Fear of childbirth and emergency caesarean section in low-risk nulliparous women: a prospective cohort study

Objective: To assess the association between fear of childbirth (FOC) and emergency caesarean section. Design: A prospective cohort study of low-risk nulliparous women at term. Setting: Nine obstetric departments in Denmark, May 2004-July 2005. Population: A total of 2598 nulliparous women in spontaneous labor with a single fetus in cephalic presentation at term. Methods: Self-reported FOC was assessed at 37 weeks of gestation by the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) version A and at admission to the labor ward by the Delivery Fear Scale (DFS). Mode of delivery was recorded by the attending staff. Logistic regression analyses were used to estimate unadjusted and adjusted odds ratios (OR). Main outcome measures: Risk of emergency caesarean section in women who feared childbirth. Results: FOC (W-DEQ sum score >= 85 and DFS sum score >= 70) was not associated with emergency caesarean section: adjusted OR = 0.81 (95% CI: 0.48-1.36) and OR = 0.97 (95% CI: 0.55-1.71), respectively. Conclusion: In this prospective observational study, women with FOC did not have an increased risk of emergency caesarean section compared to women with no such fear.