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To examine the measurement model of the Tokophobia Severity Scale and consider issues of statistical power and sample size from the original instrument development study.Fear of childbirth (FoC) and tokophobia represents an area of increasing concern within perinatal mental health research and clinical practice. Existing measures of the FoC have been criticised due to either measurement inconsistencies, difficulties in scoring or practical clinical application. Attempting to address these limitations, researchers developed the Tokophobia Severity Scale (TSS). A fundamental assumption underpinning the use of the TSS is unidimensionality, however this assertion may have been based on sub-optimal sample size and approach taken to factor structure determination.Parallel analysis (PA), principal components analysis (PCA), exploratory factor analysis (EFA), power analysis and sample size calculation using a reconstruction of the original dataset from published summary data.Following replication of the original PCA, a three-factor model was found to offer a significantly better fit to data than a unidimensional model. Power analysis suggested the original study was underpowered.The TSS remains a promising tool but assumptions regarding its measurement model are based on an inadequate sample size. Sample sizes for a sufficiently powered study indicated.

Objective: To create a clear and acceptable measure of fear of childbirth with satisfactory content validity for use with English-speaking women in the UK.\ud Background: Fear of childbirth (FOC) can have a significant impact on a woman’s view of her pregnancy, birth and her recovery post birth. Early identification is paramount to ensure that women’s needs are recognised so that appropriately tailored care can be provided in pregnancy. Availability of reliable and valid measures to assess FOC in an English-speaking population are sparse, mainly due to issues with definitions of FOC or cultural sensitivity after translation. Recent research from phase one of the Fear of Childbirth study (FOCUS), has established key elements for FOC in an English-speaking UK population, and allows for a culturally sensitive measure of FOC to be developed. The aim was to ensure inclusion of all ten FOC elements and to attend to guidance from women in phase two of the FOCUS study about what would ensure clarity and acceptability.\ud Method: A multidisciplinary team developed items in accordance with FOCUS. The measure was then piloted with one reviewer and further refined by the team of perinatal researchers.\ud Results: The FCQ is a new 20-item fear of childbirth questionnaire, which has been developed and is grounded in fears reported by women in the UK.\ud Conclusion: A new tool to measure FOC in an English-speaking UK population with good content validity has undergone a preliminary phase of development and now needs testing for reliability and other forms of validity.

Severe fear of childbirth (tokophobia; TP) is an understudied and under‐recognised phenomenon that has significant implications for maternal mental health during pregnancy, labour and delivery. The...

SARS-CoV-2 coronavirus emerged in the world at the end of 2019. The introduction of a number of restrictions had a significant effect on numerous aspects of human life with particular influence being exerted on pregnant women and their sense of security. The study aimed to assess the level of anxiety and its main determinants in women in the third trimester of pregnancy during the coronavirus pandemic. The study technique included the present purposely designed questionnaire, Labor Anxiety Questionnaire (KLPII), and the State-Trait Anxiety Inventory (STAI). The study was conducted in a group of 315 women in the third trimester of pregnancy. A total of 258 women (81.9%) completed the questionnaire in May 2020, and 57 of them (18.1%) completed it in October 2020. The overall analysis of the Labor Anxiety Questionnaire and the STAI inventory revealed a high level of anxiety, particularly situational anxiety, in pregnant women during the SARS-CoV-2 pandemic. The age and financial status of the women were the factors which contributed to the intensification of tokophobia. Women interviewed in October 2020 were characterized by higher tokophobia levels compared to the respondents included in May 2020. It seems justified to in-crease the vigilance in the diagnostics of possible mental disorders in the perinatal period during pandemic.

Pregnancy is a life-changing event for every woman in her lifetime. In many women, due to various factors like psychology, environment, social, and etc., certain unwanted clinical manifestations arise which further develops into fear of pregnancy and childbirth. When a psychiatric disorder is associated with or exacerbated by breastfeeding, the topic requires expert experiences from several areas in medicine. This essay examines the relationship between pregnancy, depression, eating disorders, and irrational fear of childbirth, known altogether as tokophobia. Although literature in this area is scarce, an attempt is made to collect what is available and compile them together.

ObjectiveAn increase in the number of women who have fear of birth [FOB] has been reported globally; yet, how these women are identified varies. This study aimed to identify the most effective way of measuring FOB in clinical practice.DesignThis paper reports on a prospective cohort study; a core element of an explanatory mixed-methods study. This element explored the appropriateness of measures of anxiety (biomarkers and validated questionnaires) and observed any relationship between anxiety levels and clinical outcomes.ParticipantsA purposive sampling strategy was used. One hundred and forty-eight primigravida, during the 1st trimester, in two tertiary maternity units in England were included.Methods Demographic and baseline data were collected from participants in the first trimester of pregnancy along with FOB scores, and a saliva sample to measure cortisol level. In the third trimester, a second FOBS score, and saliva sample were collected, and the Personal Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) were administered to measure depression and anxiety respectively. FindingsThe FOBS was completed by 148 women in the first trimester and 80 in the third. Using a cut-off of 54, 30/148 (20%) women had a FOB in the first trimester; 21/80 (26%) had a FOB in the third trimester, 15 (19%) of whom also had a FOB in the first. Compared with the first trimester, 51/80 women showed an increase in FOBS score, with 14 scores increasing above and 8 scores decreasing below the cut-off of 54. FOBS scores were not correlated with salivary cortisol in either trimester (first trimester Spearman’s ρ=0.08, p=0.354, n=144; third trimester ρ=0.12, p=0.309, n=71) but they were correlated with PHQ-9 and GAD-7 scores in the third trimester (PHQ-9 ρ=0.53, p=0.010, n=23; GAD-7 ρ=0.45, p=0.033, n=23) although not sufficiently high enough to demonstrate convergent validity against those measures of depression and anxiety. They were also associated with a previous history of depression but only in the first trimester (p=0.011). FOBS scores showed considerable variability and a high measurement error, indicating a need for further refinement and psychometric testing. ConclusionThe FOBS is a potentially effective way of measuring FOB in clinical practice and research, but it requires refining. Scores are not related to salivary cortisol levels but are correlated with validated scores for anxiety and depression. An enhanced version of the FOBS could be used in clinical practice to measure FOB.

Annually in May, there is a spotlight on maternal mental health (MMH) globally. In the UK, MMH awareness week is coordinated by the perinatal mental health partnership (@PMHPUK) (3 May 2021 to 9 May 2021)1; while in the USA, ‘The Blue Dot Project’2 uses a blue dot as a symbol for unity and awareness for those living with mental health (MH) conditions.2 This annual focus enables professionals, stakeholders and individuals to raise awareness and influence policy on this critical issue. Evidenced based nursing will be supporting MMH Awareness week by publishing a series of blogs representing a range of views during May 2021. Perinatal mental health (PMH) encompasses any MH condition affecting people during pregnancy and in the first year after having a baby.3 This includes conditions ranging from mild depression and anxiety to psychosis; pre-existing MH and MH recurrence during pregnancy.3 PMH conditions can be pregnancy specific such as tokophobia (fear of childbirth), or postpartum traumatic stress disorder; or be more generalised, and range in the degree to which they can impact on quality of life. In general, PMH conditions affect 10–20% of pregnancies, although reported prevalence rates differ by …

Background Fear of childbirth (FOC) may contribute to postpartum depression, impaired maternal-infant relation, and preference for cesarean in future pregnancies. We aimed to investigate predictors of FOC and normal vaginal birth among postpartum women who had planned for a normal vaginal birth. Methods This cross-sectional study was conducted in 2019 with postpartum women during the first 24 h after the birth. A sample of 662 women, selected using a convenient sampling method, filled out the questionnaire composed of socio-demographic and obstetric questions and the Wijma Delivery-Expectancy Questionnaire (W-DEQ). We used multiple logistic regression analyses to determine predictors of FOC and normal vaginal birth. Results The percentage of women with mild (score ≤ 37), moderate (38–65), high (66–84), severe (85–99), and intense FOC (score ≥ 100) were 7.9, 19.5, 40.9, 21.1, and 10.6% respectively. Predictors of intense FOC were age Conclusions The rate of severe and intense FOC among this group of postpartum women is high. Our findings highlight modifiable factors for reducing FOC and increasing normal vaginal birth. In designing programs to increase the rate of normal vaginal birth, the following factors should be considered: limiting induced labor, encouraging women to recruit a doula to help them at labor, facilitate husband’s attendance throughout antenatal/intrapartum, and postnatal care to support his wife, and pay attention to women’s common misunderstandings about the effect of vaginal birth on marital/sexual relationship. Our findings indicate that seeking novel ways to promote marital/sexual satisfaction and helping women to have a smooth, hassle-free pregnancy may contribute to a reduction in the rate of the FOC.

Background: Quality of maternal care offered in hospitals significantly determines the health outcomes of expectant women and their newborns. The study aimed at understanding the perceptions and experiences of new mothers diagnosed with tokophobia; regarding the quality of maternal services offered in public hospitals in Kenya.Methods: This was a qualitative study consisting of in-depth interviews with 29 women who had given birth recently in a referral hospital in Kenya; and had been screened and found with high fear of childbirth at 22 weeks’ gestation period. The framework for assessing the quality of care of institutional maternity services developed by the University of Southampton was adopted in this study. Thematic analysis was used in this study. Results: The identified challenges were categorized into two: the provision of care and the actual experience of care. In the provision of care, there were perceptions and experiences relating to human and physical resources, inadequate referral systems, and inadequate management of emergencies. In regards to the actual experience of care, there were perceptions and experiences relating to inadequacies in human and physical resources, lack of cognition, lack of respect, dignity and equity, and inadequacies in emotional support.Conclusion: The study identified systemic challenges related to the provision of maternal care and actual experience of care contributing to tokophobia. In this regard, there is a need to judiciously analyze all the critical steps identified in the framework for assessing the quality of maternal care, as this will reduce the intangible challenges identified in this study.

Context: Tokophobia is an intense fear of childbirth that may result in considerable outcomes. This phenomenon may also be observed in fathers. However, studies are infrequent on tokophobia frequency and its related factors in fathers. Therefore, this study aimed to address tokophobia in fathers. Evidence Acquisition: A comprehensive literature search was performed in databanks such as Ovid and Google Scholar, as well as electronic databases including PubMed, ProQuest, Web of Science, Science Direct, Magiran, Scientific Information Database (SID), and Barakat (IranMedex), without time limit. Articles were published between 1988 and 2020. Results: Initially, 150 studies were recruited, and finally, 55 of them remained for the final appraisal after omitting unrelated studies. The findings from related studies were organized as the epidemiology of tokophobia in men, biopsychosocial etiology, clinical signs, diagnosis, treatment, and prognosis of tokophobia in men. Considering the tendency of fathers to hide tokophobia, providing suitable knowledge and support from health providers can probably retain the trust in this population and help them cope with tokophobia. Conclusions: During pregnancy, fathers may suffer from fear of childbirth that can impact their health and abilities. Thus, during counseling and prenatal care, the providers should pay attention to fathers.

Background A high number of Australian women report experiencing traumatic birth events. Despite high incidence and potential wide spread and long-lasting effects, birth trauma is poorly recognised and insufficiently treated. Birth trauma can trigger ongoing psychosocial symptoms for women, including anxiety, tokophobia, bonding difficulties, relationship issues and PTSD. Additionally, women’s future fertility choices can be inhibited by birth trauma. Aim To summarize the existing literature to provide insight into women’s experiences of birth trauma unrelated to a specific pre-existing obstetric or contextual factor. Methods The review follows 5 stages of Arksey and O’Malley’s framework. 7 databases were searched using indexed terms and boolen operators. Data searching identified 1354 records, 5 studies met inclusion criteria. Findings Three key themes emerged; (1) health care providers and the maternity care system. (2) Women’s sense of knowing and control. (3) Support. Discussion Continuity of carer creates the foundations for facilitative interactions between care provider and woman which increases the likelihood of a positive birth experience. Women are able to gain a sense of feeling informed and being in control when empowering and individualized care is offered. Functional social supports and forms of debriefing promotes psychological processing and can enable post traumatic growth. Conclusion Existing literature highlights how birth trauma is strongly influenced by negative health care provider interactions and dysfunctional operation of the maternity care system. A lack of education and support limited informed decision-making, resulting in feelings of losing control and powerlessness which contributes to women’s trauma. Insufficient support further compounds women’s experiences.

International audience; Background: Recent research has suggested that pretraumatic stress related to a forthcoming predictable traumatic event might exist and that such stress reactions would be a key, ‘but largely ignored’, aspect of the etiology of Posttraumatic Stress Disorder (PTSD). While it is now acknowledged that childbirth may lead to PTSD, less is known regarding pretraumatic reactions in pregnancy. This study aims to (a) explore the frequency of PTSD, Fear of Childbirth and tokophobia associated with the forthcoming delivery and (b) highlight associated features of pre-traumatic stress symptoms.Methods: At 34 weeks’ gestation, a sample of 102 women completed questionnaires assessing anticipated labour pain, fear of childbirth, fear of pain, pretraumatic stress symptoms, perceived social support and depressive and anxiety symptoms.Results: 8.8% of women met DSM-IV-TR criteria for PTSD related to the threatening forthcoming delivery. Fear of childbirth, anticipated labour pain, anxiety, and depressive symptoms were significant predictors of pretraumatic stress intensity.Conclusion: Our results extend prior findings on postpartum PTSD by showing that fear of labour pain is a specific construct, clearly independent from the experience of general pain. Our results suggest that childbirth may be experienced as threatening and traumatic and that this traumatic impact might develop way before the delivery. As a potential traumatic continuum from pre- to posttraumatic stress might exist, further longitudinal studies assessing pre-, peri- and posttraumatic reactions is needed to provide support for this hypothesis.

Objective:To identify the prevalence of and to determine the risk factors for developing a fear of childbirth (tokophobia).Methods:We evaluated 191 pregnant women during Parenting and Childbirth Classes. Participants were approached when attending Parenting and Childbirth Classes between June 2014 and September 2014 and were asked to complete several questionnaires related to depression (CES-D), anxiety (STAI X1 and X2), satisfaction with life (SWLS), delivery expectation/experience (W-DEQ), and specific fears.Results:Most (90%) of the responders were nulliparous. As many as 75% of the participants reported low to moderate tokophobia, whereas 25% exhibited high or very high fear of childbirth. Pathological fear occurred in 1.6% of the participants. The most significant was the fear of having an episiotomy followed by fear of having no control on the situation and fear of pain. An association exists between a preferred elective cesarean birth and tokophobia.Conclusions:The results draw attention to the need for early detection and treatment of fear of childbirth. The data may help identifying women at risk that require prenatal psychological intervention.

Introduction Tocophobia is defined as a severe fear of pregnancy and childbirth. There is increasing evidence that tocophobia may have short‐term and long‐term adverse effects on mother and baby. We performed a systematic review and meta‐analysis to determine the global prevalence of tocophobia in pregnancy. Material and methods Relevant articles were identified through searching six relevant databases: MEDLINE, CINAHL, Pubmed, PsycINFO, Maternity & Infant Care and Scopus between 1946 and April 2016. We used search terms for tocophobia prevalence in pregnant women that we agreed on with a medical librarian. There were no language restrictions. Two review authors independently assessed data for inclusion, extracted data and assessed quality using a standardized appraisal tool. Meta‐analysis was performed to determine the overall pooled‐prevalence of tocophobia. Several subgroup and sensitivity analyses were conducted. Results Thirty‐three studies were included in the systematic review from 18 countries of which data from 29 studies were used in the meta‐analysis of 853 988 pregnant women. Definition of tocophobia varied, whereas prevalence rates ranged between 3.7 and 43%. The overall pooled prevalence of tocophobia, using a random‐effects model, was 14% (95% CI 0.12–0.16). Significant heterogeneity was observed (I2 = 99.25%, p = 0.00), which was not explained in subgroup analyses including tocophobia definition used, screening trimester and parity. Conclusion The prevalence of tocophobia is estimated at 14% and appears to have increased in recent years (2000 onwards). Considerable heterogeneity (99.25%) was noted that may be attributed to lack of consensus on the definition of tocophobia, so our results should be interpreted with caution.

Women today have made many choices before even meeting with a midwife in their early pregnancy. When a midwife makes that contact it may already be evident that she is worried and certainly anxious about the changes that are happening to her body. How do these women approach pregnancy? What do they say? What kind of things are they worried about? What is it that midwives and doctors can be alerted to which may show that woman is vulnerable to stressful situations that may cause her more anxiety? The services that are currently being developed in response to these women will be discussed together with an overview of how women respond. What is this and how is it recognised and managed. This chapter uses the experiences of two consultant midwives who have developed care pathways to identify, support and treat such women. Both are based in the UK, one in London and the other in Birmingham serving a wide range of childbearing women.

Background Fear of childbirth is related to but not synonymous with general anxiety, and represents a superior predictor for maternal and infant outcomes. There is a need to improve the identification and provision of support for women experiencing high fear of childbirth. However it is uncertain as to whether existing measurement tools have appropriate content validity (i.e. cover the relevant domains within the construct), practical utility, and whether they are acceptable for use with a UK population. This study aimed to (1) identify the utility and acceptability of existing measures of fear of childbirth (FOC) with a small UK sample and (2) map the content of existing measures to the key concepts of fear of childbirth established by previous research. Methods Ten pregnant women; five with high and five with low fear of childbirth participated in a cognitive interview covering four most commonly used measures of fear of childbirth: 1. The Wijma Delivery Expectancy Questionnaire (WDEQ A), 2. The Oxford Worries about Labour Scale (OWLS), 3. The Slade-Pais Expectations of Childbirth Scale – fear subscale (SPECS) and 4. The Fear of Birth scale (FOBS). Each measure was also reviewed by participants for ease and clarity of understanding and acceptability. The measures were then reviewed against the key domains identified in the fear of childbirth literature to ascertain the adequacy of content validity of each measure. Interviews were analysed using thematic analysis for each scale item. Results All measures except the FOBS, included items that either women did not understand or, if where there was understanding the meanings were inconsistent across women. All measures demonstrated limited acceptability and content validity for the specific construct of FOC. Therefore, none of the measurement tools currently used within the UK met criteria for understanding, acceptability and content validity for measurement of FOC. Conclusions Findings emphasise a need to develop a specific fear of childbirth tool with good clarity which demonstrates appropriate content validity, and that is acceptable in presentation and length for pregnant women in a UK population.

This paper seeks to identify the risk factors of fear of childbirth (FOC) and posttraumatic stress disorder (PTSD) related to birth and reviews the efficacy of their respective screening tools and therapeutic interventions. Biofeedback, hypnosis, internet-based cognitive behavioral therapy, and antenatal education are promising treatments for FOC. Training midwives to address traumatic birth experiences could help in preventing PTSD. A shorter more pragmatic screening tool for FOC than the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ) is needed. Women with PTSD attributed a mismatch between the expected mode of delivery (MOD) and the actual MOD as the cause of their trauma. A history of mental health disorders, lack of social support, previous negative birth experiences, and MOD are correlated to FOC and postpartum PTSD. Psycho-education and CBT-based treatments have been found to reduce levels of FOC and PTSD.

Objective: The primary objective was to estimate the population prevalence of specific phobias (including pregnancy related specific phobias) and associated mental disorders. The secondary objective was to investigate the effectiveness of routinely collected screening tools (depression and anxiety screens, Whooley and GAD-2 respectively) in identifying specific phobias. Specific phobias are the most common anxiety disorder to occur during pregnancy, but studies on prevalence and clinical correlates of specific phobias, including pregnancy related specific phobias are lacking.Design: Cross-sectional survey using a two-phase sampling design stratified according to being positive or negative on the Whooley questions routinely asked by midwives. Approaching all whooley positive women and drawing a random sample of Whooley negative women. Sampling weights were used to account for the bias induced by the stratified sampling.Participants: 545 pregnant women attending their first antenatal appointment. Language interpreters were used where required. Setting: Inner-city maternity service, London, UK. Measurements: The Structured Clinical Interview for DSM-IV Axis I Mental Disorders were administered to assess mental disorders and 544 women responded to the anxiety module on specific phobias. Results: The maternity population prevalence estimate for specific phobias was 8.4% (95%CI: 5.8 – 12.1%) and for pregnancy related phobias was 1.5% (95%CI: 0.6 – 3.7%), most of which were needle phobias. The prevalence estimate of tokophobia was 0.032% (95%CI: 0.0044–0.23%). Over half (52.4%) the women with specific phobias had comorbid mental disorders. Routinely administered screening tools (Whooley and GAD-2) were not helpful in identifying phobias. Key conclusions and implications for practice: Phobias in pregnancy are common but pregnancy related phobias are rare, particularly tokophobia. As routinely administered screening tools were not helpful in identifying phobias, other indicators could be considered, such as avoidance of blood tests and requests for caesarean sections.

Background Emergency service is a complex and dynamic environment mostly simultaneously managing the conditions of different patients and which is delicate in terms of time. Health care providers should be aware of influence the environment during labour. Aims The aim of this research was to determine the level of fear of childbirth of primiparaous women, who has applied to emergency obstetric units. We also examined some variable which could effect on the level of fear of childbirth such as reasons for applying the emergency obstetric units, knowledge about birth process and readiness to birth. Methods This study is a cross-sectional study. The sample of the study is 473 primiparaous women who have applied to emergency obstetric units. A personal information form and ";;;Wijma Birth Expectancy / Experience Scale Version";;; have been used to determine the fear level of childbirth by conducting face-to-face interviews. Results It has been determined that 67.7 per cent of the pregnant women have applied to the emergency unit due to pain. It has also determined that the mean score of fear of childbirth is 66.33±25.25 among women who have applied to emergency services. Also, 21.8 per cent of the women have been found to have a fear of childbirth at a severe-clinical level. Women who have early membrane ruptures have the highest level of fear of childbirth. There is also significant difference between women’s fear of childbirth level depending on knowledge about birth process, readiness to give birth and desired/planned birth (p=0.000). Conclusion This study showed that on third of the primiparaous who apply to emergency obstetric care has a severe grade of fear of childbirth. It has been determined that fear of childbirth has been found to be lower in the women who has received childbirth education, who has known what they would live during birth, and who has felt ready for delivery. This finding suggests that childbirth education is important to provide low level fear of childbirth for women who apply to emergency obstetric unit.

Background: The fear of death during delivery develops before pregnancy; it is called "tokophobia". Aim: To compare the self-efficacy perceptions of pregnant women based on the degree of their fear of giving birth and to determine the relationship between the two considerations. Methods: This study was conducted with a descriptive and corelational design between January 2 and October 31, 2014 in a maternity hospital in Eastern Turkey. Women in their 28th–40th gestational week, visiting the hospital were included in the study. Version A of the Wijma delivery expectancy/experience scale and the short version of the birth self-efficacy inventory were used to collect the data. Results: Among the pregnant women with low fear of giving birth, the mean scores were 61.88±13.35 for Wijma and 217.50±40.31 for the self-efficacy scale. For the pregnant women with high fear of giving birth, Wijma scores were 115.98±15.92 and self-efficacy scale was 169.57±44.26. Conclusion: This study emphasize that pregnant women with low fear of giving birth had higher levels of self-efficacy perception compared to those with high fear of giving birth.

Tokophobia is actually an extreme fear of childbirth. And it’s on the increase, researcher Catriona Jones from the University of Hull warned the British Science Festival last week. So much so that NHS perinatal mental health services have asked her to look into the problem after a rise in the number of women asking for …

International audience; Objectives: Given that prepartum psychiatric symptoms have been reported to be associated with postpartum disorders, focusing on the prepartum period appears of prime importance. The aim of the current study was threefold: (a) to identify the prevalence rates of women suffering from fear of childbirth (FOC) and tokophobia (b) to explore the association between FOC, obstetrical and psychopathological variables and (c) to identify the independent predictors of the intensity of FOC symptoms, FOC and tokophobia. Methods: at 36 weeks' gestation, 98 women completed questionnaires assessing FOC, pretraumatic stress, fear of pain, depressive and anxiety symptomatology as well as perceived social support. Socio-demographic and gynecological data were also gathered. Results: 22.45% of women reported a probable FOC and 20.41% suffered from a potential tokophobia. Epidural anesthesia (ß = 5.62, p < 0.05), and the intensity of pretraumatic stress symptoms (ß= 0.69, p < 0.05), were independently associated with the intensity of FOC symptoms. Planning a c-section was significantly related to FOC (β = 0.09, p = 0.03). Planning an epidural anesthesia was also an independent predictor of both FOC and tokophobia (β = 1.33, p = 0.03; β = 1.26, p = 0.04, respectively). Conclusions: Given the high rates of FOC and tokophobia highlighted, developing an appropriate preparation to childbirth is of great relevance. Longitudinal studies should be developed in order to provide an in-depth examination of the course of prepartum psychiatric disorders, maintenance of symptoms and their impact on subsequent infant development.

Background providing appropriate care for pregnant women with high or severe fear of childbirth (FOC) is a challenge in midwifery care today. FOC is associated with predisposing anamnestic factors, various sociodemographic and psychosocial characteristics, and may result in serious healthrelated consequences. It is therefore important to establish which interventions may increase a woman's faith in her own ability to cope with labour and birth. Aim to systematically identify and review studies examining interventions for relief of severe fear of childbirth in pregnancy and their underlying conceptual foundation. Methods a systematic literature search was performed following Cochrane Collaboration and PRISMA Statement recommendations. Inclusion criteria were: studies including pregnant women diagnosed with high or severe FOC or who requested a caesarean section due to severe FOC, studies (regardless of design) observing the effect of an intervention addressing FOC, and studies published in English. Publications addressing anxiety or stress were excluded. 377 references were screened by title and abstract. The risk of bias was assessed. Findings 19 articles referring to 15 research projects were included in the analysis. The studies show heterogeneity regarding assessment methods, type, conceptualisation and application of interventions. There is evidence that both cognitive therapy sessions and a theory-based group psychoeducation with relaxation are effective interventions. Key conclusions despite methodological limitations, single or group psychoeducation sessions for nulliparous women or therapeutic conversation during pregnancy (in group or individual sessions) have the potential to strengthen women's self-efficacy and decrease the number of caesarean sections due to FOC. The theoretical validation of an intervention deepens the understanding of psychological processes in women coping with severe FOC. Implications for practice theory-based concepts of care for both antenatal and intrapartum support of pregnant women with high or severe FOC should be developed, piloted, tested, evaluated and implemented within the given healthcare system. Midwives need to be competent to address pregnant women's fears regarding labour and birth in antenatal care. The use of a valid assessment tool to identify the level of FOC in women, even if they do not raise the issue, is recommended in routine antenatal care so that appropriate expert support can be offered. A one-on-one conversation may be feasible for those women unwilling to fill in a questionnaire. Cooperative local networks between midwives, psychologists and obstetricians qualified in psychotherapy should be established to ensure timely and effective care for women with high or severe FOC.

Women who struggle with distressing pregnancy-related phobic anxiety disorders are regularly encountered in maternity services, and their management poses particular challenges. Early identification is crucial in order to offer an opportunity to treat and manage their fears and enable a positive birth experience. In this article, women with different phobias (tokophobia, emetophobia and ante-cubital fossa phobia) describe their first pregnancy experience, and the ways in which the Chelsea and Westminster Hospital offered them joint maternity and psychiatric care. A multidisciplinary hospital-based approach can be effective in managing mental health problems in pregnancy. Despite maternal preconceptions and professional misgivings, this approach can work for women with phobias and enable a good birth experience and successful mother and infant bonding. The lead obstetrician for mental health and perinatal psychiatrist describe their roles in enabling successful outcomes for both the current and subsequent pregnancies. The case is made for training of maternity staff in both the identification of severe pregnancy phobias and the prompt referral for shared psychiatric and maternity care. Even if previous treatments have failed, adequate coping strategies for childbirth may be achieved in a short time frame. Long-term improvements in the phobia itself may also be found.

Background: Tokophobia, a deep‐seated fear of childbirth, causes women emotional anguish and affects the mother‐baby relationship. It can result in women avoiding future pregnancies or requesting caesarean section. This review examines evidence for the effectiveness of planned interventions in women with okophobia in both reducing requests for caesarean section and in ameliorating maternal distress.\ud \ud Objectives: 1) To synthesise the best available quantitative evidence for the effectiveness of planned interventions in reducing: a) fear/anxiety in tokophobic women, b) planned caesarean sections\ud \ud 2) To synthesise the best available qualitative evidence relating to the experiences of tokophobic women who request a caesarean section, particularly satisfaction with interventions and the childbirth experience.\ud \ud Inclusion criteria: This review considered studies that included pregnant women requesting a caesarean section for tokophobia in the absence of medical (or obstetric) indications who were offered a planned intervention.\ud \ud Search strategy: The literature search focused on published and unpublished studies in English distributed between January 1990 and April 2012. An initial limited database search was undertaken to identify keywords, followed by an extensive search of relevant databases and potential grey material.\ud \ud Methodological quality: Assessment for methodological quality was carried out independently by two reviewers using the standardised appraisal tools from the Joanna Briggs Institute.\ud \ud Data extraction: Data were extracted from papers included in the review using the standardised data extraction tool from the Joanna Briggs Institute.\ud \ud Data synthesis: Statistical meta‐analysis was not possible due to heterogeneity. Therefore, a narrative summary of the data was undertaken.\ud \ud Results: Nine quantitative papers (comprising eight studies: one randomised controlled trial, five case control studies and two descriptive case series) were included; two of these papers appertained to the same study. No qualitative papers were found.\ud \ud Definitions for tokophobia varied. Samples were confounded by the inclusion of women with complex obstetric histories or with mental health issues. Comparison groups were sometimes non‐tokophobic women. Interventions were complex and descriptions sometimes lacked clarity. Although the randomised controlled trial found no difference in birth choices between samples, a group therapy intervention predisposed women to vaginal birth. One study measured whether interventions reduced fear, finding that they did. Four studies explored satisfaction with the intervention. In three cases interventions were evaluated positively. These involved midwifery input and birth planning.\ud \ud Conclusion: More research is needed to identify how tokophobic women might be helped. Current guidelines should be upheld for the time being, in the absence of further evidence.\ud \ud Implications for practice: Due to the heterogeneous nature of the research it is impossible at this stage to draw conclusions for practice.\ud \ud Implications for research: Due to ethical concerns about randomising tokophobic women to non‐treatment groups, innovative research designs should be considered.\ud \ud More research is needed on the effectiveness of group interventions and the role of midwives in administering interventions.\ud \ud A standard, measurable definition for tokophobia is needed and careful documentation and differential analysis of women's parity, mental health and obstetric status should be made.\ud \ud Outcomes should include fear reduction. Satisfaction and birth outcome should be measured on more than one occasion.

Childbirth is a major life event, but for some women, the fear of childbirth goes beyond trepidation towards full-blown anxiety and panic, known as fear of childbirth (FOC) or tokophobia. In the present study the authors investigated and compared the intrapersonal and interpersonal factors that might be associated with FOC among women who previously gave birth (parous) and women who did not. A cross sectional survey was conducted among 529 women (parous women (n = 365) and women who had never given birth (n = 173). All participants completed self-report measures using an online survey system. The questionnaires assessed intrapersonal factors including attitudes toward pregnancy and birth, body image, self-esteem and life satisfaction as well as interpersonal factors namely relationship satisfaction. Multiple regression analyses revealed that among parous women age and attitudes toward pregnancy and birth, especially those that relate to body image and delivery were significantly associated with FOC. Among women who had never given birth, only attitudes toward pregnancy and birth, especially those that relate to body image, importance of pregnancy and delivery, and preference of caesarean section (CS), were significantly associated with FOC. In both groups, satisfaction with spousal relationship was not found to be associated with FOC. The results indicate that regarding FOC, intra-personal factors are more dominant than inter-personal factors. When assessing this medico-psychological fear, cognitive aspects should also be addressed.

Objective. To investigate Swedish women’s level of antenatal fear of childbirth at various gestational ages, and factors associated with intense fear and with preference for cesarean section. Design. A cross-sectional study. Setting. All antenatal clinics in four geographical areas. Sample. Thousand six hundred and thirty-five pregnant women at various gestational ages recruited during SeptemberOctober 2006. Method. A questionnaire completed at the antenatal clinic. The women reported their appraisal of the approaching delivery according to the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ). Main outcome measures. The level of fear of childbirth and preferred mode of delivery. Results. Mean W-DEQ score was 62.8. The prevalence of intense fear of childbirth (W-DEQ score ]85) was 15.8% and very intense fear (tocophobia) (W-DEQ score ]100) 5.7%. Nulliparous women had a higher mean score than parous women, but more parous women reported an intense fear. Preference for cesarean section was associated with fear of childbirth (OR 11.79, 6.122.59 for nulliparous and OR 8.32, 4.3615.85 for parous women) and for parous women also with a previous cesarean section (OR 18.54, 9.5535.97), or an instrumental vaginal delivery (OR 2.34, 1.025.34). The level of fear of childbirth was not associated with the gestational age. Conclusions. When a woman requests a cesarean section, both primary fear of birth and traumatic childbirth experiences need to be considered and dealt with. The W-DEQ can be used at any time during pregnancy in order to identify pregnant women who suffer from intense fear of childbirth.

Objective. Fear of childbirth (FOC) or what is historically referred to as tokophobia (a phobic state where a woman avoids childbirth despite desperately wanting a baby), is known to complicate the delivery process. In this study, the relationship of Anxiety Sensitivity (AS) to FOC was examined given that AS is a risk factor for other fears. Specifically, the contribution of three AS dimensions (physical, psychological or social concerns) relative to other factors (e.g., parity of the mother, trait anxiety) in accounting for FOC was explored. Methods. Women in their final 4 months of pregnancy (n ¼110) completed the Anxiety Sensitivity Index, the State-Trait Anxiety Inventory-Trait Scale and the Wijma Delivery Expectancy/Experience Questionnaire. Results. Most demographic variables were non-significant in predicting FOC with the exception of participants’ parity. Multiple regression analysis revealed that AS-physical concerns significantly predicted elevated FOC even after controlling for parity and trait anxiety; higher levels of AS-physical concerns, higher trait anxiety, and expecting a first child all independently predicted greater FOC. Conclusion. Variance in FOC is explained, in part, by AS-physical concerns. Further, AS-physical concerns are distinct from trait anxiety in predicting FOC. Similar to other fears, the results support the possibility that AS may be a risk factor for elevated FOC.

This review aims to clarify the scope and clinical importance of psychosomatic approaches to obstetrics, gynaecology and andrology. This gradually expanding sub-specialty covers a wide domain of complex disease conditions that can be managed more effectively if the various biological, psychological and social aspects are recognised at the start and concurrent treatment initiated. The current need to practise biopsychosocial management of disease conditions is highlighted along with a description of what this would involve. The nine-field psychosomatic approach, which can be applied to everyday clinical encounters, has been illustrated. Clinical applications of the psychosomatic approach are discussed for various conditions including chronic pelvic pain, eating disorders, tokophobia, post-traumatic stress disorder, depression, menstrual disorders, infertility, bereavement and testicular cancer. Cultural considerations and the need for further research are also briefly discussed.

OBJECTIVE: To investigate the prevalence of fear of childbirth in a nationwide sample and its association with subsequent rates of caesarean section and overall experience of childbirth. DESIGN: A prospective study using between-group comparisons. SETTING: About 600 antenatal clinics in Sweden. SAMPLE: A total of 2,662 women recruited at their first visit to an antenatal clinic during three predetermined weeks spread over 1 year. METHODS: Postal questionnaires at 16 weeks of gestation (mean) and 2 months postpartum. Women with fear of childbirth, defined as 'very negative' feelings when thinking about the delivery in second trimester and/or having undergone counselling because of fear of childbirth later in pregnancy, were compared with those in the reference group without these characteristics. MAIN OUTCOME MEASURES: Elective and emergency caesarean section and overall childbirth experience. RESULTS: In total 97 women (3.6%) had very negative feelings and about half of them subsequently underwent counselling. In addition, 193 women (7.2%) who initially had more positive feelings underwent counselling later in pregnancy. In women who underwent counselling, fear of childbirth was associated with a three to six times higher rate of elective caesarean sections but not with higher rates of emergency caesarean section or negative childbirth experience. Very negative feelings without counselling were not associated with an increased caesarean section rate but were associated with a negative birth experience. CONCLUSIONS: At least 10% of pregnant women in Sweden suffer from fear of childbirth. Fear of childbirth in combination with counselling may increase the rate of elective caesarean sections, whereas fear without treatment may have a negative impact on the subsequent experience of childbirth.

Severe fear of childbirth complicates 6% to 10% of parturients and is manifested as nightmares, physical complaints and difficulties in concentrating on work or on family activities. Very often fear of childbirth leads to request for an elective cesarean section (CS). In Finland, Sweden, and the United Kingdom, fear of childbirth or maternal request is the reason for about 7-22% of CS births. Fear of childbirth is as common in nulliparous as in parous women. Fear of labor pain is strongly associated with the fear of pain in general, and a previous complicated childbirth or inadequate pain relief are the most common reasons for requesting a CS among parous women. Previous psychological morbidity and a great number of daily stressors expose a woman to a great risk of fear of childbirth. Fear of childbirth is not an isolated problem but associated with the woman's personal characteristics, mainly general anxiety, low self-esteem, and depression, and dissatisfaction with their partnership, and lack of support. Also the partners of women with fear have a certain pattern of low psychological well-being, resulting in low life-satisfaction, dissatisfaction with partnerships, and depression. A vivid debate about the woman's right to choose the mode of delivery is going on in obstetric literature, but discussion on the reasons for women to request a CS, or on the possibilities to help them overcome the fear of vaginal childbirth is scanty. Preliminary Swedish and Finnish reports demonstrated the results of treatment during pregnancy, when more than half of the women withdrew their request after being able to discuss their anxiety and fear, and vaginal deliveries after treatment were successful.

Background: Women may experience a variety of fears in association with pregnancy and childbirth. The purpose of this study was to describe their objects, causes, and manifestations, and to identify factors associated with the fears. Methods: The study sample comprised 481 pregnant women in western Finland, of whom 329 (response rate 69%) completed a questionnaire. It was developed on the basis of semi-structured interviews and previous studies and had a 4-point scale and a dichotomous scale. Data were subjected to rotated factor analysis, and sum variables were produced. The effects of various demographic variables were calculated using the Kruskal-Wallis and Mann-Whitney U tests. Results: Of the 329 respondents, 78 percent expressed fears relating to pregnancy, to childbirth, or to both. Specific fears concerned childbirth, the child's and mother's well-being, health care staff, family life, and cesarean section. Causes of fears were negative mood, negative stories told by others, alarming information, diseases and child-related problems, and, in multiparas, negative experiences of previous pregnancy, childbirth, and baby's health and care; causes were significantly related to occupation. Fears were manifested as symptoms of stress, effects on everyday life, and a wish to have a cesarean section or to avoid pregnancy and childbirth; employment situation and elective cesarean section were the most important factors related to manifestation of fears. Parity and antenatal training were the most important variables related to objects of fears. Conclusions: Women's fears that are associated with pregnancy and childbirth can be explained by different factors. It is important for perinatal health caregivers to ask pregnant women about their feelings related to the current pregnancy, childbirth, and future motherhood, and to give women who express fears an opportunity to discuss them, paying special attention to primiparas and to multiparas with negative experiences of earlier pregnancies. (BIRTH 29:2 June 2002)

The demographic characteristics, maternal parity and personal traits of pregnant women have been frequently studied predictors of fear of childbirth (FOC). The aim of this study was to examine the role of demographic variables, expected pain level, trait anxiety and anxiety sensitivity in FOC among nulliparous and multiparous women in the last trimester of pregnancy. Two-hundred pregnant women completed a booklet with questionnaires including the Wijma Delivery Expectancy/Experience Questionnaire (W- DEQ), Anxiety Sensitivity Index (ASI), The State – Trait Anxiety Inventory (STAI) and questions on expected labor pain and demographics. Results showed that FOC was higher amongst nulliparous women, but FOC level was not associated with other demographic variables. Different predictors were established in nulliparous and multiparous women. While higher intensity of expected labor pain and anxiety sensitivity (dimension physical concern) were significant predictors in both groups, trait anxiety was significant for the first-time mothers only. Amongst all women, anxiety sensitivity (physical concerns dimension) was identified as an important vulnerability factor for FOC. As such, the level of anxiety sensitivity, and any resulting fear or expectations of pain, should be assessed in expectant mothers by clinicians in prenatal settings. Furthermore, anxiety sensitivity should be an important target for psychological interventions aimed at managing FOC.

Objectives To examine the personal characteristics and socio-economic background of women and their partners fearing vaginal childbirth. Design Questionnaire survey by the 30th week of pregnancy. Setting Sixteen outpatient maternity centres in the capital area of Finland. Participants Two hundred and seventy-eight women and their partners. Main outcome measures Personality traits, socio-economic factors, life and partnership satisfaction and pregnancy- and delivery-associated anxiety and fear. Results The more anxiety, neuroticism, vulnerability, depression, low self-esteem, dissatisfaction with the partnership, and lack of social support the women reported, the more they showed pregnancy-related anxiety and fear of vaginal delivery. In multiple regression analyses psychological variables of the woman contributed most to the prediction of pregnancy-related anxiety (increase in R2=0.20, P

The link between fear of childbirth and theories of anxiety in general is discussed. A possible expression of trait (T-fear) and state (S-fear) aspects of fear of childbirth was investigated in 77 nulliparous and 85 parous women based on data from gestational week 32, at 2 hours and at 5 weeks after childbirth. Data are based on the State Trait Anxiety Inventory and the Wijma Delivery Expectancy/Experience Questionnaire. According to their scores on the Wijma Delivery Expectancy/Experience Questionnaire during late pregnancy, women were divided into 3 groups: high, moderate and low levels of fear of childbirth. In gestational week 32, women in the low level of fear of childbirth group had lower trait anxiety than those in the moderate level of fear of childbirth group, who had lower trait anxiety than the women in the high level of fear of childbirth group. Nulliparous women had a higher level of fear of childbirth but a lower level of trait anxiety than did parous women. There was a significant decreasin...

Objective: To identify factors associated with fear of childbirth during and after first labor. Methods: We analyzed first deliveries of 100 primiparas who reported severe fear of vaginal childbirth during their second pregnancies and 200 age- and parity-matched controls who reported no later fear of delivery. The main outcome measures were previous miscarriages, participation in birth-education classes, support during labor, length of first delivery, pain relief, obstetric complications, welfare of the newborn, and time between deliveries. Results: The prevalence of emergency cesarean (adjusted odds ratio [OR] 26.9, confidence interval [CI] 11.9, 61.1) and vacuum extraction (adjusted OR 4.5, CI 2.2, 9.3) during first delivery was much higher in subjects than controls. Labor lasted longer in cases than in controls during the first (10.5 hours versus 7.8 hours, P = .016) and second stages (62 minutes versus 47 minutes, P = .002). They received epidural analgesia more often, but its timing and the amount used were not different between groups. Of the group with fear, 44% could not define any specific cause for fear and regarded the entire delivery as frightening. Conclusion: Emergency cesarean and vacuum extraction during first deliveries were associated with secondary fear of delivery. Emergency obstetric procedures cannot be avoided, so prevention of fear might require more education on causes and consequences of cesarean or vacuum extraction, eg, in birth classes and at postpartum visits.

Background Women with severe anxiety of childbirth need special support. Aims To follow up women who had received individualized psychological/obstetric support because of anxiety of delivery and to describe this model of support. Methods Questionnaires were sent to 100 women who had suffered from anxiety of delivery and to 100 matched references; 72 pairs provided answers. Results Some women in the study group (25%) accepted psychotherapy during the pregnancy, and the others a modified support. In comparison with the references they remembered the pregnancy as a less positive experience (p=0.02), less vigor (p=0.002), less psychic well-being (p=0.04), more worry about health (p=0.04), more need for encouragement (p=0.001) and less emotional preparedness for delivery (p=0.01). Their experiences of delivery were similar as the references' and in some respects even more positive. The women who initially had wished a cesarean section but eventually underwent a vaginal delivery were as satisfied as those who had not wished a cesarean section. The women recommended the staff to take women's worry seriously (study and reference group 64% and 26% respectively, p-value 0.003) and to build up trust and give support (30% and 19% respectively, p-value 0.003). Conclusion Women with fear of childbirth remembered the pregnancy as distressing, in spite of support. They remembered the delivery similarly as references, also those who initially had asked for a cesarean section but eventually underwent a vaginal delivery.

Background. The purpose of our study was to elucidate the association between fear of childbirth, general anxiety, and stress coping during the third trimester of pregnancy, and a subsequent delivery by emergency cesarean section. Methods. In a case-control study, 1,981 Swedish-speaking women completed three self-assessment questionnaires at 32 weeks' gestation. Ninety-seven of these women were delivered by emergency cesarean section. Fear of childbirth, general anxiety and the stress coping ability of these 97 cases were compared with the same features in 194 controls, matched for age and parity. Results. Women, subsequently delivered by emergency cesarean section, reported a greater anxiety and a poorer stress coping ability, and, most obviously, a greater fear of childbirth at 32 weeks' gestation. After elimination of possible confounders, the odds ratio for emergency cesarean section was examined for women whose scores were above various cut-off points according to the fear of childbirth measuring instrument. For women with a serious fear of childbirth the odds ratio was 3.0 (95% confidence interval 1.4 to 6.6), and the population attributable risk 0.167. Conclusion. Fear of childbirth during the third trimester of pregnancy may increase the risk of subsequent emergency cesarean section.

Up to now it has been difficult to study fear of childbirth because of a shortage of adequate psychological measurements. Therefore the Wijma Delivery Expectancy/ Experience Questionnaire (W-DEQ) was developed. This paper presents the theoretical background of the W-DEQ together with a documentation of the first psychometric studies. Examination of construct validity indicates that it seems to be possible to penetrate a psychological construct related to fear of childbirth by means of the W-DEQ, both before and after delivery, in nulliparous as well as in parous women. The questionnaire measures the construct more clearly in parous than in nulliparous women. Internal consistency reliability and split-half reliability of the W-DEQ ofor = 0.87 are good for a new research instrument. More research is on its way to make the W-DEQ suitable even for measurements in applied settings.

Caesarean section as a means of delivering babies has been around for centuries with numerous references to the procedure appearing in ancient writings (Simm & Matthew 2008). It is now the most common major surgical intervention carried out on women in the world, with between 23% and 30% of deliveries in the UK performed by caesarean section (Beech 2004). This rate is all the more surprising when one considers that caesarean section accounted for just 5.3% of UK births in 1973 (Kitzinger 1998). This rising rate has many implications for both clinical practice and the NHS. An Audit Commission report (1997) suggested that each 1% rise in the caesarean section rate would cost the NHS five million pounds per year. However, the increased rate also has clinical implications, with some studies suggesting that maternal mortality is three to seven times greater following abdominal rather than vaginal birth and maternal morbidity is proportionately even greater, even with elective procedures (McCourt et al 2004).

BackgroundSome women dread and avoid childbirth despite desperately wanting a baby. This is called tokophobia.AimsTo classify tokophobia for the first time in the medical literature.MethodTwenty-six women noted to have an unreasoning dread of childbirth were interviewed by the same psychiatrist, who was not the treating doctor. A qualitative analysis of these psychiatric interviews was performed.ResultsPhobic avoidance of pregnancy may date from adolescence (primary tokophobia), be secondary to atraumatic delivery (secondary tokophobia) or be a symptom of prenatal depression (tokophobia as a symptom of depression). Pregnant women with tokophobia who were refused their choice of delivery method suffered higher rates of psychological morbidity than those who achieved their desired delivery method.ConclusionsTokophobia is a specific and harrowing condition that needs acknowledging. Close liaison between the obstetrician and the psychiatrist in order to assess the balance between surgical and psychiatric morbidity is imperative with tokophobia.

Background research, conducted predominately in Scandinavian countries, suggests that a substantial number of women experience high levels of fear concerning childbirth which can impact on birth outcomes, the mother–infant relationship and the ongoing mental health of the mother. The prevalence of childbirth-related fear (CBRF) is not well known outside of the Nordic nations. This study aimed to examine the prevalence of CBRF in two rural populations (Sweden and Australia) and to pilot a short, easy-to-administer measurement tool. Methods a questionnaire assessing a range of childbirth-related issues was administered to women in the first trimester across two rural populations in Sweden ( n =386) and Australia ( n =123). CBRF was measured using the Fear of Birth Scale (FOBS) a two-item visual analogue scale. Findings close to 30% of women from the Australian and Swedish samples reported elevated levels of CBRF in the first trimester. A previous negative birth experience and less than positive attitudes to their current pregnancy and birth were predictive of high levels of fear. Swedish women with high levels of fear indicated a preference for caesarean section as the mode of birth in this pregnancy. A higher proportion (19%) of Australian women indicated that they would prefer an elective caesarean section, compared with only 8.8% of the Swedish sample; however, this was not related to high levels of fear. Preference for caesarean section was related to CBRF in the Swedish sample but not in the Australian sample. Conclusion the high proportion of women identified with CBRF suggests a need for monitoring of women during pregnancy, particularly those with a previous negative birth experience. The FOBS developed for this study could be used as a screening tool to identify women who require further investigation. Further cross-cultural research is needed to explore the role of fear in women's preference for caesarean section.

The purpose of this study was to investigate pregnant women's intentions for opting for caesarean section (CS), their experiences regarding previous births and their expectations for subsequent delivery. Our objectives were to identify medical and psychological predictors pertaining to the decision for CS on demand.The cross-sectional survey was conducted at two study centres over a three-month period including German speaking women at any time of pregnancy and consisted of an anonymous structured questionnaire. Logistic regression was computed to investigate the predictive value of medical variables, birth experience and birth anxiety on the demand for CS.Nineteen of 201 participants preferred to deliver by CS on demand and 15 felt uncertain about their decision. How the preceding delivery had been experienced was significantly better in the vaginal delivery (VD)-group (women not considering CS on demand) than in the CS-group (good experience in 81.7% and 52.0% respectively, p = 0.007). A negative previous birth experience and a preceding CS were predictors for the wish to deliver by CS.As negative birth experience predicts the wish for a CS, specific supportive care during first pregnancy could play a pivotal role in making this decision.