Women's fear of childbirth and preference for cesarean section--a cross-sectional study at various stages of pregnancy in Sweden

Acta Obstet Gynecol Scand. 2009;88(7):807-13. doi: 10.1080/00016340902998436.


Objective: To investigate Swedish women's level of antenatal fear of childbirth at various gestational ages, and factors associated with intense fear and with preference for cesarean section.

Design: A cross-sectional study.

Setting: All antenatal clinics in four geographical areas.

Sample: Thousand six hundred and thirty-five pregnant women at various gestational ages recruited during September-October 2006.

Method: A questionnaire completed at the antenatal clinic. The women reported their appraisal of the approaching delivery according to the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ).

Main outcome measures: The level of fear of childbirth and preferred mode of delivery.

Results: Mean W-DEQ score was 62.8. The prevalence of intense fear of childbirth (W-DEQ score > or =85) was 15.8% and very intense fear (tocophobia) (W-DEQ score > or =100) 5.7%. Nulliparous women had a higher mean score than parous women, but more parous women reported an intense fear. Preference for cesarean section was associated with fear of childbirth (OR 11.79, 6.1-22.59 for nulliparous and OR 8.32, 4.36-15.85 for parous women) and for parous women also with a previous cesarean section (OR 18.54, 9.55-35.97), or an instrumental vaginal delivery (OR 2.34, 1.02-5.34). The level of fear of childbirth was not associated with the gestational age.

Conclusions: When a woman requests a cesarean section, both primary fear of birth and traumatic childbirth experiences need to be considered and dealt with. The W-DEQ can be used at any time during pregnancy in order to identify pregnant women who suffer from intense fear of childbirth.

MeSH terms

  • Adult
  • Analysis of Variance
  • Cesarean Section / psychology*
  • Chi-Square Distribution
  • Cross-Sectional Studies
  • Fear*
  • Female
  • Gestational Age
  • Humans
  • Logistic Models
  • Patient Satisfaction
  • Pregnancy
  • Pregnancy Outcome
  • Prevalence
  • Risk Factors
  • Surveys and Questionnaires
  • Sweden / epidemiology