A history of abuse and operative delivery - results from a European multi-country cohort study

Objective: The main aim of this study was to assess whether a history of abuse, reported during pregnancy, was associated with an operative delivery. Secondly, we assessed if the association varied according to the type of abuse and if the reported abuse had been experienced as a child or an adult. Design: The Bidens study, a cohort study in six European countries (Belgium, Iceland, Denmark, Estonia, Norway, and Sweden) recruited 6724 pregnant women attending routine antenatal care. History of abuse was assessed through questionnaire and linked to obstetric information from hospital records. The main outcome measure was operative delivery as a dichotomous variable, and categorized as an elective caesarean section (CS), or an operative vaginal birth, or an emergency CS. Non-obstetrically indicated were CSs performed on request or for psychological reasons without another medical reason. Binary and multinomial regression analysis were used to assess the associations. Results: Among 3308 primiparous women, sexual abuse as an adult (≥ 18 years) increased the risk of an elective CS, Adjusted Odds Ratio 2.12 (1.28-3.49), and the likelihood for a non-obstetrically indicated CS, OR 3.74 (1.24-11.24). Women expressing current suffering from the reported adult sexual abuse had the highest risk for an elective CS, AOR 4.07 (1.46-11.3). Neither physical abuse (in adulthood or childhood \u3c18 years), nor sexual abuse in childhood increased the risk of any operative delivery among primiparous women. Among 3416 multiparous women, neither sexual, nor emotional abuse was significantly associated with any kind of operative delivery, while physical abuse had an increased AOR for emergency CS of 1.51 (1.05-2.19). Conclusion: Sexual abuse as an adult increases the risk of an elective CS among women with no prior birth experience, in particular for non-obstetrical reasons. Among multiparous women, a history of physical abuse increases the risk of an emergency CS

Mental health in pregnant women in Sweden

Aim: To describe self-reported mental health indicators and to develop a score for mental health status in pregnant women.Method: Cross-sectional data was used from the Swedish population of a European cohort study conducted in 6 countries (Belgium, Iceland, Denmark, Estonia, Norway and Sweden). A total of 1 025 pregnant women in Malmoe, Sweden, filled in a questionnaire including background information and validated instruments to measure signs of depression during previous week by Edinburgh Depression Scale (EDS-5) and present health status. History of psychosocial care, medication, abuse, post traumatic stress symptoms (PTSS) and life events was reported for the past twelve months. EDS score was calculated by cut off >7 and >8. Ethnicity was defined by mother tongue.Results: Most women had Swedish as their mother tongue but 215 women (21.4%) had another language than Swedish. EDS at >7 (14.1%) and >8 (9.1%) was more common in foreign than in Swedish women (p<0.0001). Signs of PTSS as having physical ailments, feelings of numbness, avoidance, intrusion and anxiety in the past 12 months were also more common in this group (p<0.0001). Conclusion Pregnant women with another mother tongue than Swedish may have a less favourable mental health status than Swedish women. The algorithm for mental health score is under development using PTSS and other relevant indicators for the Swedish data. As such it will be analysed for associations with delivery outcomes in the whole BIDENS dataset

Mental health in pregnant women in Sweden

Aim: To describe self-reported mental health indicators and to develop a score for mental health status in pregnant women.Method: Cross-sectional data was used from the Swedish population of a European cohort study conducted in 6 countries (Belgium, Iceland, Denmark, Estonia, Norway and Sweden). A total of 1 025 pregnant women in Malmoe, Sweden, filled in a questionnaire including background information and validated instruments to measure signs of depression during previous week by Edinburgh Depression Scale (EDS-5) and present health status. History of psychosocial care, medication, abuse, post traumatic stress symptoms (PTSS) and life events was reported for the past twelve months. EDS score was calculated by cut off >7 and >8. Ethnicity was defined by mother tongue.Results: Most women had Swedish as their mother tongue but 215 women (21.4%) had another language than Swedish. EDS at >7 (14.1%) and >8 (9.1%) was more common in foreign than in Swedish women (p<0.0001). Signs of PTSS as having physical ailments, feelings of numbness, avoidance, intrusion and anxiety in the past 12 months were also more common in this group (p<0.0001). Conclusion Pregnant women with another mother tongue than Swedish may have a less favourable mental health status than Swedish women. The algorithm for mental health score is under development using PTSS and other relevant indicators for the Swedish data. As such it will be analysed for associations with delivery outcomes in the whole BIDENS dataset

Prevalence and associate factors of fear of childbirth in 6 European countries

Objectives: This study set out to compare the prevalence, content and associated factors of fear of child- birth in six European countries. Method: A cross-sectional study of 6870 pregnant women attending routine antenatal care in B elgium, I celand, D enmark, E stonia, N orway and S weden (Bidens).Main outcome measure: Severe fear of child- birth, defined as a Wijma Delivery Expectancy Questionnaire score of ≥ 85. Results: Eleven percent of all women reported severe fear of childbirth, 11.4% among primiparous and 11.0% among multiparous women. There were significant differences between the countries for preva- lence of severe fear of childbirth, varying from 4.5% in Belgium to 15.6% in Estonia for primiparous women and from 7.6% in Iceland to 15.2% in Sweden for multiparous women. After adjusting for age, education and gestational age, only primiparous women from Belgium had significantly less fear of childbirth, AOR 0.35 (0.19–0.52) compared to Norway (largest participating group). Exploratory factor analyses re- vealed significant differences between the countries for the six factors extracted. Conclusion: FOC appears to be an international phenomenon, existing with similar proportions in the participating European countries, except for primiparous women in Belgium who in our study reported significantly less severe fear of childbirth. Our study suggests that the content of fear of childbirth may differ between countries

Prevalence and associate factors of fear of childbirth in 6 European countries

Objectives: This study set out to compare the prevalence, content and associated factors of fear of child- birth in six European countries. Method: A cross-sectional study of 6870 pregnant women attending routine antenatal care in B elgium, I celand, D enmark, E stonia, N orway and S weden (Bidens).Main outcome measure: Severe fear of child- birth, defined as a Wijma Delivery Expectancy Questionnaire score of ≥ 85. Results: Eleven percent of all women reported severe fear of childbirth, 11.4% among primiparous and 11.0% among multiparous women. There were significant differences between the countries for preva- lence of severe fear of childbirth, varying from 4.5% in Belgium to 15.6% in Estonia for primiparous women and from 7.6% in Iceland to 15.2% in Sweden for multiparous women. After adjusting for age, education and gestational age, only primiparous women from Belgium had significantly less fear of childbirth, AOR 0.35 (0.19–0.52) compared to Norway (largest participating group). Exploratory factor analyses re- vealed significant differences between the countries for the six factors extracted. Conclusion: FOC appears to be an international phenomenon, existing with similar proportions in the participating European countries, except for primiparous women in Belgium who in our study reported significantly less severe fear of childbirth. Our study suggests that the content of fear of childbirth may differ between countries

Pregnant women's preference for cesarean section and subsequent mode of birth - a six-country cohort study

Introduction: The rate of cesarean section (CS) for non-medical reasons has risen and it is a concern for health care. Women’s preferences may vary across countries for psychosocial or obstetric reasons. Methods: A prospective cohort study of 6549 women in routine antenatal care giving birth in Belgium, Iceland, Denmark, Estonia, Norway or Sweden. Preference for mode of birth was self-reported in mid-pregnancy. Birth outcome data were collected from hospital records. Results: A CS was preferred by 3.5% of primiparous women and 8.7% of the multiparous women. Preference for CS was associated with severe fear of childbirth (FOC), with a negative birth experience in multiparous women and with depressive symptoms in the primiparous. Women were somewhat more prone to prefer a cesarean in Iceland, odd ratio (OR) 1.70 (1.02–2.83), adjusted for age, education, depression, FOC, history of abuse, previous cesarean and negative birth experience. Out of the 404 women who preferred CS during pregnancy, 286 (70.8%) delivered by CS, mostly for a medical indication. A total of 9% of the cesareans in the cohort had a non-medical indication only. Conclusions: Women’s preference for CS often seems to be due to health concerns. Both medical and psychological factors need to be addressed in antenatal counseling. Obstetricians need to convey accurately to women the risks and benefits of CS in her specific case. Maternity professionals should identify and explore psychosocial reasons for women’s preferences

Treatment of nulliparous women with severe fear of childbirth via the Internet : a feasibility study

Objective: The aim of the present study was to test the feasibility of Internet interventions among nulliparous women suffering from severe fear of childbirth (FOC) by means of an Internet-delivered therapist-supported self-help program based on cognitive behavioral therapy (ICBT). Design: Prospective, longitudinal cohort study.Setting: A feasibility study of an ICBT program for the treatment of severe FOC in pregnant women.Sample: Twenty-eight Swedish-speaking nulliparous women with severe FOC recruited via a project home page from January 2012 to December 2013. Methods: The main components of the ICBT program for the treatment of severe FOC comprised psycho-education, breathing retraining, cognitive restructuring, imaginary exposure, in vivo exposure and relapse prevention. The study participants were anonymously self-recruited over the Internet, interviewed by telephone and then enrolled. All participants were offered 8 weeks of treatment via the Internet. Participants reported their homework weekly, submitted measurements of their fear and received feedback from a therapist via a secure online contact management system. Main outcome measures: Level of FOC measured with the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ A) during screening at enrollment and weekly during the treatment (W-DEQ version A), and after the delivery (W-DEQ version B). Results: A statistically significant (pâ\u80\u89&lt;â\u80\u890.0005) decrease of FOC [W-DEQ sum score decreased pre to post-therapy, with a large effect size (Cohenâ\u80\u99s dâ\u80\u89=â\u80\u890.95)].Conclusions: The results of this feasibility study suggest that ICBT has potential in the treatment of severe FOC during pregnancy in motivated nulliparous women. The results need to be confirmed by randomized controlled studies.Funding agencies: Swedish Research Council for Health, Working Life and Welfare (FORTE); Medical Research Council of Southeast Sweden (FORSS); County Council in Ostergotland (LIO)</p

Mental health status in pregnancy among native and non-native Swedish speaking women : a Bidens study

Objectives. To describe mental health status in native and non-native Swedish-speaking pregnant women and explore risk factors of depression and of posttraumatic stress symptoms. Design and setting. A cross-sectional questionnaire study was conducted at midwife-based antenatal clinics in Southern, Sweden. Sample. A non-selected group of women in mid-pregnancy participated. Methods. Participants completed a questionnaire including background characteristics, social support, life events, mental health variables and the short Edinburgh Depression Scale. Main outcome measures. Depressive symptoms during last week and posttraumatic stress symptoms during past year. Results. Out of 1003 women, 21.4% reported another language than Swedish as their mother tongue and were defined as non-native. These women were more likely to be younger, have fewer years of education, potential financial problems, and lack of social support. More non-native speakers self-reported depressive, posttraumatic stress, anxiety and, psychosomatic symptoms, and fewer had had consultations with a psychiatrist or psychologist. Of all women 13.8% had depressive symptoms defined by Edinburgh Depression Scale as 7 or above. Non-native status was associated with statistically increased risks of depressive symptoms and having ≥ 1 posttraumatic stress symptom compared to native speaking women. Multivariate modeling including all selected factors resulted in adjusted OR for depressive symptoms of 1.75 (95% CI: 1.11-2.76) and of 1.56 (95% CI: 1.10-2.34) for posttraumatic stress symptoms in non-native Swedish speakers. Conclusion. Non-native Swedish-speaking women had a more unfavorable mental health status than native speakers. In spite of this, non-native speaking women had sought less mental health care