Diagnostic Aspects of Fear of Childbirth

Abstract: The first study presents the theoretical background of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) and an examination of this new instrument's construct validity and reliability. The W-DEQ has good reliability and measures the construct "fear of childbirth", when compared with other questionnaires.In the second study the link between fear of childbirth and theories on anxiety is discussed and a possible expression of trait and state aspects of fear of childbirth is investigated. Nulliparous and parous pregnant women with high, moderate and low fear of childbirth are compared before and after delivery. Before delivery, in general, nulliparous women had more fear of childbirth than parous women. In the high fear group, however, there was no difference in fear of childbirth between nulliparous and parous women. The difference for parity disappeared after delivery. There was a decreasing trend in fear of childbirth from immediately after the delivery to five weeks later, in a parallell way for all groups with high, moderate and low fear of childbirth, regardless parity. A vicious cycle principle is discussed, which implies that fear of childbirth comprises a part of trait fear of childbirth; during labour women experience what they are afraid of, which also influences women's postpartum cognitive appraisalof the delivery.In the third study the prevalence of extreme fear of childbirth (women who had or were going to ask for a cesarean section due to their fear of childbirth) and anxiety disorders is investigated and the relation between fear of childbirth and anxiety disorders is explored. A subgroup of women (2.4%) fulfilled the criteria for an extreme, or phobia-like, fear of childbirth. It was shown that anxiety disorders and fear of childbirth are related. In the fourth study the results show that pre- and postpartum anxiety are related to mode of delivery. The prevalence of anxiety disorders, assessed by means of an interview prior to delivery, was highest in the emergency cesarean section group. From before to after delivery, the prevalence of traumatic anxiety symptoms decreased in all groups, except in the emergency cesarean section group. The emergency cesarean section group also had the highest amount of traumatic stress symptoms before and after the delivery.