Search

Background: In The Netherlands, women with low-risk pregnancy are routinely given the option of home birth, providing a unique opportunity to study the relationship between fear of childbirth (FOC) and preference for childbirth location, and whether women experience higher FOC when the actual location differs from their preference., Methods: In this prospective cohort study, 331 nulliparous and parous women completed a questionnaire at gestational week 30 (T1) and two months postpartum (T2). FOC was assessed using versions A (T1) and B (T2) of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ)., Results: At T1, women who preferred home birth had significantly lower FOC compared with women who preferred a hospital birth (mean ± SD W-DEQ scores: 55 ± 19.8 and 64 ± 18.3, respectively, P < .01). About 28% of women who responded at T2 gave birth at home. Congruence between the preferred and actual childbirth location was not predictive of FOC assessed at T2 when adjusted for obstetric and psychological variables. In an extended analysis, we found that except for prepartum FOC, the following variables also correlated with postpartum FOC: being referred because of complications and poor neonatal condition., Conclusions: Compared to women who prefer hospital birth, women who prefer home birth have lower prepartum and postpartum FOC. Giving birth at a location other than the preferred location does not appear to affect postpartum FOC. Whether giving birth at home or in the hospital, caregivers should pay extra attention to women with high FOC because they are vulnerable to postpartum FOC, especially after a complicated birth and referral., (© 2019 The Authors. Birth published by Wiley Periodicals, Inc.)

Background: Individuals with body dysmorphic disorder (BDD) are highly distressed and impaired owing to perceived defects in their physical appearance that are not noticeable to others. They are frequently concerned about their skin and often present to dermatologists rather than psychiatrists. However, BDD patients attending dermatology clinics may be at risk of not receiving an appropriate assessment and beneficial treatment. The aims of this study were to estimate the BDD prevalence rate among Swedish female dermatology patients and to assess the psychological condition of BDD patients compared to that of other dermatology patients., Methods: The occurrence of BDD was estimated using the Body Dysmorphic Disorder Questionnaire (BDDQ), a validated self-report measure for BDD. Symptoms of depression and anxiety were measured by the Hospital Anxiety and Depression Scale (HADS), and quality of life was assessed using the Dermatology Life Quality Index (DLQI)., Results: The prevalence rate of BDD among female Swedish dermatology patients was 4.9% (95% CI 3.2-7.4). Anxiety (HADS A ≥ 11) was 4-fold more commonly reported by patients with positive BDD screening (48% vs. 11%), and depression (HADS D ≥ 11) was over 10-fold more common in patients with positive BDD screening (19% vs. 1.8%) (P < 0.001). The median DLQI score was 18 in the BDD group, compared to a score of 4 in the non-BDD group (P < 0.001)., Conclusions: Our results indicate that BDD is fairly common among female Swedish dermatology patients (4.9%) and that BDD patients have high levels of depression and anxiety and severely impaired quality of life., (© 2017 The International Society of Dermatology.)

Objective: It is a generally accepted idea that women who give birth at home are less fearful of giving birth than women who give birth in a hospital. We explored fear of childbirth (FOC) in relation to preferred and actual place of birth. Since the Netherlands has a long history of home birthing, we also examined how the place where a pregnant woman׳s mother or sisters gave birth related to the preferred place of birth., Design: A prospective cohort study., Setting: Five midwifery practises in the region Leiden/Haarlem, the Netherlands., Participants: 104 low risk nulliparous and parous women., Method: Questionnaires were completed in gestation week 30 (T1) and six weeks post partum (T2)., Measurements and Findings: No significant differences were found in antepartum FOC between those who preferred a home or a hospital birth. Women with a strong preference for either home or hospital had lower FOC (mean W-DEQ=60.3) than those with a weak preference (mean W-DEQ=71.0), t (102)=-2.60, p=0.01. The place of birth of close family members predicted a higher chance (OR 3.8) of the same place being preferred by the pregnant woman. Pre- to postpartum FOC increased in women preferring home- but having hospital birth., Key Conclusions: The idea that FOC is related to the choice of place of birth was not true for this low risk cohort. Women in both preference groups (home and hospital) made their decisions based on negative and positive motivations. Mentally adjusting to a different environment than that preferred, apart from the medical complications, can cause more FOC post partum., Implications for Practice: The decreasing number of home births in the Netherlands will probably be a self-reinforcing effect, so in future, pregnant women will be less likely to feel supported by their family or society to give birth at home. Special attention should be given to the psychological condition of women who were referred to a place of birth and caregiver they did not prefer, by means of evaluation of the delivery and being alert to anxiety or other stress symptoms after childbirth. These women have higher chance of fear post partum which is related to a higher risk of psychiatric problems., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: About six percent of pregnant women suffer from severe fear of childbirth. These women are at increased risk of obstetric labour and delivery interventions and pre- and postpartum complications, e.g., preterm delivery, emergency caesarean section, caesarean section at maternal request, severe postpartum fear of childbirth and trauma anxiety. During the last decade, there is increasing clinical evidence suggesting that haptotherapy might be an effective intervention to reduce fear of childbirth in pregnant women. The present study has been designed to evaluate the effects of such intervention., Methods/design: Included are singleton pregnant women with severe fear of childbirth, age ≥ 18 year, randomised into three arms: (1) treatment with haptotherapy, (2) internet psycho-education or (3) care as usual. The main study outcome is fear of childbirth. Measurements are taken at baseline in gestation week 20-24, directly after the intervention is completed in gestation week 36, six weeks postpartum and six months postpartum. Secondary study outcomes are distress, general anxiety, depression, somatization, social support, mother-child bonding, pregnancy and delivery complications, traumatic anxiety symptoms, duration of delivery, birth weight, and care satisfaction., Discussion: The treatment, a standard haptotherapeutical treatment for pregnant women with severe fear of childbirth, implies teaching a combination of skills in eight one hour sessions. The internet group follows an eight-week internet course containing information about pregnancy and childbirth comparable to childbirth classes. The control group has care as usual according to the standards of the Royal Dutch Organisation of Midwives and the Dutch Organization of Obstetrics and Gynaecology., Trial Registration: This trial was entered in the Dutch Trial Register and registered under number NTR3339 on March 4th, 2012.

Purpose: This prospective cohort study aimed to investigate the interrelation between preferred/actual mode of delivery and pre- and postpartum fear of childbirth (FOC).Material and Methods: Participants from 13 midwifery practices and four hospitals in Southwest Netherlands filled out questionnaires at 30 weeks' gestation (n = 561) and two months postpartum (n = 463), including questions on preferred mode of delivery, the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) and Hospital Anxiety Depression Scale (HADS). Results were related to obstetric data.Results: Both severe FOC (OR 7.0, p < .001) and previous Cesarean section (CS) (OR 16.6, p < .001) predicted preference for CS. Severe prepartum FOC also predicted actual CS. Preferring a vaginal delivery (VD) and actually having a CS predicted higher postpartum W-DEQ scores (partial r = 0.107, p < .05). Other significant predictors for high postpartum W-DEQ scores were high prepartum W-DEQ (partial r = 0.357) and HADS anxiety scores (partial r = 0.143) and the newborn in need of medical assistance (partial r = -0.169).Conclusions: Women preferring a VD but ending up with a CS are at risk for severe FOC postpartum, while the same risk was not demonstrated for women who preferred a CS but had a VD. Prepartum FOC is strongly associated with postpartum FOC, regardless of congruence between preferred and actual mode of delivery. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship of fear of childbirth (FOC), general anxiety and depression during pregnancy and postpartum with birth complications. Methods: For this prospective cohort study 105 healthy women with low-risk pregnancies (until at least 30 weeks gestation) completed the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) and the Hospital Anxiety and Depression Scale (HADS) at 30 weeks gestation and 6 weeks postpartum. These results were related with delivery characteristics. Results: FOC during pregnancy was not related to complications during labour and delivery. In a regression analysis, both multiparity and medical interventions were predictors for higher postpartum FOC. A positive correlation was found between FOC during pregnancy and FOC at six weeks postpartum, corrected for complications during childbirth ( r = 0.45, p < 0.001). Conclusions: The birth giving process was not related to FOC during pregnancy, but the pre-partum level of FOC certainly is predictive of the level of postpartum FOC, suggesting that FOC as measured during gestation may influence the interpretation of the birth experience itself. We did find a positive relationship between both parity and medical interventions during childbirth and FOC postpartum. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To describe the views of Swedish midwives on severe fear of childbirth (SFOC). Study design: In this cross sectional study, a random sample of 1000 midwives, selected from the database of the Swedish Association of Midwives, received a questionnaire. The response rate was 84% (n =834), with 726 questionnaires included in the final analysis. Main outcome measures: The views of midwives on SFOC in different contexts of work: antenatal care clinic (ACC), labour ward (LW) either ACC/LW or Neither-Nor ACC/LW. Results: The majority of respondents thought that the frequency of SFOC has increased during the last 10years (67%), and that pregnant women today are more likely to discuss their fears (70%). Midwives at ACCs thought that special education in SFOC is needed (p <0.001) and that they have more responsibility to identify women with SFOC (p <0.001) than midwives at LWs. The majority of respondents, both at ACCs (60%) and LWs (65%), intuitively sensed when they were meeting a woman with SFOC. Opinions among midwives who alternate between working in ACCs and LWs reflected the views of the midwives working either in an ACC or an LW. Conclusions: The views of midwives on SFOC are partly in concordance and partly contradictory in relation to the different workplaces as well as research data. Knowledge of the views of midwives on SFOC is a necessary pre-requisite to improve care for pregnant women. [Copyright &y& Elsevier]

Background: In a representative Swedish sample, we investigated lifetime prevalence of physical, sexual and psychological abuse of women and their current suffering. The relationship between current suffering from abuse and psychological health problems was also studied. Method: The study was cross-sectional and population-based. The Abuse Screening Inventory (ASI), measuring experiences of physical, sexual and psychological abuse and including questions on health and social situation, was sent by mail to 6000 women, randomly selected from the population register. The questionnaire was completed and returned by 4150 (70%) of 5896 eligible women. Results: 27.5% of the women reported abuse of any kind. Of those, 69.5% reported current suffering from abuse. Abused suffering women reported more anxiety, depression and sleep disturbances, and a less advantageous social situation than both non-abused and abused non-suffering women. Also, abused non-suffering women reported more depression than non-abused women. Somatization was reported more often by both abused suffering and non-suffering women than by non-abused women, with no difference between suffering and non-suffering women when adjusted for possible confounders. Conclusion: A majority of abused women, when investigating lifetime history of abuse, report current suffering thereof, which warrants considering abuse an important societal problem. Suffering could be a valuable construct, possibly useful to assess psychological health problems normally not captured by existing diagnostic instruments, although further investigations of the concept are needed. [ABSTRACT FROM AUTHOR]

Background. An increasing body of research shows that a proportion of women experience significant symptoms of Post-Traumatic Stress Disorder (PTSD) following childbirth. Aims and method. An international group of researchers, clinicians, and user-group representatives met in 2006 to discuss the research to date into PTSD following childbirth, issues and debates within the field, and recommendations for future research. This paper reports the content of four discussions on (1) prevalence and comorbidity, (2) screening and treatment, (3) diagnostic and conceptual issues, and (4) theoretical issues. Conclusions. Current knowledge from the perspectives of the researchers is summarized, dilemmas are articulated and recommendations for future research into PTSD following childbirth are made. In addition, methodological and conceptual issues are considered. [ABSTRACT FROM AUTHOR]

Traumatic stress has traditionally been studied in the aftermath of traumatic events. In contrast, this study aimed to explore if traumatic stress can occur before an event that is perceived as threatening or feared. Traumatic stress, as related to the forthcoming delivery, was studied in 1224 women. Background data and psychological characteristics were assessed in early pregnancy and traumatic stress and fear of childbirth in late pregnancy. Of all subjects, 2.3% met all DSM-IV criteria for posttraumatic stress disorder (PTSD) and 5.8% fulfilled criteria B, C, and D in late pregnancy. Traumatic stress and fear of childbirth correlated significantly. High trait anxiety, depressive symptomatology, psychological/psychiatric counseling related to childbirth, and self-reported psychological problems, measured in early pregnancy, were risk factors for traumatic stress and fear of childbirth in late pregnancy. Results suggest the occurrence of “pre”traumatic stress (i.e., a threatening forthcoming event provoking symptoms similar to those after a traumatic event). [Copyright &y& Elsevier]

In a group of late pregnant women we investigated the prevalence of extreme fear of childbirth and anxiety disorders, both assessed by means of diagnostic interviews. We also explored the relation between anxiety disorders and extreme fear of childbirth on the one hand and fear of childbirth, as measured by means of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ), on the other hand. A subgroup of women (2.4%) fulfilled the criteria for a phobia-like fear of childbirth. Anxiety disorders were related to fear of childbirth, as measured by the W-DEQ. The group of women with extreme fear of childbirth (with or without anxiety disorders) had obviously the highest W-DEQ scores. But also in the group of women with anxiety disorders only the W-DEQ scores were high. Clinical assessment of anxiety disorders among pregnant women should be considered, above all in women who report fear of the anticipated delivery. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The link between fear of childbirth and theories of anxiety in general is discussed. A possible expression of trait (T-fear) and state (S-fear) aspects of fear of childbirth was investigated in 77 nulliparous and 85 parous women based on data from gestational week 32, at 2 hours and at 5 weeks after childbirth. Data are based on the State Trait Anxiety Inventory and the Wijma Delivery Expectancy/Experience Questionnaire. According to their scores on the Wijma Delivery Expectancy/Experience Questionnaire during late pregnancy, women were divided into 3 groups: high, moderate and low levels of fear of childbirth. In gestational week 32, women in the low level of fear of childbirth group had lower trait anxiety than those in the moderate level of fear of childbirth group, who had lower trait anxiety than the women in the high level of fear of childbirth group. Nulliparous women had a higher level of fear of childbirth but a lower level of trait anxiety than did parous women. There was a significant decreasing trend in fear of childbirth from 2 hours to 5 weeks after delivery, in a parallel way for all 3 groups. Differences in fear of childbirth between nulliparous and parous women disappeared after delivery. These findings suggest that fear of childbirth comprises a considerable part of T-fear, with the risk of a vicious cycle, i.e. that during labour women experience what they are afraid of, which also influences the women's postpartum cognitive appraisal of the delivery. [ABSTRACT FROM AUTHOR]