Definitions, measurements and prevalence of fear of childbirth: a systematic review (2025)

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research-article

Definitions, measurements and prevalence of fear of childbirth: a systematic review (1)

Author(s):

C. Nilsson 1 , 2 , ,

E. Hessman 3 ,

H. Sjöblom 3 ,

A. Dencker 2 ,

E. Jangsten 2 ,

M. Mollberg 2 ,

H. Patel 2 ,

C. Sparud-Lundin 2 ,

H. Wigert 2 ,

C. Begley 4 , 2

Publication date (Electronic): 12 January 2018

Journal: BMC Pregnancy and Childbirth

Publisher: BioMed Central

Keywords: Fear of childbirth, Systematic review, Prevalence, W-DEQ, FOBS, Request for caesarean section

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      Abstract

      Background

      Fear of Childbirth (FOC) is a common problem affecting women’s health and wellbeing, and a common reason for requesting caesarean section. The aims of this review were to summarise published research on prevalence of FOC in childbearing women and how it is defined and measured during pregnancy and postpartum, and to search for useful measures of FOC, for research as well as for clinical settings.

      Methods

      Five bibliographic databases in March 2015 were searched for published research on FOC, using a protocol agreed a priori. The quality of selected studies was assessed independently by pairs of authors. Prevalence data, definitions and methods of measurement were extracted independently from each included study by pairs of authors. Finally, some of the country rates were combined and compared.

      Results

      In total, 12,188 citations were identified and screened by title and abstract; 11,698 were excluded and full-text of 490 assessed for analysis. Of these, 466 were excluded leaving 24 papers included in the review, presenting prevalence of FOC from nine countries in Europe, Australia, Canada and the United States. Various definitions and measurements of FOC were used. The most frequently-used scale was the W-DEQ with various cut-off points describing moderate, severe/intense and extreme/phobic fear. Different 3-, 4-, and 5/6 point scales and visual analogue scales were also used. Country rates (as measured by seven studies using W-DEQ with ≥85 cut-off point) varied from 6.3 to 14.8%, a significant difference (chi-square = 104.44, d.f. = 6, p< 0.0001).

      Conclusions

      Rates of severe FOC, measured in the same way, varied in different countries. Reasons why FOC might differ are unknown, and further research is necessary. Future studies on FOC should use the W-DEQ tool with a cut-off point of ≥85, or a more thoroughly tested version of the FOBS scale, or a three-point scale measurement of FOC using a single question as ‘Are you afraid about the birth?’ In this way, valid comparisons in research can be made. Moreover, validation of a clinical tool that is more focussed on FOC alone, and easier than the longer W-DEQ, for women to fill in and clinicians to administer, is required.

      Electronic supplementary material

      The online version of this article (10.1186/s12884-018-1659-7) contains supplementary material, which is available to authorized users.

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      Most cited references101

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      The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review

      Meghan Bohren, Joshua P. Vogel, Erin C. Hunter (2015)

      Background Despite growing recognition of neglectful, abusive, and disrespectful treatment of women during childbirth in health facilities, there is no consensus at a global level on how these occurrences are defined and measured. This mixed-methods systematic review aims to synthesize qualitative and quantitative evidence on the mistreatment of women during childbirth in health facilities to inform the development of an evidence-based typology of the phenomenon. Methods and Findings We searched PubMed, CINAHL, and Embase databases and grey literature using a predetermined search strategy to identify qualitative, quantitative, and mixed-methods studies on the mistreatment of women during childbirth across all geographical and income-level settings. We used a thematic synthesis approach to synthesize the qualitative evidence and assessed the confidence in the qualitative review findings using the CERQual approach. In total, 65 studies were included from 34 countries. Qualitative findings were organized under seven domains: (1) physical abuse, (2) sexual abuse, (3) verbal abuse, (4) stigma and discrimination, (5) failure to meet professional standards of care, (6) poor rapport between women and providers, and (7) health system conditions and constraints. Due to high heterogeneity of the quantitative data, we were unable to conduct a meta-analysis; instead, we present descriptions of study characteristics, outcome measures, and results. Additional themes identified in the quantitative studies are integrated into the typology. Conclusions This systematic review presents a comprehensive, evidence-based typology of the mistreatment of women during childbirth in health facilities, and demonstrates that mistreatment can occur at the level of interaction between the woman and provider, as well as through systemic failures at the health facility and health system levels. We propose this typology be adopted to describe the phenomenon and be used to develop measurement tools and inform future research, programs, and interventions.

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        An evidence-based practice guideline for the peer review of electronic search strategies.

        Margaret Sampson, Jessie L. McGowan, Elise Cogo (2009)

        Complex and highly sensitive electronic literature search strategies are required for systematic reviews; however, no guidelines exist for their peer review. Poor searches may fail to identify existing evidence because of inadequate recall (sensitivity) or increase the resource requirements of reviews as a result of inadequate precision. Our objective was to create an annotated checklist for electronic search strategy peer review. A systematic review of the library and information retrieval literature for important elements in electronic search strategies was conducted, along with a survey of individuals experienced in systematic review searching. Six elements with a strong consensus as to their importance in peer review were accurate translation of the research question into search concepts, correct choice of Boolean operators and of line numbers, adequate translation of the search strategy for each database, inclusion of relevant subject headings, and absence of spelling errors. Seven additional elements had partial support and are included in this guideline. This evidence-based guideline facilitates the improvement of search quality through peer review, and thus the improvement in quality of systematic reviews. It is relevant for librarians/information specialists, journal editors, developers of knowledge translation tools, research organizations, and funding bodies.

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          The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework.

          S Ayers, R R Bond, S Bertullies (2016)

          There is evidence that 3.17% of women report post-traumatic stress disorder (PTSD) after childbirth. This meta-analysis synthesizes research on vulnerability and risk factors for birth-related PTSD and refines a diathesis-stress model of its aetiology. Systematic searches were carried out on PsycINFO, PubMed, Scopus and Web of Science using PTSD terms crossed with childbirth terms. Studies were included if they reported primary research that examined factors associated with birth-related PTSD measured at least 1 month after birth. In all, 50 studies (n = 21 429) from 15 countries fulfilled inclusion criteria. Pre-birth vulnerability factors most strongly associated with PTSD were depression in pregnancy (r = 0.51), fear of childbirth (r = 0.41), poor health or complications in pregnancy (r = 0.38), and a history of PTSD (r = 0.39) and counselling for pregnancy or birth (r = 0.32). Risk factors in birth most strongly associated with PTSD were negative subjective birth experiences (r = 0.59), having an operative birth (assisted vaginal or caesarean, r = 0.48), lack of support (r = -0.38) and dissociation (r = 0.32). After birth, PTSD was associated with poor coping and stress (r = 0.30), and was highly co-morbid with depression (r = 0.60). Moderator analyses showed that the effect of poor health or complications in pregnancy was more apparent in high-risk samples. The results of this meta-analysis are used to update a diathesis-stress model of the aetiology of postpartum PTSD and can be used to inform screening, prevention and intervention in maternity care.

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            Author and article information

            Contributors

            C. Nilsson:

            ORCID: http://orcid.org/0000-0002-3195-5702

            christina.nilsson@hb.se

            E. Hessman: eva.hessman@ub.gu.se

            H. Sjöblom: helen.sjoblom@ub.gu.se

            A. Dencker: anna.dencker@gu.se

            E. Jangsten: elisabeth.jangsten@gu.se

            M. Mollberg: margareta.mollberg@gu.se

            H. Patel: harshida.patel@gu.se

            C. Sparud-Lundin: carina.s-lundin@fhs.gu.se

            H. Wigert: helena.wigert@gu.se

            C. Begley: cbegley@tcd.ie

            Journal

            Journal ID (nlm-ta): BMC Pregnancy Childbirth

            Journal ID (iso-abbrev): BMC Pregnancy Childbirth

            Title: BMC Pregnancy and Childbirth

            Publisher: BioMed Central (London )

            ISSN (Electronic): 1471-2393

            Publication date (Electronic): 12 January 2018

            Publication date PMC-release: 12 January 2018

            Publication date Collection: 2018

            Volume: 18

            Electronic Location Identifier: 28

            Affiliations

            [1 ]ISNI 0000 0000 9477 7523, GRID grid.412442.5, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, ; S-501 90 Borås, Sweden

            [2 ]ISNI 0000 0000 9919 9582, GRID grid.8761.8, Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, ; Box 457, -405 30 Gothenburg, SE Sweden

            [3 ]ISNI 0000 0000 9919 9582, GRID grid.8761.8, Biomedical Library, Gothenburg University Library at University of Gothenburg, ; Box 416, -405 30 Gothenburg, SE Sweden

            [4 ]ISNI 0000 0004 1936 9705, GRID grid.8217.c, Chair of Nursing and Midwifery, School of Nursing and Midwifery,Trinity College Dublin, ; 24, D’Olier St. Dublin 2, Dublin, Ireland

            Author information
            Article

            Publisher ID: 1659

            DOI: 10.1186/s12884-018-1659-7

            PMC ID: 5766978

            PubMed ID: 29329526

            SO-VID: 72f5c934-03e0-4de0-93e8-1d78069a138f

            Copyright © © The Author(s). 2018

            License:

            Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

            History

            Date received : 16 January 2017

            Date accepted : 7 January 2018

            Categories

            Subject: Research Article

            Custom metadata

            issue-copyright-statement © The Author(s) 2018


            ScienceOpen disciplines:

            Keywords: fear of childbirth,systematic review,prevalence,w-deq,fobs,request for caesarean section

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            ScienceOpen disciplines:

            Keywords: fear of childbirth, systematic review, prevalence, w-deq, fobs, request for caesarean section

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