Fear of Childbirth and Risk of Cesarean Delivery: A Cohort Study in Six European Countries

Few studies have examined 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 section in North European women. Methods: A longitudinal cohort study was conducted of 6,422 unselected 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, Odds Ratio (OR) 1.66 (1.05–2.61). Among 3,233 multiparous women, severe fear of childbirth increased the risk of elective cesarean, OR 1.87 (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 (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 ‘non-medical’ among those with severe fear of childbirth; 16.7% vs 4.6% in primiparous women, and 31.7% vs 17.5% 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. Counseling for women who do not look forward to vaginal birth should be further evaluated.This is the authors pre-refereed manuscript to the article. © 1999-2016 John Wiley & Sons, Inc