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‘No worries’: A longitudinal study of fear, attitudes and beliefs about childbirth from a cohort of Australian and Swedish women
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Much is known about childbirth fear in Sweden including its relationship to caesarean birth. Less is understood about this in Australia. Sweden has half the rate of caesarean birth compared to Australia. Little has been reported about women’s beliefs and attitudes to birth in either country. The contribution of psychosocial factors such as fear, attitudes and beliefs about childbirth to the global escalation of caesarean birth in high-income countries is an important topic of debate.

The overall aim of this thesis is to investigate the prevalence and impact of fear on birthing outcomes in two cohorts of pregnant women from Australia and Sweden and to explore the birth attitudes and beliefs of these women.  

A prospective longitudinal cohort study from two towns in Australia and Sweden (N=509) was undertaken in the years 2007-2009. Pregnant women completed self-report questionnaires at mid-pregnancy, late pregnancy and two months after birth. Fear of birth was measured in mid-pregnancy with a tool developed in this study: the Fear of Birth Scale (FOBS). The FOBS showed promise as a clinically practical way to identify women with significant fear. A similar prevalence of fear of birth (30 percent) was found in the Australian and Swedish cohorts (Paper I). 

The Swedish women had attitudes indicating a greater concern for the personal impacts of birth and a belief system that situated birth as a natural event when compared to the Australian women (Paper II). Finally, when women’s attitudes and levels of fear were combined, three profiles were identified: Self determiners, Take it as it comes and Fearful (Paper III). Belonging to the Fearful profile had the most negative outcomes for women including higher rates of elective caesarean, more negative feelings in pregnancy and post birth and poorer perceptions of the quality of their antenatal and intra-partum care (Paper IV).

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. , p. 100
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 843
Keywords [en]
Fear of birth, attitudes, beliefs, Australia, Sweden, cluster analysis, profiles
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:uu:diva-185081ISBN: 978-91-554-8547-4 (print)OAI: oai:DiVA.org:uu-185081DiVA, id: diva2:570597
Public defence
2013-01-18, Auditorium Minus, Gustavianum, Akademigatan 3, Uppsala, 09:00 (English)
Opponent
Supervisors
Available from: 2012-12-19 Created: 2012-11-20 Last updated: 2013-02-11Bibliographically approved
List of papers
1. Cross-cultural comparison of levels of childbirth-related fear in an Australian and Swedish sample
Open this publication in new window or tab >>Cross-cultural comparison of levels of childbirth-related fear in an Australian and Swedish sample
2011 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, no 4, p. 560-567Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

research, conducted predominately in Scandinavian countries, suggests that a substantial number of women experience high levels of fear concerning childbirth which can impact on birth outcomes, the mother-infant relationship and the ongoing mental health of the mother. The prevalence of childbirth-related fear (CBRF) is not well known outside of the Nordic nations. This study aimed to examine the prevalence of CBRF in two rural populations (Sweden and Australia) and to pilot a short, easy-to-administer measurement tool.

METHODS:

a questionnaire assessing a range of childbirth-related issues was administered to women in the first trimester across two rural populations in Sweden (n = 386) and Australia (n = 123). CBRF was measured using the Fear of Birth Scale (FOBS) a two-item visual analogue scale.

FINDINGS:

close to 30% of women from the Australian and Swedish samples reported elevated levels of CBRF in the first trimester. A previous negative birth experience and less than positive attitudes to their current pregnancy and birth were predictive of high levels of fear. Swedish women with high levels of fear indicated a preference for caesarean section as the mode of birth in this pregnancy. A higher proportion (19%) of Australian women indicated that they would prefer an elective caesarean section, compared with only 8.8% of the Swedish sample; however, this was not related to high levels of fear. Preference for caesarean section was related to CBRF in the Swedish sample but not in the Australian sample.

CONCLUSION:

the high proportion of women identified with CBRF suggests a need for monitoring of women during pregnancy, particularly those with a previous negative birth experience. The FOBS developed for this study could be used as a screening tool to identify women who require further investigation. Further cross-cultural research is needed to explore the role of fear in women's preference for caesarean section.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-185026 (URN)10.1016/j.midw.2010.05.004 (DOI)20598787 (PubMedID)
Available from: 2012-11-19 Created: 2012-11-19 Last updated: 2017-12-07Bibliographically approved
2. Womens' attitudes and beliefs of childbirth and association with birth preference: A comparison of a Swedish and an Australian sample in mid-pregnancy
Open this publication in new window or tab >>Womens' attitudes and beliefs of childbirth and association with birth preference: A comparison of a Swedish and an Australian sample in mid-pregnancy
2012 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, no 6, p. e850-e856Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

the rate of caesarean in Australia is twice that of Sweden. Little is known about women's attitudes towards birth in countries where the caesarean rate is high compared to those where normal birth is a more common event.

OBJECTIVES:

to compare attitudes and beliefs towards birth in a sample of Australian and Swedish women in mid-pregnancy.

PARTICIPANTS:

women from rural towns in mid Sweden (n=386) and north-eastern Victoria in Australia (n=123).

METHODS:

questionnaire data was collected from 2007 to 2009. Levels of agreement or disagreement were indicated on sixteen attitude and belief statements regarding birth. Principal components analysis (PCA) identified the presence of subscales within the attitudes inventory. Using these subscales, attitudes associated with preferred mode of birth were determined. Odds ratios were calculated at 95% CI by country of care.

RESULTS:

the Australian sample was less likely than the Swedish sample to agree that they would like a birth that: 'is as pain free as possible' OR 0.4 (95% CI: 0.2-0.7), 'will reduce my chance of stress incontinence' OR 0.2 (95% CI: 0.1-0.8), 'will least affect my future sex life' OR 0.3 (95% CI: 0.2-0.6), 'will allow me to plan the date when my baby is born' OR 0.4 (95% CI: 0.2-0.7) and 'is as natural as possible' OR 0.4 (95% CI: 0.2-0.9). They were also less likely to agree that: 'if a woman wants to have a caesarean she should be able to have one under any circumstances' OR 0.4 (95% CI: 0.2-0.7) and 'giving birth is a natural process that should not be interfered with unless necessary' OR 0.3 (95% CI: 0.1-0.7). Four attitudinal subscales were found: 'Personal Impact of Birth', 'Birth as Natural Event', 'Freedom of Choice' and 'Safety Concerns'. Women who preferred a caesarean, compared to those who preferred a vaginal birth, across both countries were less likely to think of 'Birth as a natural event'.

KEY CONCLUSIONS:

the Australian women were less likely than the Swedish women to hold attitudes and beliefs regarding the impact of pregnancy and birth on their body, the right to determine the type of birth they want and to value the natural process of birth. Women from both countries who preferred caesarean were less likely to agree with attitudes related to birth as a natural event.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-164069 (URN)10.1016/j.midw.2011.09.011 (DOI)000311936100003 ()22098781 (PubMedID)
Available from: 2011-12-15 Created: 2011-12-15 Last updated: 2017-12-08Bibliographically approved
3. The influence of women's fear, attitudes and beliefs of childbirth on mode and experience of birth
Open this publication in new window or tab >>The influence of women's fear, attitudes and beliefs of childbirth on mode and experience of birth
2012 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 12, p. 55-Article in journal (Refereed) Published
Abstract [en]

Background: Women's fears and attitudes to childbirth may influence the maternity care they receive and the outcomes of birth. This study aimed to develop profiles of women according to their attitudes regarding birth and their levels of childbirth related fear. The association of these profiles with mode and outcomes of birth was explored.

Methods: Prospective longitudinal cohort design with self report questionnaires containing a set of attitudinal statements regarding birth (Birth Attitudes Profile Scale) and a fear of birth scale (FOBS). Pregnant women responded at 18-20 weeks gestation and two months after birth from a regional area of Sweden (n = 386) and a regional area of Australia (n = 123). Cluster analysis was used to identify a set of profiles. Odds ratios (95% CI) were calculated, comparing cluster membership for country of care, pregnancy characteristics, birth experience and outcomes.

Results: Three clusters were identified - 'Self determiners' (clear attitudes about birth including seeing it as a natural process and no childbirth fear), 'Take it as it comes' (no fear of birth and low levels of agreement with any of the attitude statements) and 'Fearful' (afraid of birth, with concerns for the personal impact of birth including pain and control, safety concerns and low levels of agreement with attitudes relating to women's freedom of choice or birth as a natural process). At 18 - 20 weeks gestation, when compared to the 'Self determiners', women in the 'Fearful' cluster were more likely to: prefer a caesarean (OR = 3.3 CI: 1.6-6.8), hold less than positive feelings about being pregnant (OR = 3.6 CI: 1.4-9.0), report less than positive feelings about the approaching birth (OR = 7.2 CI: 4.4-12.0) and less than positive feelings about the first weeks with a newborn (OR = 2.0 CI 1.2-3.6). At two months post partum the 'Fearful' cluster had a greater likelihood of having had an elective caesarean (OR = 5.4 CI 2.1-14.2); they were more likely to have had an epidural if they laboured (OR = 1.9 CI 1.1-3.2) and to experience their labour pain as more intense than women in the other clusters. The 'Fearful' cluster were more likely to report a negative experience of birth (OR = 1.7 CI 1.02-2.9). The 'Take it as it comes' cluster had a higher likelihood of an elective caesarean (OR 3.0 CI 1.1-8.0).

Conclusions: In this study three clusters of women were identified. Belonging to the 'Fearful' cluster had a negative effect on women's emotional health during pregnancy and increased the likelihood of a negative birth experience. Both women in the 'Take it as it comes' and the 'Fearful' cluster had higher odds of having an elective caesarean compared to women in the 'Self determiners'. Understanding women's attitudes and level of fear may help midwives and doctors to tailor their interactions with women.

Keywords
Pregnancy, Attitudes, Childbirth fear, Cluster analysis, Scale
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-183245 (URN)10.1186/1471-2393-12-55 (DOI)000309115600001 ()
Available from: 2012-10-25 Created: 2012-10-23 Last updated: 2017-12-07Bibliographically approved
4. The Role of Women’s Attitudinal Profiles in Satisfaction with the Quality of their Antenatal and Intrapartum Care
Open this publication in new window or tab >>The Role of Women’s Attitudinal Profiles in Satisfaction with the Quality of their Antenatal and Intrapartum Care
2013 (English)In: Journal of Obstetric, Gynecologic and Neonatal Nursing, ISSN 0884-2175, E-ISSN 1552-6909, Vol. 42, no 4, p. 428-441Article in journal (Other academic) Published
Abstract [en]

Objective

To compare perceptions of antenatal and intrapartum care in women categorized into three profiles based on attitudes and fear. 

Design

Prospective longitudinal cohort study using self-report questionnaires. Profiles were constructed from responses to the Birth Attitudes Profile Scale and the Fear of Birth Scale at pregnancy weeks 18 to 20. Perception of the quality of care was measured using the Quality from Patient's Perspective index at 34 to 36 weeks pregnancy and 2 months after birth.

Setting

Two hospitals in Sweden and Australia. 

Participants

Five hundred and five (505) pregnant women from one hospital in Vasternorrland, Sweden (n=386) and one in northeast Victoria, Australia (n=123). 

Results 

Women were categorized into three profiles: self-determiners, take it as it comes, and fearful. The self-determiners reported the best outcomes, whereas the fearful were most likely to perceive deficient care. Antenatally the fearful were more likely to indicate deficiencies in medical care, emotional care, support received from nurse-midwives or doctors and nurse-midwives'/doctors' understanding of the woman's situation. They also reported deficiencies in two aspects of intrapartum care: support during birth and control during birth. 

Conclusions 

Attitudinal profiling of women during pregnancy may assist clinicians to deliver the style and content of antenatal and intrapartum care to match what women value and need. An awareness of a woman's fear of birth provides an opportunity to offer comprehensive emotional support with the aim of promoting a positive birth experience.

Keywords
Fear of birth, attitudes, profiling, satisfaction, childbirth
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-185080 (URN)10.1111/1552-6909.12221 (DOI)000321822800007 ()
Available from: 2012-11-20 Created: 2012-11-20 Last updated: 2017-12-07Bibliographically approved

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