Personality, fear of childbirth and cesarean delivery on demand

Objectives. To investigate both the psychological traits and the demographic factors associated with cesarean section on maternal demand. Design. Cross-sectional questionnaire study. Setting. Delivery ward, Edith Wolfson Medical Center, Holon, Israel. Sample. Fifty-nine healthy primigravida with a singleton pregnancy were recruited during 2009, of whom 28 requested and were delivered by cesarean section without obstetrical indication, whereas 31 opted for spontaneous vaginal delivery. Methods. All questionnaires were administered to the two groups at term. Various psychological (fear of childbirth questionnaire, Millon Clinical Multiaxial Inventory III, Anxiety Sensitivity Index, State-Trait Anxiety Index and social support scale) as well as demographic variables were measured before labor and compared. A priori power calculation yielded a power of 95%. Main Outcome Measures. Fear of childbirth, various personality disorders and psychiatric clinical syndromes (29 Millon Clinical Multiaxial Inventory III scales), Anxiety Sensitivity, State Anxiety Index, social support and demographic variables. Results. Differences in age and method of conceiving (p<0.001) were found between the groups. The study group reported a higher level of fear of childbirth (p<0.001), but no differences were found in all other personality characteristics measured (29 Millon Clinical Multiaxial Inventory III scales, State-Trait Anxiety, Anxiety Sensitivity and social support scale). The origin of the difference regarding the fear of childbirth was located to two specific questions: 'Have you always been afraid of giving birth?' and 'Have you sometimes thought of the delivery as something unnatural?' Conclusions. The only psychological variable associated with the choice for cesarean section on maternal request was the fear of childbirth.