Bibi A, Lin M, Zhang X Psychometric properties and measurement invariance of Depression, Anxiety and Stress Scales (DASS-21) across cultures. Int J Psychol. 2020; 55:916-925

Dahlberg U, Aune I. The woman's birth experience—the effect of interpersonal relationships and continuity of care. Midwifery. 2013; 29:(4)407-415

Dencker AC, Nilsson C, Begley E Causes and outcomes in studies of fear of childbirth: a systematic review. Women Birth. 2019; 32:(2)99-111

Deng Y, Lin Y, Yang L A comparison of maternal fear of childbirth, labor pain intensity and intrapartum analgesic consumption between primiparas and multiparas: a crosssectional study. Int J Nurs Sci. 2021; 8:(4)380-387

do Souto SPA, da Silva RCG, Prata AP, Guerra MJ, Couto C, de Albuquerque RS. Midwives' interventions for reducing fear of childbirth in pregnant women: a scoping review. JBI Evid Synth. 2022; 20:(12)2867-2935

Drew LB, Wilkinson JP, Nundwe W Long-term outcomes for women after obstetric fistula repair in Lilongwe, Malawi: a qualitative study. BMC Pregnancy Childbirth. 2016; 16:(1)

Eide KT, Morken NH, Bærøe K. Maternal reasons for requesting planned cesarean section in Norway: a qualitative study. BMC Pregnancy Childbirth. 2019; 19:(1)

Fenwick J, Gamble J, Nathan E, Bayes S, Hauck Y. Pre- and postpartum levels of childbirth fear and the relationship to birth outcomes in a cohort of Australian women. J Clin Nurs. 2009; 18:(5)667-677

Fielding-Singh P, Dmowska A. Obstetric gaslighting and the denial of mothers' realities. Soc Sci Med. 2022; 301

Green G, Tesler R, Marques A. Primiparous and multiparous women's mode of birth and negative emotions. Int J Environ Res Public Health. 2022; 19:(9)

Haines H, Pallant JF, Karlström A, Hildingsson I. Cross-cultural comparison of levels of childbirth-related fear in an Australian and Swedish sample. Midwifery. 2011; 27:(4)560-567

Laursen M, Johansen C, Hedegaard M. Fear of childbirth and risk for birth complications in nulliparous women in the Danish National Birth Cohort. BJOG. 2009; 116:(10)1350-1355

Leinweber J, Fontein-Kuipers Y, Karlsdottir SI Developing a woman-centered, inclusive definition of positive childbirth experiences: a discussion paper. Birth. 2023; 50:(2)362-383

Mannava P, Durrant K, Fisher J, Chersich M, Luchters S. Attitudes and behaviours of maternal health care providers in interactions with clients: a systematic review. Global Health. 2015; 11:(1)

Moghaddam Hosseini V, Makai A, Varga K, Ács P, Prémusz V, Várnagy Á. Assessing fear of childbirth and its predictors among Hungarian pregnant women using Wijma delivery expectancy/experience questionnaire subscales. Psychol Health Med. 2019; 24:(7)879-889

Nguyen LD, Nguyen LH, Ninh LT Fear of childbirth and preferences for prevention services among urban pregnant women in a developing country: a multicenter, cross-sectional study. Int J Environ Res Public Health. 2021; 18:(10)

Nilsson C, Hessman E, Sjöblom H Definitions, measurements and prevalence of fear of childbirth: a systematic review. BMC Pregnancy Childbirth. 2018; 18:(1)

O'Connell MA, Leahy-Warren P, Kenny LC, O'Neill SM, Khashan AS. The prevalence and risk factors of fear of childbirth among pregnant women: a cross-sectional study in Ireland. Acta Obstet Gynecol Scand. 2019; 98:(8)1014-1023

Osman A, Wong JL, Bagge CL, Freedenthal S, Gutierrez PM, Lozano G. The Depression Anxiety Stress Scales-21 (DASS-21): further examination of dimensions, scale reliability, and correlates. J Clin Psychol. 2012; 68:(12)1322-1338

Otley H. Fear of childbirth: understanding the causes, impact and treatment. Br J Midwifery. 2011; 19:(4)215-220

Phunyammalee M, Buayaem T, Boriboonhirunsarn D. Fear of childbirth and associated factors among low-risk pregnant women. J Obstet Gynaecol. 2019; 39:(6)763-767

Rúger-Navarrete AJM, Vázquez-Lara I, Antúnez-Calvente L Antenatal fear of childbirth as a risk factor for a bad childbirth experience. Healthcare. 2023; 11:(3)

Sanjari S, Chaman R, Salehin S, Goli S, Keramat A. Update on the global prevalence of severe fear of childbirth in low-risk pregnant women: a systematic review and meta-analysis. Int J Womens Health Reprod Sci. 2021; 10:(1)3-10

Shakarami A, Mirghafourvand M, Abdolalipour S Comparison of fear, anxiety and self-efficacy of childbirth among primiparous and multiparous women. BMC Pregnancy Childbirth. 2021; 21

Skitmore NQueensland: School of Psychology, The University of Queensland; 2015

Ternström E, Hildingsson I, Haines H, Rubertsson C. Higher prevalence of childbirth related fear in foreign born pregnant women – findings from a community sample in Sweden. Midwifery. 2015; 31:(4)445-450

Toohill J, Fenwick J, Gamble J, Creedy DK. Prevalence of childbirth fear in an Australian sample of pregnant women. BMC Pregnancy Childbirth. 2014; 14:(1)

Waldenström U, Hildingsson I, Ryding EL. Antenatal fear of childbirth and its association with subsequent caesarean section and experience of childbirth. BJOG. 2006; 113:(6)638-646

Wijma K, Wijma B, Zar M. Psychometric aspects of the W-DEQ; a new questionnaire for the measurement of fear of childbirth. J Psychosom Obstet Gynaecol. 1998; 19:(2)84-97

Fear of childbirth in nulliparous and multiparous women in Australia

02 December 2023
Volume 31 · Issue 12



Although maternity care in developed countries is safe, fear of childbirth is a common problem. There is limited research in this area on nulliparous and multiparous women. The aim of this study was to compare fear of childbirth, its risk factors and birth outcomes between Australian nulliparous and multiparous women.


In this prospective cohort study, 141 nulliparous women and 212 multiparous women were recruited from antenatal clinics. Data were collected using standardised questionnaires and analysed.


A third of nulliparous (33%) and multiparous women (31%) feared childbirth. Nulliparous women with high–severe fear were more likely to have a lower family income, attend antenatal education classes, undergo assisted conception and report higher levels of depression, anxiety and stress. They also had greater odds of prelabour cervical ripening, oxytocin for induction or augmentation of labour, instrumental birth, episiotomy and greater volume of blood loss during birth than multiparous women.


To empower and support women with fear of childbirth, their unique needs must be recognised. A assistance in coping with fear and anxiety must be made available to contribute to a positive pregnancy experience and birth outcome.

Pregnancy and birth are described as a transition phase or existential threshold that childbearing women must cross. Childbirth is an experience with multifaceted dimensions and is unique for each woman, as well as being strongly influenced by her psychosocial context. Women's expectations and experiences of pregnancy and birth are both positive and negative in nature, involving feelings of joy and faith but also worries, anxiety and fears (Dencker et al, 2019).

Although maternity care in high-income countries is safe, fear of childbirth is a common problem affecting the health and wellbeing of women before, during and after pregnancy. Fear of childbirth can result in consequences for women's relationships with their baby, partner and family, and often leads to a higher rate of childbirth interventions and requests for caesarean section by women striving for control in an exposed situation (Nilsson et al, 2018). Fear of childbirth has also been shown to be associated with emergency caesarean section, increased risk of dystocia, protracted labour, preterm birth, low birth weight, unsuccessful breastfeeding, extended postnatal hospital stay and a negative childbirth experience (Waldenström et al, 2006; Laursen et al, 2009).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month