Influence of instrument choice on fear of childbirth after assisted vaginal delivery: A secondary analysis of the Bergen birth study

Introduction

Assisted vaginal delivery has been associated with a negative childbirth experience and the development of secondary fear of childbirth, although it is less consistent than emergency Cesarean delivery. Whether the choice of instrument influences this, and the woman's preference for delivery mode in a potential subsequent pregnancy, is unknown. Our objective was to assess the association between the choice of instrument during assisted vaginal delivery, secondary fear of childbirth, and preference for an elective Cesarean delivery in a potential subsequent pregnancy.

Material and Methods

Study design: Secondary analysis of Bergen birth study, a prospective observational study assessing maternal and neonatal outcomes after assisted vaginal delivery in primiparas at term, inclusion period: June 2021–April 2023. Wijma Delivery Expectancy/Experience Questionnaire version B was completed within a week after delivery. This validated instrument has 33 questions, a total score range from 0 to 165, and a score of ≥85 was used as a cutoff to define fear of childbirth. Preferred mode of delivery in a potential subsequent pregnancy, pain, and overall birth experience was also measured. Main outcome measures: Secondary fear of childbirth and request for Cesarean delivery in the next pregnancy.

Results

132 women after forceps, 160 after vacuum, and 139 after spontaneous delivery answered the questionnaires. Overall prevalence of secondary fear of childbirth was 12.2% after spontaneous and 14.4% after both forceps and vacuum deliveries. Compared with spontaneous delivery, the adjusted odds ratio of developing fear of childbirth was aOR 1.63 (95% CI 0.45–5.17, p = 0.4) after vacuum and aOR 1.71 (95% CI 0.43–6.14, p = 0.4) after forceps delivery. Secondary fear of childbirth (aOR: 11.3 (95% CI 5.30–24.6), p < 0.001) and maternal age ≥35 (aOR: 3.66 (95% CI: 1.49–8.81), p = 0.004) were associated with a preference for cesarean delivery in a potential subsequent pregnancy. Severe pain was reported just as often in the spontaneous delivery cohort (33.8%) as in the vacuum (25.6%) and forceps (24.2%) cohorts. Less than 5% in each cohort indicated that they were very unsatisfied with their birth experience.

Conclusions

The choice of instrument during assisted vaginal delivery was not associated with secondary fear of childbirth or preference for cesarean delivery in a potential subsequent pregnancy.