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  • 1.
    Haines, Helen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    ‘No worries’: A longitudinal study of fear, attitudes and beliefs about childbirth from a cohort of Australian and Swedish women2012Doctoral 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).

    List of papers
    1. Cross-cultural comparison of levels of childbirth-related fear in an Australian and Swedish sample
    Open this publication in new window or tab >>Cross-cultural comparison of levels of childbirth-related fear in an Australian and Swedish sample
    2011 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, no 4, p. 560-567Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND:

    research, conducted predominately in Scandinavian countries, suggests that a substantial number of women experience high levels of fear concerning childbirth which can impact on birth outcomes, the mother-infant relationship and the ongoing mental health of the mother. The prevalence of childbirth-related fear (CBRF) is not well known outside of the Nordic nations. This study aimed to examine the prevalence of CBRF in two rural populations (Sweden and Australia) and to pilot a short, easy-to-administer measurement tool.

    METHODS:

    a questionnaire assessing a range of childbirth-related issues was administered to women in the first trimester across two rural populations in Sweden (n = 386) and Australia (n = 123). CBRF was measured using the Fear of Birth Scale (FOBS) a two-item visual analogue scale.

    FINDINGS:

    close to 30% of women from the Australian and Swedish samples reported elevated levels of CBRF in the first trimester. A previous negative birth experience and less than positive attitudes to their current pregnancy and birth were predictive of high levels of fear. Swedish women with high levels of fear indicated a preference for caesarean section as the mode of birth in this pregnancy. A higher proportion (19%) of Australian women indicated that they would prefer an elective caesarean section, compared with only 8.8% of the Swedish sample; however, this was not related to high levels of fear. Preference for caesarean section was related to CBRF in the Swedish sample but not in the Australian sample.

    CONCLUSION:

    the high proportion of women identified with CBRF suggests a need for monitoring of women during pregnancy, particularly those with a previous negative birth experience. The FOBS developed for this study could be used as a screening tool to identify women who require further investigation. Further cross-cultural research is needed to explore the role of fear in women's preference for caesarean section.

    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Identifiers
    urn:nbn:se:uu:diva-185026 (URN)10.1016/j.midw.2010.05.004 (DOI)20598787 (PubMedID)
    Available from: 2012-11-19 Created: 2012-11-19 Last updated: 2017-12-07Bibliographically approved
    2. Womens' attitudes and beliefs of childbirth and association with birth preference: A comparison of a Swedish and an Australian sample in mid-pregnancy
    Open this publication in new window or tab >>Womens' attitudes and beliefs of childbirth and association with birth preference: A comparison of a Swedish and an Australian sample in mid-pregnancy
    2012 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, no 6, p. e850-e856Article 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.

    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:uu:diva-164069 (URN)10.1016/j.midw.2011.09.011 (DOI)000311936100003 ()22098781 (PubMedID)
    Available from: 2011-12-15 Created: 2011-12-15 Last updated: 2017-12-08Bibliographically approved
    3. The influence of women's fear, attitudes and beliefs of childbirth on mode and experience of birth
    Open this publication in new window or tab >>The influence of women's fear, attitudes and beliefs of childbirth on mode and experience of birth
    2012 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 12, p. 55-Article in journal (Refereed) Published
    Abstract [en]

    Background: Women's fears and attitudes to childbirth may influence the maternity care they receive and the outcomes of birth. This study aimed to develop profiles of women according to their attitudes regarding birth and their levels of childbirth related fear. The association of these profiles with mode and outcomes of birth was explored.

    Methods: Prospective longitudinal cohort design with self report questionnaires containing a set of attitudinal statements regarding birth (Birth Attitudes Profile Scale) and a fear of birth scale (FOBS). Pregnant women responded at 18-20 weeks gestation and two months after birth from a regional area of Sweden (n = 386) and a regional area of Australia (n = 123). Cluster analysis was used to identify a set of profiles. Odds ratios (95% CI) were calculated, comparing cluster membership for country of care, pregnancy characteristics, birth experience and outcomes.

    Results: Three clusters were identified - 'Self determiners' (clear attitudes about birth including seeing it as a natural process and no childbirth fear), 'Take it as it comes' (no fear of birth and low levels of agreement with any of the attitude statements) and 'Fearful' (afraid of birth, with concerns for the personal impact of birth including pain and control, safety concerns and low levels of agreement with attitudes relating to women's freedom of choice or birth as a natural process). At 18 - 20 weeks gestation, when compared to the 'Self determiners', women in the 'Fearful' cluster were more likely to: prefer a caesarean (OR = 3.3 CI: 1.6-6.8), hold less than positive feelings about being pregnant (OR = 3.6 CI: 1.4-9.0), report less than positive feelings about the approaching birth (OR = 7.2 CI: 4.4-12.0) and less than positive feelings about the first weeks with a newborn (OR = 2.0 CI 1.2-3.6). At two months post partum the 'Fearful' cluster had a greater likelihood of having had an elective caesarean (OR = 5.4 CI 2.1-14.2); they were more likely to have had an epidural if they laboured (OR = 1.9 CI 1.1-3.2) and to experience their labour pain as more intense than women in the other clusters. The 'Fearful' cluster were more likely to report a negative experience of birth (OR = 1.7 CI 1.02-2.9). The 'Take it as it comes' cluster had a higher likelihood of an elective caesarean (OR 3.0 CI 1.1-8.0).

    Conclusions: In this study three clusters of women were identified. Belonging to the 'Fearful' cluster had a negative effect on women's emotional health during pregnancy and increased the likelihood of a negative birth experience. Both women in the 'Take it as it comes' and the 'Fearful' cluster had higher odds of having an elective caesarean compared to women in the 'Self determiners'. Understanding women's attitudes and level of fear may help midwives and doctors to tailor their interactions with women.

    Keywords
    Pregnancy, Attitudes, Childbirth fear, Cluster analysis, Scale
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-183245 (URN)10.1186/1471-2393-12-55 (DOI)000309115600001 ()
    Available from: 2012-10-25 Created: 2012-10-23 Last updated: 2017-12-07Bibliographically approved
    4. The Role of Women’s Attitudinal Profiles in Satisfaction with the Quality of their Antenatal and Intrapartum Care
    Open this publication in new window or tab >>The Role of Women’s Attitudinal Profiles in Satisfaction with the Quality of their Antenatal and Intrapartum Care
    2013 (English)In: Journal of Obstetric, Gynecologic and Neonatal Nursing, ISSN 0884-2175, E-ISSN 1552-6909, Vol. 42, no 4, p. 428-441Article in journal (Other academic) Published
    Abstract [en]

    Objective

    To compare perceptions of antenatal and intrapartum care in women categorized into three profiles based on attitudes and fear. 

    Design

    Prospective longitudinal cohort study using self-report questionnaires. Profiles were constructed from responses to the Birth Attitudes Profile Scale and the Fear of Birth Scale at pregnancy weeks 18 to 20. Perception of the quality of care was measured using the Quality from Patient's Perspective index at 34 to 36 weeks pregnancy and 2 months after birth.

    Setting

    Two hospitals in Sweden and Australia. 

    Participants

    Five hundred and five (505) pregnant women from one hospital in Vasternorrland, Sweden (n=386) and one in northeast Victoria, Australia (n=123). 

    Results 

    Women were categorized into three profiles: self-determiners, take it as it comes, and fearful. The self-determiners reported the best outcomes, whereas the fearful were most likely to perceive deficient care. Antenatally the fearful were more likely to indicate deficiencies in medical care, emotional care, support received from nurse-midwives or doctors and nurse-midwives'/doctors' understanding of the woman's situation. They also reported deficiencies in two aspects of intrapartum care: support during birth and control during birth. 

    Conclusions 

    Attitudinal profiling of women during pregnancy may assist clinicians to deliver the style and content of antenatal and intrapartum care to match what women value and need. An awareness of a woman's fear of birth provides an opportunity to offer comprehensive emotional support with the aim of promoting a positive birth experience.

    Keywords
    Fear of birth, attitudes, profiling, satisfaction, childbirth
    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Research subject
    Obstetrics and Gynaecology
    Identifiers
    urn:nbn:se:uu:diva-185080 (URN)10.1111/1552-6909.12221 (DOI)000321822800007 ()
    Available from: 2012-11-20 Created: 2012-11-20 Last updated: 2017-12-07Bibliographically approved
  • 2.
    Haines, Helen
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Pallant, Julie F
    The University of Melbourne, Rural Health Academic Centre .
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    The Role of Women’s Attitudinal Profiles in Satisfaction with the Quality of their Antenatal and Intrapartum Care2013In: Journal of Obstetric, Gynecologic and Neonatal Nursing, ISSN 0884-2175, E-ISSN 1552-6909, Vol. 42, no 4, p. 428-441Article in journal (Other academic)
    Abstract [en]

    Objective

    To compare perceptions of antenatal and intrapartum care in women categorized into three profiles based on attitudes and fear. 

    Design

    Prospective longitudinal cohort study using self-report questionnaires. Profiles were constructed from responses to the Birth Attitudes Profile Scale and the Fear of Birth Scale at pregnancy weeks 18 to 20. Perception of the quality of care was measured using the Quality from Patient's Perspective index at 34 to 36 weeks pregnancy and 2 months after birth.

    Setting

    Two hospitals in Sweden and Australia. 

    Participants

    Five hundred and five (505) pregnant women from one hospital in Vasternorrland, Sweden (n=386) and one in northeast Victoria, Australia (n=123). 

    Results 

    Women were categorized into three profiles: self-determiners, take it as it comes, and fearful. The self-determiners reported the best outcomes, whereas the fearful were most likely to perceive deficient care. Antenatally the fearful were more likely to indicate deficiencies in medical care, emotional care, support received from nurse-midwives or doctors and nurse-midwives'/doctors' understanding of the woman's situation. They also reported deficiencies in two aspects of intrapartum care: support during birth and control during birth. 

    Conclusions 

    Attitudinal profiling of women during pregnancy may assist clinicians to deliver the style and content of antenatal and intrapartum care to match what women value and need. An awareness of a woman's fear of birth provides an opportunity to offer comprehensive emotional support with the aim of promoting a positive birth experience.

  • 3.
    Haines, Helen M.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Pallant, Julie F.
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    The influence of women's fear, attitudes and beliefs of childbirth on mode and experience of birth2012In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 12, p. 55-Article in journal (Refereed)
    Abstract [en]

    Background: Women's fears and attitudes to childbirth may influence the maternity care they receive and the outcomes of birth. This study aimed to develop profiles of women according to their attitudes regarding birth and their levels of childbirth related fear. The association of these profiles with mode and outcomes of birth was explored.

    Methods: Prospective longitudinal cohort design with self report questionnaires containing a set of attitudinal statements regarding birth (Birth Attitudes Profile Scale) and a fear of birth scale (FOBS). Pregnant women responded at 18-20 weeks gestation and two months after birth from a regional area of Sweden (n = 386) and a regional area of Australia (n = 123). Cluster analysis was used to identify a set of profiles. Odds ratios (95% CI) were calculated, comparing cluster membership for country of care, pregnancy characteristics, birth experience and outcomes.

    Results: Three clusters were identified - 'Self determiners' (clear attitudes about birth including seeing it as a natural process and no childbirth fear), 'Take it as it comes' (no fear of birth and low levels of agreement with any of the attitude statements) and 'Fearful' (afraid of birth, with concerns for the personal impact of birth including pain and control, safety concerns and low levels of agreement with attitudes relating to women's freedom of choice or birth as a natural process). At 18 - 20 weeks gestation, when compared to the 'Self determiners', women in the 'Fearful' cluster were more likely to: prefer a caesarean (OR = 3.3 CI: 1.6-6.8), hold less than positive feelings about being pregnant (OR = 3.6 CI: 1.4-9.0), report less than positive feelings about the approaching birth (OR = 7.2 CI: 4.4-12.0) and less than positive feelings about the first weeks with a newborn (OR = 2.0 CI 1.2-3.6). At two months post partum the 'Fearful' cluster had a greater likelihood of having had an elective caesarean (OR = 5.4 CI 2.1-14.2); they were more likely to have had an epidural if they laboured (OR = 1.9 CI 1.1-3.2) and to experience their labour pain as more intense than women in the other clusters. The 'Fearful' cluster were more likely to report a negative experience of birth (OR = 1.7 CI 1.02-2.9). The 'Take it as it comes' cluster had a higher likelihood of an elective caesarean (OR 3.0 CI 1.1-8.0).

    Conclusions: In this study three clusters of women were identified. Belonging to the 'Fearful' cluster had a negative effect on women's emotional health during pregnancy and increased the likelihood of a negative birth experience. Both women in the 'Take it as it comes' and the 'Fearful' cluster had higher odds of having an elective caesarean compared to women in the 'Self determiners'. Understanding women's attitudes and level of fear may help midwives and doctors to tailor their interactions with women.

  • 4.
    Haines, Helen
    et al.
    School of Rural Health The University of Melbourne, Australia.
    Pallant, Julie F
    The University of Melbourne, Rural Health Academic Centre.
    Karlström, Annika
    Mid Sweden University .
    Hildingsson, Ingegerd
    Mid Sweden University .
    Cross-cultural comparison of levels of childbirth-related fear in an Australian and Swedish sample2011In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, no 4, p. 560-567Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    research, conducted predominately in Scandinavian countries, suggests that a substantial number of women experience high levels of fear concerning childbirth which can impact on birth outcomes, the mother-infant relationship and the ongoing mental health of the mother. The prevalence of childbirth-related fear (CBRF) is not well known outside of the Nordic nations. This study aimed to examine the prevalence of CBRF in two rural populations (Sweden and Australia) and to pilot a short, easy-to-administer measurement tool.

    METHODS:

    a questionnaire assessing a range of childbirth-related issues was administered to women in the first trimester across two rural populations in Sweden (n = 386) and Australia (n = 123). CBRF was measured using the Fear of Birth Scale (FOBS) a two-item visual analogue scale.

    FINDINGS:

    close to 30% of women from the Australian and Swedish samples reported elevated levels of CBRF in the first trimester. A previous negative birth experience and less than positive attitudes to their current pregnancy and birth were predictive of high levels of fear. Swedish women with high levels of fear indicated a preference for caesarean section as the mode of birth in this pregnancy. A higher proportion (19%) of Australian women indicated that they would prefer an elective caesarean section, compared with only 8.8% of the Swedish sample; however, this was not related to high levels of fear. Preference for caesarean section was related to CBRF in the Swedish sample but not in the Australian sample.

    CONCLUSION:

    the high proportion of women identified with CBRF suggests a need for monitoring of women during pregnancy, particularly those with a previous negative birth experience. The FOBS developed for this study could be used as a screening tool to identify women who require further investigation. Further cross-cultural research is needed to explore the role of fear in women's preference for caesarean section.

  • 5.
    Haines, Helen
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Pallant, Julie F
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Womens' attitudes and beliefs of childbirth and association with birth preference: A comparison of a Swedish and an Australian sample in mid-pregnancy2012In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, no 6, p. e850-e856Article in journal (Refereed)
    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.

  • 6.
    Hildingsson, Ingegerd
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Haines, Helen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Cross, Maddalena
    Rural Health Academic Centre, University of Melbourne, Victoria, Australia.
    Pallant, Julie F
    Rural Health Academic Centre, University of Melbourne, Victoria, Australia.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Women's satisfaction with antenatal care: Comparing women in Sweden and Australia2013In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 26, no 1, p. e9-e14Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Satisfaction with antenatal care could differ depending on the organisation and the context of care.

    AIM:

    To compare antenatal care in Australia and Sweden, to identify deficiencies in the content of antenatal care and what aspects contributed most in dissatisfaction with antenatal care.

    METHODS:

    A longitudinal survey of 123 Australian and 386 Swedish women recruited during one year in regional hospitals in Sweden and Australia. Data collected by three questionnaires.

    RESULTS:

    Women in Australia had more antenatal visits, less continuity of midwife caregiver but were more satisfied with antenatal education and the emotional aspects of antenatal care. Although the overall satisfaction was high, deficiencies were found in more than half of the studied variables in the content of care. Women in Sweden were more dissatisfied with information about labour and birth (OR 3.1; 1.8-5.3) and information about the time following birth (OR 3.8; 2.2-6.3), but more satisfied with the involvement of the father (OR 0.3; 0.2-0.6). Factors that contributed most to dissatisfaction with antenatal care overall were deficiency in information about pregnancy related issues (OR 3.4; 1.3-8.7) and not being taken seriously by the midwife (OR 4.1; 1.6-10.1).

    CONCLUSION:

    Satisfaction with antenatal care was high in both groups of women. Australian women were more satisfied than the Swedish women with the emotional aspects of care. Deficiencies were found in more than half of the variables measured relating to the specific aspects of care. Lack of information and not being treated seriously were important factors for not being satisfied.

  • 7.
    Hildingsson, Ingegerd
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Haines, Helen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Johansson, Margareta
    Södersjukhuset, Stockholm, Sweden.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Fenwick, Jennifer
    School of Nursing and Midwifery, Maternity and Family, Centre for Health Practice Innovation (HPI), Griffith Health Institute, Griffith University, Australia.
    Childbirth fear in Swedish fathers is associated with parental stress as well as poor physical and mental health2014In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, no 2, p. 248-254Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    to compare self-rated health and perceived difficulties during pregnancy as well as antenatal attendance, birth experience and parental stress in fathers with and without childbirth related fear.

    DESIGN:

    a longitudinal regional survey. Data were collected by three questionnaires.

    SETTING:

    three hospitals in the middle-north part of Sweden.

    PARTICIPANTS:

    1047 expectant fathers recruited in mid-pregnancy and followed up at two months and one year after birth.

    MEASUREMENTS:

    childbirth fear was assessed using the Fear of Birth Scale (FOBS). Self-rated physical and mental health and perceived difficulties were assessed in mid pregnancy. Two months after birth antenatal attendance, mode of birth and the birth experience were investigated. Parental stress was measured using the Swedish Parental Stress Questionnaire (SPSQ). Crude and adjusted odds ratios were calculated between expectant fathers who scored 50 and above (childbirth fear) and those that did not (no fear).

    FINDINGS:

    expectant fathers with childbirth related fear (13.6%) reported poorer physical (OR 1.8; 95% CI 1.2-2.8) and mental (OR 3.0; 1.8-5.1) health than their non-fearful counterparts. The fearful fathers were more likely to perceive difficulties in pregnancy (OR 2.1; 1.4-3.0), and the forthcoming birth (OR 4.3; 2.9-6.3) compared to fathers without childbirth fear. First-time fathers with fear attended fewer antenatal classes. Fathers with high fear reported higher mean scores in four of the five subscales of the SPSQ. Childbirth related fear was not associated with mode of birth or fathers' birth experience.

    KEY CONCLUSIONS:

    expectant fathers with childbirth related fear had poorer health, viewed the pregnancy, birth and the forthcoming parenthood with more difficulties. They were less often present during antenatal classes and had higher parental stress.

    IMPLICATIONS FOR PRACTICE:

    this study provides insight into the health of expectant fathers during pregnancy and highlights the importance of understanding how childbirth fear may affect expectant fathers in both the short and longer term.

  • 8.
    Hildingsson, Ingegerd
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden..
    Haines, Helen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Univ Melbourne, Rural Hlth Acad Ctr, Melbourne, Vic, Australia..
    Karlström, Annika
    Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden..
    Nystedt, Astrid
    Umea Univ, Dept Nursing, Umea, Sweden..
    Presence and process of fear of birth during pregnancy: Findings from a longitudinal cohort study2017In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 30, no 5, p. E242-E247Article in journal (Refereed)
    Abstract [en]

    Background: The prevalence of fear of birth has been estimated between 8-30%, but there is considerable heterogeneity in research design, definitions, measurement tools used and populations. There are some inconclusive findings about the stability of childbirth fear.

    Aim: to assess the prevalence and characteristics of women presenting with scores >= 60 on FOBS-The Fear of Birth Scale, in mid and late pregnancy, and to study change in fear of birth and associated factors.

    Methods: A prospective longitudinal cohort study of a one-year cohort of 1212 pregnant women from a northern part of Sweden, recruited in mid pregnancy and followed up in late pregnancy. Fear of birth was assessed using FOBS-The fear of birth scale, with the cut off at >= 60.

    Findings: The prevalence of fear of birth was 22% in mid pregnancy and 19% in late pregnancy, a statistically significant decrease. Different patterns were found where some women presented with increased fear and some with decreased fear. The women who experienced more fear or less fear later in pregnancy could not be differentiated by background factors.

    Conclusions: More research is needed to explore factors important to reduce fear of childbirth and the optimal time to measure it.

  • 9.
    Hildingsson, Ingegerd
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Johansson, Margareta
    Mid Sweden University, Department of Health Science, Sundsvall, Sweden.
    Fenwick, Jennifer
    Griffith University, Gold Coast Hospital, Australia.
    Haines, Helen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Childbirth fear in expectant fathers: Findings from a regional Swedish cohort study2014In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, no 2, p. 242-247Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    to investigate the prevalence of childbirth related fear in Swedish fathers and associated factors.

    DESIGN:

    a regional cohort study. Data was collected by a questionnaire.

    SETTING:

    three hospitals in the middle-north part of Sweden

    PARTICIPANTS:

    1047 expectant fathers recruited in mid-pregnancy during one year (2007) who completed the Fear of Birth Scale (FOBS).

    MEASUREMENTS:

    prevalence of childbirth fear and associated factors. Crude and adjusted odds ratios were calculated between men who scored 50 and above (childbirth fear) and those that did not (no fear). Logistic regression analysis was used to assess which factors contributed most to childbirth fear in fathers.

    FINDINGS:

    the prevalence of childbirth fear in men was 13.6%. Factors associated with childbirth related fear were as follows: Less positive feelings about the approaching birth (OR 3.4; 2.2-5.2), country of birth other than Sweden (OR 2.8; 1.3-6.1), a preference for a caesarean birth (OR 2.1; 1.7-4.1), childbirth thoughts in mid-pregnancy (OR 1.9; 1.1-2.0) and expecting the first baby (OR 1.8; 1.2-2.6).

    KEY CONCLUSIONS:

    high levels of fear were associated with first time fathers and being a non-native to Sweden. Men with fear were more likely to experience pregnancy and the coming birth as a negative event. These men were also more likely to identify caesarean section as their preferred mode of birth.

    IMPLICATIONS FOR PRACTICE:

    engaging expectant fathers in antenatal conversations about their experiences of pregnancy and feelings about birth provides health-care professionals with an opportunity to address childbirth fear, share relevant information and promote birth as a normal but significant life event.

  • 10.
    Hildingsson, Ingegerd
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden..
    Karlström, Annika
    Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden..
    Haines, Helen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.;Univ Melbourne, Rural Hlth Acad Ctr, Melbourne Med Sch, Northeast Hlth Wangaratta Educ & Res Unit, Melbourne, Vic, Australia. Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden..
    Johansson, Margareta
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Swedish women's interest in models of midwifery care - Time to consider the system?: A prospective longitudinal survey2016In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 7, p. 27-32Article in journal (Refereed)
    Abstract [en]

    Background: Sweden has an international reputation for offering high quality maternity care, although models that provide continuity of care are rare. The aim was to explore women's interest in models of care such as continuity with the same midwife, homebirth and birth center care. Methods: A prospective longitudinal survey where 758 women's interest in models such as having the same midwife throughout antenatal, intrapartum and postpartum care, homebirth with a known midwife, and birth center care were investigated. Results: Approximately 50% wanted continuity of care with the same midwife throughout pregnancy, birth and the postpartum period. Few participants were interested in birth center care or home birth. Fear of giving birth was associated with a preference for continuity with midwife. Conclusions: Continuity with the same midwife could be of certain importance to women with childbirth fear. Models that offer continuity of care with one or two midwives are safe, cost-effective and enhance the chance of having a normal birth, a positive birth experience and possibly reduce fear of birth. The evidence is now overwhelming that all women should have maternity care delivered in this way.

  • 11.
    Hildingsson, Ingegerd
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Karlström, Annika
    Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden.
    Haines, Helen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Univ Melbourne, Rural Hlth Acad Ctr, Melbourne, Vic, Australia.
    Caseload midwifery for women with fear of birth is a feasible option2018In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 16, p. 50-55Article in journal (Refereed)
    Abstract [en]

    Objective: Continuity with a known midwife might benefit women with fear of birth, but is rare in Sweden. The aim was to test a modified caseload midwifery model of care to provide continuity of caregiver to women with fear of birth. Methods: A feasibility study where women received antenatal and intrapartum care from a known midwife who focused on women's fear during all antenatal visits. The study was performed in one antenatal clinic in central Sweden and one university hospital labor ward. Data was collected with questionnaires in mid and late pregnancy and two months after birth. The main outcome was fear of childbirth. Result Eight out of ten women received all antenatal and intrapartum care from a known midwife. The majority had a normal vaginal birth with non-pharmacological pain relief. Satisfaction was high and most women reported that their fear of birth alleviated or disappeared. Conclusion: Offering a modified caseload midwifery model of care seems to be a feasible option for women with elevated levels of childbirth fear as well as for midwives working in antenatal clinics as it reduces fear of childbirth for most women. Women were satisfied with the model of care and with the care provided.

  • 12.
    Johansson, Margareta
    et al.
    Karolinska Inst, Dept Clin Sci & Educ, Sjukhusbacken 10, SE-11883 Stockholm, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth, SE-11883 Stockholm, Sweden..
    Thomas, Jan
    Kenyon Coll, Dept Sociol, Gambier, OH 43022 USA..
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Karolinska Inst, Dept Womens & Childrens Hlth, SE-11883 Stockholm, Sweden.;Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden..
    Haines, Helen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Karolinska Inst, Dept Womens & Childrens Hlth, SE-11883 Stockholm, Sweden.;Univ Melbourne, Rural Hlth Acad Ctr, Melbourne Med Sch, Northeast Hlth Wangaratta Educ & Res Unit, Melbourne, Vic, Australia..
    Swedish fathers contemplate the difficulties they face in parenthood2016In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 8, p. 55-62Article in journal (Refereed)
    Abstract [en]

    Objective: The aim was to explore what concerns Swedish fathers had about parenting difficulties at two months after the birth of their baby. Methods: Self-report questionnaires were used and data were analyzed with mixed methods. Results: Thirty percent of the 827 fathers reported concerns about the difficulties of parenthood. The theme 'Managing the demands of being a father' emerged and was based on concerns about how to raise the baby, having enough money, health issues, lack of time and finding balance in the new family pattern. Financial worries, feeling less positive about expecting a baby, and self-reported poor emotional health were related to fathers who perceived parenthood as difficult. Conclusion: Experienced fathers as well as new fathers expressed similar concerns about parenthood. Preparation classes for reassurance and skills coaching about child raising may provide important support for fathers. This is especially important for fathers who may have poor emotional health or who may not be feeling positive about expecting a baby. Policy-makers and health care providers should recognize that offering support for all fathers benefits not only men, but also their children, and their partners and can help encourage egalitarian practices at home and work.

  • 13. Pallant, Julie F.
    et al.
    Haines, Helen M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Cross, Maddalena
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Psychometric evaluation and refinement of the Prenatal Attachment Inventory2014In: Journal of Reproductive and Infant Psychology, ISSN 0264-6838, E-ISSN 1469-672X, Vol. 32, no 2, p. 112-125Article in journal (Refereed)
    Abstract [en]

    Objective:

    To explore the underlying structure of the Prenatal Attachment Inventory (PAI) and to assess the psychometric properties of the subscales.

    Background:

    The establishment of the mother–fetus relationship is an important developmental task for successful adaption to pregnancy, with implications for the well-being of mother and child. The PAI was developed to measure the relationship between a women and her fetus. Although originally developed as a single dimension, other researchers have suggested alternative factor structures.

    Methods:

    A self-report questionnaire, including the PAI, was administered to 775 Swedish women in late pregnancy. Psychometric assessment of the PAI was undertaken using exploratory (EFA) and confirmatory factor analysis (CFA), and Rasch analysis.

    Results:

    EFA indicated a three-factor solution, which was confirmed by CFA. The previously reported single-factor and five-factor solutions were not supported. Rasch analysis was used to form three 6-item PAI-Revised subscales (Anticipation,Interaction,Differentiation). All subscales showed good overall fit to the Rasch model and good internal consistency. The three subscales were moderately intercorrelated, sharing between 23% and 42% of their variance, suggesting they should be used separately, pending further research concerning their unique predictive power.

    Conclusion:

    These results suggest that PAI-Revised is a psychometrically sound tool, suitable for use in research and clinical settings. It can be used to guide the identification, support, and follow-up of pregnant women with low attachment. The three subscales, although related, may tap different aspects of the attachment construct, with different antecedents and consequences for the well-being of mother and child.

  • 14. Rondung, Elisabet
    et al.
    Ternström, Elin
    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, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Hildingsson, Ingegerd
    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, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Haines, Helen
    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, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Sundin, Örjan
    Ekdahl, Johanna
    Karlström, Annika
    Larsson, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Segebladh, Birgitta
    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, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Baylis, Rebecca
    Rubertsson, Christine
    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, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    A randomized controlled trial comparing Internet-based cognitive behavior therapy with standard care for women with fear of birthManuscript (preprint) (Other academic)
  • 15.
    Ternström, Elin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Haines, Helen
    Rural Health Academic Centre, University of Melbourne, Victoria, Australia.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Higher prevalence of childbirth related fear in foreign born pregnant women: Findings from a community sample in Sweden2015In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 31, no 4, p. 445-450Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    to investigate the prevalence of childbirth related fear (CBRF) in early pregnancy among both Swedish born and foreign born women living in Sweden.

    DESIGN:

    a cross sectional prevalence study. Data was collected by a questionnaire, which was available in Swedish and eight other languages.

    SETTING:

    a university hospital in the middle of Sweden.

    PARTICIPANTS:

    the recruitment took place during a two month period where the participating women completed the Fear of Birth Scale (FOBS) in mid-pregnancy.

    MEASUREMENTS:

    prevalence of CBRF, the cut-point of 60 and above. Odds ratios with a 95% confidence interval were calculated between women born in Sweden and women born in a foreign country. Stratified analyses were also performed separately for Swedish born and foreign born women.

    FINDINGS:

    in total 606 women completed the survey, 78% were born in Sweden and 22% were born in a foreign country. About 22% of the total sample scored 60 or more on the FOBS-scale. Almost 18% (n=85) of the women born in Sweden reported CBRF whereas 37 % (n=49) of the foreign born women reported CBRF. Being born outside Sweden (OR 2.7; CI 1.7-4.0) and expecting the first baby (OR 1.9; CI 1.3-2.8) were associated with CBRF. There were no differences in age, civil status or level of education between women with or without FOBS≥60. However, a stratified analysis showed that primiparas born in a foreign country (OR 3.8; CI 1.8-8.0) were more likely to score 60 or more on the FOBS-scale compared to multiparas born in a foreign country.

    KEY CONCLUSIONS:

    childbirth related fear was almost three times as common among foreign born women when compared to Swedish women. Foreign born childbearing women are an extremely vulnerable group who need culturally sensitive and targeted support from caregivers. Further research is needed to clearly identify the components of women׳s childbirth related fear in various ethnic groups.

  • 16.
    Ternström, Elin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Haines, Helen
    Rural Health Academic Centre, University of Melbourne, Victoria, Australia.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Pregnant women's thoughts when assessing fear of birth on the Fear of Birth Scale2016In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 29, no 3, p. E44-E49Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Fear of childbirth is common during pregnancy but rarely assessed in clinical practice. The Fear of Birth Scale has been proposed as a valid measure suitable for assessing fear of birth in an antenatal clinical context. To make sure that the scale makes sense in relation to the known constructs of fear of birth, it is important to find out what women think when responding to the Fear of Birth Scale.

    AIM:

    To report what women in mid-pregnancy think when assessing fear of birth on the Fear of Birth Scale.

    METHODS:

    A qualitative design using semi-structured interviews with a think aloud technique was used. Thirty-one women were recruited in gestational week 17-20. Content analysis was conducted to describe the different dimensions of fear of birth.

    FINDINGS:

    Worry was described as unspecific feelings and thoughts, often with a negative loading. Fear was described as a strong feeling connected to something specific. Furthermore, the women thought about aspects that influence their worries and fears and explained the strategies that helped them to cope with their fear of birth.

    CONCLUSION:

    Women could clearly assess, describe, and discuss fear of birth using the Fear of Birth Scale. This supports the use of the Fear of Birth Scale in clinical settings as a starting point for further dialogue about women's fear of birth. The dialogue may identify women's need for information, treatment, and referral when necessary.

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