‘No worries’ A longitudinal study of fear, attitudes and beliefs about childbirth from a cohort of Australian and Swedish women

Abstract: 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).