Agnes Fredrick Massae: Women’s fear of childbirth and depressive symptoms before and after birth: Studies on the magnitude, challenges, and coping strategies in Pwani region, Tanzania

Abstract

Most women experience fear of childbirth (FoB) and depressive symptoms (DS), which have been associated with adverse obstetric outcomes. Such adverse effects are rarely screened in clinical practice, and knowledge of magnitude, associated factors, challenges, and coping strategies is lacking in Tanzania. This thesis aimed to assess the magnitude, challenges, and coping strategies regarding women's fear of childbirth and depressive symptoms before and after childbirth.

A mixed-method study was carried out in the Pwani region, Tanzania. A longitudinal study was performed to establish psychometric properties of W-DEQ-A and W-DEQ-B (Paper I), prevalence and predictors of FoB and DS during pregnancy (Paper II), and patterns and predictors of FoB and DS from pregnancy and postpartum (Paper III). Six hundred ninety-four pregnant women were recruited, and 625 completed the study. Individual interviews with women (n = 13) and traditional birth attendants (n = 3) and focus group discussions with women (n = 5), men (n = 2), and nurse-midwives (n = 4) were conducted to explore barriers, support, and coping strategies for overcoming FoB (Paper IV). 

Factor analysis for W-DEQ revealed seven factors with 29 items with acceptable indices. Both versions of W-DEQ had good internal consistency.

The prevalence rates of FoB decreased from 16.2% during pregnancy to 13.9% after childbirth, while DS reduced significantly from 18.2% to 8.5% (p < 0.001). Some women had persistent FoB (6.4%) or DS (4.3%). Pregnant women above 30 years old, with informal education, and/or nulliparous were more likely to have FoB and DS. Giving birth by cesarean section and spending more than 12 hours at a health facility from admission to birth were associated with postnatal FoB. Furthermore, giving birth to an ill or dead baby was a predictor for postpartum DS. 

In coping with FoB, three themes were identified: (i) perceived barriers to overcoming FoB, (ii) individual strength, family, community, and friendly healthcare facilities as proposed sources of support, (iii) turning to a higher power, socializing, and preparation as strategies to cope with FoB.

The Kiswahili W-DEQ-A-Revised and W-DEQ-B-Revised are reliable for measuring FoB with a multifactorial structure, incorporating seven factors with 29 items. FoB and DS coexist and get reduced with time. Recognizing predictors of both conditions, barriers to overcoming FoB, support, and coping strategies will help in the early identification of women at risk and in planning for timely interventions. Standardized tools and routine screening for FoB and DS during the perinatal period are recommended.