Childbirth fear in expectant fathers: Findings from a regional Swedish cohort study

Factors influencing childbirth fear among Asian women: a scoping review

Fear of childbirth (FOC) or tokophobia adversely affects women during pregnancy, delivery, and postpartum. Childbirth fear may differ across regions and cultures. We aimed to identify factors influencing the fear of childbirth among the Asian population. A systematic literature search was performed using the PubMed, Scopus, and Web of Science databases in November 2023. Original articles in English with research conducted in Asian countries were included. The independent factors associated with childbirth fear, from the relevant studies were identified and discussed. Forty-six papers met the eligibility criteria but only 26 studies were discussed in this review. The significant factors were categorized into (1) demographics, (2) clinical, (3) healthcare service, (4) childbirth education & information, and (5) COVID-19 pandemic. The prevalence of childbirth fear among Asians ranged between 56.6 and 84.8%. Significant demographic factors included age, education, marital status, economic status, and area of residence. Greater levels of tokophobia were linked to nulliparity, unplanned pregnancy, infertility, miscarriage, and pregnancies at risk. Effective doctor-patient communication and more frequent antenatal visits were shown to alleviate maternal childbirth fear. There was consistent evidence of prenatal childbirth education's benefit in reducing FOC. The usage of smartphone apps and prolonged exposure to electronic devices were linked to a higher degree of tokophobia. Nulliparas who received too much pregnancy-related information also reported increased childbirth fear. There was a positive correlation between maternal fear of COVID-19 infection and FOC. Keeping updated with COVID-19 information increased the maternal childbirth fear by two-fold. In conclusion, a stable economy and relationship contribute to lesser childbirth fear among Asian women. Poor maternal health and pregnancy complications were positive predictors of FOC. Health practitioners may reduce maternal childbirth through women's education, clear communication as well as accurate information and guidance to expectant mothers. Further study is required into the content of childbirth fear among Asian women. These research findings hopefully will lead to the development of culturally adapted screening tools and interventions that reduce the burden of FOC among expectant mothers.

Psychometric properties of the Wijma Delivery Expectancy/Experience Questionnaire version A among Chinese expectant fathers

BACKGROUND

Evidence on the mental status of expectant fathers indicates that their fears of childbirth (FOC) are of great concern. In consideration of expectant fathers' increasing involvement during pregnancy and childbirth, it is necessary to provide a reliable instrument to measure the psychometric properties of expectant fathers. The purpose of this study was to revise the Wijma Delivery Expectancy/Experience Questionnaire version A (W-DEQ A) for expectant fathers, analyze the psychometric properties and explore its applicability to the Chinese population.

METHODS

The W-DEQ A was revised to apply to Chinese men following the completion of a cross-sectional study. Content validity was assessed by an expert panel of specialists in obstetrics. Construct validity was assessed using exploratory factor analysis and confirmatory factor analysis. Reliability was assessed by the internal consistency coefficient and retest reliability.

RESULTS

A total of 741 expectant fathers participated in this study. The item-level content validity index (I-CVI) was greater than 0.8, while the scale-level CVI (S-CVI) was 0.92, indicating satisfactory content validity. Exploratory factor analysis revealed eight factors, accounting for 60.97% of the cumulative variance. Confirmatory factor analysis revealed acceptable structural validity of the father's version of the W-DEQ A (W-DEQ AF), demonstrating a good model fit. The Cronbach's alpha for the W-DEQ AF was 0.843, indicating good reliability of the scale.

CONCLUSIONS

The Chinese version of the W-DEQ-AF is reliable and could be considered for use with expectant fathers in China to assess their psychological status and fear of childbirth during pregnancy of their spouse.

Assessing primary Tokophobia among Lebanese childless men and nulliparous women: psychometric validation of the Arabic versions of the fathers' fear of childbirth scale and Tokophobia severity scale

INTRODUCTION

Tokophobia is an intense and pathological fear of pregnancy and childbirth. Despite its significance, no research in Lebanon has investigated primary tokophobia within the general population. Nevertheless, it is crucial to assess the attitudes of both women and men, as potential future parents, towards pregnancy and childbirth, particularly during these challenging times for the Lebanese population. Therefore, this study aims to evaluate the psychometric properties of the Tokophobia Severity Scale (TSS) and Fathers' Fear of Childbirth Scale (FFCS) for assessing primary tokophobia among Lebanese nulliparous women and childless men, respectively.

METHODS

This cross-sectional investigation encompassed all Lebanese governorates; 651 women and 618 men were recruited via social media platforms, using a snowball sampling technique. The questionnaire included the Tokophobia Severity Scale, the Fathers' Fear of Childbirth Scale, the Patient Health Questionnaire, and the Lebanese Anxiety Scale.

RESULTS

Factorial analysis of the TSS in women revealed a three-factor model: concerns related to personal complications (Factor 1), fetal well-being (Factor 2), and outward behavioral responses to fear (Factor 3). The FFCS also yielded a three-factor measurement model: emotional responses during the partner's childbirth (Factor 1), concerns regarding the hospital environment during childbirth (Factor 2), and anxieties surrounding the perinatal health of both the partner and child (Factor 3). Both scales were internally consistent with Cronbach's alpha > 0.9, indicating their reliability. The TSS and FFCS demonstrated statistically significant correlations with measures of anxiety and depression, thus attesting to convergent validity.

CONCLUSION

The results of this study provide evidence for the psychometric validity and reliability of the TSS and FFCS scales in Arabic-speaking populations. Given the previously overlooked nature of primary tokophobia in these populations, the availability of these validated instruments can significantly enhance the ability to detect and address this condition, ultimately facilitating the provision of necessary support services.

Relationship between dyadic coping, resilience and fear of childbirth in expectant couples: An actor-partner interdependence model approach

BACKGROUND

Fear of childbirth is a common concern in pregnant women and their spouses due to the unpredictability of the process and outcome of a delivery, which results in adverse effects on mental health, birth outcomes and family intimacy. However, there is a lack of studies that explore the influencing factors of fear of childbirth among expectant couples from a dyadic perspective. The aim of this study is to explore the correlation of dyadic coping, resilience and fear of childbirth in pregnant couples and to construct an actor-partner interdependence model to verify dyadic effects.

METHODS

This cross-sectional survey included 420 couples and was conducted between November 2022 and March 2023 in the obstetric department at two hospitals in China. Convenience sampling and an actor-partner interdependence model was used.

FINDINGS

The prevalence of fear of childbirth among pregnant women and their spouses is 37.4 % and 33.1 %, respectively. Women's resilience and dyadic coping had a partner effect on spouses' fear of childbirth, in addition to an actor effect on their own fear of childbirth. Spouses' resilience and dyadic coping had only actor effects on themselves, and no partner effect was found on the pregnant women.

CONCLUSION

Women's fear of childbirth was positively associated with spouses' fear of childbirth. Interventions for fear of childbirth should include improving resilience and enhancing dyadic stress support and coping. This study provides empirical evidence for future clinical research and interventions on the psychological status of pregnant women and their partners during pregnancy.

Fear of childbirth and influencing factors of expectant fathers in China: a cross-sectional study

Fear of childbirth not only brings negative psychological experiences to expectant fathers and affect their ability to prepare for parenthood but can even affect children's emotional and cognitive development. It is essential to identify men with a more severe fear of birth and its related risk factors for the better transition of fathers' role. The objective of this study was to investigate the prevalence of fear of childbirth among Chinese expectant fathers, identify its contributing factors and explore the association among fear of childbirth, resilience and dyadic coping. A cross-sectional survey was conducted in the obstetric department of two tertiary hospitals in Wuhan, China. The socio-demographic questionnaire, the father's version of the Wijma Delivery Expectancy/Experience Questionnaire version A (W-DEQ A), the Connor-Davidson Resilience Scale-10 (CD-RISC), and the Dyadic Coping Inventory (DCI) were used to explore the correlation of fear of childbirth, resilience and dyadic coping of participants. Ultimately, a total of 1176 expectant fathers were included in this study. The prevalence of fear of childbirth was 32.1%. Gestational weeks of pregnant women, monthly income, adverse birth experience, gravidity and parity of pregnant women were considered risk factors for the expectant fathers with fear of childbirth. Furthermore, there was a weak negative correlation between fear of childbirth and resilience and dyadic coping. In conclusion, the prevalence of fear of childbirth in expectant fathers in China was high. Adequate identification of factors influencing the fear of childbirth among expectant fathers is necessary to reduce the fear of childbirth and to develop appropriate interventions in preparing fathers for their new parenting role.

Support Needs, Barriers, and Facilitators for Fathers With Fear of Childbirth in Sweden: A Mixed-Method Study

The aim of this mixed-method study was to identify support needs, as well as barriers and facilitators to seeking support in a sample of Swedish fathers with a fear of childbirth (FOC). Participants completed an anonymous quantitative online survey (N = 131), with three free-text items for those self-identifying as having an FOC (N = 71) and five individual in-depth interviews. Data analysis included descriptive and chi-square analyses for quantitative data, and manifest content analysis for qualitative data. Those with a severe FOC were more likely to report having on-going mental health difficulties (p = .039) and one fifth (21%) of the participants with severe FOC wanted to receive professional treatment, but only 8.1% received treatment. Most participants either preferred individual support or to receive support together with their partner. Fathers with severe FOC were more likely to report one or more barriers than those without FOC (p = .005), where unwanted social stigma was the single largest barrier. Qualitative findings identified one main category: Expectant fathers missing and wishing for support for FOC composed four generic categories: (1) support in developing an understanding of their fear, (2) coping by being aware of feelings, (3) professional support through trust and respect, and (4) needing individualized support. To encourage healthy fathers, clinical professionals should find ways to support fathers, such as by providing them with their own perinatal appointments, asking them about their feelings, as well as screening, diagnosing, and treating fathers with severe FOC.

The Fathers' Fear of Childbirth Scale: a Turkish validity and reliability study

PURPOSE

Fathers' Fear of Childbirth Scale (FFCS) was developed specifically to measure fathers' fear of childbirth. The aim of this study was to investigate the Turkish validity and reliability of the FFCS.

DESIGN

This study used a cross-sectional and methodological design.

METHODS

The population of the study consists of 315 pregnant spouses who were registered at a hospital in Ankara, Turkey, between August 11 and 5 November 2021. The mean age of expectant fathers are 31.57 (5.88). After translating the FFCS to Turkish, a confirmatory factor analysis was conducted to examine its construct validity. Concurrent validity was established by examining the correlation between the FFCS-Turkish with the Fear of Birth Scale (FOBS) and the male version of the Childbirth Fear-Prior to Pregnancy scale (M-CFPP). Both internal consistency and test-retest reliability were examined for the FFCS-Turkish. Results: The scope validity index of the scale was found to be 0.96. Based on the results of confirmatory factor analysis, a two-factor structure with 17 items was verified. The fit indices were found to be χ2 = 309.610, χ2/df = 2.76, root mean square error = 0.075, goodness of fit index = 0.89, comparative fit index = 0.93, and adjusted goodness of fit index = 0.86. All fit indices were at good levels. A strong correlation was found between the FFCS and the FOBS and M-CFPP scales within the scope of concurrent validity. Cronbach's alpha reliability coefficient for the entire scale was 0.93. The test-retest reliability was also high.

CONCLUSIONS

The FFCS is a valid and reliable scale and measurement tool that can be used on Turkish expectant fathers.

Childbirth as a traumatic event for attendant fathers

Background: Negative reactions such as post-traumatic stress disorder (PTSD) following childbirth have been increasingly reported in mothers, particularly following objectively and subjectively difficult childbirth experiences. A small body of research has examined fathers' reactions to childbirth, with mixed results.Objective: The study aimed to further these studies, investigating whether objective and subjective aspects of fathers' participation in childbirth were related to levels of PTSD and fear of childbirth symptoms, in the first year following childbirth.Method: In total, 224 fathers whose partners had given birth within the previous 12 months answered online questionnaires that examined participation in childbirth, subjective appraisals, levels of fear of childbirth, and PTSD symptoms. Data were analysed using structural equation modelling, examining both direct and indirect effects.Results: Approximately 6% of fathers reported symptoms consistent with probable PTSD. Negative cognitions mediated the path between an emergency caesarean and PTSD. Fear of childbirth was related to emergency caesareans and lack of information from the medical team.Conclusions: Future studies should examine the level of fathers' participation, their subjective appraisal of childbirth, and fear of childbirth, when assessing fathers' reactions to childbirth.

Development and psychometric evaluation of the questionnaire on the contributing factors of tendency towards voluntary single-childedness and childlessness: a mixed method study

Couples' tendency towards voluntary single-childedness and childlessness (VSCC) has turned into a major challenge in all societies and led to different problems such as population aging. A key step to VSCC management is to determine its contributing factors through valid and reliable instruments. This exploratory sequential mixed method study (qualitative-quantitative) was conducted in 2020-2021. Phases of qualitative consists of all couples aged 15-49 in Babol, Iran, who were single or childless. Sampling is based on the purpose, and the number of samples is 20 couples. To collect data, face-to-face and semi-structured interviews were conducted with the participants. Sampling continued until data saturation. The data were analyzed by the conventional content analysis method and quantitative phase. Initially, a qualitative study was conducted on twenty couples, and were analyzed through conventional content analysis. Findings were used to develop QFT-VSCC and then, the face, content, and construct validity as well as reliability were assessed. Construct validity was assessed through exploratory and confirmatory factor analyses and reliability was assessed through internal consistency and stability assessments. The results of the qualitative part analysis consist of 140 codes, 30 primary categories, and nine main categories and two themes (individual limitations and social limitations). The primary QFT-VSCC had 78 items. Fifty-eight items were omitted during validity assessment and the remaining twenty-two items were loaded on five factors during factor analysis. These factors were threatened priorities, inappropriate familial context for childbearing, sense of occupational and social insecurity for the child, social modeling of childlessness, and tendency towards change or stability in marital life. The five factors explained 52.56% of the total variance. All model fit indices in confirmatory factor analysis were acceptable and the Cronbach's alpha values of QFT-VSCC and all its factors were more than 0.70. The results of convergent validity analysis revealed that all factors had an AVE value greater than 0.5, and the HTMT index for all factors was less than 0.85. This indicated that discriminant validity had been achieved. QFT-VSCC is a simple valid and reliable instrument for VSCC assessment among both men and women.

Discrepancy in parental fear of childbirth: A scoping review

BACKGROUND

Fear of childbirth is a prevalent clinical psychological issue for both mother and father; however, there is a lack of research comparing and summarizing discrepancies in parental fear of childbirth.

AIM

This study aimed to explore differences in parental fear of childbirth, identify gaps in related research area, and provide directions for future studies.

METHODS

Original references were searched from six databases by using subject terms associated with fear of childbirth. The guideline of the scoping review framework proposed by Arksey and O' Malley were applied.

RESULTS

The review covered 203 publications in all. Of them, 181 were maternal studies and 22 were paternal studies. 105 articles examined prevalence and influencing factors ranging from 0.7 % to 89.3 % in mothers and 5 % to 54.3 % in fathers. The current study included 84 influencing factors, 9 of which were common to parents and 75 of which were different, containing fathers' specific influences on fear of childbirth are perceived pregnancy difficulties, perceived birth difficulties, feelings about the upcoming birth, more frequent thoughts of birth in the middle of pregnancy and not attending parent education classes. 12 articles dealt with the experience of fear of childbirth, and the parents' fear of childbirth had 5 common themes, including fear of the birthing process, fear related to the baby, fear of lack of support, fear of postnatal health and life, and adverse psychological problems. But they have different sub-themes. 61 articles on fear of childbirth interventions, including 8 mother-specific approaches and 4 identical approaches for parents, and all of these methods were effective in reducing the prevalence of parental fear of childbirth.

CONCLUSION

Factors such as marital status, personality, etc., that are specific to mothers can also be applied to paternal fear of childbirth. Cognitive-behavioral therapy and group discussion, which are unique to maternal fear of childbirth, may be attempted for paternal fear of childbirth. In addition, future research should be devoted to developing a specific measurement tool for fathers, studying paternal fear of childbirth in depth from various aspects.

Fathers attending the birth of their baby: Views, intentions and needs

BACKGROUND

There is limited information about fathers' views, intentions and needs leading up to childbirth.

AIMS

This study explores the factors influencing fathers' intention to attend the birth, and the needs and supports required leading up to childbirth.

METHODS

Cross-sectional survey of 203 prospective fathers attending antenatal appointments at an outer metropolitan public teaching hospital in Brisbane, Australia.

RESULTS

A total of 201/203 (99.0%) participants intended to attend the birth. The reported reasons included: responsibility (99.5%), protectiveness (99.0%), love for their partner (99.0%), the right thing to do (98.0%), desire to see the birth (98.0%), the perception that partners should attend (97.4%), duty (96.4%) and partner preference (91.4%). Some felt pressured by their partner (12.8%), society (10.8%), cultural expectations (9.6%) and family (9.1%), and 10.6% perceived adverse consequences for not attending. Most participants (94.6%) felt well supported, experienced good communication (72.4%), had the opportunity to ask questions (69.8%) and received an explanation of events (66.3%). They were less often supported by antenatal visits (46.7%) and by a plan for future visits (32.2%). Ten per cent of all fathers and 13.8% of experienced fathers requested better mental health support, and 9.0% prefer better clinician communication.

CONCLUSIONS

Most fathers intend to attend childbirth for personal and moral reasons; however, a small proportion feel pressured. Most fathers feel well supported, although potential improvements include planning for future visits, provision of information, mental health support, clinician communication, increased involvement in their partner's care, the opportunity to ask questions and more frequent clinic visits.

A structural equation model analysis of the relationship between expectant fathers' fear of COVID-19 and their fear of childbirth: The mediating role of maternal fear of childbirth

BACKGROUND

Pregnancy and childbirth may provoke various emotional responses in expectant fathers including excessive fear of childbirth. It is not unreasonable to assume that fear of contracting the virus during the COVID-19 pandemic, may have intensified fathers' fear of childbirth. This study aims to determine the mediating role of the expectant mothers' fear of childbirth in the relationship between expectant fathers' fear of COVID-19 and their fear of childbirth.

METHODS

This cross-sectional study was conducted on 270 pregnant women and their spouses attending health centers from Aug 2021 to April 2022. Fathers' fear of childbirth scale (FFCS), Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ-A), and Fear of COVID-19 Scale (FCV-19S) were used to collect data. To examine the relationships between variables and to develop the final model, we used the structural equation model (SEM).

RESULTS

The prevalence of severe fear of childbirth in fathers and their female spouses were 40.9% and 22.4%, respectively. The mean score and standard deviation of fear of childbirth in the fathers and their female spouses were 49.2 ± 17.1 and 62.5 ± 29.4, respectively. Results showed that fathers' fear of COVID-19 was directly (B = 0.44, p = 0.004) and indirectly (B = 0.13, p = 0.015) associated with fathers' fear of childbirth. Also, women's fear of childbirth was positively associated with fathers' fear of childbirth (B = 0.45, p = 0.030). In the final model, the values of χ2/df, CFI, PCFI, RMSEA, and SRMR were equal to 2.32, 0.94, 0.76, 0.07, and 0.06, respectively.

CONCLUSIONS

We found a high prevalence of severe fear of childbirth in Iranian expectant fathers which means that fathers' fear of childbirth is a national health concern that needs to be addressed. The findings of the present study indicate that mothers' fear of childbirth has a mediating role in the relationship between fathers' fear of COVID and fear of childbirth. Therefore, to alleviate fathers' fear of childbirth, interventions to reduce fathers' fear of COVID-19 and women's fear of childbirth should be developed and implemented. The impact of fathers' mental health on the fear of childbirth in expectant couples should be further investigated.

Fathers' Educational Needs Assessment in Relation to Their Participation in Perinatal Care: A Systematic Review

Even though they are crucial for a positive pregnancy experience, many fathers may not be aware of the significance of their role in perinatal care. As it is important to identify the needs of the target population in the initial phases of a health plan in order to ensure success, the current systematic review is the first one to address the reported needs for men's antenatal education.

METHODS

All studies written in English and published between 1997 and 2021 relevant to the theme were included in the review. The electronic databases of various mainstream journals were used to evaluate 87 studies.

RESULTS

In total, the validity of 17 studies was determined based on their compliance with the inclusion criteria. According to the review, men's participation in antenatal education can significantly influence pregnancy, childbirth, parenting, couple's relationship, and overall family functioning.

CONCLUSION

Providing face-to-face antenatal education to men by doctors or midwives is emphasized as an important component of perinatal care preparation because it leads to positive outcomes.

Psychometric properties of the Chinese version of the fathers' fear of childbirth scale: A cross-sectional study

BACKGROUND AND AIM

Fear of childbirth (FOC) is one of the most common mental health concerns among expectant fathers, which can cause adverse consequences for themselves and their families. A valid and accurate tool is the key to the identification of FOC. This study aimed to translate and culturally adapt the fathers' fear of childbirth scale (FFCS) into simplified Chinese and test the scale's psychometric properties among expectant fathers in mainland China.

METHODS

Researchers obtained translation permission and followed the multiphase translation guidelines to develop the Chinese version of the fathers' fear of childbirth scale (C-FFCS). Relevant psychometric properties were selected for the scale's psychometric validation on the basis of the Consensus-based Standards for the Selection of Health Status Measurement Instruments checklist. In this cross-sectional study, two samples of expectant fathers were collected in a university-affiliated hospital in Hangzhou between September and October 2022.

RESULTS

A total of 381 expectant fathers completed the C-FFCS, resulting in an effective response rate of 95.6%. The C-FFCS is a 3-factor structure consisting of 16 items, which explained 66.374% of the total variance. The content validity index of items ranged from 0.833 to 1.00, and the scale-level content validity index was 0.931. The confirmatory factor analysis confirmed the scale's 3-factor structure. Evidence of convergent validity (average variance extracted = 0.508-0.780) as well as discriminant validity offered excellent psychometric support. The Cronbach's α coefficient, McDonald's ω coefficient, intraclass correlation coefficient, Spearman-Brown coefficient, and Guttman split-half coefficient are within the satisfactory range (> 0.80). Significant correlations between the scores of the C-FFCS and Childbirth Attitude Questionnaire (r = 0.658, p < 0.01) and Fear of Birth Scale (r = 0.555, p < 0.01) both revealed good concurrent validity. The structure of C-FFCS was invariant across different parity groups, with no floor and ceiling effect.

CONCLUSION

The C-FFCS was demonstrated to be a sound instrument with good reliability and validity for measuring Chinese expectant fathers' FOC levels. However, further studies are advocated to verify the C-FFCS among a larger sample that is more representative of the Chinese expectant father population.

A structural equation model analysis of the relationship between maternal fear of childbirth and expectant fathers' fear of childbirth: The mediating role of fathers' depression, anxiety, and stress

INTRODUCTION

Some fathers experience traumatic and unpleasant feelings such as fear of childbirth during pregnancy and childbirth. This study aimed to determine the mediating role of the expectant fathers' depression, anxiety, and stress in the relationship between maternal fear of childbirth and paternal fear of childbirth.

METHODS

In this cross-sectional study, using a two-stage sampling method, 502 expectant Iranian fathers and their wives in the second half of pregnancy were recruited. The participants completed self-administered questionnaires, including the fathers' fear of childbirth scale, the Wijma delivery expectancy/experience questionnaire, and the depression, anxiety, and stress scale-21. To analyze the data, structural equation modeling was employed in the Amos software version 24.

RESULTS

Results indicated an acceptable fit of the model to the data. Maternal fear of childbirth was associated with paternal fear of childbirth, directly (β = 0.23, p = .046) and indirectly through the mediator of paternal depression, anxiety, and stress (β = .17, p = .007). The expectant fathers' stress had a greater impact on their fear of childbirth.

CONCLUSIONS

By considering the role of maternal fear of childbirth as well as expectant fathers' depression, anxiety, and stress on paternal fear of childbirth, it seems this study has some practical implications for improving the fathers' psychological well-being.

The effect of midwifery-led counseling on expectant fathers' fear of childbirth: a smartphone- based randomized controlled trial

BACKGROUND

Expectant fathers experience a range of different emotions during their wife's pregnancy; one of these feelings is fear. It has adverse consequences on both the father and his family. The aim of this study was to investigate the effect of midwifery-led counseling on the fear of childbirth among expectant fathers.

METHODS

A two-armed parallel design randomized controlled trial was conducted from July to August 2020. Fifty expectant fathers with severe fear of childbirth at the 24th-27th weeks of gestation, in the Iranian setting, were assigned to intervention and control groups (allocation ratio1:1) using permuted block randomization. Participants assigned to the intervention group were engaged in six 60-90-min midwifery-led counseling sessions (twice a week) in the Skyroom platform. Measures were administered at recruitment, post-intervention, and one-month follow-up. The primary outcome was the change in fear of childbirth score between groups over time. Secondary outcomes were changes in the General Self-Efficacy score as well as changes in the frequency of the preferred type of delivery between groups over time.

RESULTS

The mean age of the participants was 31.64 (3.33) years. In the intention-to-treat analysis, the fear of childbirth score in the intervention group significantly decreased (β = - 11.84; 95% Confidence Interval: - 21.90 to - 1.78; P = 0.021) compared to that of the control group. In terms of secondary outcomes, the intervention group showed a significant increase in General Self-Efficacy compared to the intervention group at one-month follow-up measurement (β = 1.43; 95% Confidence Interval: 0.28 to 2.58; P = 0.014). However, the frequency of preferred delivery type was not significantly different between the intervention and control groups (P = 0.139).

CONCLUSIONS

Midwifery-led counseling can be an effective approach in reducing expectant fathers' childbirth fear with potential clinical significance. Although the inconclusive results imply more research on this issue.

TRIAL REGISTRATION

Registration number: IRCT20150608022609N6 . Registered 12/04/2019.

A dreaded delight: A longitudinal qualitative interview study of paternal childbirth fear during the transition to fatherhood

INTRODUCTION

Childbirth is a life-changing event where fathers desire being involved. As fathers take a more active role, fear of childbirth can arise. The aim of this study was to explore fathers' experiences of childbirth fear during pregnancy and after the birth of their baby.

METHODS

This was a qualitative longitudinal prospective study that included 14 interviews with seven fathers, one during the prenatal period, and one follow-up interview after childbirth. Data were analyzed using thematic analysis according to Braun and Clark.

RESULTS

The main theme 'Being vulnerable during the transition to fatherhood' was based on the perception of childbirth as risky with threats toward the woman's and baby's health, not being able to give and receive enough support, unable to handle the unknown process of birth, and not being a good father. Helpful strategies for coping with fear were to talk about fear, to learn more about childbirth and techniques on how to handle fear, and to avoid dealing with fear. Fathers' fear of childbirth changed after the birth of their baby. Their thoughts of another childbirth did not evoke the same strong feelings of fear. Issues important for the reduction of childbirth fear were: receiving professional support, actively taking part in the childbirth process, and the partner having an uncomplicated birth.

CONCLUSIONS

Fathers with childbirth fear regarded childbirth as risky, but they expressed helpful coping strategies. After the birth of their baby, they became less fearful. Quality of fear-reducing support to expectant fathers may influence how they cope with their transition into fatherhood.

A systematic review of clinical trials affecting anxiety, stress and fear of childbirth in expectant fathers

AIM

To investigate clinical trials affecting anxiety, stress and fear of childbirth in fathers.

DESIGN

A systematic literature search was conducted based on Cochrane Collaboration statement recommendation and Preferred Reporting Items for Systematic reviews and Meta-Analyses checklist.

METHODS

With assistance of Medical Subject Headings, keywords were employed to search for relevant trials. Articles published between November 2000-November 2019 were searched in five electronic databases including PubMed, Web of Science, Google Scholar, Scopus and Cochrane as well as Iranian databases. The risk of bias was assessed by Cochrane Risk of Bias Scale.

RESULTS

A total of eight studies met the inclusion criteria. Interventions were classified into four categories including pre-natal education, music therapy, massage therapy and relaxation training. The results showed that there is no evidence of a best intervention, but it showed that non-pharmacological interventions can decrease anxiety, stress and fear of childbirth and increase the positive experience of childbirth in the expectant fathers.

Women's experiences of interventions for fear of childbirth in the perinatal period: A meta-synthesis of qualitative research evidence

ISSUE

Fear of childbirth (FOC) can be debilitating, impacting women's lives in pregnancy, the puerperium and beyond. Research investigated various interventions for FOC in the perinatal period, but there been no synthesis of the experiences of women who engaged with these interventions, which would inform clinical practice guidance and the development of future interventions.

AIM

To conduct a review and synthesis of qualitative studies of interventions for fear of childbirth in the perinatal period and women's experiences of them.

METHODS

A meta-synthesis was performed to examine all relevant qualitative studies describing women's experiences of interventions for FOC, in all languages. A comprehensive search of relevant databases from 1978 to 2019 was conducted. In total, following appraisal, seven qualitative studies were eligible for inclusion. The findings were integrated using thematic synthesis for the final stages in the thematic analysis.

FINDINGS

One overarching theme "Ownership of Childbirth" and three analytical themes "Facing the fear", "Feeling empowered", "Managing the fear with a sense of security" were generated through the synthesis. There were no studies outside of Scandinavia located.

DISCUSSION

This meta-synthesis provides a new way to describe the process of moving from fear to "Ownership of childbirth". The first step in the process appears to be acknowledging and identifying the individual's fears. Women can be empowered to self-manage FOC but may be influenced by external factors such as the support of partners and staff.

CONCLUSION

These findings provide evidence to inform the development of future interventions for FOC and highlight the need for further qualitative research globally.

Design and psychometric evaluation of the fathers' fear of childbirth scale: a mixed method study

Background

Fear of childbirth is reported in 13% of fathers, and it may have adverse consequences for the fathers’ health as well as their families. To reduce the fear of childbirth in the expectant fathers, an appropriate screening tool is needed. Due to the lack of a valid and reliable questionnaire to measure fathers’ fear of childbirth, this study was conducted to develop the Fathers’ Fear of Childbirth Scale and evaluate its psychometric properties.

Methods

This mixed method study was conducted in two phases. In the qualitative phase (or item generation), semi-structured interviews were conducted with 20 expectant fathers, and a literature review was performed to generate the Fathers’ Fear of Childbirth Scale items pool. In the quantitative phase (or psychometric evaluation), reliability as well as face, content, and construct validity of this scale were evaluated. To establish construct validity, exploratory and confirmatory factor analyses were performed. Reliability was evaluated through internal consistency and composite reliability measures.

Results

The primary version of Fathers’ Fear of Childbirth Scale contained 32 items, which were reduced to 17 items while establishing construct validity. Exploratory factor analysis extracted two factors, namely fear of childbirth process (12 items) and fear of hospital (5 items). These factors explained 50.82% of the total variance. Goodness of fit indices within the confirmatory factor analysis was acceptable. Internal consistency and composite reliability indices of all the factors were greater than 0.70.

Conclusion

The Fathers’ Fear of Childbirth Scale has a suitable validity and reliability for assessing fear of childbirth in fathers. It is a simple report instrument that can be easily implemented by health care professionals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03696-7.

The Paternal Experience of Fear of Childbirth: An Integrative Review

BACKGROUND

It is estimated that approximately 13% of expectant fathers experience a pathological and debilitating fear of childbirth.

OBJECTIVE

The aim of this integrative review was to examine and synthesise the current body of research relating to paternal experience of fear of childbirth.

METHODS

A systematic literature search of five databases-CINAHL, Cochrane Library, MEDLINE, PsycArticles and PsycInfo-identified seventeen papers. Methodological quality of studies was assessed using the Crowe Critical Appraisal Tool.

RESULTS

Thematic data analysis identified three themes: the focus of fathers' childbirth-related fears, the impact of fear of childbirth on health and wellbeing, and fear of childbirth as a private burden.

DISCUSSION

Fear of childbirth is a significant and distressing experience for expectant fathers who may benefit from an opportunity to express their childbirth-related fears in an environment where they feel validated and supported. Antenatal education is recommended to enhance fathers' childbirth-related self-efficacy to reduce fear of childbirth.

CONCLUSIONS

Fear of childbirth may negatively impact the lives of men and consequently their families. Further investigation into methods and models for identifying and supporting men at risk of or experiencing fear of childbirth is required to improve outcomes for this population of men.

Tokophobia and fear of birth: a workshop consensus statement on current issues and recommendations for future research

Objective: To discuss and develop a statement on the current state of the evidence and opinion in Fear of Childbirth (FoC) and Tokophobia (Tocophobia), and to provide recommendations. Background: A group met in 2019 to discuss the state of clinical and academic knowledge relating to FoC/Tokophobia. Five key areas were agreed as the focus of the meeting. Methods: 12 internationally acknowledged experts, in this or a closely related area (e.g. PTSD) met to discuss their understanding of the evidence for FoC/ Tokophobia and current practice. The consensus described in this paper constitutes the expression of the general opinion of the participants and does not necessarily imply unanimity. Keys points: Work focussed on tokophobia is recent and there remains a wide range of issues, which were addressed in the workshop including complexity in defining prevalence, a theoretical lack of understanding, which creates challenge for robust assessment and the identification of risk factors. An improved aetiological and developmental understanding of the tokophobia is required to underpin appropriate, effective and evidence-based interventions. Evaluation of pathways of care and relevant interventions, should be a focus of future research. Conclusion: Significant gaps remain within the FoC/tokophobia knowledge base. Further research is necessary.

Cross-cultural adaptation and validation of the First-Time Fathers Questionnaire in China

OBJECTIVE

The study aimed to cross-culturally adapt and validate the First-Time Fathers Questionnaire (FTFQ) in the cultural context of China.

DESIGN

Prospective validation study.

SETTING

The study was conducted in four public hospitals in Hangzhou, a southeast coastal city of China.

PARTICIPANTS

Four hundred and nineteen first-time fathers (mean age=30.45 years, SD=3.44, range 22-46) whose partners had given birth between July 20 and October 10, 2019.

METHODS

The instrument "First Time Fathers Questionnaire (FTFQ)" was translated and culturally adapted to the Chinese context according to the methodological criteria of the International Society for Pharmacoeconomic and Outcomes Research. The construct-related validity of the instrument was tested through EFA and CFA. Content validity was evaluated with an analysis of the expert judgment. Reliability was assessed based on the internal consistency.

RESULTS

Four domains were identified: "Worry", "Information", "Emotional Support", and "Acceptance", with 19 items and adequate internal reliability (0.86, 0.80, 0.86, and 0.72, respectively) and a total variance of 64.65%. The CFA model showed there is a good fit for the data: X²/df =1.20; RMSA = 0.03; CFI = 0.99; and NFI = 0.93. Additionally, each item achieved an I-CVI ≧0.83, and the S-CVI/Ave = 0.90.

KEY CONCLUSIONS

The Chinese version of the FTFQ is a valid and reliable instrument to assess first-time fathers' experience of childbirth in China.

IMPLICATIONS FOR PRACTICE

This study provides a validated questionnaire that is suitable for the Chinese cultural context. It contributes to the knowledge of first-time fathers' experience of childbirth and facilitate further actions to improve paternal satisfaction and behavior as labour companion.

Transition to fatherhood in the prenatal period: a qualitative study

Becoming a father requires a process of personal development, inner reorientation, and adaptation to a new role. The literature on this process has been sparse, devaluing how challenging and problematic the transition to becoming a father can be. This qualitative, exploratory, descriptive, cross-sectional and retrospective study sought to understand the experiences of men in the transition to fatherhood during the prenatal period. It included a sample of 10 men experiencing, for the first time, a partner's pregnancy. The data collection technique used was semi-structured interviews. The content analysis technique with semantic categorization and an inductive approach was used to analyze the data. As a result, 3 topics emerged: "experiencing the transition," "development of the father identity" and "(de)constructing bridges for the transition". This study deepens the understanding of this developmental transition and challenges the restructuring of prenatal care towards the inclusion of the father figure.

Experiences, views and needs of first-time fathers in pregnancy-related care: a qualitative study in south-East Nigeria

Background

Given the relevance of paternal involvement in maternal care, there is a need to prepare first-time fathers to participate in pregnancy and childbirth actively. This study explores the experiences and needs of first-time fathers; and how these influences their involvement during pregnancy and childbirth in Nigeria.

Methods

A descriptive qualitative study was conducted. Semi-structured interviews with 50 men recruited from rural and urban workplaces, hospitals, and markets, generated data used to explore the experiences, views and needs of first-time fathers’ in pregnancy-related care in south-east Nigeria. All data were transcribed and analysed using thematic analysis.

Results

Six major themes were identified: gender roles, antenatal involvement, care costs and delivery choices, need to be informed, dealing with emotions, and dealing with the delivery day. The key finding reveals that inexperience and perceptions of gender roles greatly influenced the support provided by first-time fathers to their spouses and the support they received from their social support networks. Two primary needs were identified: need to be informed and the need to know about the cost of care in health settings. First-time fathers acknowledged the role of information on their decision making and final choices.

Conclusion

Findings reveal the influence of gender norms, beliefs, and social support on first-time fathers’ involvement in pregnancy and childbirth. This study also highlights the urgent need to provide informational support for first-time fathers and presents insights into what hospitals can do to achieve this need.

Partners of nulliparous women with severe fear of childbirth: A longitudinal study of psychological well-being

BACKGROUND

Little is known about the psychological status of partners of women with severe fear of childbirth (FOC). In this longitudinal study from Helsinki University Central Hospital, we investigated FOC, depression, and posttraumatic stress in the partners of women with severe FOC, and possible effects of group psychoeducation and mode of birth.

METHODS

During pregnancy, 250 partners of nulliparous women with severe FOC participated, 93 in the intervention group and 157 in the control group. At 3 months postpartum, 52 partners in the intervention group and 93 in the control group participated. Both the partners and the childbearing women filled in the Wijma Delivery Expectancy/Experience Questionnaire and the Edinburgh Postnatal Depression Scale mid-pregnancy as well as 3 months postpartum, when they also filled in the Traumatic Event Scale.

RESULTS

Partners of women with severe FOC reported less antenatal and postnatal FOC and fewer depressive symptoms than the childbearing women. No partner reached the threshold of severe FOC. No partner reported a possible posttraumatic stress disorder. Group psychoeducation with relaxation was not associated with better or worse psychological well-being of the partners. An emergency cesarean delivery was associated with a more fearful delivery experience in the partners.

CONCLUSION

Partners of nulliparous women with severe FOC neither seem to suffer from severe FOC nor reported posttraumatic stress symptoms after childbirth. They reported better psychological well-being than the mothers both during pregnancy and after delivery. An unexpected cesarean may be a negative experience even for partners of childbearing women.

Negative impressions of childbirth in a North-West England student population

BACKGROUND

Sociocultural childbirth representations can influence the perceptions of childbirth negatively. In this paper we report on a survey study to explore the factors associated with negative impressions of childbirth in a North-West England University student sample. We also explored whether different sources and perceptions of childbirth information were linked to fear of childbirth.

METHODS

All students received a survey link via an online messaging board and/or direct e-mail. Female students who were 18-40 years of age and childless (but planned to have children in the future) were invited to participate. Demographics, birth preferences, a fear of birth and general anxiety measures were included as well as questions about what sources of information shaped students' attitudes toward pregnancy and birth (i.e. visual/written media, experiences of friends/family members, school-based education and other) and impressions of birth from these sources (i.e. positive, negative, both positive and negative and not applicable).

RESULTS

Eligible students (n = 276) completed the online questionnaire. The majority were Caucasian (87%) with a mean age of 22.6 years. Ninety-two students (33.3%) reported negative childbirth impressions through direct or vicarious sources. Students with negative birth impressions were significantly more likely to report higher fear of birth scores. Negatively perceived birth stories of friends/family members, and mixed perceptions of visual media representations of birth were associated with higher fear of birth scores. Having witnessed a birth first-hand and describing the experience as amazing was linked to lower fear scores.

CONCLUSION

First-hand observations of birth, especially positive experiences, had implications for salutary outcomes. Negative or conflicting perceptions of vicarious experiences were associated with increased levels of childbirth fear. While further research is needed, these insights suggest a need for positive birth stories and messages to be disseminated to mitigate any negative effects of indirect accounts.

First-time fathers' perception of their childbirth experiences

Birth satisfaction impacts on a man's adjustment to his new role as father. Fathers have been found to have needs similar to those of mothers during pregnancy and childbirth. Research suggests that these needs may not be being met for first-time fathers. In a quantitative survey, fathers' birth satisfaction was similar to mothers. This study then used a phenomenological form of thematic analysis to gain an insight into the birth experiences of 155 first-time New Zealand fathers. Core themes included safety of mother and baby, understanding support role, mother in control and managing pain and care and communication after birth. Fathers commented on what impacted on their childbirth experiences and in so doing outlined their needs for a positive experience. Fathers experienced a high level of satisfaction along with a need to be involved and included.

Fathers' Worries During Pregnancy: A Qualitative Content Analysis of Reddit

Qualitative investigations into the emotional needs of expectant fathers have been limited by difficulties with recruitment. This study aimed to unobtrusively obtain insights into fathers' worries during pregnancy by analyzing the content of posts on the Internet forum Reddit. The majority of worries related to infant well-being (50.8%), particularly the potential for perinatal loss (23.0%). Concerns relating to partner well-being and the couple relationship were also common, comprising 17.0% of posts. Several posts related to individual factors, such as apprehension about the father role (16.3%). Finally, situational factors such as work-family conflict accounted for 15.9% of posts. These findings contribute to the growing literature on fathers' experiences of pregnancy and can inform the development of father-inclusive perinatal education.

What do expectant fathers expect of antenatal care in Sweden? A cross-sectional study

BACKGROUND

In Sweden expectant fathers are now assumed to be active participants in pregnancy and birth, but few studies have focused on fathers' expectations of antenatal care. Knowledge of expectant fathers' views about what is important in antenatal care will enable the design of care that is more inclusive and meets the expectant fathers' needs.

OBJECTIVES

To identify expectant fathers' expectations regarding the content of antenatal care during pregnancy and to examine associations between expectations and social factors.

METHODS

The current study uses data from a quasi-experimental trial that took place from 2009 to 2010, in which 627 expectant fathers were recruited from different parts of Sweden.

RESULTS

Checking the health of the baby (85.3%) and the mother (80.8%) were rated highest in importance by expectant fathers, whereas attending parent classes (14.9%), becoming acquainted with other expectant parents (7.0%) and paying attention to their own emotional well-being (6.9%) were rated lowest. Furthermore, less than half of the expectant fathers had a very high expectation of being treated in a way that made them feel involved (38.5%).First-time fathers, young fathers and fathers with very good emotional health had higher expectations about most aspects of antenatal care.

CONCLUSION

Expectant fathers had low expectations of receiving support or of meeting other parents as they thought that antenatal care should have a medical focus. First-time fathers, young fathers and fathers with very good emotional health had higher expectations of antenatal care in most areas.

Association between childbirth attitudes and fear on birth preferences of a future generation of Australian parents

BACKGROUND

The reality of childbirth fear is recognised for expectant parents but we lack knowledge about the childbirth attitudes of the next generation of Australian parents.

AIM

Examination of adults' attitudes toward childbirth including influencing contributing factors, fear scores, birth preferences and reasons for this preference.

METHODS

A cross-sectional online study was conducted with 654 Western Australian students attending one tertiary institution. Students (male and female) were eligible to participate if they were less than 40 years of age and did not currently have children but confirmed their intention to become parents. To assess associations or comparison of means, bi-variable analyses (Chi square test, Fisher's Exact test, Independent Student's t-test or one way ANOVA) were used. Factors associated with childbirth fear and birth preferences were assessed with binary logistic regression analysis.

FINDINGS

Childbirth attitudes were shaped by family members' (82.0%) and friends' experiences (64.4%) plus media (TV, YouTube, and movies) (63.5%). Furthermore, 15.6% of adults indicated a preference for a caesarean birth, even without obstetric complications. Likewise, 26.1% reported elevated fear; students with elevated fear scores had 2.6 times greater odds of wanting a caesarean birth. Only 23.4% of students felt confident about their childbirth knowledge.

CONCLUSION

Adults reported fear levels that warrant attention prior to a future pregnancy. Although the majority would choose a vaginal birth, they require awareness of benefits and risks for both vaginal and caesarean births to ensure their decisions reflect informed choice rather than influences of inadequate knowledge or fear.

Partners' perspective on care-system support before, during and after childbirth in relation to parenting roles

OBJECTIVES

To explore (i) ways in which partners experience support from care systems before, during, and after childbirth in relation to their parenting roles and (ii) ways in which support can improve.

METHODS

Four focus group interviews (n = 17; median age = 35; age range = 24-46) and inductive content analysis.

RESULTS

Analysis revealed the following three categories: (1) Care staff include or exclude in relation to partners' parenting role; (2) Care systems continuity; (3) Being a supportive partner. The latent content of the categories was formulated into a theme: being engaged and wanting to be included.

CONCLUSIONS

Because partners are engaged parents, who support the woman giving birth, they must feel included during pregnancy, birth, and postpartum care and during encounters within child health care units. This would require (i) information that directly targets partners before and after childbirth, (ii) specially adapted venues for parent education, and (iii) personal, partner-focused discussions with care staff.

A meta-ethnographic synthesis of fathers' experiences of complicated births that are potentially traumatic

INTRODUCTION

birth is a natural and for many, life enhancing phenomenon. In rare circumstances however birth can be accompanied with complications that may place the mother and infant at risk of severe trauma or death. Witnessing birth complications or obstetric emergencies can be distressing and potentially traumatic for the father.

AIM

the aim of this paper is to report on the findings of a meta-ethnographic synthesis of father's experiences of complicated births that are potentially traumatic.

METHODS

databases searched included CINAHL, Scopus, PubMed and PsycINFO with Full Text. The search was conducted in February and March 2013 and revised in February 2015 for any new papers, and the search was limited to papers published in English, full text and peer-reviewed journals published between January 2000 to December 2013.

INCLUSION CRITERIA

studies were included if they focused on fathers/men's experiences of witnessing a birth with complications including a caesarean section or an adverse obstetric event. Studies included needed to use qualitative or mixed methods research designs with a substantial qualitative component. ANALYTIC STRATEGY: a meta-ethnographic approach was used using methods of reciprocal translation guided by the work of Noblit and Hare (1988) on meta-ethnographic techniques. Quality appraisal was undertaken using the Critical Appraisal Skills Programme (CASP) tool.

FINDINGS

eight qualitative studies with a total of 100 participants were included in the final sample. The men ranged in age from 19 to 50 years.

SYNTHESIS

Four major themes were identified: 'the unfolding crisis', 'stripped of my role: powerless and helpless', 'craving information' and 'scarring the relationship'. Participants described the fear and anxiety they felt as well as having a sense of worthlessness and inadequacy. Men did not receive sufficient information about the unfolding events and subsequently this birth experience impacted on some men's interactions and relationships with their partners.

CONCLUSIONS

witnessing a complicated or unexpected adverse birth experience can be distressing for men and some may report symptoms of birth trauma. Being informed by and receiving support from midwives and other health professionals appears to help mitigate the negative impact of birth complications. Effective support may help address men's confusion about their role, however genuinely including men as recipients of care or service in pregnancy, labour and birth raises important questions about whether the father is also a recipient of maternity care and if the transition to fatherhood is itself becoming a medical event?

Nocebo and the potential harm of 'high risk' labelling: a scoping review

AIMS

A discussion of the existence, prevalence and characteristics of the nocebo effect in health care.

BACKGROUND

There is increasing but inconsistent evidence for nocebo effects (the opposite of placebo). Causal mechanisms are believed to be similar to placebo (negative effects result from suggestions of negative clinical outcomes). Risk screening in health care may produce this unintended effect through labelling some patients as high risk. Given health care's almost universal coverage this potentially affects many people.

DESIGN

Discussion paper following a scoping review of the existence and frequency of nocebo.

DATA SOURCES

Literature databases (PsycINFO, MEDLINE, CCTR, CINAHL and EMBASE) searched from inception dates to 2013.

IMPLICATIONS FOR NURSING

Significant empirical evidence indicates that negative beliefs may impact on health outcomes (incidence estimates range from 3-27%). The nocebo effect, rooted in the complex interplay between physiological functioning and social factors, appears significantly more common among women and where prior negative knowledge or expectations exist. Pre-existing psychological characteristics (anxiety, neuroses, panic disorder or pessimism) exacerbate it.

CONCLUSION

While the placebo effect is well documented, there has been no systematic attempt to synthesize primary empirical research on the role of nocebo. It is possible that nocebo outcomes may be preventable through careful consideration of information provision and the prior identification of potentially high risk individuals. This paper summarizes the scale and importance of the nocebo effect, its distribution according to a range of social and clinical variables and its known relation to psychological precursors. It identifies important gaps in the research literature.

Identifying women who are afraid of giving birth: A comparison of the fear of birth scale with the WDEQ-A in a large Australian cohort

BACKGROUND

The WDEQ-A is the most widely used measure of childbirth fear in pregnant women; however there is increasing discussion in the literature that simpler, more culturally transferrable tools may offer a better solution to identifying fearful women in clinical practice.

AIM

To compare the two item Fear of Birth Scale (FOBS) with the 33 item WDEQ-A in a large cohort of Australian pregnant women.

METHOD

Self-report questionnaires during second trimester including Wijma Delivery Expectancy Questionnaire (WDEQ-A) and Fear of Birth Scale (FOBS). Correlation of FOBS and WDEQ-A was tested using Spearman's correlation coefficients. Receiver operating characteristic (ROC) curve assessed the sensitivity and specificity of possible cut-points on the FOBS against WDEQ-A cut-point of ≥85. Sensitivity, specificity, positive and negative predictive values were determined. Fearful and non-fearful women as classified by both instruments were compared for differences in demographic, psycho-social and obstetric characteristics.

RESULTS

1410 women participated. The correlation between the instruments was strong (Spearman's Rho = 0.66, p < 0.001). The area under the ROC was 0.89 indicating high sensitivity with a FOBS cut-point of 54. Sensitivity was 89%, specificity 79% and Youden index 0.68. Positive predictive value was 85% and negative predictive value 79%. Both instruments identified high fear as significantly associated with first time mothers, previous emergency caesarean and women with self-reported anxiety and/or depression. Additionally FOBS identified a significant association between fearful women and preference for caesarean.

CONCLUSION

This study supports the use of the FOBS in clinical practice to identify childbirth fear in pregnant women.