Chased by the Past: The Relation Between Childhood Maltreatment and Fear of Childbirth

The relationship of childhood maltreatment, adult sexual victimization, depressed mood and symptoms of trauma with fear of childbirth

BACKGROUND

Fear of childbirth (FoB) is experienced to some degree by most pregnant people and can be intense enough to merit treatment. Despite significant research on the topic of FoB, studies investigating various forms of maltreatment and mental health symptoms in relation to FoB are very limited. In particular, studies including multiple forms of maltreatment along with mental health symptoms as predictors of FoB are extremely limited. We sought to fill this gap and clarify the relative contributions of these variables to the prediction of FoB.

METHODS

This was a secondary analysis of data from pregnant people in Canada. Participants (N = 881) provided demographic and reproductive history information, completed self-report measures of FoB, childhood maltreatment (multiple forms), adult sexual victimization, depressed mood and symptoms of posttraumatic stress disorder (PTSD). They were also administered a diagnostic interview to assess for specific phobia, FoB. Analyses included descriptive information, Wilcoxon rank sum tests, linear and logistic regression, and path analysis.

RESULTS

Most forms of maltreatment showed some association with increased FoB. However, when assessed together, only emotional maltreatment remained a significant predictor of FoB. Both depressed mood and symptoms of PTSD contributed more to FoB than maltreatment, and mediated the relationship of emotional maltreatment with FoB. The only direct effects of childhood emotional maltreatment on FoB were for fears of medical interventions and feelings of embarrassment during labour and delivery.

LIMITATIONS

Study findings fill significant gaps in our understanding of the relationship between maltreatment, mental health symptoms and FoB. However, the study sample was limited to Canadian participants, most of whom were socio-economically advantaged, cis-gender women of European descent, thus limiting the generalizability of the findings. Further, as childhood maltreatment and sexual assault experiences in adulthood were reported retrospectively, study findings are also vulnerable to recall bias.

CONCLUSIONS

Findings contribute to our understanding of the relationship between childhood maltreatment, adult sexual victimization, mental health and FoB. These findings can facilitate future research and improved care via a focus on depressed mood, symptoms of PTSD, emotional maltreatment and specific fears of medical interventions and social discomfort as significant contributors to one's experience of FoB.

Pre- and postpartum fear of childbirth and its predictors among rural women in China

BACKGROUND

Fear of childbirth (FOC) can influence both maternal and child health. Research on FOC in China is scarce, especially on rural women. This study aimed to assess pre- and postpartum FOC and its predictors among Chinese rural women.

METHODS

This was a prospective correlation study. A total of 569 women completed the prenatal questionnaire in the third trimester, and 477 of them completed the postpartum questionnaire within three days after childbirth. Maternal socio-demographic information, clinical information, childbirth self-efficacy and prenatal and postpartum FOC were investigated. FOC was evaluated using the Wijma Childbirth Expectancy/ Experience Questionnaire (WDEQ). Descriptive, bivariate, multivariate linear regression analysis, univariate and multivariate logistic regression analyses were performed.

RESULTS

The mean pre- and postpartum FOC scores were 64.5 (standard deviation: 25.1) and 64.3 (standard deviation: 23.9), respectively, with 20.8% of women reporting severe fear before childbirth and 18.2% after childbirth. Multivariate linear regression analysis revealed predictors for higher levels of prenatal FOC including higher education level, nullipara, higher monthly household income, lower family support, and lower childbirth self-efficacy (p < 0.05) and the predictors for higher levels of postpartum FOC included unemployed status, lower childbirth self-efficacy, and higher prenatal FOC (p < 0.05). Multivariate logistic regression showed that higher childbirth self-efficacy reduced the likelihood of severe prenatal FOC (OR: 0.99, p < 0.001), while severe prenatal FOC increased the likelihood of severe postpartum FOC (OR: 3.57, p < 0.001).

CONCLUSION

The rural women have high levels of FOC before and after childbirth, with approximately 20% experiencing severe FOC during both periods. Higher education level, nullipara, higher monthly household income, lower family support, and lower childbirth self-efficacy are predictors of heightened prenatal FOC. Unemployed status, lower childbirth self-efficacy, and higher prenatal FOC are predictors of heightened postpartum FOC. Notably, enhancing childbirth self-efficacy emerges as crucial in mitigating severe prenatal FOC, while severe prenatal FOC significantly increases the likelihood of severe postpartum FOC. The development of targeted intervention strategies for the above factors can help reduce women's FOC level and improve their overall pregnancy and childbirth experience.

The experience of bearing a child: implications on body boundaries and their link to preterm birth

BACKGROUND

Preterm birth, which occurs when a baby is born before 37 weeks, has enormous implications for public health. It is the leading cause of infant death and mortality in children under the age of five. Unfortunately, the multifaceted causes of preterm birth are not fully understood. One construct that has received increasing attention in women's transition to motherhood is body boundaries, i.e., the metaphorical barriers that separate the self from the outer, surrounding "not self." This study aims to examine the role of well-defined and disturbed body boundaries in predicting preterm birth.

METHODS

A sample of 655 Israeli pregnant women reported their sense of body boundaries (BBS, as measured by the Sense of Body Boundaries Survey) pre- and postnatally. We performed a General Linear Model (GLM) testing the effect of the BBS total score on the days women delivered before their due date and controlling for whether it was the women's first child.

RESULTS

Our GLMs controlling for whether it was the women's first child showed that the BBS total mean exhibited a significant predictive effect on the number of days delivered before the due date (F(57,313) = 3.65, p < .001).

CONCLUSIONS

These results demonstrate heterogeneity in women's sense of body boundaries during pregnancy and are the first to disentangle a link between disturbed body boundaries and preterm birth. Mediating mechanisms in this relation, e.g., psychosocial stress, as well as clinical implications are discussed in detail.

Sense of mastery among older adults and its relation to invalidating childhood experiences

ObjectivesSense of mastery, a well-recognized resource for older adults, has been shown to be related to early life experiences, especially parent-child interactions. Yet while there are indications that a reduced sense of mastery is related to early experiences of child maltreatment, this association has not been studied among older adults. The aim of this study was to examine the relation between experiences of childhood parental invalidation and sense of mastery among older adults, through the mediation of self-objectification and perceived disrupted body boundaries.Methods: Three-hundred-and-sixteen older adults (Mean = 72.24; SD = 8.12 years; range: 60-94) filled out a battery of questionnaires assessing their levels of exposure to childhood parental invalidation experiences, sense of self-objectification, disrupted body boundaries, and sense of masteryResults: A structural equation modeling (SEM) analysis supported the hypothesized research model. More specifically, two significant indirect effects were observed, according to which the association between invalidating childhood experiences and sense of mastery was mediated by both self-objectification and by disrupted body boundaries.Conclusion: As these results suggest that early life experiences continue to affect individuals' sense of self in older age, they should be considered an important factor for evaluation and intervention.

Is Childhood Maltreatment Associated with Body Image Disturbances in Adulthood? A Systematic Review and Meta-Analysis

PURPOSE

We aimed to synthesize the evidence for an association between childhood maltreatment and body image disturbances in adulthood. Information on maltreatment subtypes and mediator variables was included to gain further insights into the mechanisms of the association. In addition, we aimed to examine the role of body image disturbances in the development of negative mental health outcomes associated with childhood maltreatment.

METHODS

Based on a comprehensive search strategy, eligible studies were identified in PubMed, Scopus, and Web of Science. The eligibility assessment was performed by two reviewers, and 132 articles were studied full-text. To reduce heterogeneity, only non-clinical samples were included in the meta-analysis. A meta-regression was computed to examine the influence of maltreatment subtype on body image disturbances.

RESULTS

Our results provide evidence for a robust association between childhood maltreatment and cognitive-affective body image, both in clinical and community samples. Included studies (N = 40) indicate that body image disturbances are especially pronounced in individuals suffering from Posttraumatic Stress Disorder (PTSD) after childhood maltreatment. The meta-analysis included 12 studies with a total of 15.481 participants, and indicates a small overall effect size (r = 0.21, 95% CI = [0.16, 0.26], p < .001). Meta-regression revealed no significant impact of maltreatment subtype in non-clinical samples.

CONCLUSION

Childhood maltreatment should be considered as a distal risk factor for the development of a negative cognitive-affective body image. We argue for future longitudinal studies which allow a better understanding of the pathways linking childhood maltreatment, body image disturbances and associated psychopathology.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40653-021-00379-5.