Patterns and predictors of fear of childbirth and depressive symptoms over time in a cohort of women in the Pwani region, Tanzania
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Date
2022-11-03
Authors
Journal Title
Journal ISSN
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Publisher
PLoS one
Abstract
Background
Fear of childbirth (FoB) and depressive symptoms (DS) are experienced by many women
and can negatively affect women during and after pregnancy. This study assessed patterns
of FoB and DS over time and associations of postpartum FoB and DS with sociodemo-
graphic and obstetric characteristics.
Methods
We conducted a longitudinal study at six health facilities in Tanzania in 2018–2019. Preg-
nant women were consecutively assessed for FoB and DS before and after childbirth using
the Wijma Delivery Expectancy/Experience Questionnaire versions A & B and the Edin-
burgh antenatal and postnatal depressive scale. This paper is based on 625 women who
completed participation.
Results
The prevalence rates of FoB and DS during pregnancy were 16% and 18.2%, respectively,
and after childbirth, 13.9% and 8.5%. Some had FoB (6.4%) and DS (4.3%) at both time-
points. FoB was strongly associated with DS at both timepoints (p < 0.001). Both FoB (p =
0.246) and DS (p < 0.001) decreased after childbirth. Never having experienced obstetric
complications decreased the odds of postpartum and persisting FoB (adjusted odds ratio
(aOR) 0.44, 95% confidence interval (CI) 0.23–0.83). Giving birth by caesarean section
(aOR 2.01, 95% CI 1.11–3.65) and having more than 12 hours pass between admission
and childbirth increased the odds of postpartum FoB (aOR 2.07, 95% CI 1.03–4.16). Post-
partum DS was more common in women with an ill child/stillbirth/early neonatal death (aOR4.78, 95% CI 2.29–9.95). Persisting DS was more common in single (aOR 2.59, 95% CI
1.02–6.59) and women without social support from parents (aOR 0.28, 95% 0.11–0.69).
Conclusions
FoB and DS coexist and decrease over time. Identifying predictors of both conditions will aid
in recognising women at risk and planning for prevention and treatment. Screening for FoB
and DS before and after childbirth and offering psychological support should be considered
part of routine antenatal and postnatal care. Furthermore, supporting women with previous
obstetric complications is crucial. Using interviews instead of a self-administered approach
might have contributed to social desirability. Also, excluding women with previous caesar-
ean sections could underestimate FoB and DS prevalence rates.
Description
Keywords
Fear of childbirth, Cohort of women, Pwani region, Tanzania
Citation
Massae, A.F., Larsson, M., Pembe, A.B., Mbekenga, C. and Svanberg, A.S., 2022. Patterns and predictors of fear of childbirth and depressive symptoms over time in a cohort of women in the Pwani region, Tanzania. PLoS one, 17(11), p.e0277004.