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Reproduction, fear of childbirth and obstetric outcomes in women treated for fear of childbirth in their first pregnancy: A historical cohort
Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.ORCID iD: 0000-0003-3238-3811
Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
Värnamo Cty Hosp, Sweden.
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2019 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, no 3, p. 374-381Article in journal (Refereed) Published
Abstract [en]

Introduction About 8% of the pregnant women in Sweden receive counseling for fear of childbirth (FOC) during pregnancy. Little is known about the long-term reproductive and obstetric outcomes after counseling for FOC: Therefore, the objective of this historical cohort study was to compare the long-term reproductive and obstetric outcomes in women treated for FOC in their first pregnancy to women without FOC. Material and methods All nulliparas consecutively referred for treatment of severe FOC between 2001 and 2007 (n = 608) were compared with all other nulliparas giving birth on the same day (n = 431). Women who were not fluent in Swedish, missing a postal address, had moved out of the area, given birth at another hospital or had a late spontaneous abortion were excluded (n = 555). A total of 235 women agreed to participate in the study, 63 (39%) women in the index group and 172 (53%) in the reference group. The women were contacted by letter in 2015, ie 7-14 years after first childbirth, and asked to permit access to their medical charts from pregnancies and childbirths and to fill out a study specific questionnaire. Based on data from the medical charts and questionnaire, the mode of delivery, birth experience, obstetric complications, FOC, counseling for FOC and number of childbirths were compared in the two groups. Results Women in the index group less often gave birth more than twice compared with the reference group (8.2% vs 22.0%, P = 0.012). We found no significant differences in complications during subsequent pregnancies and deliveries. Women in the index group more often gave birth by CS in their first (P = 0.002) and second childbirth (P = 0.001), more often had a less positive birth experience (index group NRS: median 6.0, interquartile range 6 vs reference group NRS: 7.0, interquartile range 5, P = 0.004) in their first delivery and more often received counseling for FOC (58.7% vs 12.5%, P amp;lt; 0.001) in subsequent pregnancies. Women in the index group more often experienced FOC (18% vs 5.3%, P = 0.001) 7-14 years after first childbirth. Conclusions FOC is not easily treated. Despite treatment and exposure to childbirth many women received treatment in their next pregnancy and still suffered from FOC 7-14 years after the first childbirth.

Place, publisher, year, edition, pages
WILEY , 2019. Vol. 98, no 3, p. 374-381
Keywords [en]
birth experience; cesarean section on maternal request; counseling; fear of childbirth
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:liu:diva-154981DOI: 10.1111/aogs.13503ISI: 000459481000013PubMedID: 30431149OAI: oai:DiVA.org:liu-154981DiVA, id: diva2:1297566
Note

Funding Agencies|Medical Research Council of Southeast Sweden, FORSS

Available from: 2019-03-20 Created: 2019-03-20 Last updated: 2019-06-28
In thesis
1. Health, obstetric outcomes and reproduction in women with vulvar pain or primary fear of childbirth
Open this publication in new window or tab >>Health, obstetric outcomes and reproduction in women with vulvar pain or primary fear of childbirth
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Fear of childbirth (FOC) is common and affects approximately 5-20 % of all pregnant women. FOC is associated with giving birth by caesarean section on maternal request (CSMR). The rate of caesarean sections (CS) and CSMR has increased during the last decades. To decrease these women’s fear, the rate of CSMR and to promote a more positive birth experience, many treatments for FOC have been evaluated. In Sweden, the treatment is individualized and given by obstetricians, midwives, psychologists or psychotherapists in the specialist care.

Women with FOC suffer more often from psychiatric illness and rate their general health as less good, which is important to consider when counselling these women and deciding on mode of delivery. Little is known about the long term obstetric and reproductive outcomes for women with FOC. Therefore, the aim of the studies on which this thesis is based was to compare psychiatric care before and after childbirth in women giving birth by CSMR to women giving birth by other modes of delivery and to follow the subsequent obstetric and reproductive outcomes in women receiving counselling for FOC in their first childbirth. Furthermore, we hypothesized that women with localized provoked vulvodynia (LPV) and/or vaginismus might fear vaginal childbirth and little is known about their reproduction and obstetric outcomes which is why we investigated the parity and obstetric outcomes in women diagnosed with LPV/vaginismus before first childbirth.

Based on data linked from several Swedish National registers, the prevalence of psychiatric in- and outpatient care before (paper I) and after first childbirth (paper II) was compared in primiparae giving birth by CSMR to primiparae giving birth by other modes of delivery. The prevalence of psychiatric disorders was found to be significantly higher in women giving birth by CSMR, indicating a severe burden of psychiatric illness in these women.

In paper III, also based on data from several Swedish National registers, a diagnosis of LPV/vaginismus before childbirth was shown to decrease the odds of giving birth. When giving birth these women had an increased risk of CS, especially CSMR. This could possibly indicate FOC in these women. Further, women with vaginismus had an increased risk of pelvic floor injuries.

Paper IV was a follow-up study of women who received counselling for FOC in their first pregnancy leading to parturition. It was based on data from medical records and a questionnaire. The women were followed 7-14 years after their first childbirth. Women treated for FOC more often gave birth by CS, rated their first birth experience as less positive and more often required counselling for FOC in their subsequent pregnancies compared to women without FOC in their first pregnancy. There were no significant differences in the rate of complications during pregnancy and childbirth compared to the other women. Women treated for FOC less often gave birth more than twice. Despite being given counselling and being exposed to childbirth almost one in five women felt fearful towards childbirth 7-14 years after the first childbirth.

In conclusion, women with FOC are a vulnerable group suffering from a significant burden of psychiatric illness. FOC is not easily treated; many women require counselling in subsequent pregnancies and many still fear childbirth after the childbearing years. Furthermore, LPV/vaginismus is a risk factor for giving birth by CSMR, possibly indicating FOC, and these women are less likely to give birth. Our study shows it is important not only to address sexual function in these women but reproductive function as well. Further studies are needed to establish how to optimize their care regarding fertility, antenatal, obstetric and post-partum care.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2019. p. 72
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1681
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-156622 (URN)10.3384/diss.diva-156622 (DOI)9789176850770 (ISBN)
Public defence
2019-05-24, Berzeliussalen, Campus US, Linköping, 09:00 (English)
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Supervisors
Available from: 2019-04-30 Created: 2019-04-30 Last updated: 2019-08-06Bibliographically approved

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Möller, LouiseJosefsson, AnnLilliecreutz, CarolineBladh, MarieSydsjö, Gunilla
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Division of Children's and Women's healthFaculty of Medicine and Health SciencesDepartment of Gynaecology and Obstetrics in Linköping
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