Changes in Fear of Childbirth and Its Predictors Over Three COVID-19 Pandemic Waves in Poland.

Background: The COVID-19 pandemic posed new and unpredictable challenges worldwide, having a particular effect on vulnerable groups, including pregnant women. The occurrence of these stressful circumstances likely increased women's fear of childbirth, a critical issue in pregnancy with consequences for various outcomes.

Methods: This cross-sectional study investigated fear of childbirth in pregnant women during three waves of the COVID-19 pandemic in Poland and identified factors predicting severe fear. Participants were recruited through social media platforms. In total, 2462 pregnant women completed the study questionnaire during the first (n = 1079), second (n = 1119), or third (n = 264) waves of the pandemic. Fear of childbirth was measured with the Fear of Birth visual analog scale (FOBS) using a cut-off score of ≥ 54 to indicate clinically relevant fear of childbirth. COVID-19-related stress was assessed using the Pandemic-Related Pregnancy Stress Scale (PREPS).

Results: Fear of childbirth was present in 51.5%, 61.9%, and 56.8% of participants at the three waves, respectively. Women who were pregnant during the first and third waves had lower fear of childbirth scores than those who were pregnant during the second wave. This could be explained by changes in infection rates and the severity of the disease, restrictions in maternity care, and the availability of vaccinations. In successive pandemic waves, predictors of severe fear of childbirth (FoC), especially related to COVID-19, differed. Across waves, the most powerful predictor was stress originating from feeling unprepared for birth.

Discussion: Fear of childbirth differed across pandemic time points. Pandemic waves should be considered in future review studies and meta-analyses.