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Womens' attitudes and beliefs of childbirth and association with birth preference: A comparison of a Swedish and an Australian sample in mid-pregnancy
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
2012 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, no 6, e850-e856 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

the rate of caesarean in Australia is twice that of Sweden. Little is known about women's attitudes towards birth in countries where the caesarean rate is high compared to those where normal birth is a more common event.

OBJECTIVES:

to compare attitudes and beliefs towards birth in a sample of Australian and Swedish women in mid-pregnancy.

PARTICIPANTS:

women from rural towns in mid Sweden (n=386) and north-eastern Victoria in Australia (n=123).

METHODS:

questionnaire data was collected from 2007 to 2009. Levels of agreement or disagreement were indicated on sixteen attitude and belief statements regarding birth. Principal components analysis (PCA) identified the presence of subscales within the attitudes inventory. Using these subscales, attitudes associated with preferred mode of birth were determined. Odds ratios were calculated at 95% CI by country of care.

RESULTS:

the Australian sample was less likely than the Swedish sample to agree that they would like a birth that: 'is as pain free as possible' OR 0.4 (95% CI: 0.2-0.7), 'will reduce my chance of stress incontinence' OR 0.2 (95% CI: 0.1-0.8), 'will least affect my future sex life' OR 0.3 (95% CI: 0.2-0.6), 'will allow me to plan the date when my baby is born' OR 0.4 (95% CI: 0.2-0.7) and 'is as natural as possible' OR 0.4 (95% CI: 0.2-0.9). They were also less likely to agree that: 'if a woman wants to have a caesarean she should be able to have one under any circumstances' OR 0.4 (95% CI: 0.2-0.7) and 'giving birth is a natural process that should not be interfered with unless necessary' OR 0.3 (95% CI: 0.1-0.7). Four attitudinal subscales were found: 'Personal Impact of Birth', 'Birth as Natural Event', 'Freedom of Choice' and 'Safety Concerns'. Women who preferred a caesarean, compared to those who preferred a vaginal birth, across both countries were less likely to think of 'Birth as a natural event'.

KEY CONCLUSIONS:

the Australian women were less likely than the Swedish women to hold attitudes and beliefs regarding the impact of pregnancy and birth on their body, the right to determine the type of birth they want and to value the natural process of birth. Women from both countries who preferred caesarean were less likely to agree with attitudes related to birth as a natural event.

Place, publisher, year, edition, pages
2012. Vol. 28, no 6, e850-e856 p.
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-164069DOI: 10.1016/j.midw.2011.09.011ISI: 000311936100003PubMedID: 22098781OAI: oai:DiVA.org:uu-164069DiVA: diva2:466312
Available from: 2011-12-15 Created: 2011-12-15 Last updated: 2017-12-08Bibliographically approved
In thesis
1. ‘No worries’: A longitudinal study of fear, attitudes and beliefs about childbirth from a cohort of Australian and Swedish women
Open this publication in new window or tab >>‘No worries’: A longitudinal study of fear, attitudes and beliefs about childbirth from a cohort of Australian and Swedish women
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Much is known about childbirth fear in Sweden including its relationship to caesarean birth. Less is understood about this in Australia. Sweden has half the rate of caesarean birth compared to Australia. Little has been reported about women’s beliefs and attitudes to birth in either country. The contribution of psychosocial factors such as fear, attitudes and beliefs about childbirth to the global escalation of caesarean birth in high-income countries is an important topic of debate.

The overall aim of this thesis is to investigate the prevalence and impact of fear on birthing outcomes in two cohorts of pregnant women from Australia and Sweden and to explore the birth attitudes and beliefs of these women.  

A prospective longitudinal cohort study from two towns in Australia and Sweden (N=509) was undertaken in the years 2007-2009. Pregnant women completed self-report questionnaires at mid-pregnancy, late pregnancy and two months after birth. Fear of birth was measured in mid-pregnancy with a tool developed in this study: the Fear of Birth Scale (FOBS). The FOBS showed promise as a clinically practical way to identify women with significant fear. A similar prevalence of fear of birth (30 percent) was found in the Australian and Swedish cohorts (Paper I). 

The Swedish women had attitudes indicating a greater concern for the personal impacts of birth and a belief system that situated birth as a natural event when compared to the Australian women (Paper II). Finally, when women’s attitudes and levels of fear were combined, three profiles were identified: Self determiners, Take it as it comes and Fearful (Paper III). Belonging to the Fearful profile had the most negative outcomes for women including higher rates of elective caesarean, more negative feelings in pregnancy and post birth and poorer perceptions of the quality of their antenatal and intra-partum care (Paper IV).

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 100 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 843
Keyword
Fear of birth, attitudes, beliefs, Australia, Sweden, cluster analysis, profiles
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-185081 (URN)978-91-554-8547-4 (ISBN)
Public defence
2013-01-18, Auditorium Minus, Gustavianum, Akademigatan 3, Uppsala, 09:00 (English)
Opponent
Supervisors
Available from: 2012-12-19 Created: 2012-11-20 Last updated: 2013-02-11Bibliographically approved

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Haines, HelenRubertsson, ChristineHildingsson, Ingegerd

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