Kathrin Stoll

Childbirth Fear, Anxiety, Fatigue, and Sleep Deprivation in Pregnant Women

OBJECTIVE To explore womens levels of childbirth fear, sleep deprivation, anxiety, and fatigue and their relationships during the third trimester of pregnancy. DESIGN A cross-sectional descriptive survey of a community sample. PARTICIPANTS Six hundred and fifty English-speaking nulliparous and multiparous women, 17 to 46 years of age and between 35 and 39 weeks gestation, with uncomplicated pregnancies. METHODS Wijma Delivery Expectancy/Experience Questionnaire, Spielberger State Anxiety Inventory, Mindells Sleep Questionnaire, and the Multidimensional Assessment of Fatigue Questionnaire. RESULTS Twenty-five percent of women reported high levels of childbirth fear and 20.6% reported sleeping less than 6 hours per night. Childbirth fear, fatigue, sleep deprivation, and anxiety were positively correlated. Fewer women attending midwives reported severe fear of childbirth than those attending obstetricians. Women with high childbirth fear were more likely to have more daily stressors, anxiety, and fatigue, as well as less help. Higher levels of anxiety predicted higher levels of childbirth fear among women. CONCLUSION One fourth of women reported high childbirth fear. Womens fear of childbirth was related to fatigue, available help, stressors, and anxiety. Fear of childbirth appears to be part of a complex picture of womens emotional experiences during pregnancy.

Distance matters: a population based study examining access to maternity services for rural women

BackgroundIn the past fifteen years there has been a wave of closures of small maternity services in Canada and other developed nations which results in the need for rural parturient women to travel to access care. The purpose of our study is to systematically document newborn and maternal outcomes as they relate to distance to travel to access the nearest maternity services with Cesarean section capabililty.MethodsStudy population is all women carrying a singleton pregnancy beyond 20 weeks and delivering between April 1, 2000 and March 31, 2004 and residing outside of the core urban areas of British Columbia. Maternal and newborn data was linked to specific geographic catchments by the B.C. Perinatal Health Program. Catchments were stratified by distance to nearest maternity service with Cesarean section capabililty if greater than 1 hour travel time or level of local service. Hierarchical logistic regression was used to test predictors of adverse newborn and maternal outcomes.Results49,402 cases of women and newborns resident in rural catchments were included. Adjusted odds ratios for perinatal mortality for newborns from catchments greater than 4 hours from services was 3.17 (95% CI 1.45-6.95). Newborns from catchments 2 to 4 hours, and 1 to 2 hours from services generated rates of 179 and 100 NICU 3 days per thousand births respectively compared to 42 days for newborns from catchments served by specialists.ConclusionsDistance matters: rural parturient women who have to travel to access maternity services have increased rates of adverse perinatal outcomes.

“It's All the Rage These Days”: University Students' Attitudes Toward Vaginal and Cesarean Birth

BACKGROUND At 30 percent, British Columbia has the highest cesarean section rate in Canada. Little is known about the childbirth views and birthing preferences of college-aged women and men. The objectives of this study were to document (a) the prevalence of cesarean versus vaginal delivery as the preferred mode of delivery among nonpregnant university students without a history of childbirth, (b) the reasons for reported childbirth preferences, and (c) confidence in vaginal birth as a predictor of childbirth preference. METHODS A cohort of 3,680 male and female university students without a history of childbirth participated in an online survey of childbirth preferences. The study used a mixed methods approach (quantitative thematic analysis and logistic regression modeling). Prevalence of, and reasons for, preferred mode of delivery were analyzed separately for male and female respondents. RESULTS Most men and women responded that they preferred vaginal delivery, with 9 percent stating a preference for cesarean delivery. Reasons for preferred mode of delivery were similar for men and women. For women, confidence in vaginal birth emerged as a significant predictor of childbirth preference. CONCLUSIONS Results indicate that a preference for cesarean section is linked to fear of childbirth and driven by low confidence in vaginal birth. Educational strategies targeting university-aged men and women may be helpful in alleviating fears of vaginal birth and providing evidence-based information about different birth options.

Stress and anxiety associated with lack of access to maternity services for rural parturient women.

OBJECTIVE The objective of this study is to compare the level of stress and anxiety between women resident in communities with different degrees of access to local maternity services. DESIGN   Cross-sectional survey. SETTING Fifty-two communities across rural British Columbia with different levels of access to maternity care services (ranging from no services to local specialist obstetrician). PARTICIPANTS A total of 187 women, 40 of whom were from communities with no local access to services. MAIN OUTCOME MEASURES Stress score on the R ural Pregnancy Experience Scale including financial and continuity of care subscales. RESULTS Parturient women who had to travel more than one hour to access services were 7.4 times more likely to experience moderate or severe stress when compared to women who had local access to maternity services. CONCLUSIONS Lack of access is strongly associated with stress in rural parturient women.

Psychometric Evaluation of the Multidimensional Assessment of Fatigue Scale for Use with Pregnant and Postpartum Women.

Although fatigue is a common experience for pregnant women and new mothers, few measures of fatigue have been validated for use with this population. To address this gap, the authors assessed psychometric properties of the Multidimensional Assessment of Fatigue (MAF) scale, which was used in 2 independent samples of pregnant women. Results indicated that the psychometric properties of the scale were very similar across samples and time points. The scale possesses a high level of internal consistency, has good convergent validity with measures of sleep quality and depression, and discriminates well from a measure of social support. Contrary to previous evaluations of the MAF, data strongly suggest that the scale represents a unidimensional construct best represented by a single factor. Results indicate that the MAF is a useful measure of fatigue among pregnant and postpartum women.

A prospective study of effects of psychological factors and sleep on obstetric interventions, mode of birth, and neonatal outcomes among low-risk British Columbian women.

BackgroundObstetrical interventions, including caesarean sections, are increasing in Canada. Canadian women’s psychological states, fatigue, and sleep have not been examined prospectively for contributions to obstetric interventions and adverse neonatal outcomes.Context and purpose of the study: The prospective study was conducted in British Columbia (BC), Canada with 650 low-risk pregnant women. Of those women, 624 were included in this study. Women were recruited through providers’ offices, media, posters, and pregnancy fairs. We examined associations between pregnant women’s fatigue, sleep deprivation, and psychological states (anxiety and childbirth fear) and women’s exposure to obstetrical interventions and adverse neonatal outcomes (preterm, admission to NICU, low APGARS, and low birth weight).MethodsData from our cross-sectional survey were linked, using women’s personal health numbers, to birth outcomes from the Perinatal Services BC database. After stratifying for parity, we used Pearson’s Chi-square to examine associations between psychological states, fatigue, sleep deprivation and maternal characteristics. We used hierarchical logistic regression modeling to test 9 hypotheses comparing women with high and low childbirth fear and anxiety on likelihood of having epidural anaesthetic, a caesarean section (stratified for parity), assisted vaginal delivery, and adverse neonatal outcomes and women with and without sleep deprivation and high levels of fatigue on likelihood of giving birth by caesarean section, while controlling for maternal, obstetrical (e.g., infant macrosomia), and psychological variables.ResultsSignificantly higher proportions of multiparas, reporting difficult and upsetting labours and births, expectations of childbirth interventions, and health stressors, reported high levels of childbirth fear. Women who reported antenatal relationship, housing, financial, and health stressors and multiparas reporting low family incomes were significantly more likely to report high anxiety levels. The hypothesis that high childbirth fear significantly increased the risk of using epidural anaesthesia was supported.ConclusionsControlling for some psychological states and sleep quality while examining other contributors to outcomes decreases the likelihood of linking childbirth fear anxiety, sleep deprivation, and fatigue to increased odds of caesarean section. Ameliorating women’s childbirth fear to reduce their exposure to epidural anaesthesia can occur through developing effective interventions. These include helping multiparous women process previous experiences of difficult and upsetting labour and birth.

Fear of Childbirth and Preference for Cesarean Delivery Among Young American Women Before Childbirth: A Survey Study

BACKGROUND Fear of birth and mode of delivery preferences are similar among pregnant and nonpregnant women, suggesting that attitudes toward birth are formed in young adulthood or earlier. Understanding why some young women fear birth and prefer obstetric interventions can inform public health initiatives aimed at reducing fear and promoting birth as a normal life event. METHODS We conducted an online survey with 752 American nulliparous young women to assess their preferences and attitudes toward childbirth. We identified explanatory variables associated with reported fear of childbirth and cesarean delivery (CD) preferences. RESULTS A preference for CD was reported by 14 percent of young women and 27 percent had scores indicating elevated fear of birth. Fear of birth increased the likelihood of cesarean preference (adjusted relative risk (ARR) 3.84 [95% CI 2.49-5.95]) as did a family history of CD (ARR 1.65 [95% CI 1.13-2.42]). The likelihood of reporting elevated childbirth fear was increased among young women who reported concerns about the physical changes pregnancy and birth have on womens bodies (ARR 2.04 [95% CI 1.50-2.78]). Young women who reported a high degree of confidence in their knowledge about childbirth were significantly less likely to report childbirth fear (ARR 0.61 [95% CI 0.42-0.87]). Access to childbirth information was also associated with a decreased likelihood of fear of birth (ARR 0.75 [95% CI 0.59-0.95]). CONCLUSIONS Young women reporting high levels of childbirth fear are nearly four times more likely to prefer a CD. Specific fears, such as worries over the influence of pregnancy and birth on the female body, need to be addressed before pregnancy.

Attitudes and Preferences of Young Women With Low and High Fear of Childbirth

We examined constructions of labor and birth for 461 Canadian women who attended the University of British Columbia (Canada) and participated in an online survey about pregnancy and birth, using a combination of Likert items and open-ended questions. We performed a content analysis of women’s open-ended responses about their feelings toward birth and analyzed comments of women with high and low fear of childbirth separately. Students with high fear of birth described childbirth as a frightening and painful ordeal and viewed obstetric interventions as a means to make labor and birth more manageable. Students with low fear constructed birth as a natural event and regarded interventions more critically. Students in both groups supported women’s autonomous maternity care decisions. Our findings contribute to care providers’ and educators’ knowledge about preferences and fears expressed by the next generation of maternity care consumers and potential strategies to reduce their fear of childbirth.

Vicarious birth experiences and childbirth fear: does it matter how young canadian women learn about birth?

In our secondary analysis of a cross-sectional survey, we explored predictors of childbirth fear for young women (n = 2,676). Young women whose attitudes toward pregnancy and birth were shaped by the media were 1.5 times more likely to report childbirth fear. Three factors that were associated with reduced fear of birth were women’s confidence in reproductive knowledge, witnessing a birth, and learning about pregnancy and birth through friends. Offering age-appropriate birth education during primary and secondary education, as an alternative to mass-mediated information about birth, can be evaluated as an approach to reduce young women’s childbirth fear.

The Canadian Birth Place Study: Describing maternity practice and providers' exposure to home birth

OBJECTIVES (1) to describe educational, practice, and personal experiences related to home birth practice among Canadian obstetricians, family physicians, and registered midwives; (2) to identify barriers to provision of planned home birth services, and (3) to examine inter-professional differences in attitudes towards planned home birth. DESIGN the first phase of a mixed-methods study, a quantitative survey, comprised of 38 items eliciting demographic, education and practice data, and 48 items about attitudes towards planned home birth, was distributed electronically to all registered midwives (N=759) and obstetricians who provide maternity care (N=800), and a random sample of family physicians (n=3,000). SETTING Canada. This national investigation was funded by the Canadian Institutes for Health Research. PARTICIPANTS Canadian registered midwives (n=451), obstetricians (n=245), and family physicians (n=139). FINDINGS almost all registered midwives had extensive educational and practice experiences with planned home birth, and most obstetricians and family physicians had minimal exposure. Attitudes among midwives and physicians towards home birth safety and advisability were significantly different. Physicians believed that home births are less safe than hospital births, while midwives did not agree. Both groups believed that their views were evidence-based. Midwives were the most comfortable with including planned home birth as an option when discussing choice of birth place with pregnant women. Both midwives and physicians expressed discomfort with inter-professional consultation related to planned home births. In addition, both family physicians and obstetricians reported discomfort with discussing home birth with their patients. A significant proportion of family physicians and obstetricians would have liked to attend a home birth as part of their education. CONCLUSIONS the amount and type of education and exposure to planned home birth practice among maternity care providers were associated with attitudes towards home birth, comfort with discussing birth place options with women, and beliefs about safety. Barriers to home birth practice across professions were both logistical and philosophical. IMPLICATIONS FOR PRACTICE formal mechanisms for midwifery and medical education programs to increase exposure to the theory and practice of planned home birth may facilitate evidence based informed choice of birth place, and increase comfort with integration of care across birth settings. An increased focus among learners and clinicians on reliable methods for assessing the quality of the evidence about birth place and maternal-newborn outcomes may be beneficial.