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A national online survey of UK maternity unit service provision for women with fear of birth

02 August 2015
11 min read
Volume 23 · Issue 8


In the UK, fear of birth (FoB) is considered a valid reason to request an elective caesarean section, and the National Institute for Health and Care Excellence (NICE, 2011) provided guidance in respect of women with a FoB requesting operative delivery. However, it was not clear how many maternity units in the UK offered support for women in line with this guidance. Consequently, a national online audit survey was undertaken to determine current service provision in maternity units. Hence in 2013, 202 maternity units were surveyed over 9 weeks; there was a 63% (n=128) response rate.

It was evident that 47.3% (n=52) of all units did not offer specialist support for women with FoB. However, where support was available, this varied from the benchmark recommendation for referral to a consultant obstetrician (NICE, 2001) to specialist midwifery clinics and psychological support services. Overall, the survey revealed that care pathways for FoB had not been widely implemented in the UK.

There is no agreed definition on what fear of birth (FoB) is, largely due to the differences in its diagnostic testing (Haines et al, 2011). However, Areskog (1982: 263) defined severe FoB in women who ‘expressed a strong anxiety which had impacted their daily functions and wellbeing’.

The evidence for a true prevalence of FoB is scarce; however, between 7 and 26% of women in high income countries fear childbirth (Hofberg and Ward, 2004; Laursen et al, 2008; Kjærgaard et al, 2008; Fenwick et al, 2009) with 6% reporting the fear as ‘disabling’ (Searle, 1996).

A FoB was documented as early as 1858 by French psychiatrist, Marcé (Hofberg and Brockington, 2000: 83):

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