Cluster Analysis of Fear of Childbirth, Anxiety, Depression, and Childbirth Self-Efficacy

Objective

To identify clusters of women based on anxiety, depression, fear of birth, and childbirth self-efficacy and factors associated with the clusters.

Design

Cross-sectional survey.

Setting

Online in Sweden.

Participants

Pregnant women (N = 1,419).

Methods

We collected data through online questionnaires. We included scales to measure anxiety, depression, worries about and fear of birth, and self-efficacy in a kappa-means cluster analysis. We calculated odds ratios with 95% confidence intervals between clusters and background variables.

Results

We identified 4 clusters based on severity: Resourceful–Robust, Resourceful–Fearful, Vulnerable–Fearful, and Fragile–Fearful. Participants in the Resourceful–Fearful and Vulnerable–Fearful clusters were more likely to report mental health problems than those in the Resourceful–Robust cluster. Participants in the Vulnerable–Fearful and Fragile–Fearful clusters were more likely to report mental health problems than those in the Resourceful–Robust cluster. Participants in the Fragile–Fearful cluster were more likely to be multiparous, report that their pregnancy was not normal, and prefer cesarean birth than those in the Resourceful–Robust cluster.

Conclusions

Women with childbirth fear may be vulnerable to anxiety and depression during the perinatal period, although the severity might vary. Self-efficacy might be a mediator against mental health problems. Findings demonstrated levels of severity, and the one-size-fits-all approach in Swedish health care may benefit from a more targeted approach for women with fear of childbirth.