Prevalence of fear of childbirth among nulliparous women in Thailand

Introduction: Pregnancy and childbirth lead to significant changes in women, impacting various dimension of their lives. Fear of childbirth (FOC) is an extreme anxiety about childbirth. It was associated with increased risk of postpartum depression and a subsequent decrease in pregnancy rate.Objectives: This study aimed to investigate the prevalence and factors associated with FOC among nulliparous Thai women and explore the relationship between FOC and postpartum depression.Method: A cross-sectional study was conducted at Thammasat University Hospital among nulliparous women between March and August 2023. Demographics, obstetric data and FOC, using Wijma Delivery Expectancy Experience Questionnaire-A (WDEQ-A), were collected prior to delivery. After childbirth, the risk of postpartum depression was assessed by using Edinburgh Postpartum Depression Scale (EPDS).Result:  Prevalence of high to severe FOC and risk of postpartum depression in nulliparous women were 19.5% and 46.7%, respectively. No family support and no information about delivery were associated with increased level of FOC significantly, while no family support was a significant predictor of high to severe FOC (OR 5.62 95%CI 1.34-23.51, p-value 0.018). Factors significantly associated with risk of postpartum depression, including health insurance scheme, occupation, family income and level of FOC. Additionally, pregnant women with high to severe FOC had 2.68 times more likely to develop postpartum depression (OR 2.68 95% CI 1.29-5.56, p-value 0.008) while those with high income (> 1600 USD) had a 67% lower risk of postpartum depression (OR 0.33, 95% CI 0.11-0.95; p-value 0.008).Conclusion: The prevalence of high to severe FOC is approximately 20%, which found to be a significant predictor of high-risk postpartum depression. Therefore, the evaluation of FOC in the antepartum should be done for early detection and timely intervention, in order to improve the quality of antenatal care and postpartum care for both the mother and child.