Fear of childbirth, women's preference for cesarean section and childhood abuse: a longitudinal study

Objective. To examine the association between childhood abuse and fear of childbirth and the wish for cesarean section during second pregnancy. Design. A longitudinal cohort study using data from the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health. Setting. Fifty maternity units in Norway, 1999-2006. Sample. We included 4,876 women who participated in the MoBa study during their first and second pregnancy. Methods. Postal questionnaires at 18 and 30 weeks' gestation and 6 months postpartum linked to the Medical Birth Registry of Norway. Main Outcome Measures. Associations between childhood abuse and women's fear of childbirth and preference for cesarean section during second pregnancy were assessed using regression analyses, adjusting for confounding factors such as mode of delivery and birth experience of first pregnancy. Results. Of 4,876 women, 1,023 (21%) reported some form of childhood abuse. Compared to women without a history of childhood abuse, childhood-abused women more frequently reported fear of childbirth (23% vs. 15%, p < 0.001) and the wish for cesarean section (6.4% vs. 4.0%, p < 0.002) during second pregnancy. The association between childhood abuse and fear of childbirth and preference for cesarean section remained significant after adjusting for mode of first delivery and experience of first birth (adjusted odds ratio [OR] 1.53, 95%CI 1.24-1.90 and 1.57, 1.09-2.27, respectively). Conclusion. Childhood abuse is associated with fear of childbirth and preference for cesarean section during second pregnancy. Mode of delivery and postpartum self-reported birth experience of the first pregnancy did not alter this association significantly.