Understanding women's experiences of fear of childbirth

Objective: Fear of childbirth (FOC) can have negative implications for women during and following pregnancy. This review aimed to gain a clearer understanding of FOC by synthesising peer-reviewed literature that had explored psychosocial associates of FOC.

Design: Five electronic databases were systematically searched for studies related to FOC in nulliparous and parous women. Thirty-one papers met the inclusion criteria. Data were extracted and described in a narrative analysis.

Findings: Psychosocial associates of FOC were grouped by identified themes: mental health; self-efficacy, self-esteem and decisional conflict; personality traits; precipitating life events and stressors; stress and fatigue, perceived social support; and cultural influences. Psychosocial associates of FOC according to parity were also summarised.

Key conclusions: Anxiety, depression, low self-esteem, low self-efficacy, poor social support, certain personality traits, precipitating life events (including previous traumatic and subjectively negative pregnancy and childbirth experiences, prior trauma unrelated to childbirth, and experiences of childhood abuse and experiences of abuse in healthcare), stress and fatigue and exposure to ‘horror stories’ were associated with FOC. Some differences according to parity were identified, however, findings were mixed for most psychosocial factors. This could be understood through the concept of a ‘vicious’ circle of FOC.

Implications for practice: An individualised, biopsychosocial perspective is suggested when working with women experiencing FOC. Early identification of FOC through routine screening is recommended, along with implementation of interventions that provide accuratechildbirth information, build self-esteem, self-efficacy and optimism, reduce stress, manage anxiety, and improve mood. Future research is recommended.