Pre- and postpartum levels of childbirth fear and the relationship to birth outcomes in a cohort of Australian women

J Clin Nurs. 2009 Mar;18(5):667-77. doi: 10.1111/j.1365-2702.2008.02568.x.


Aim: To investigate pre- and postpartum levels of childbirth fear in a cohort of childbearing women and explore the relationship to birth outcomes.

Background: While results are mixed, there is evidence that fear of childbirth is associated with mode of birth. Limited theoretical work around childbirth fear has been undertaken with Australian women.

Design: A prospective correlation design. Method. Women (n = 401) completed the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) version A at 36 weeks gestation, with 243 (61%) women also completing version B at six weeks postpartum. Scores were summarised with means and standard deviations. Content analysis of the free statements identified nine issues of concern.

Results: Twenty-six per cent of pregnant women reported low levels of childbirth fear, 48% were moderately fearful and 26% were highly fearful. Fear decreased after birth for those women in the high antenatal fear group, however surgical intervention at birth (n = 238, anova, F(1,230) = 12.39, p = 0.001) and suspected fetal compromise (F(1,230) = 4.33, p = 0.039) increased levels of postpartum fear. Univariately, high antenatal fear was associated with emergency caesarean delivery (n = 324, Wald 5.05, p = 0.025) however after adjustment for nulliparity and fetal compromise the association disappeared. Australian-born women were more likely to report higher levels of fear and experience higher rates of caesarean section than participants of non-Australian origin.

Conclusions: Results support those from earlier studies in showing that nulliparous women experience more fear than parous women before birth and that there is no difference in levels of postpartum fear between these two groups. Fear levels were higher in Australian women when compared to a Swedish sample.

Relevance to clinical practice: The results of this study add to our preliminary understanding of the phenomena of childbirth fear within an Australian context and are particularly useful in profiling women for whom secondary fear of childbirth is more likely to occur.

MeSH terms

  • Adaptation, Psychological*
  • Adult
  • Cesarean Section / psychology
  • Cohort Studies
  • Confidence Intervals
  • Emergencies
  • Factor Analysis, Statistical
  • Fear*
  • Female
  • Humans
  • Multivariate Analysis
  • Neonatal Nursing / methods*
  • Odds Ratio
  • Parity
  • Parturition / psychology*
  • Postpartum Period / psychology*
  • Pregnancy
  • Pregnancy Outcome* / psychology
  • Prospective Studies
  • Qualitative Research
  • Surveys and Questionnaires
  • Western Australia
  • Young Adult