Kedir Ayantu, Bekele Habtamu, Tefera Maleda
School of Nursing, College of Health and Medical Sciences, Haramaya University, Ethiopia.
School of Midwifery, College of Health and Medical Sciences, Haramaya University, Ethiopia.
Womens Health (Lond). 2025 Jan-Dec;21:17455057251349628. doi: 10.1177/17455057251349628. Epub 2025 Aug 1.
Women's multidimensional expectations of pregnancy and childbirth can involve many emotions, from joy to fear. It is estimated that most women in Africa suffer from childbirth fear (20%-61.2%). However, to our knowledge, no study has been conducted on fear of childbirth (FOC) in women who had a prior cesarean section, particularly in the study area. This study aimed to fill this gap by assessing the level of childbirth fear and identifying its contributing factors.
Institusional based cross-sectional study was conducted among 314 pregnant women with previous cesarean sections from selected public and private health facilities in Dire Dawa. FOC was assessed using the Wilma Delivery Expectancy Questionnaire (W-DEQ-A), which comprises 33 items rated on a 6-point Likert scale, ranging from low to severe FOC, and data were analyzed using multivariable ordinal regression.
A total of 314 pregnant women participated in this study, with a response rate of 99.3%. Sixty-seven (21.3%, 95% confidence interval (CI): 17%-26%) moderate, 81 (25.8%, 95% CI: 21%-31%) high and severe 30 (9.6%, 95% CI: 6%-13%). The mean W-DEQ score was 54.35 ± 23.6. The mean score for FOC was 54.35 ± 23.6. Being unemployed (adjusted odds ratio (AOR) = 0.442; 95% CI: 0.225, 0.870), having previous pregnancy/labor-related indication for cesarean section (maternal/fetal; AOR = 0.085; 95% CI: 0.020, 0.360, AOR = 0.067; 95% CI: 0.015, 0.297), unplanned pregnancy (AOR = 0.137; 95% CI: 0.057, 0.326), current pregnancy complications (AOR = 4.581; 95% CI: 2.144, 9.788), recurrent cesarean section delivery (AOR = 0.393; 95% CI: 0.175, 0.880) and low and moderated social support of the women (AOR = 109.666; 95% CI: 33.230, 361.926) and (AOR = 5.252; 95% CI: 2.438, 11.314) were factors associated with severe FOC.
In this study, a quarter of the women with previous cesarean section records suffer from a high degree of FOC. Thus, accommodating counseling during antenatal care visits is needed to address those women who are at a high risk of considerable childbirth fear and its health consequences.
女性对怀孕和分娩的多维度期望可能涉及多种情绪，从喜悦到恐惧。据估计，非洲大多数女性患有分娩恐惧（20%-61.2%）。然而，据我们所知，尚未对有剖宫产史的女性的分娩恐惧（FOC）进行研究，特别是在本研究区域。本研究旨在通过评估分娩恐惧程度并确定其影响因素来填补这一空白。
在迪雷达瓦选定的公立和私立卫生设施中，对314名有剖宫产史的孕妇进行了基于机构的横断面研究。使用威尔玛分娩期望问卷（W-DEQ-A）评估FOC，该问卷包括33个项目，采用6点李克特量表评分，范围从低到严重FOC，并使用多变量有序回归分析数据。
共有314名孕妇参与了本研究，回复率为99.3%。67名（21.3%，95%置信区间（CI）：17%-26%）为中度，81名（25.8%，95%CI：21%-31%）为高度，30名（9.6%，95%CI：6%-13%）为严重。W-DEQ平均得分为54.35±23.6。FOC平均得分为54.35±23.6。失业（调整后的优势比（AOR）=0.442；95%CI：0.225，0.870）、既往有妊娠/分娩相关剖宫产指征（母体/胎儿；AOR=0.085；95%CI：0.020，0.360，AOR=0.067；95%CI：0.015，0.297）、意外怀孕（AOR=0.137；95%CI：0.057，0.326）、当前妊娠并发症（AOR=4.581；95%CI：2.144，9.788）、再次剖宫产分娩（AOR=0.393；95%CI：0.175，0.880）以及女性的低和中度社会支持（AOR=109.666；95%CI：33.230，361.926）和（AOR=5.252；95%CI：2.438，11.314）是与严重FOC相关的因素。
在本研究中四分之一有剖宫产史记录的女性患有高度FOC。因此，需要在产前检查期间提供咨询，以应对那些有相当高的分娩恐惧风险及其健康后果的女性。
