Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
PLoS One. 2022 Nov 3;17(11):e0277004. doi: 10.1371/journal.pone.0277004. eCollection 2022.
Fear of childbirth (FoB) and depressive symptoms (DS) are experienced by many women and can negatively affect women during and after pregnancy. This study assessed patterns of FoB and DS over time and associations of postpartum FoB and DS with sociodemographic and obstetric characteristics.
We conducted a longitudinal study at six health facilities in Tanzania in 2018-2019. Pregnant women were consecutively assessed for FoB and DS before and after childbirth using the Wijma Delivery Expectancy/Experience Questionnaire versions A & B and the Edinburgh antenatal and postnatal depressive scale. This paper is based on 625 women who completed participation.
The prevalence rates of FoB and DS during pregnancy were 16% and 18.2%, respectively, and after childbirth, 13.9% and 8.5%. Some had FoB (6.4%) and DS (4.3%) at both timepoints. FoB was strongly associated with DS at both timepoints (p < 0.001). Both FoB (p = 0.246) and DS (p < 0.001) decreased after childbirth. Never having experienced obstetric complications decreased the odds of postpartum and persisting FoB (adjusted odds ratio (aOR) 0.44, 95% confidence interval (CI) 0.23-0.83). Giving birth by caesarean section (aOR 2.01, 95% CI 1.11-3.65) and having more than 12 hours pass between admission and childbirth increased the odds of postpartum FoB (aOR 2.07, 95% CI 1.03-4.16). Postpartum DS was more common in women with an ill child/stillbirth/early neonatal death (aOR 4.78, 95% CI 2.29-9.95). Persisting DS was more common in single (aOR 2.59, 95% CI 1.02-6.59) and women without social support from parents (aOR 0.28, 95% 0.11-0.69).
FoB and DS coexist and decrease over time. Identifying predictors of both conditions will aid in recognising women at risk and planning for prevention and treatment. Screening for FoB and DS before and after childbirth and offering psychological support should be considered part of routine antenatal and postnatal care. Furthermore, supporting women with previous obstetric complications is crucial. Using interviews instead of a self-administered approach might have contributed to social desirability. Also, excluding women with previous caesarean sections could underestimate FoB and DS prevalence rates.
分娩恐惧（FoB）和抑郁症状（DS）是许多女性经历的问题，会在怀孕和产后对女性产生负面影响。本研究评估了 FoB 和 DS 随时间的变化模式，以及产后 FoB 和 DS 与社会人口学和产科特征的关联。
我们在 2018-2019 年在坦桑尼亚的六个卫生机构进行了一项纵向研究。使用 Wijma 分娩期望/体验问卷 A 和 B 版本以及爱丁堡产前和产后抑郁量表，在分娩前后连续评估孕妇的 FoB 和 DS。本文基于 625 名完成参与的女性。
怀孕期间 FoB 和 DS 的患病率分别为 16%和 18.2%，分娩后分别为 13.9%和 8.5%。有些女性在两个时间点都有 FoB（6.4%）和 DS（4.3%）。FoB 在两个时间点均与 DS 强烈相关（p < 0.001）。FoB 和 DS 在产后均下降（p = 0.246）。从未经历过产科并发症会降低产后和持续 FoB 的几率（调整后的优势比（aOR）为 0.44，95%置信区间（CI）为 0.23-0.83）。剖腹产分娩（aOR 2.01，95%CI 1.11-3.65）和分娩前 12 小时以上入院会增加产后 FoB 的几率（aOR 2.07，95%CI 1.03-4.16）。产后 DS 在有患病儿童/死产/早期新生儿死亡的女性中更为常见（aOR 4.78，95%CI 2.29-9.95）。持续的 DS 在单身女性（aOR 2.59，95%CI 1.02-6.59）和没有父母社会支持的女性中更为常见（aOR 0.28，95%CI 0.11-0.69）。
FoB 和 DS 共存并随时间减少。识别这两种情况的预测因素将有助于识别处于危险中的女性，并为预防和治疗做好计划。在分娩前后进行 FoB 和 DS 筛查并提供心理支持应被视为常规产前和产后护理的一部分。此外，支持有产科并发症的女性至关重要。使用访谈而不是自我管理方法可能会导致社会期望。此外，排除以前接受过剖腹产的女性可能会低估 FoB 和 DS 的患病率。
