Preferred and actual mode of delivery in relation to fear of childbirth.

PURPOSE: This prospective cohort study aimed to investigate the interrelation between preferred/actual mode of delivery and pre- and postpartum fear of childbirth (FOC). MATERIAL AND METHODS: Participants from 13 midwifery practices and four hospitals in Southwest Netherlands filled out questionnaires at 30 weeks' gestation (n = 561) and two months postpartum (n = 463), including questions on preferred mode of delivery, the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) and Hospital Anxiety Depression Scale (HADS). Results were related to obstetric data. RESULTS: Both severe FOC (OR 7.0, p < .001) and previous Cesarean section (CS) (OR 16.6, p < .001) predicted preference for CS. Severe prepartum FOC also predicted actual CS. Preferring a vaginal delivery (VD) and actually having a CS predicted higher postpartum W-DEQ scores (partial r = 0.107, p < .05). Other significant predictors for high postpartum W-DEQ scores were high prepartum W-DEQ (partial r = 0.357) and HADS anxiety scores (partial r = 0.143) and the newborn in need of medical assistance (partial r = -0.169). CONCLUSIONS: Women preferring a VD but ending up with a CS are at risk for severe FOC postpartum, while the same risk was not demonstrated for women who preferred a CS but had a VD. Prepartum FOC is strongly associated with postpartum FOC, regardless of congruence between preferred and actual mode of delivery.

Is fear of childbirth related to the woman's preferred location for giving birth? A Dutch low-risk cohort study.

BACKGROUND: In The Netherlands, women with low-risk pregnancy are routinely given the option of home birth, providing a unique opportunity to study the relationship between fear of childbirth (FOC) and preference for childbirth location, and whether women experience higher FOC when the actual location differs from their preference. METHODS: In this prospective cohort study, 331 nulliparous and parous women completed a questionnaire at gestational week 30 (T1) and two months postpartum (T2). FOC was assessed using versions A (T1) and B (T2) of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). RESULTS: At T1, women who preferred home birth had significantly lower FOC compared with women who preferred a hospital birth (mean ± SD W-DEQ scores: 55 ± 19.8 and 64 ± 18.3, respectively, P < .01). About 28% of women who responded at T2 gave birth at home. Congruence between the preferred and actual childbirth location was not predictive of FOC assessed at T2 when adjusted for obstetric and psychological variables. In an extended analysis, we found that except for prepartum FOC, the following variables also correlated with postpartum FOC: being referred because of complications and poor neonatal condition. CONCLUSIONS: Compared to women who prefer hospital birth, women who prefer home birth have lower prepartum and postpartum FOC. Giving birth at a location other than the preferred location does not appear to affect postpartum FOC. Whether giving birth at home or in the hospital, caregivers should pay extra attention to women with high FOC because they are vulnerable to postpartum FOC, especially after a complicated birth and referral.

Does fear of childbirth or family history affect whether pregnant Dutch women prefer a home- or hospital birth?

OBJECTIVE: It is a generally accepted idea that women who give birth at home are less fearful of giving birth than women who give birth in a hospital. We explored fear of childbirth (FOC) in relation to preferred and actual place of birth. Since the Netherlands has a long history of home birthing, we also examined how the place where a pregnant woman׳s mother or sisters gave birth related to the preferred place of birth. DESIGN: A prospective cohort study. SETTING: Five midwifery practises in the region Leiden/Haarlem, the Netherlands. PARTICIPANTS: 104 low risk nulliparous and parous women. METHOD: Questionnaires were completed in gestation week 30 (T1) and six weeks post partum (T2). MEASUREMENTS AND FINDINGS: No significant differences were found in antepartum FOC between those who preferred a home or a hospital birth. Women with a strong preference for either home or hospital had lower FOC (mean W-DEQ=60.3) than those with a weak preference (mean W-DEQ=71.0), t (102)=-2.60, p=0.01. The place of birth of close family members predicted a higher chance (OR 3.8) of the same place being preferred by the pregnant woman. Pre- to postpartum FOC increased in women preferring home- but having hospital birth. KEY CONCLUSIONS: The idea that FOC is related to the choice of place of birth was not true for this low risk cohort. Women in both preference groups (home and hospital) made their decisions based on negative and positive motivations. Mentally adjusting to a different environment than that preferred, apart from the medical complications, can cause more FOC post partum. IMPLICATIONS FOR PRACTICE: The decreasing number of home births in the Netherlands will probably be a self-reinforcing effect, so in future, pregnant women will be less likely to feel supported by their family or society to give birth at home. Special attention should be given to the psychological condition of women who were referred to a place of birth and caregiver they did not prefer, by means of evaluation of the delivery and being alert to anxiety or other stress symptoms after childbirth. These women have higher chance of fear post partum which is related to a higher risk of psychiatric problems.

No relationship between fear of childbirth and pregnancy-/delivery-outcome in a low-risk Dutch pregnancy cohort delivering at home or in hospital.

OBJECTIVE: To examine the relationship of fear of childbirth (FOC), general anxiety and depression during pregnancy and postpartum with birth complications. METHODS: For this prospective cohort study 105 healthy women with low-risk pregnancies (until at least 30 weeks gestation) completed the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) and the Hospital Anxiety and Depression Scale (HADS) at 30 weeks gestation and 6 weeks postpartum. These results were related with delivery characteristics. RESULTS: FOC during pregnancy was not related to complications during labour and delivery. In a regression analysis, both multiparity and medical interventions were predictors for higher postpartum FOC. A positive correlation was found between FOC during pregnancy and FOC at six weeks postpartum, corrected for complications during childbirth (r = 0.45, p < 0.001). CONCLUSIONS: The birth giving process was not related to FOC during pregnancy, but the pre-partum level of FOC certainly is predictive of the level of postpartum FOC, suggesting that FOC as measured during gestation may influence the interpretation of the birth experience itself. We did find a positive relationship between both parity and medical interventions during childbirth and FOC postpartum.

Capturing product experiences: a split-modality approach.

When people interact with products, all sensory modalities are open to receive information. To assess each modality's potential contribution to overall product experiences, we developed a split-modality approach, in which subjects experienced real-life products through only one modality: vision, touch, audition, or olfaction. Responses focused on (1) description of the sensory experience, (2) product identification, and (3) descriptions of associations and memories linked to this experience. Visual and tactual information were most detailed, made product identification easiest, and yielded the clearest memories of past events, associations to persons, and associations with other products. Because vision may have an advantage over touch by the speed with which information is processed, vision is likely to dominate product experiences in real-life situations.

Post-mortem organ donation and grief: a study of consent, refusal and well-being in bereavement.

Concern about the grief processes of organ donors' families are reported by medical staff as a reason not to ask for organ donation. Objectives of the current study were to examine the relation between consenting to a post-mortem organ donation procedure and subsequent process of grief in the bereaved. A cross-section survey was conducted in a representative time-sample of 95 bereaved who lost a first-degree family member on intensive care wards in 27 Dutch hospitals. In 36 cases an organ donation procedure took place, in 23 cases consent was refused and in 36 cases no request for organ donation was made to the bereaved. The authors found there were no differences in levels of depression and problems with detachment from the deceased between bereaved (first-degree family members) who participated in an organ donation procedure, those who refused consent, and families who were not approached for poet-mortem organ donation. No differences were found in levels of main outcome measures between three donation conditions. However, dissatisfaction with hospital care was associated with depressive and grief symptoms. The results indicate that consenting to organ donation in itself neither hinders nor furthers the grief process.