Prevalence of fear of childbirth, its risk factors and birth outcomes in Australian multiparous women

Table 1 Comparison of sociodemographic characteristics between women with low–moderate fear of childbirth and women with high–severe fear of childbirth (Wijma Delivery Expectancy/Experience Questionnaire cut-off = 66), n (%)/mean ± SD¹

Variable	Low-moderate FoC (n = 147)	High-severe FoC (n = 65)	P value
Age			0.542
< 25	6 (4)	2 (3)
25–35	102 (69)	41 (63)
> 35	39 (27)	22 (34)
Education			0.314
No formal education	4 (3)	5 (8)
High school certificate or lower	33 (22)	14 (22)
Diploma or undergraduate degree	82 (56)	31 (48)
Postgraduate degree	28 (19)	15 (23)
Country of origin			0.092
Australia	51 (35)	15 (23)
Other	96 (65)	50 (77)
Country of birth			0.069
Australia	55 (37)	16 (25)
Other	92 (63)	49 (75)
Employment status			0.704
No formal occupation	26 (18)	17 (26)
Stopped working due to pregnancy	41 (28)	16 (25)
Casual worker	6 (4)	3 (5)
Part-time	25 (17)	9 (14)
Full-time	49 (33)	20 (31)
Marital status			0.058
Married or de facto	138 (94)	57 (88)
Divorced/separated/widow	5 (3)	2 (3)
Single	4 (3)	6 (9)
Annual family income			0.018
< $50000	35 (24)	18 (28)
$50000–100000	49 (33)	32 (49)
> $100000	63 (43)	15 (23)
Living situation			0.262
With partner	109 (74)	41 (63)
With family/friends	32 (22)	20 (32)
Alone	6 (4)	4 (6)
Support person			0.4832
Herself only	13 (9)	5 (8)
Others	134 (91)	60 (92)
Major life stressor			0.148
No	101 (69)	38 (59)
Yes	46 (31)	27 (42)
Alcohol intake			0.0692
No	134 (91)	64 (99)
Yes	13 (9)	1 (2)
Cigarette smoking			0.1572
No	133 (91)	63 (97)
Yes	14 (10)	2 (3)
History of sexual assault during childhood			0.8112
No	131 (89)	59 (91)
Yes	16 (11)	6 (9)
History of sexual assault during adulthood			0.2352
No	135 (92)	63 (97)
Yes	12 (8)	2 (3)
Age (range 22–43 years)	32 ± 4.4	33 ± 4.3	0.155
Body mass index (range 14–52)	28 ± 5.9	28 ± 5.9	0.689
Years living in Australia (range 05–43)	18 ± 12.9	17 ± 11.6	0.311

¹Percentages may not add up to 100 due to rounding.

²Fisher’s exact test.

FoC: Fear of childbirth.

Table 2 Comparison of medical and obstetric history between women with low–moderate fear of childbirth and women with high–severe fear of childbirth, n (%)/mean ± SD¹

Variable	Low–moderate FoC (n = 147)	High–severe FoC (n = 65)	P value
Pre-pregnancy anxiety/depression			0.089
No	107 (73)	43 (66)
Anxiety only	15 (10)	8 (12)
Depression only	4 (3)	7 (11)
Both	21 (14)	7 (11)
Pre-existing health problem			0.003
No	108 (74)	34 (52)
Yes	39 (27)	31 (48)
Previous mode of birth			0.015
Normal vaginal delivery	82 (56)	32 (49)
Instrumental	30 (20)	5 (8)
Emergency caesarean section	25 (17)	19 (29)
Planned caesarean section	10 (7)	9 (14)
Previous childbirth experience			< 0.001
Neutral	46 (31)	28 (43)
Empowering	73 (50)	14 (22)
Traumatic	28 (19)	23 (35)
Previous 3rd or 4th degree tear			0.541
No	112 (76)	52 (80)
Yes	35 (24)	13 (20)
Attended antenatal educational classes			0.659
No	127 (86)	58 (89)
Yes	20 (14)	7 (11)
Type of conception			0.178
Planned	100 (68)	38 (59)
Unplanned	47 (32)	27 (42)
Gestational age at baseline (range 14–41 weeks)	30+5 ± 7+1	29 ± 7+1	0.521
Expected length of hospital stay after vaginal birth (range 0–7 days)	2 ± 1.1	2 ± 1.2	0.206
Expected length of hospital stay after caesarean section (range 0–10 days)	3 ± 1.9	3 ± 2.0	0.927

¹Percentages may not add up to 100 due to rounding.

FoC: Fear of childbirth.

Table 3 Comparison of mental health status between women with low–moderate fear of childbirth and women with high–severe fear of childbirth¹

Variable	Low–moderate FoC	High–severe FoC	Unadjusted risk ratio (95%CI)	t value (degree of freedom)	P value
FoBS-Feeling calm about the approaching birth					< 0.001
Moderately to very calm (< 50)	100/147 (68%)	23/65 (35%)	0.40 (0.3–0.6)
Moderately to very worried (≥ 50)	47/147 (32%)	42/65 (65%)	1.5 (1.2–1.9)
mean ± SD (range 0–100)	31 ± 26.3	53 ± 28.3	22.4 (14.5–30.3)3	-5.57 (210)	< 0.001
FoBS-Feeling fear about the approaching birth					< 0.001
No or mild fear (< 50)	103/147 (70%)	24/65 (37%)	0.39 (0.23–0.6)
Moderate to high fear (≥ 50)	44/147 (30%)	41/65 (63%)	1.67 (1.3–2.0)
mean ± SD (range 0–100)	30 ± 26.8	50 ± 27.5	19.8 (11.8–27.7)3	-4.91 (210)	< 0.001
DASS-Depression					0.2432
Mild to moderate (0–10)	139/143 (97%)	57/61 (93%)	0.58 (0.3–1.2)
Severe to extremely severe (≥ 11)	4/143 (3%)	4/61 (7%)	1.42 (0.7–2.9)
mean ± SD (range 0–21)	2 ± 3.5	4 ± 4.4	1.8 (0.6–2.9)3	-3.02 (202)	0.001
DASS-Anxiety					0.005
Mild to moderate (0-10)	126/143 (88%)	44/61 (72%)	0.52 (0.3–0.8)
Severe to extremely severe (≥ 11)	17/143 (12%)	17/61 (28%)	1.48 (1.1–2.1)
mean ± SD (range 0–20)	3 ± 3.6	5 ± 4.5	1.3 (0.1–2.5)3	-2.18 (202)	0.015
DASS-Stress					0.4562
Mild to moderate (0–10)	138/143 (97%)	57/61 (93%)	0.66 (0.3–1.4)
Severe to extremely severe (≥ 11)	5/143 (4%)	4/61 (7%)	1.27 (0.7–2.3)
mean ± SD (range 0–21)	4 ± 4.1	6 ± 4.9	1.8 (0.5–3.1)3	-2.75 (202)	0.003
RAS (n = 197)					0.001
Higher relationship satisfaction (≥ 4)	122/139 (88%)	39/58 (67%)	2.18 (1.4–3.3)
Less relationship satisfaction (< 4)	17/139 (12%)	19/58 (33%)	0.62 (0.4–1.0)
mean ± SD (range 2–5)	5 ± 0.7	4 ± 0.7	0.4 (0.2–0.6)3	4.45 (195)	< 0.001
FSFI (n = 198)					0.502
Normal sexual function	25/139 (18%)	8/57 (14%)	0.81 (0.4–1.5)
Sexual dysfunction	114/139 (82%)	49/57 (86%)	1.08 (0.9–1.4)
mean ± SD (range 1–34)	17 ± 9.3	16 ± 9.3	1.9 (-1.0–4.8)3	1.35 (195)	0.089
FSFI sub-groups, mean ± SD
Desire (range 1–6)	3 ± 1.1	3 ± 1.0	0.3 (-0.1–0.6)	1.66 (195)	0.105
Arousal (range (0–6)	3 ± 2.0	3 ± 1.9	0.5 (-0.1–1.1)	1.74 (195)	0.093
Lubrication (0–6)	3 ± 2.2	3 ± 2.2	0.6 (-0.1–1.3)	1.77 (195)	0.085
Orgasm (range 0–6)	3 ± 2.4	3 ± 2.2	0.7 (-0.03–1.4)	1.92 (195)	0.061
Satisfaction (range 0–6)	3 ± 1.6	3 ± 1.7	0.02 (-0.05–0.6)	0.17 (195)	0.913
Pain (range 0–6)	2 ± 2.5	2 ± 2.3	-0.2 (-1.0–0.5)	-0.54 (195)	0.558

¹Percentages may not add up to 100 due to rounding.

²Fisher’s exact test.

³Mean difference (confidence interval).

FoBS: Fear of Birth Scale; DASS: Depression, Anxiety and Stress Scale; RAS: Relationship Assessment Scale; FSFI: Female Sexual Function Index; FoC: Fear of childbirth.

Table 4 Multivariable logistic regression analysis comparing women with low–moderate fear of childbirth and women with high–severe fear of childbirth with respect to variables that predicted fear of childbirth

Variable	Crude OR	Unadjusted 95%CI	Adjusted OR	Adjusted 95%CI	P value
DASS Anxiety					< 0.001
Mild to moderate (0-10)	1		1
Severe to extremely severe (≥ 11)	2.44	0.59–1.09	3.79	1.35–5.61
Previous traumatic childbirth experience					0.033
No	1		1
Yes	2.12	1.21–4.48	2.45	1.15–3.98
History of sexual assault during childhood				1.11–4.81	0.036
No	1		1
Yes	1.20	0.45–3.22	5.25	1.11–4.81
Pre-existing health problem pregnancy					0.004
No	1		1
Yes	2.53	1.37–4.64	2.92	1.40–6.12
RAS					< 0.001
Higher relationship satisfaction (≥ 4)	1		1
Less relationship satisfaction (< 4)	3.50	1.67–7.38	5.28	2.15–6.98

OR: Odds ratio; DASS: Depression, Anxiety and Stress Scale; RAS: Relationship Assessment Scale.

Table 5 Comparison of birth outcome in women with low–moderate fear of childbirth and women with high–severe fear of childbirth, mean ± SD/ median (25^th-75^th percentiles)¹

Variable	Low-moderate FoC (n = 133)	High-severe FoC (n = 62)	RR (95%CI)	P value
Maternal
Epidural/spinal				0.204
No	61/94 (65%)	19/36 (53%)	0.70 (0.40–1.21)
Yes	33/94 (35%)	17/36 (47%)	1.16 (0.92–1.46)
Episiotomy3				0.576
No	80/94 (85%)	32/36 (89%)	1.29 (0.52–3.20)
Yes	14/94 (15%)	4/36 (11%)	0.92 (0.70–1.21)
Third- or fourth-degree tear3				1.000
No	92/94 (98%)	36/36 (100%)
Yes	2/94 (2%)	0
Mode of birth
Normal vaginal delivery	87 (59%)	34 (52%)	0.83 (0.55–1.24)	0.351
Instrumental	7 (5%)	2 (3%)	0.72 (0.21–2.47)	0.7252
Caesarean section	39 (27%)	26 (40%)	1.51 (1.01–2.52)	0.050
Cumulative blood loss (range 50-6500 millilitres)	300 (200–400)	300 (235–400)		0.365
Total duration of labour (range 1-26.4 hours)3	2.3 (2.3–3.6)	1.2 (0.1–3.5)		0.684
Length of postnatal hospital stay (range 4-163 hours)	45.5 (24–72)	43.5 (24–60)		0.855
Neonatal
Gestational age at birth (range 252-42.0 weeks)	38.9 ± 2.1	38.7 ± 1.5	-0.17 (-0.75-0.41)	0.559
Apgar score at 5 minutes (range 1-9)	8.8 ± 0.9	8.9 ± 0.5	0.09 (-0.16–0.34)	0.467
Birth weight (range 800-4685 g)	3291.2 ± 550.9	3333.3 ± 614.5	42.04 (-131.4-215.5)	0.633
Resuscitation after birth				0.716
No	106 (80%)	48 (77%)	0.91 (0.56–1.48)
Yes	27 (20%)	14 (23%)	1.05 (0.82–1.34)
SCN/NICU admission after birth				0.006
No	119 (90%)	46 (74%)	0.52 (0.35–0.79)
Yes	14 (11%)	16 (27%)	1.55 (1.04–2.29)
Received infant formula during hospital stay				0.273
No	87/123 (71%)	35/56 (63%)	0.78 (0.50–1.21)
Yes	36/123 (29%)	21/56 (38%)	1.13 (0.90–1.42)

¹Percentages may not add up to 100 due to rounding.

²Fisher’s exact test.

³Excluding caesarean section births.

RR: Relative risk; SCN: Special care nursery; NICU: Neonatal intensive unit; FoC: Fear of childbirth.