Fear is in the air Midwives ́ perspectives of fear of childbirth and childbirth self-ef cacy and fear of childbirth in nulliparous pregnant women

................................................................................................................. 1 LIST OF PAPERS ........................................................................................................ 3 INTRODUCTION ....................................................................................................... 5 BACKGROUND ........................................................................................................... 7 Fear of childbirth.................................................................................................. 7 Risk factors for experiencing fear of childbirth .......................................... 8 Content of fear of childbirth .......................................................................... 9 Consequences of fear of childbirth ............................................................... 9 Treatment of fear of childbirth .................................................................... 11 Self-efficacy ......................................................................................................... 11 Self-efficacy and reproductive health ........................................................ 13 Midwifery practice............................................................................................. 14 AIMS ............................................................................................................................ 16 METHOD ................................................................................................................... 17 Designs ................................................................................................................. 17 Samples and settings ......................................................................................... 18 Data collection .................................................................................................... 22 Study I ............................................................................................................. 22 Study II ........................................................................................................... 24 Study III .......................................................................................................... 24 Study IV .......................................................................................................... 25 Data analysis ....................................................................................................... 26 Studies I and IV ............................................................................................. 26 Studies II and III ............................................................................................ 29 Ethical considerations ....................................................................................... 30 Validity and reliability ..................................................................................... 31 RESULTS .................................................................................................................... 34 Fear of childbirth the midwives’ perspective main findings of Study I and Study II ......................................................................................................... 34 Appearances of FOC..................................................................................... 34 Origins of FOC .............................................................................................. 35 Consequences of FOC .................................................................................. 35 FOC and midwifery care ............................................................................. 36 Self-efficacy and fear of childbirth main findings of Study III and Study IV ............................................................................................................... 39 Fear of childbirth................................................................................................ 39 Self-efficacy .................................................................................................... 39 Fear of childbirth and self-efficacy ............................................................. 39 Summary of results ....................................................................................... 44 DISCUSSION ............................................................................................................ 46 Discussion of findings ...................................................................................... 46 Midwives’ perceptions and views on fear of childbirth ......................... 46 Methodological considerations ....................................................................... 51 Study I ............................................................................................................. 51 Study II ........................................................................................................... 52 Study IV .......................................................................................................... 54 Conclusions ......................................................................................................... 54 Clinical implications ......................................................................................... 56 Future directions ................................................................................................ 56 SVENSK SAMMANFATTNING .......................................................................... 58 ACKNOWLEDGEMENTS ...................................................................................... 61 Grants ................................................................................................................... 62 REFERENCES ............................................................................................................ 63