Rates of fear of childbirth after previous cesarean section in Dire Dawa City, Ethiopia.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.