Personality, fear of childbirth and cesarean delivery on demand

Objectives: To investigate both the psychological traits and the demographic factors associated with cesarean section on maternal demand.

Design: Cross-sectional questionnaire study.

Setting: Delivery ward, Edith Wolfson Medical Center, Holon, Israel.

Sample: Fifty-nine healthy primigravida with a singleton pregnancy were recruited during 2009, of whom 28 requested and were delivered by cesarean section without obstetrical indication, whereas 31 opted for spontaneous vaginal delivery.

Methods: All questionnaires were administered to the two groups at term. Various psychological (fear of childbirth questionnaire, Millon Clinical Multiaxial Inventory III, Anxiety Sensitivity Index, State-Trait Anxiety Index and social support scale) as well as demographic variables were measured before labor and compared. A priori power calculation yielded a power of 95%.

Main outcome measures: Fear of childbirth, various personality disorders and psychiatric clinical syndromes (29 Millon Clinical Multiaxial Inventory III scales), Anxiety Sensitivity, State Anxiety Index, social support and demographic variables.

Results: Differences in age and method of conceiving (p<0.001) were found between the groups. The study group reported a higher level of fear of childbirth (p<0.001), but no differences were found in all other personality characteristics measured (29 Millon Clinical Multiaxial Inventory III scales, State-Trait Anxiety, Anxiety Sensitivity and social support scale). The origin of the difference regarding the fear of childbirth was located to two specific questions: 'Have you always been afraid of giving birth?' and 'Have you sometimes thought of the delivery as something unnatural?'

Conclusions: The only psychological variable associated with the choice for cesarean section on maternal request was the fear of childbirth.