Logotyp: till Uppsala universitets webbplats

Childbirth can be associated with both positive and negative psychological reactions. Pregnancy and birth and the emotions connected to it are subjective, multidimensional and complex, including both physiological and psychological factors. Fear of childbirth (FOC) represents a significant psychological challenge for both expectant mothers and fathers, with implications for mental health, self-efficacy, and support needs. FOC during pregnancy can lead to various psychiatric disorders, such as postpartum depression and anxiety disorders as well as an increase in instrumental births and emergency caesarean sections. The overall aim of this thesis was to identify the needs and preferences of prospective and newly become parents experiencing FOC and what kinds of barriers and facilitators there are in help-seeking. The work is summarized in four papers originating from a cross-sectional study and interviews with men and women with FOC. Paper I explores the experiences of Swedish pregnant women with severe FOC, highlighting unmet support needs and barriers to seeking help. Paper II employs cluster analysis to examine the relationships between FOC, anxiety, depression, and self-efficacy in pregnant women. Paper III turns its focus to fathers, examining their support needs, barriers, and facilitators related to FOC. Paper IV describes and analyses women’s expectations of childbirth, their needs and wishes for support and treatment for FOC during pregnancy. Results from Paper I showed that women identified stigma, lack of empathetic healthcare encounters, and logistical obstacles as primary deterrents to accessing care. Despite many participants desiring support, only a small group of women found the available support effective. Respectful, individualized care was a critical facilitator of positive outcomes. Paper II identified four clusters: Resourceful–Robust, Resourceful–Fearful, Vulnerable–Fearful, and Fragile–Fearful. Women in the Vulnerable–Fearful and Fragile–Fearful clusters showed the highest levels of anxiety and depression, coupled with the lowest self-efficacy. Paper III reported that fathers experienced anxiety, stress, and a lack of recognition for their emotional needs within the maternal-focused healthcare system. The stigma of expressing vulnerability, compounded by societal expectations of stoicism, often deterred men from seeking help. Individualized support and proactive engagement from healthcare providers were identified as critical to addressing these issues. Paper IV showed that the women had FOC long before their first pregnancy. The women’s fear was to a very small degree about actual risks of injury, illness and death. Instead, they were afraid of being stripped of control over themselves and the situation, not being treated respectfully, being abandoned and the risk of medical procedures being performed without their consent. In summary, FOC is closely tied to mental health, self-efficacy, and the quality of available support systems. Women and men experience FOC differently, necessitating gender-sensitive approaches in childbirth and postpartum care. The results suggest that providing empathetic and individualized care, and addressing systemic barriers, may reduce FOC and improve perinatal outcomes. The findings underscore the need for tailored interventions, particularly for those with heightened vulnerability to mental health challenges.