The role of self-esteem on fear of childbirth and birth experience.

Objective: Fear of childbirth (FOC), also referred to as tokophobia, can have detrimental consequences for a woman's well-being during pregnancy and for their subjective birth experience. However, it is unknown what role self-esteem plays in the relationship between FOC and the experience of childbirth. This study investigates the relation between FOC and the birth experience, and the role of self-esteem in that relation.

Methods: We studied 125 nulliparous and parous Finnish women from their third trimester of pregnancy to 4-8 weeks postpartum. Path analysis with MLR estimation was conducted using MPlus to predict the childbirth experience according to prior self-esteem and fear of childbirth as well as their interaction. Also, age and parity were included as predictors of the birth experience, as well as their interactions with self-esteem. FOC was measured with the Wijma Delivery Expectancy/Experience Questionnaire - version A (W-DEQ-A), self-esteem with the Rosenberg Self-Esteem Scale (RSES), and birthing experience with the Delivery Satisfaction Scale (DSS).

Results: We found that self-esteem moderated the association between fear of childbirth and the subjective birth experience: the lower the self-esteem, the stronger the negative connection between FOC and the birth experience; and, reversely, the higher the self-esteem, the weaker the connection between FOC and the birth experience.

Conclusions: The results highlight intra-group differences between fearful women and contribute to theory formation. They can be used in clinical practice and when planning interventions to reduce negative birth experiences.