labor analgesia: A nationwide register‐based analysis in Finland
Vaajala, M., Kekki, M., Mattila, V. M., & Kuitunen, I. (2023) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.14781 · Cited by 13
Should women be able to request a caesarean section? No
Rouhe, H. (2011) · BMJ · doi:10.1136/bmj.d7565 · Cited by 13
Self-citationEstrategias de relajación durante el período de gestación. Beneficios para la salud
Bjorn, M. B. N., de Jesús, S. N., & Casado‐Morales, M. I. (2013) · Clínica y Salud · doi:10.5093/cl2013a9 · Cited by 13
Weaver, J. J., Browne, J., Aras-Payne, A., & Magill‐Cuerden, J. (2013) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2013-606 · Cited by 13
Cluster Analysis of Fear of Childbirth, Anxiety, Depression, and Childbirth Self-Efficacy
Hildingsson, I., Nordin-Remberger, C., Wells, M. B., & Johansson, M. (2024) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1016/j.jogn.2024.04.004 · Cited by 12
What to expect when you're expecting? Representations of birth in British newspapers
Maclean, E. (2014) · British Journal of Midwifery · doi:10.12968/bjom.2014.22.8.580 · Cited by 12
Long-Acting Injectable Antipsychotic Treatment during Pregnancy: A Case Series
Eleftheriou, G., Butera, R., Sangiovanni, A., Palumbo, C., & Bondi, E. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20043080 · Cited by 12
“The most plausible reason of an elective C-section is the psychiatric vulnerability of the patients and the possible tokophobia; the last topic is more often diagnosed in women suffering from psychiatric disorders and in women who have received psychiatric treatment [21,22].”
Möller, L., Josefsson, A., Lilliecreutz, C., Gunnervik, C., Bladh, M., & Sydsjö, G. (2018) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.13503 · Cited by 12
Veringa‐Skiba, I. K., de Bruin, E. I., Mooren, B., van Steensel, F. J. A., & Bögels, S. M. (2021) · Midwifery · doi:10.1016/j.midw.2021.102969 · Cited by 11
Perceived stress and its predictors in women with threatened preterm labour: A cross‐sectional study
Najjarzadeh, M., Abbasalizadeh, S., Mohammad‐Alizadeh‐Charandabi, S., Jafarabadi, M. A., & Mirghafourvand, M. (2021) · Nursing Open · doi:10.1002/nop2.1055 · Cited by 9
Risk factors for preterm delivery among early onset cancer survivors: A Finnish register‐based study
Melin, J. M., Heinävaara, S. H., Malila, N. K., Tiitinen, A. E., Gissler, M., & Madanat‐Harjuoja, L. M. (2018) · International Journal of Cancer · doi:10.1002/ijc.31938 · Cited by 10
“Mental health problems are twice as common among women with fear of childbirth as in nonfearful controls.(25) Depression is the most common mental disease among pregnant women with a prevalence of 10–15% of all pregnant women.”
BackgroundSelf-citationFear of childbirth after medical vs surgical abortion. Population‐based register study from Finland
Kemppainen, V., Niinimäki, M. J., Bloigu, A. H., Saisto, T., Rouhe, H., Gissler, M., Heikinheimo, O., & Mentula, M. J. (2021) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.14078 · Cited by 10
Self-citationHallström, S., Grundström, H., Malmquist, A., Eklind, M., & Nieminen, K. (2022) · Journal of Psychosomatic Obstetrics & Gynecology · doi:10.1080/0167482x.2022.2089555 · Cited by 9
Fear of Childbirth, Fatigue, and Well-being in Pregnant Women
Mortazavi, F., & Borzoee, F. (2019) · Journal of Obstetrics Gynecology and Cancer Research · doi:10.30699/jogcr.4.2.45 · Cited by 10
Choisir la césarienne : une pratique où convergent habitus de classe et intérêts médicaux
Gelly, M., Cristofalo, P., & Gasquet‐Blanchard, C. (2019) · Revue française des affaires sociales · doi:10.3917/rfas.193.0071 · Cited by 8
Metadata
- Authors
- Rouhe, H., Salmela-Aro, K., Gissler, M., Halmesmäki, E., & Saisto, T.
- Affiliations
- Helsinki University Hospital (FI)
- Finnish Institute for Health and Welfare (FI)
- Corresponding author
- Rouhe, H
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2011-04-13
- Volume
- 118
- Issue
- 9
- Pages
- 1104-1111
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- OpenAlex
- W2161058314
- Cited by
- 159
- References
- 33
- Citations by year
- 2026: 7 · 2025: 7 · 2024: 13 · 2023: 10 · 2022: 9 · 2021: 15 · 2020: 10 · 2019: 15 · 2018: 16 · 2017: 9 · 2016: 12 · 2015: 9 · 2014: 10 · 2013: 7 · 2012: 5
- FWCI
- 8.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
- PubMed (publishedVersion)
- STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
- Funders
- Yrjö Jahnssonin Säätiö
- Emil Aaltosen Säätiö
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- fear of childbirth, mental illness, psychiatric nursing, psychotropic drugs, mood disorders, anxiety disorders, women of reproductive age, perinatal mental health
- MeSH terms
- Adolescent, Adult, Analgesia, Mental Disorders, Cesarean Section, Fear, Female, Finland, Humans, Mental Health Services, Middle Aged, Pregnancy, Psychotropic Drugs, Registries, Retrospective Studies, Case-Control Studies, Parturition, Labor Pain, Young Adult
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