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Table 1 Characteristics of included studies on Fear of Childbirth

From: Definitions, measurements and prevalence of fear of childbirth: a systematic review

First author, year of publication [reference number] EP-HPP rating Aim of study Study design Population Sample size (response rate, %) Country
Adams 2012 [80] S To assess the association between FOC and duration of labour Prospective cohort study, using postal survey at 32 weeks All women scheduled to give birth at a University hospital Nov 2008-April 2010 2206 (63.0) Norway
Elvander 2013 [63] M To estimate the effects of different levels of fear of birth and mode of delivery on birth experience 1 month after birth Prospective study, using telephone interviews in the third trimester of pregnancy and 1 month after birth Nulliparous English and Spanish-speaking women aged 18–35, with a single fetus, who birthed >34 weeks’, recruited in a variety of ways, in 2009–2011 3005 (NA)
Number eligible not mentioned
Eriksson 2005 [71] S To investigate and compare experiential factors associated with childbirth-related fear in women (and men) Cross-sectional observational study, using postal survey 14–26 months postnatal. FOC was assessed retrospectively All women who had a baby in a University hospital, March 1997–March 1998 410 (73.5) Sweden
Fabian 2004 [73] M To investigate the attendance rate at childbirth and parenthood education classes // and describe the characteristics of women who did not attend Cohort study using a postal questionnaire in early pregnancy and at 2 months postpartum All women attending 97% of all antenatal clinics in Sweden for 1 week in May and September 1999, and January 2000 2546 (55.0) Sweden
Fenwick 2009 [77] M To investigate levels of pre- and postpartum of childbirth fear in a cohort of childbearing women and explore the relationship to birth outcomes A prospective correlation design using postal surveys at 36 weeks’ gestation and 6 weeks’ postpartum All women (English-speaking with a single healthy fetus) attending antenatal clinic at a tertiary hospital, September 2005–March 2006 401 (43.0) Australia
Geissbuehler 2002 [69] M To examine the intensity and type of childbirth fears among pregnant women in the 2nd-3rd trimester //
to consider whether birth preparation influences childbirth anxiety
Cross-sectional, self-administered survey in 24th–28th weeks All women booked to give birth in a large hospital, November 1991–October 1999 8528 (79.1) Switzerland
Haines 2011 [67] S To examine the prevalence of childbirth-related fear (CBRF) in two rural populations (Sweden and Australia) and to pilot a short easy-to-administer tool Cross-sectional study, using postal survey at 18 weeks gestation Women undergoing routine ultrasound at 17–19 weeks at a regional Swedish hospital during 2007 and women booked booked at 18–20 weeks in an Australian regional hospital, year not described 509 (NA)
(Sweden: n = 386 and Australia: n = 123)
Number eligible not mentioned
Sweden and Australia
Hall 2009 [85] S To explore women’s levels of childbirth fear, sleep deprivation, anxiety, and fatigue and their relationships during the 3rd trimester of pregnancy Cross-sectional using surveys at term in a convenience sample at 35–39 weeks English speaking low-risk women at 35–39 weeks gestation from May 2005–July 2007 650 (NA)
Number eligible not mentioned
Heimstad 2006 [78] M To estimate prevalence of FOC in a defined area in Norway and to study the possible relationship between FOC and psychosocial background, degree of anxiety and abuse Cross-sectional study, using postal questionnaires at 18–20 weeks All pregnant women scheduled for a routine ultrasound at a University Hospital, June 2001–August 2002 1452 (54.2) Norway
Hildingsson 2010 [60] S To describe and study background characteristics, feelings and support in relation to thoughts about childbirth in mid-pregnancy Cross-sectional study, using self-administered surveys at 17–19 weeks All pregnant women who had a routine ultrasound at three hospitals in one region, year 2007 1212 (51.4) Sweden
Jespersen 2014 [81] S To assess the association between FOC and emergency caesarean section Prospective cohort study using 2 questionnaires; at 37 weeks gestation and at admission to labour ward All nulliparous, pregnant low risk women in spontaneous labour at 4 major university hospitals, 3 country hospitals and 2 local district departments, May 2004–July 2005 2598 (71.1) Denmark
Jokić-Begić 2014 [82] S To examine the role of demographic variables, expected pain level, trait anxiety and anxiety sensitivity in FOC among nulliparous and multi-parous women in the last trimester of pregnancy Cross-sectional/single cohort study using one questionnaire in 8th–9th months of pregnancy Pregnant women attending at a perinatal clinic at one University hospital in Zagreb, Jan-May 2012 200 (67.6) Croatia
Laursen 2008 [64] M To describe the association between FOC and social, demographics and psychological factors in healthy nulliparous women with uncomplicated pregnancies Population-based prospective cohort study
(pre-post design), using telephone interviews at 16 and 32 weeks
All nulliparous women with uncomplicated pregnancies, 1997–2003 30,480 (approx. 30%) Denmark
Lowe 2000 [74] M To test whether the theoretically predicted inverse relationship between childbirth self-efficacy and fear exists, and to characterize specific personality attributes associated with women who express low or high FOC Cross-sectional cohort study (secondary analysis), using the Childbirth Attitudes Questionnaire distributed in the third trimester and returned by post Nulliparous women enrolled in childbirth education classes, year for data collection not described 280 (NA)
Number eligible not mentioned
Lukasse 2014 [62] M To assess the prevalence of severe FOC and investigate the association between severe FOC and selected background variables Cohort study, using a self-completed survey in pregnancy at varying times Pregnant women attending antenatal care in 6 countries between March 2008–August 2010 6870;
828 (B)
585 (I),
1252 (D)
896 (E)
2351 (N)
958 (S)
Norway, Iceland, Denmark Estonia
Nieminen 2009 [79] M Investigate the prevalence of intense FOC, association between the level of FOC and gestational age, the risk factors for intense FOC in primi and multiparous, and risk factors associated with preference for caesarean section Cross-sectional, using a self-completed survey in pregnancy All Swedish speaking primi and multiparous women in four districts, September–October 2006 1635 (98.3) Sweden
Nilsson 2012 [61] S To explore FOC during pregnancy and 1 year after birth and its association with birth experience and mode of birth A population based prospective longitudinal survey (pre and post design), using postal surveys in mid and late pregnancy, 2 months and 1 year postpartum All pregnant women who had a routine ultrasound at three hospitals in one region, year 2007
(Same population as in Hildingsson 2010)
763 (86) Sweden
Poikkeus 2006 [75] M To compare the prevalence and predictors of severe FOC and pregnancy related anxiety in groups of assisted reproduction treatment (ART) and spontaneously conceiving women with singleton pregnancies Prospective longitudinal study with cohort (ART) and matched control (consecutive enrolment) groups, using a self-completed survey at 20 weeks ART group = 367, and consecutive controls = 379, year 1999 746 (86.6) Finland
Rouhe 2015 [65] S To assess effects of psycho-education versus conventional care during pregnancy in women with FOC All nulliparous women at time of routine ultrasound at 11–13 weeks.
371 women with severe FOC participated in an RCT
using psycho-education as relaxation (6 sessions during pregnancy, one postnatal) and conventional care by community nurses
Questionnaires completed twice during pregnancy and/or 3 months postpartum
4575 screened by W-DEQ for severe FOC during routine ultra-sonography at 11–13 weeks. Those with scores >100 were included in the trial, in October 2007–August 2009 4575 (NA)
Number eligible not mentioned
Räisänen 2014 [66] S To identify risk factors for FOC and evaluate relation between FOC and adverse perinatal outcomes Cohort register study, using The Finnish Medical Birth Register, with FOC defined according to ICD – code 099.80 All singleton births during 1997–2010 788,317 (100?) Finland
Söderqvist 2004 [83] S To investigate association between traumatic stress symptoms and FOC in late pregnancy Cohort using self-completed survey at week 32 Consecutive recruitment of pregnant women visiting hospital in Kalmar and Linköping, in 1997 951 (48.2) Sweden
Ternström 2014 [72] S To investigate the prevalence of childbirth-related fear in early pregnancy among Swedish and foreign-born women living in Sweden Cross-sectional study of a total population attending ultrasound screening, using a self-completed questionnaire at 17–20 weeks University hospital, 615 women screened during routine ultra-sonography, and asked to participate, year not described 606 (96.2) Sweden
Waldenström 2006 [70] M To investigate the prevalence of FOC in a nationwide sample and its association with subsequent rates of CS and overall experience of childbirth A longitudinal national cohort study, using postal survey at 16 weeks gestation and 2 months postpartum All pregnant women invited to participate at 16th week gestation and at 2 months postpartum, 3 weeks: May and September 1999 and January 2000 2662 (97.0) Sweden
Zar 2002 [84] S To investigate the prevalence of extreme FOC and anxiety disorders in late pregnancy Prospective study using postal survey at week 28–30 and interview at 32 weeks Pregnant women from a country hospital were invited to participate, during 8 months, year not described 506 (82.5) Sweden
  1. M Moderate, S Strong, EPHPP Effective Public Health Practice Project, FOC Fear Of Childbirth, CS Caesarean Section