Emotional health across the perinatal period: Longitudinal patterns of fear of birth and depressive symptoms in a midwifery continuity of care context

Objectives

Perinatal depressive symptoms affect both maternal and infant well-being and are associated with fear of giving birth. Midwifery continuity of care (MCoC) has shown potential in reducing anxiety and depression, particularly among vulnerable women. The aim of this study was to explore the trajectories of fear of birth and depressive symptoms, in relation to background, attitudes and birth-related data.

Methods

A prospective longitudinal study was conducted among women with fear of birth or depressive symptoms who, after a screening procedure were offered care in a MCoC model. Fear of birth and depressive symptoms were assessed with the Fear of Birth Scale (FOBS) and Edinburgh Postnatal Depression Scale (EPDS) and measured at screening, in mid pregnancy and twice after birth. Chi-square tests and analysis of variance were used for comparing groups.

Results

The questionnaires were completed by 175 women during pregnancy and by 140 postpartum. During screening 84% presented with fear of birth and 24% with depressive symptoms. The degree of fear of birth and the depressive symptoms changed over time with the highest prevalence during pregnancy and a decline after birth. The trajectory of depressive symptoms was mainly related to women’s attitudes, while birth-related variables concerned fear of birth.

Conclusion

This study showed that fear of birth as well as depressive symptoms changed over time. These changes may represent natural progression but might be associated with the intervention. Working with women’s attitudes might change the trajectories, especially in women with both fear of birth and depressive symptoms.