Mental health problems common in women with fear of childbirth

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Abstract

Please cite this paper as: Rouhe H, Salmela-Aro K, Gissler M, Halmesmäki E, Saisto T. Mental health problems common in women with fear of childbirth. BJOG 2011;118:1104–1111.

Objective

To investigate whether women with fear of childbirth have more mental health problems than women of childbearing age in general.

Design

Register-based retrospective study.

Setting

The maternity clinic of Helsinki University Central Hospital.

Population

In all, 2405 women referred for consultation because of fear of childbirth during 1996–2002 and 4676 comparable control women.

Methods

Data were linked to the Medical Birth Register, the Hospital Discharge Register and the Drug Reimbursement Register 5–12 years before and after the initial childbirth (during 1990–2008).

Main outcome measures

Prevalence of psychiatric care as evidenced by the use of psychotropic medication, and episodes of either psychiatric inpatient or outpatient care in women with fear of childbirth compared with nonfearful controls.

Results

Women with fear of childbirth had significantly more often had psychiatric care (54.0% versus 33.6%, P < 0.001) during the study period. Fearful and nonfearful women differed from each other (P < 0.001) regarding psychiatric inpatient care (7.2% versus 3.6%), outpatient care (19.0% versus 9.8%) and the use of psychotropic medication (51.3% versus 31.3%). Mood and anxiety disorders were the most common psychiatric diagnoses in both groups. The major predictors for a need for psychiatric care after the initial childbirth were previous psychiatric care (adjusted odds ratio 4.5; 95% CI 4.0–5.1) and fear of childbirth (adjusted odds ratio 1.9; 95%CI 1.7–2.1).

Conclusions

A remarkable mental morbidity was seen among women of childbearing age. Mental health problems were twice as common among women with a fear of childbirth as in nonfearful controls. Clinical practice on how to evaluate and treat women fearing childbirth should be developed.

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