"Fearfulness Approaching Labor Among U.S. Women: Results of a National Survey"

Abstract-

Objective: Studies from other countries have found that fear of labor may be a predictor of caesarean section, length of labor, and possibly other maternal outcomes such as post-partum depression. This paper will analyze maternal reports of fear of labor among U.S. women and the birth experiences of those women.

Methods: Statistical analysis will be conducted from a national survey, Listening to Mothers II, which is a representative sample of U.S. mothers 18-45 who gave birth to a single infant in a hospital in 2005.

Results: More than half (53%) of mothers reported fear as one of the feelings experienced approaching labor (44% did not and 3% were unsure). First-time mothers (65%) were much more likely than multiparas (48%) to express fear and we stratified subsequent analysis by parity. Some basic demographic characteristics were significantly related to fearfulness with younger, and Hispanic women reporting higher rates of fearfulness. White Non-Hispanic first time mothers who expressed fearfulness were 56% more likely to experience a cesarean (44% compared to 28%) (p<.05). Black Non-Hispanic first time mothers who expressed fearfulness experienced a 61% cesarean rate compared to 48% for those not expressing fear.

Conclusion: Among U.S. women overall, fear approaching labor is reported by a majority of mothers and is related to birth experiences. White non-Hispanic and Black non-Hispanic primiparous mothers who report fearfulness approaching labor were more likely to have had a cesarean. More research is needed to describe how U.S. women experience fear of and how it can be effectively reduced.

2 Page Summary-

Fear of labor has not been extensively studied in the United States, but studies from other countries have indicated that fear may influence maternal experiences during and after labor. A series of studies from Scandinavian countries found that fear of labor may be a predictor of caesarean section, length of labor, and in some cases other maternal outcomes such as post-partum depression and detection of anxiety already present in the woman.1 According to these studies, severe fear of labor is present in approximately 6% of all parturients and it is estimated that 20% of pregnancies in developed countries are complicated by a fear of childbirth.2,3 Factors influencing fear of labor may differ depending on parity and previous experiences with birth; fear of labor was present among mothers after a previous pregnancy where emergency cesarean occurred. 4 Other factors influencing fear of labor in these studies include unemployment, primiparity, a previous cesarean and lack of social support.1,3,4 The results from studies on whether fear of labor increases the likelihood of cesarean sections have been mixed. 4, 5, 6 At the same time, a randomized controlled trial utilizing counseling observed a reduction in request for cesarean section among women expressing a fear of labor.7 This finding is potentially significant considering the rising rates of cesarean sections in many industrialized countries.8

Methods:

This paper will use an existing data source, Listening to Mothers II, regarding women's experience with fearfulness before and during pregnancy9. The survey, conducted by Harris Interactive, consisted of 1,373 online and 200 telephone interviews with women who had given birth in a hospital to a single live baby in 2005, with weighting of data to reflect the target population. The weighting included propensity scores, to adjust for the propensity to be online, a methodology developed and validated by Harris Interactive. Interviews were conducted from January 20 through February 21, 2006, and the survey took approximately 30 minutes to complete. The survey population is representative of U.S. mothers 18-45 who gave birth to a single infant in a hospital in 2005, with respondents generally comparable to published national data for U.S. birthing mothers on age, race/ethnicity, education, birth attendant and method of birth.10 Mothers were asked to check yes or no regarding whether some terms described their feelings as they approached labor with “fearful” as one of the responses. Statistical analysis was conducted using SPSS 15.1. Key questions in this paper will include: 1.) who are the mothers that express fear of childbirth? 2.)what is the relationship between expressed fear of labor and a variety of birth outcomes including feelings during delivery, method of delivery, length of labor, postpartum mental health, and desire for additional children?

Results:

More than half (53%) of mothers checked “yes” for fear as one of the feelings they experienced (44% said no and 3% were unsure). First-time mothers (65%) were much more likely than multiparas (48%) to express fear and we stratified subsequent analysis by parity. Some basic demographic characteristics were significantly related to fearfulness with younger (72% among women age 18-24), and Hispanic (72%) women reporting significantly higher rates of fearfulness. Black Non-Hispanic women were the least likely racial/ethnic group to express fearfulness. White Non-Hispanic first time mothers who expressed fearfulness were 56% more likely (44% compared to 28%) to experience a cesarean section (p<.05). Black Non-Hispanic first time mothers who expressed fearfulness experienced a 61% cesarean rate compared to 48% among Black Non-Hispanic women not expressing fearfulness.In subsequent analyses we will examine this relationship more thoroughly using logistic regression to better control for potential confounders.

Conclusion:

Among U.S. women overall, fear approaching labor is reported by a majority of mothers and is related to both demographic characteristics and birth experiences. Primiparous white non-Hispanic and black non-Hispanic mothers who report fearfulness approaching labor were more likely to also have had a cesarean. More research is needed to describe how U.S. women experience fear of labor and how it can be effectively reduced. Future intervention studies may want to further examine the relationship between fear of labor, methods to reduce anxiety and cesarean sections.

References

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8 The Childbirth Connection. Cesarean Section Why Does the U. S National Cesarean Section Rate Keep Going Up? Retreived online on February 5, 2008 at http://www.childbirthconnection.org/article.asp?ck=10456

9 Declercq ER, Sakala C, Corry M, Applebaum S. Listening to Mothers II Report of the Second National U.S. Survey of Women's Childbearing Experiences. New York: Childbirth Connections. (104 pp) (Oct. 2006)

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