Description of studies
This study showed that studies had been conducted in different provinces of Iran, including the northern, central, western, southeastern, and northeastern provinces. Three studies were carried out on FOC causes, one paper on the fears related to pregnancy and childbirth, and two articles on the relationship between FOC and delivery mode. Different questionnaires were used in these studies (Table 1).
Table 1
Characteristics of included studies
Author, year | Study purpose | Type of study | Sample size | Tool | County | Results | STROBE checklist score |
Taheri et al. 2015 [29] | To investigate the causes of FOC in pregnant women in Shahrekord | Cross-sectional | 130 | FOC Questionnaire | Shahrekord | The main causes of FOC in pregnant women were fear of painful injections during labor, suturing in childbirth, labor pain, and loss of control during labor. | 22 |
Khorsandi et al (2014) [30]. | To investigate the causes and factors related to natural childbirth among pregnant women who attended prenatal care of Arak. | Cross-sectional | 595 | Lowe Questionnaire | Arak | The most common causes of fear were possible harm to the baby, baby infirmity, and labor pain, respectively. | 30 |
Farajzadtouli et al (2018) [31] | To assess prevalence and causes of FOC in primiparous pregnant women | Cross-sectional | 181 | Harman Childbirth Attitude Questionnaire | Talesh | The most common cause of FOC was harm to the baby. Fear of baby infirmity and fear of labor was in the second and third ranks. | 34 |
Matinnia et al (2015) [32] | To examine the content of maternal fear and the associated demographic factors in a sample of Iranian primigravidae. | Cross-sectional | 342 | FOC Questionnaire | Hamedan | The most frequent factor for all the respondents was 'fear related to the process of labor and childbirth'. These factors were included labor pain, vaginal rupturing, being injured during childbirth, losing one's own life during childbirth, an unpredictable problem during childbirth, prolonged labor, and delivery, and ending up with emergency interventions. | 22 |
Andaroon et al (2017) [33] | To determine the relationship between the intensity of FOC and choosing the type of childbirth in primiparous women | Cross-sectional | 220 | Wijma FOC Questionnaire | Mashhad | The most common cause of FOC was fear of labor pain. | 28 |
Negahban et al (2009) [34] | To assess the relationship between fears from vaginal delivery with the occurrence of emergency cesarean in primiparous women. | Cross-sectional | 243 | Structured Questionnaire | Rafsanjan | The most mentioned reasons for FOC were labor pain and harm to the baby, respectively. | 24 |
Based on the study results, determinants of the FOC in nulliparous women were: biological factor (the process of labor and childbirth and labor pain [29–34]), concern for the baby factor (harm to the baby and baby infirmity [30, 31, 34]), psychological factor (painful injections during labor and suturing in childbirth [29]), and individual factor (loss of control during labor [29]).
Taheri et al.'s (2015) research was conducted on the causes of FOC among pregnant women in Shahrekord. The results showed that 94.61% of mothers stated that they were afraid of painful injections during childbirth, 91.53% of suturing in childbirth, 87.71% of labor pain, and 62.31% due to loss of control during labor. Based on the findings, the mean FOC score was significantly higher in the nulliparous women than in multiparous women. Nightmare, harm to the baby, baby disability, hospital environment, bleeding, being left alone, not receiving care, not cooperating with the doctor, losing control, delivery anxiety, and labor pain, respectively, were other factors [29].
A cross-sectional study by Khorsandi et al. (2014) was conducted to investigate different factors of fear in vaginal delivery among pregnant women in Arak. The mean score for nulliparous women on the FOC questionnaire was significantly higher than in multiparous women. There was a significant difference between the birth scores of women with vaginal childbirth and women with cesarean section. Furthermore, the results indicated that the most common causes of FOC were the possible harm to the baby, baby infirmity, and labor pain, respectively. Other reasons were included assessing delivery anxiety, giving birth, losing control, suturing, being alone, lack of cooperation with the physician, not receiving care, bleeding, hospital environment, injections, and nightmare [30].
A study by Farajzadtouli et al. on prevalence and causes of FOC in nulliparous women showed that 82.7% of mothers had a degree of FOC. There was a significant difference between the knowledge of the complications of cesarean section and the mean score of FOC, as FOC reduced with increased awareness. In addition, the most common cause of FOC was harm to the baby; fear of baby infirmity and fear of labor was in the second and third ranks. Other reasons included the following, respectively: labor anxiety, losing control, being alone, suturing, not receiving care, lack of cooperation with midwife or physician, injections, labor pain, bleeding, hospital environment, and nightmare [31].
The study of Matin Nia et al. (2015) was conducted to investigate the content of maternal fear and the associated demographic factors in a sample of Iranian nulliparous. According to the study results, all nulliparous reported some degree of fear. Six categories were identified. The most frequent common factor for all the respondents was 'fear related to the process of labor and childbirth, followed by health and life of the baby, competence and behavior of maternity ward personnel, own capabilities and reactions, becoming a parent and family life after deliver, and general fear in pregnancy' [32].
The study of Andaroon et al. (2017) was performed to determine the relationship between FOC with choosing the mode of delivery in primiparous women referred to the health centers of Mashhad. According to the study results, there was a significant association between selecting the mode of delivery and the intensity of FOC. The majority of women with intense FOC had selected cesarean section. Moreover, the most common cause of FOC was fear of labor pain, followed by baby health, hearing the experiences of others, physical complications, and lack of trust in employees, respectively [33].
Negahban et al. (2009) studied the relationship between fear from vaginal delivery with the occurrence of emergency cesarean in primiparous women. The results showed a high percentage of women expressed an intense fear of natural childbirth. There was a significant relationship between fear and the method of delivery. Moreover, the most mentioned reasons for FOC were labor pain and harm to the baby, respectively. The other causes of FOC were the suggestion of those around the person, vaginal examination, maternal injury, and the cry of other women [34].