Women’s childbirth experiences are multidimensional and unique to each woman, and can be positive, negative, or a mixture of both. The experience can be influenced by personal feelings, perceptions of personal performance [1], mental and physical health, and communication and interaction with health care providers [2, 3]. Moreover, type of childbirth, childbirth preferences regarding vaginal birth versus caeserean section (C/S) [4, 5], freedom in the expression of feelings related to childbirth, involvement in the birth experience, support from a partner and relatives [1, 2, 5], and other environmental factors, like lack of privacy during childbirth [1], can affect the childbirth experience. Some women who have a negative birth experience develop fear of having more children in the future [6–8].
The prevalence of antenatal fear of childbirth (FoB) varies between countries. Worldwide, FoB ranges between 5 and 30% [9–14] and depressive symptoms (DS) affect 5–34% of women during pregnancy [15–19]. In previous studies, there is a correlation between FoB, other anxiety problems, and DS [20, 21].
Quantitative studies across the world have shown that factors associated with FoB include sociodemographic factors like young maternal age, lack of social support from male partners, relatives and friends, unemployment, financial worries, and a history of abuse [22–24]. Obstetric factors like nulliparity and adverse obstetric events, such as a previous operative birth, may provoke childbirth fear [22, 25–27]. Also, not being mentally/physically prepared for giving birth, an expectation of unendurable pain, a feeling of loss of control during labour and birth, and fear of death have been deemed to predict FoB [25, 26]. Inappropriate support from the birth team contributes to low childbirth confidence among women [22, 26].
In previous studies, depressive symptoms were associated with unwanted pregnancy [28, 29], young age/teenage pregnancy [29, 30], low levels of education, unemployment, and low prestigious employment [28, 31, 32]. Other factors reportedly associated with significant DS include inadequate social support (emotional, physical, and financial) and poor relationships with spouse/partner [19, 28, 30, 32]. These include negative marital relationships involving abuse, insufficient care, infidelity, polygamy, and conflicts on unwelcome sexual practices [19, 31, 33].
FoB is associated with pre-existing psychological problems like DS. An association between FoB and depression has been reported in a register study of 788,317 pregnant women in Finland, where depression was found to be the most potent risk factor for FoB, regardless of parity [34]. There are similar findings from other studies performed around the world [35–37].
Fear of childbirth may have consequences in the lives of women and their babies. It is associated with poor emotional and psychological health for women in general [23, 38]. During childbirth, it can lead to C/S on maternal request [6, 39–41], increased use of pharmacologic pain relief [38], prolonged labour [42], aggravated maternal and foetal distress [38], and increased obstetric interventions, like labour argumentation [39, 40]. Maternal FoB and DS can also affect the infant’s future, potentially leading to decreased birth weight, delayed psychosocial development, reduced breastfeeding duration, hindered growth, severe malnutrition, more episodes of diarrhoea, and poor compliance with immunisation plans [23, 42, 43]. This might create problematic mother-newborn bonding, with subsequent attachment difficulties that may affect infant growth and development, including cognitive development [44–46].
To the best of our knowledge, no published studies have assessed FoB and its predictors among Tanzanian women, despite advocacy on integrated mental health in maternal and child health services in the health system and proven long-lasting consequences of maternal FoB and/or DS. Studies on the prevalence of FoB and DS, their predictors, effects, and management, have been performed mainly in European countries, with a few from India [47] and African countries [13, 14]. In Tanzania, some studies have assessed DS during pregnancy, revealing a prevalence of 11.5% in the Kilimanjaro region, northern Tanzania [17], and 33.8% in the Mwanza region [19]. Antenatal care relates to women’s care during pregnancy, with the target being a healthy mother and child at end of pregnancy/birth. It is essential to increase understanding of FoB and DS during pregnancy to enhance the chances of providing the right support. Hence, the study’s primary objective was to determine the prevalence of FoB and DS among pregnant women at ³ 32 weeks of gestation. The secondary objective was to investigate the predictors of FoB and DS, focusing on sociodemographic factors and previous obstetric experiences.