Background
Methods
Inclusion criteria
Types of participants
Types of studies
Types of outcome
Search and selection strategy
Selection of studies
Quality assessment of included studies
Data extraction and analysis
Results
Results of search and selection strategy
Methodological quality of included studies
First author, year of publication [reference number] | EP-HPP rating | Aim of study | Study design | Population | Sample size (response rate, %) | Country |
---|---|---|---|---|---|---|
Adams 2012 [80] | S | To assess the association between FOC and duration of labour | Prospective cohort study, using postal survey at 32 weeks | All women scheduled to give birth at a University hospital Nov 2008-April 2010 | 2206 (63.0) | Norway |
Elvander 2013 [63] | M | To estimate the effects of different levels of fear of birth and mode of delivery on birth experience 1 month after birth | Prospective study, using telephone interviews in the third trimester of pregnancy and 1 month after birth | Nulliparous English and Spanish-speaking women aged 18–35, with a single fetus, who birthed >34 weeks’, recruited in a variety of ways, in 2009–2011 | 3005 (NA) Number eligible not mentioned | USA |
Eriksson 2005 [71] | S | To investigate and compare experiential factors associated with childbirth-related fear in women (and men) | Cross-sectional observational study, using postal survey 14–26 months postnatal. FOC was assessed retrospectively | All women who had a baby in a University hospital, March 1997–March 1998 | 410 (73.5) | Sweden |
Fabian 2004 [73] | M | To investigate the attendance rate at childbirth and parenthood education classes // and describe the characteristics of women who did not attend | Cohort study using a postal questionnaire in early pregnancy and at 2 months postpartum | All women attending 97% of all antenatal clinics in Sweden for 1 week in May and September 1999, and January 2000 | 2546 (55.0) | Sweden |
Fenwick 2009 [77] | M | To investigate levels of pre- and postpartum of childbirth fear in a cohort of childbearing women and explore the relationship to birth outcomes | A prospective correlation design using postal surveys at 36 weeks’ gestation and 6 weeks’ postpartum | All women (English-speaking with a single healthy fetus) attending antenatal clinic at a tertiary hospital, September 2005–March 2006 | 401 (43.0) | Australia |
Geissbuehler 2002 [69] | M | To examine the intensity and type of childbirth fears among pregnant women in the 2nd-3rd trimester // to consider whether birth preparation influences childbirth anxiety | Cross-sectional, self-administered survey in 24th–28th weeks | All women booked to give birth in a large hospital, November 1991–October 1999 | 8528 (79.1) | Switzerland |
Haines 2011 [67] | S | To examine the prevalence of childbirth-related fear (CBRF) in two rural populations (Sweden and Australia) and to pilot a short easy-to-administer tool | Cross-sectional study, using postal survey at 18 weeks gestation | Women undergoing routine ultrasound at 17–19 weeks at a regional Swedish hospital during 2007 and women booked booked at 18–20 weeks in an Australian regional hospital, year not described | 509 (NA) (Sweden: n = 386 and Australia: n = 123) Number eligible not mentioned | Sweden and Australia |
Hall 2009 [85] | S | To explore women’s levels of childbirth fear, sleep deprivation, anxiety, and fatigue and their relationships during the 3rd trimester of pregnancy | Cross-sectional using surveys at term in a convenience sample at 35–39 weeks | English speaking low-risk women at 35–39 weeks gestation from May 2005–July 2007 | 650 (NA) Number eligible not mentioned | Canada |
Heimstad 2006 [78] | M | To estimate prevalence of FOC in a defined area in Norway and to study the possible relationship between FOC and psychosocial background, degree of anxiety and abuse | Cross-sectional study, using postal questionnaires at 18–20 weeks | All pregnant women scheduled for a routine ultrasound at a University Hospital, June 2001–August 2002 | 1452 (54.2) | Norway |
Hildingsson 2010 [60] | S | To describe and study background characteristics, feelings and support in relation to thoughts about childbirth in mid-pregnancy | Cross-sectional study, using self-administered surveys at 17–19 weeks | All pregnant women who had a routine ultrasound at three hospitals in one region, year 2007 | 1212 (51.4) | Sweden |
Jespersen 2014 [81] | S | To assess the association between FOC and emergency caesarean section | Prospective cohort study using 2 questionnaires; at 37 weeks gestation and at admission to labour ward | All nulliparous, pregnant low risk women in spontaneous labour at 4 major university hospitals, 3 country hospitals and 2 local district departments, May 2004–July 2005 | 2598 (71.1) | Denmark |
Jokić-Begić 2014 [82] | S | To examine the role of demographic variables, expected pain level, trait anxiety and anxiety sensitivity in FOC among nulliparous and multi-parous women in the last trimester of pregnancy | Cross-sectional/single cohort study using one questionnaire in 8th–9th months of pregnancy | Pregnant women attending at a perinatal clinic at one University hospital in Zagreb, Jan-May 2012 | 200 (67.6) | Croatia |
Laursen 2008 [64] | M | To describe the association between FOC and social, demographics and psychological factors in healthy nulliparous women with uncomplicated pregnancies | Population-based prospective cohort study (pre-post design), using telephone interviews at 16 and 32 weeks | All nulliparous women with uncomplicated pregnancies, 1997–2003 | 30,480 (approx. 30%) | Denmark |
Lowe 2000 [74] | M | To test whether the theoretically predicted inverse relationship between childbirth self-efficacy and fear exists, and to characterize specific personality attributes associated with women who express low or high FOC | Cross-sectional cohort study (secondary analysis), using the Childbirth Attitudes Questionnaire distributed in the third trimester and returned by post | Nulliparous women enrolled in childbirth education classes, year for data collection not described | 280 (NA) Number eligible not mentioned | USA |
Lukasse 2014 [62] | M | To assess the prevalence of severe FOC and investigate the association between severe FOC and selected background variables | Cohort study, using a self-completed survey in pregnancy at varying times | Pregnant women attending antenatal care in 6 countries between March 2008–August 2010 | 6870; 828 (B) 585 (I), 1252 (D) 896 (E) 2351 (N) 958 (S) (NA) | Belgium, Norway, Iceland, Denmark Estonia Sweden |
Nieminen 2009 [79] | M | Investigate the prevalence of intense FOC, association between the level of FOC and gestational age, the risk factors for intense FOC in primi and multiparous, and risk factors associated with preference for caesarean section | Cross-sectional, using a self-completed survey in pregnancy | All Swedish speaking primi and multiparous women in four districts, September–October 2006 | 1635 (98.3) | Sweden |
Nilsson 2012 [61] | S | To explore FOC during pregnancy and 1 year after birth and its association with birth experience and mode of birth | A population based prospective longitudinal survey (pre and post design), using postal surveys in mid and late pregnancy, 2 months and 1 year postpartum | All pregnant women who had a routine ultrasound at three hospitals in one region, year 2007 (Same population as in Hildingsson 2010) | 763 (86) | Sweden |
Poikkeus 2006 [75] | M | To compare the prevalence and predictors of severe FOC and pregnancy related anxiety in groups of assisted reproduction treatment (ART) and spontaneously conceiving women with singleton pregnancies | Prospective longitudinal study with cohort (ART) and matched control (consecutive enrolment) groups, using a self-completed survey at 20 weeks | ART group = 367, and consecutive controls = 379, year 1999 | 746 (86.6) | Finland |
Rouhe 2015 [65] | S | To assess effects of psycho-education versus conventional care during pregnancy in women with FOC | All nulliparous women at time of routine ultrasound at 11–13 weeks. 371 women with severe FOC participated in an RCT using psycho-education as relaxation (6 sessions during pregnancy, one postnatal) and conventional care by community nurses Questionnaires completed twice during pregnancy and/or 3 months postpartum | 4575 screened by W-DEQ for severe FOC during routine ultra-sonography at 11–13 weeks. Those with scores >100 were included in the trial, in October 2007–August 2009 | 4575 (NA) Number eligible not mentioned | Finland |
Räisänen 2014 [66] | S | To identify risk factors for FOC and evaluate relation between FOC and adverse perinatal outcomes | Cohort register study, using The Finnish Medical Birth Register, with FOC defined according to ICD – code 099.80 | All singleton births during 1997–2010 | 788,317 (100?) | Finland |
Söderqvist 2004 [83] | S | To investigate association between traumatic stress symptoms and FOC in late pregnancy | Cohort using self-completed survey at week 32 | Consecutive recruitment of pregnant women visiting hospital in Kalmar and Linköping, in 1997 | 951 (48.2) | Sweden |
Ternström 2014 [72] | S | To investigate the prevalence of childbirth-related fear in early pregnancy among Swedish and foreign-born women living in Sweden | Cross-sectional study of a total population attending ultrasound screening, using a self-completed questionnaire at 17–20 weeks | University hospital, 615 women screened during routine ultra-sonography, and asked to participate, year not described | 606 (96.2) | Sweden |
Waldenström 2006 [70] | M | To investigate the prevalence of FOC in a nationwide sample and its association with subsequent rates of CS and overall experience of childbirth | A longitudinal national cohort study, using postal survey at 16 weeks gestation and 2 months postpartum | All pregnant women invited to participate at 16th week gestation and at 2 months postpartum, 3 weeks: May and September 1999 and January 2000 | 2662 (97.0) | Sweden |
Zar 2002 [84] | S | To investigate the prevalence of extreme FOC and anxiety disorders in late pregnancy | Prospective study using postal survey at week 28–30 and interview at 32 weeks | Pregnant women from a country hospital were invited to participate, during 8 months, year not described | 506 (82.5) | Sweden |
Description of studies
Definitions and measurements of FOC used by included studies
First author, year of publication, [reference number] | Measurement tools used, in descending order of cut-off point | Level of FOC | Time point of FOC | Prevalence, % (95% CI) | Number | Parity groupa |
---|---|---|---|---|---|---|
W-DEQ | ||||||
Rouhe 2015 [65] | W-DEQ, with score ≥ 100 | Very severe FOC | Early pregnancy | 8.1 (7.3–8.9) | 371/4575 | 1 |
Heimstad 2006 [78] | W-DEQ score > 100 W-DEQ > 95 | ‘Serious FOC; of clinical importance’ | Mid pregnancy | 5.5 (4.3–6.8) 7.3 (5.9–8.8) | 72/1321 96/1321 | 2 |
Nieminen 2009 [79] | W-DEQ score ≥ 100 W-DEQ score ≥ 85 | Very intense FOC Intense FOC | Pregnancy (various times) | 5.7 (4.6–6.9) 15.6 (13.8–17.4) | 93/1635 254/1635 | 2 |
Adams 2012 [80] | W-DEQ score ≥ 85 | ‘High fear’ | At 32 weeks | 7.5 (6.4–8.7) | 165/2206 | 2 |
Jespersen 2014 [81] | W-DEQ score ≥ 85 | Severe FOC | At 37 weeks | 9.0 (7.8–10.2) | 207/2310 | 1 |
Jokić-Begić 2014 [82] | W-DEQ score ≥ 85 | FOC | Late pregnancy | 11.5 (7.4–16.8) | 23/200 | 2 |
Lukasse 2014 [62] | W-DEQ score ≥ 85 | Severe FOC | In pregnancy (various times) | 11.2 (total population in six countries) b(10.5–12.0) Belgium: 6.3 (4.7–8.2) Iceland: 8.4 (6.3–10.9) Denmark: 9.2 (7.6–10.9) Norway: 11.8 (10.5–13.2) Sweden: 14.8 (12.6–17.2) Estonia: 14.8 (12.6–17.3) | Total: 769/6870 B: 52/828 I: 49/585 D: 115/1252 N: 278/2351 S: 142/958 E: 133/896 | 2 |
Söderqvist 2004 [83] | W-DEQ score ≥ 85 | Severe FOC | Late pregnancy | 13.5 (11.4–15.8) | 127/942 | 2 |
Zar 2002 [84] | W-DEQ score ≥ 85 | Severe FOC | Late pregnancy | 11.1 (8.5–14.1) | 56/506 | 2 |
Fenwick 2009 [77] | W-DEQ score ≥ 71 | ‘High level of fear’ | Late pregnancy 6 weeks postpartum | 26.2 (21.9–30.8) 22.4 (17.3–28.1) | 105/401 55/246 | 2 |
Hall 2009 [85] | W-DEQ score ≥ 66 | ‘High fear’ | Late pregnancy | 24.9 (21.6–28.4) | 162/650 | 2 |
Fear of Birth scale (FOBS) | ||||||
Haines 2011 [67] | Fear of Birth Scale (FOBS) score > 50. | Elevated level of FOC | Mid-pregnancy | Sweden: 31.1 (26.5–36.0) Australia: 29.5 (21.6–38.4) | 119/383 36/122 | 2 |
Ternström 2014 [72] | Fear of Birth Scale (FOBS) score > =60. | Childbirth related fear (CBRF) | Mid-pregnancy | 22.1 (18.9–25.6) | 134/606 | 2 |
Various scales to measure FOC | ||||||
Elvander 2013 [63] | First Baby Study Birth Anticipation Scale score 21–30 | High fear | Late pregnancy | 20.3 (18.9–21.8) | 611/3005 | 1 |
Lowe 2000 [74] | Childbirth Attitudes Questionnaire, 1 Standard Deviation above mean | High fear | Late pregnancy | 19.3 (14.8–24.4) | 54/280 | 1 |
Poikkeus 2006 [75] | Revised Fear-of-Childbirth questionnaire, total score ≥ 6 | Severe fear | Mid pregnancy | 11.0 (8.8–13.5) | 82/746 | 2 |
Single item question – 3 point Likert response scale | ||||||
Geissbuehler 2002 [69] | ‘Are you anxious or afraid about the birth?’, answer by ‘Yes, very afraid’ | FOC | Late pregnancy | 5.3 (4.8–5.8) | 450/8528 | 2 |
Laursen 2008 [64] | ‘Are you anxious about the course of the upcoming delivery?’ answered with ‘A lot‘ | FOC | Early pregnancy Late pregnancy | 7.6 (7.3–7.9) 7.4 (7.1–7.7) | 2308/30,480 2245/30,480 | 1 |
Single item question – 4 point Likert response scale | ||||||
Hildingsson 2010 [60] | ’How do you feel when thinking about labour and birth?’ answered with: ‘A lot/very much’ | Childbirth related fear | Mid pregnancy | 14.0 (12.1–16.1) | 170/1212 | 2 |
Nilsson 2012 [61] | ’To what extent do you experience worries and fear?’ answered with: ‘A great deal/very much’ c | FOC | 1 year after childbirth | 15.1 (12.6–17.9) | 115/761 | 2 |
Single item question – 5/6 point Likert response scale | ||||||
Eriksson 2005 [71] | A statement ‘Childbirth-related fear influences my daily life in a negative sense’ with a 6-point Likert scale | Intense fear | Assessed retrospectively | 22.9 (18.9–27.3) | 94/410 | 2 |
Waldenström 2006 [70] | A question: ‘How do you feel when thinking about labour and birth?‘answered by ‘Very negative‘ | Childbirth related fear | Early pregnancy | 3.6 (3.0–4.4) | 97/2662 | 2 |
Miscellaneous | ||||||
Fabian 2004 [73] | Yes to a question on whether they had attended/needed to attend a clinic for counseling because of FOC | FOC | Early pregnancy | 15.4 (14.0–16.9) | 385/2503 | 2 |
Räisänen 2014 [66] | Register study. FOC defined according to ICD – code 099.80 | FOC | Pregnancy | 3.7 (3.6–3.7) | 28,960/ 788,317 | 2 |
Prevalence
Comparison of country rates
First author, year of publication | Prevalence | Country total | Average country prevalence |
---|---|---|---|
Lukasse 2014 | 142 out of 958 (14.8%) | Sweden | 579 out of 4041 (14.3%) |
Nieminen 2009 | 254 out of 1635 (15.5%)a | ||
Söderqvist 2004 | 127 out of 942 (13.5%) | ||
Zar 2002 | 56 out of 506 (11%) | ||
Adams 2012 | 165 out of 2206 (7.5%) | Norway | 443 out of 4557 (9.7%) |
Lukasse 2014 | 278 out of 2351 (11.8%) | ||
Jespersen 2014 | 207 out of 2310 (9.0%) | Denmark | 322 out of 3562 (9.0%) |
Lukasse 2014 | 115 out of 1252 (9.2%) | ||
Jokić-Begić 2014 | Croatia | 23 out of 200 (11.5%) | |
Lukasse 2014 | Belgium | Belgium: 52 out of 828 (6.3%) | |
Iceland | Iceland: 49 out of 585 (8.4%) | ||
Estonia | Estonia: 133 out of 896 (14.8%) |