Does fear of childbirth during pregnancy predict emergency caesarean section?

Objective Caesarean section rates are rising dramatically in the UK. It has been estimated that they have increased from 10% to 22% of all births over 15 years. A Swedish study has suggested that fear of childbirth during pregnancy may increase the risk of emergency caesarean section. The aim of this study is to identify whether fear of childbirth can predict the occurrence of emergency caesarean section in a UK sample. Design A prospective design using between-group comparisons. Setting Sheffield, S. Yorkshire, UK. Sample Four hundred and forty-three pregnant women, recruited at 32 weeks of gestation, over 16 years of age. Methods Participants completed self-assessment, postal questionnaires assessing fear of labour and anxiety using the Wijma Delivery Expectancy Scale (W-DEQ) and the Speilberger State Trait Anxiety Scale (STAI), together with their expectations about their mode of delivery. Delivery information was gathered via birth summary sheets. Main outcome measure Mode of delivery. Results Emergency caesarean section was associated with previous caesarean section, parity, age and a score reflecting medical risk, but not fear of childbirth or anxiety measures. There were no differences in fear between women experiencing spontaneous-vertex, forceps/ventouse, emergency or elective caesarean deliveries. The W-DEQ was factor analysed and was found to measure four distinct domains: fear, lack of positive anticipation and the degree to which women anticipate isolation and riskiness in childbirth. However, these individual factors also failed to contribute to the prediction of mode of delivery. Primiparous women in the UK sample showed highly elevated fear scores when compared with a Swedish sample. Such discrepancies were not found for the multiparous sample. Conclusions Fear of childbirth during the third trimester is not associated with mode of delivery in a UK sample. Possible cross-cultural differences are discussed.