Korean J Women Health Nurs.  2020 Dec;26(4):358-366. 10.4069/kjwhn.2020.12.14.

Do childbirth confidence, prenatal depression, childbirth knowledge, and spousal support influence childbirth fear in pregnant women?

• Cho H
• Ahn S

• KMID: 2510372
• DOI: http://doi.org/10.4069/kjwhn.2020.12.14

Abstract

Purpose
This study investigated levels of childbirth fear and related prenatal factors (self-confidence for childbirth, prenatal depression, knowledge about childbirth, and spousal support) among pregnant women in South Korea.
Methods
A correlational study design was used to explore levels of childbirth fear and related prenatal factors in 200 pregnant women over 28 weeks of gestation. A self-administered questionnaire was used to measure fear of childbirth and related factors, such as self-confidence for childbirth, prenatal depression, knowledge about childbirth, and spousal support.
Results
One-third of the pregnant women were aged 35 years and older. Sixty-one percent of women were nulliparae, but only 26.0% had experienced prenatal education. The mean score for fear of childbirth was 66.99 out of 165. The prevalence of fear of childbirth was 72.0%, and childbirth fear was severe in 26.5% of the participants and moderate in 45.5%. Fear of childbirth was negatively related to self-confidence (r=.45, p<.001), but positively related to prenatal depression (r=.21, p=.002). Two significant predictors were found to explain the fear of childbirth. Higher self-confidence for childbirth was associated with less severe fear of childbirth (β=–6.49, p<.001), while higher prenatal depression was associated with more severe fear of childbirth (β=2.08, p=.038).
Conclusion
The level of fear of childbirth was higher among pregnant women with lower self-confidence and higher prenatal depression. Reasonable evidence should be provided for implementing prenatal and childbirth classes to reduce pregnant women’s depression and to increase their confidence.

Keyword

Childbirth; Confidence; Depression; Fear; Pregnancy; 출산; 자신감; 우울; 두려움; 임신

Reference

References

1. Räisänen S, Lehto SM, Nielsen HS, Gissler M, Kramer MR, Heinonen S. Fear of childbirth in nulliparous and multiparous women: a population-based analysis of all singleton births in Finland in 1997-2010. BJOG. 2014; 121(8):965–970. https://doi.org/10.1111/1471-0528.12599.

2. Saisto T, Halmesmäki E. Fear of childbirth: a neglected dilemma. Acta Obstet Gynecol Scand. 2003; 82(3):201–208.

3. O’Connell MA, Leahy-Warren P, Khashan AS, Kenny LC, O’Neill SM. Worldwide prevalence of tocophobia in pregnant women: systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2017; 96(8):907–920. https://doi.org/10.1111/aogs.13138.

4. Nilsson C, Hessman E, Sjöblom H, Dencker A, Jangsten E, Mollberg M, et al. Definitions, measurements and prevalence of fear of childbirth: a systematic review. BMC Pregnancy Childbirth. 2018; 18(1):28. https://doi.org/10.1186/s12884-018-1659-7.

5. Toohill J, Fenwick J, Gamble J, Creedy DK. Prevalence of childbirth fear in an Australian sample of pregnant women. BMC Pregnancy Childbirth. 2014; 14:275. https://doi.org/10.1186/1471-2393-14-275.

6. Salomonsson B, Gullberg MT, Alehagen S, Wijma K. Self-efficacy beliefs and fear of childbirth in nulliparous women. J Psychosom Obstet Gynaecol. 2013; 34(3):116–121. https://doi.org/10.3109/0167482X.2013.824418.

7. O’Connell MA, O’Neill SM, Dempsey E, Khashan AS, Leahy‐Warren P, Smyth RM, et al. Interventions for fear of childbirth (tocophobia). Cochrane Database Syst Rev. 2019; (5):CD013321. https://doi.org/10.1002/14651858.CD013321.

8. Storksen HT, Eberhard-Gran M, Garthus-Niegel S, Eskild A. Fear of childbirth; the relation to anxiety and depression. Acta Obstet Gynecol Scand. 2012; 91(2):237–242. https://doi.org/10.1111/j.1600-0412.2011.01323.x.

9. Adams SS, Eberhard-Gran M, Eskild A. Fear of childbirth and duration of labour: a study of 2206 women with intended vaginal delivery. BJOG. 2012; 119(10):1238–1246. https://doi.org/10.1111/j.1471-0528.2012.03433.x.

10. O’Connor TG, Heron J, Glover V; Alspac Study Team. Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. J Am Acad Child Adolesc Psychiatry. 2002; 41(12):1470–1477. https://doi.org/10.1097/00004583-200212000-00019.

11. Laursen M, Hedegaard M, Johansen C; Danish National Birth Cohort. Fear of childbirth: predictors and temporal changes among nulliparous women in the Danish National Birth Cohort. BJOG. 2008; 115(3):354–360. https://doi.org/10.1111/j.1471-0528.2007.01583.x.

12. Jaju S, Al Kharusi L, Gowri V. Antenatal prevalence of fear associated with childbirth and depressed mood in primigravid women. Indian J Psychiatry. 2015; 57(2):158–161. https://doi.org/10.4103/0019-5545.158152.

13. Jang HS. Employed wife’s maternal role satisfaction by job satisfaction, spousal support, mother’s attachment and children’s attachment [dissertation]. Seoul: Ewha Womans University;2007. 60.

14. Kang SK, Choi JH, Chung MR. The effects of personal characteristics, marital intimacy and family support of pregnant couples on parent-fetal attachment. Early Child Educ Care. 2017; 12(2):223–245. https://doi.org/10.16978/ecec.2017.12.02.010.

15. Pazzagli C, Laghezza L, Capurso M, Sommella C, Lelli F, Mazzeschi C. Antecedents and consequences of fear of childbirth in nulliparous and parous women. Infant Ment Health J. 2015; 36(1):62–74. https://doi.org/10.1002/imhj.21483.

16. Nieminen K, Stephansson O, Ryding EL. Women’s fear of childbirth and preference for cesarean section--a cross-sectional study at various stages of pregnancy in Sweden. Acta Obstet Gynecol Scand. 2009; 88(7):807–813. https://doi.org/10.1080/00016340902998436.

17. Waldenström U, Hildingsson I, Ryding EL. Antenatal fear of childbirth and its association with subsequent caesarean section and experience of childbirth. BJOG. 2006; 113(6):638–646. https://doi.org/10.1111/j.1471-0528.2006.00950.x.

18. Serçekuş P, Başkale H. Effects of antenatal education on fear of childbirth, maternal self-efficacy and parental attachment. Midwifery. 2016; 34:166–172. https://doi.org/10.1016/j.midw.2015.11.016.

19. Størksen HT, Garthus-Niegel S, Adams SS, Vangen S, Eberhard-Gran M. Fear of childbirth and elective caesarean section: a population-based study. BMC Pregnancy Childbirth. 2015; 15:221. https://doi.org/10.1186/s12884-015-0655-4.

20. Phunyammalee M, Buayaem T, Boriboonhirunsarn D. Fear of childbirth and associated factors among low-risk pregnant women. J Obstet Gynaecol. 2019; 39(6):763–767. https://doi.org/10.1080/01443615.2019.1584885.

21. Alipour Z, Lamyian M, Hajizadeh E, Vafaei MA. The association between antenatal anxiety and fear of childbirth in nulliparous women: a prospective study. Iran J Nurs Midwifery Res. 2011; 16(2):169–173.

22. Schwartz L, Toohill J, Creedy DK, Baird K, Gamble J, Fenwick J. Factors associated with childbirth self-efficacy in Australian childbearing women. BMC Pregnancy Childbirth. 2015; 15:29. https://doi.org/10.1186/s12884-015-0465-8.

23. Wijma K, Wijma B, Zar M. Psychometric aspects of the W-DEQ; a new questionnaire for the measurement of fear of childbirth. J Psychosom Obstet Gynaecol. 1998; 19(2):84–97. https://doi.org/10.3109/01674829809048501.

24. Ahn S, Park S, Yoo H, Cho H, Kim SA. Validation of the Korean version of the Wijma Delivery Expectancy Questionnaire (W-DEQ): version A. Poster session presented at: 30th International Nursing Research Congress; 2019 July 25-29; Calgary, Canada. Calgary: Sigma Theta Tau International Honor Society of Nursing, 2019.

25. Lee MK. Effects of San-Yin-Jiao (SP-6) acupressure on labor pain, delivery time, serum β-endorphin and intensity of uterine contractions in women during labor [dissertation]. Seoul: Yonsei University;2003. 78.

26. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987; 150:782–786. https://doi.org/10.1192/bjp.150.6.782.

27. Kim YK, Hur JW, Kim KH, Oh KS, Shin YC. Clinical application of Korean version of Edinburgh Postnatal Depression Scale. J Korean Neuropsychiatr Assoc. 2008; 47(1):36–44.

28. Choi YS. The effects of childbirth education on labor pain [dissertation]. Seoul: Yonsei University;1983. 55.

29. Kessler RC. Stress, social status, and psychological distress. J Health Soc Behav. 1979; 20(3):259–272. https://doi.org/10.2307/2136450.

30. Lukasse M, Schei B, Ryding EL; Bidens Study Group. Prevalence and associated factors of fear of childbirth in six European countries. Sex Reprod Healthc. 2014; 5(3):99–106. https://doi.org/10.1016/j.srhc.2014.06.007.