A Prospective Investigation of Prenatal Mood and Childbirth Perceptions in an Ethnically Diverse, Low-Income Sample

Birth. 2016 Jun;43(2):159-66. doi: 10.1111/birt.12221. Epub 2016 Mar 7.


Introduction: Few studies have examined prenatal mood as a means to identify women at risk for negative childbirth experiences. We explore associations between prenatal mood and birth perceptions in a socioeconomically diverse, American sample.

Methods: We conducted a prospective study of 136 predominantly low-income and ethnic minority women of mixed parity. Prenatal measures of perceived stress, pregnancy-related anxiety, and depressive symptoms were used to predict maternal perceptions of birth experiences 1 month postpartum, using the childbirth experience questionnaire (CEQ; 1).

Results: After adjusting for sociodemographic variables and mode of delivery, higher third-trimester stress predicted worse CEQ total scores. This association was predominantly explained by two CEQ domains: own capacity (e.g., feelings of control and capability), and perceived safety. Pregnancy-related anxiety and depressive symptoms correlated with perceived stress, though neither independently predicted birth experience. An unplanned cesarean delivery was associated with a worse CEQ total score. Vaginal delivery predicted greater perceived safety. Altogether, sociodemographic covariates, mode of delivery, and prenatal mood accounted for 35 percent of the variance in birth experience (p < 0.001).

Discussion: Our finding that prenatal stress explains a significant and likely clinically meaningful proportion of the variance in birth experience suggests that women perceive and recall their birth experiences through a lens that is partially determined by preexisting personal circumstances and emotional reserves. Since childbirth perceptions have implications for maternal and child health, patient satisfaction, and health care expenditures, these findings warrant consideration of prenatal stress screening to target intervention for women at risk for negative birth experiences.

Keywords: birth; pregnancy-related anxiety; prenatal depression; prenatal stress.

Publication types

  • Controlled Clinical Trial

MeSH terms

  • Adult
  • Anxiety / epidemiology*
  • California
  • Cesarean Section / statistics & numerical data
  • Depression / epidemiology*
  • Ethnicity / statistics & numerical data*
  • Female
  • Humans
  • Linear Models
  • Multivariate Analysis
  • Parturition / psychology*
  • Patient Satisfaction
  • Poverty
  • Pregnancy / psychology
  • Pregnancy Complications / psychology*
  • Pregnancy Trimester, Third
  • Prenatal Care
  • Prospective Studies
  • Psychiatric Status Rating Scales
  • Stress, Psychological
  • Surveys and Questionnaires
  • Young Adult