Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2018 Sep 5;18(1):362.
doi: 10.1186/s12884-018-1997-5.

Childbirth preferences and related fears - comparison between Norway and Israel

Heidi Preis  1 , Yael Benyamini  1 , Malin Eberhard-Gran  2   3   4 , Susan Garthus-Niegel  5   6
Affiliations
Comparative Study

Childbirth preferences and related fears - comparison between Norway and Israel

Heidi Preis et al. BMC Pregnancy Childbirth. .

Abstract

Background: Fear of childbirth (FOC) could have significant impact on women's childbearing choices and experience. Culture affects the way women conceptualize childbirth, influencing the fears and expectations they may hold in relation to it. In the current study, we examined differences in childbirth preferences of cesarean section and use of epidural analgesia between Norwegian and Israeli pregnant women. Later, we used the Norwegian six-factor solution of the widely-used Wijma Delivery Expectancy Questionnaire (W-DEQ-A) to compare levels of the different FOC factors. Finally, we investigated differences in the associations between FOC and childbirth preferences between the two countries.

Methods: Secondary analysis of two large surveys. Women from Israel (n = 490) and Norway (n = 2918) were recruited during prenatal check-ups in community clinics and a university hospital. At around 32 weeks of gestation, all participants filled out questionnaires, including the W-DEQ-A. Statistical analysis included exploratory factor analysis, confirmatory factor analysis, M/ANOVA, Spearman's Rho and Fisher's Z tests for the significance of the difference between independent correlations.

Results: The Norwegian six-factor solution of the W-DEQ fit well with the Israeli data. Norwegian women were more concerned about loneliness, feeling less self-efficacy, negatively appraising birth, and lacking positive anticipation. Israeli women were more concerned about negative outcomes for the child and experienced greater general fear and fear of pain. Norwegian women preferred more cesarean sections compared to Israeli women, who preferred more epidural use than Norwegians. FOC factors were more strongly related to childbirth preferences among Norwegians.

Conclusions: Cultural differences between Israel and Norway are reflected by the differences seen in the levels of fear reported across the six factors. In Israel, birth culture is very medicalized, motherhood is highly revered, and there is an emphasis on having "perfect babies". In contrast, Norwegian women have fewer children, and birth is considered more natural. This could explain why Israeli women were more concerned that their child might be harmed during birth, while Norwegian women were more concerned with the physical and emotional expectations of birth.

Keywords: Cesarean section; Childbirth preferences; Confirmatory factor analysis; Cultural comparison; Epidural analgesia; Fear of childbirth; W-DEQ.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Before filling in the questionnaires, participants received an explanation about the study and provided their written consent. The Israeli study was approved by the Research Ethics Committees at the Tel Aviv University and the Maccabi Health Services in Israel (approval number 9002030a). The Norwegian study was approved by the Regional Committees for Medical and Health Research Ethics (approval number S-08013a). The Ethical approvals were granted for the original studies. In both countries, there is no requirement for additional approval for secondary analyses or for combining data with other surveys.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. Johanson R, Newburn M, Macfarlane A. Has the medicalisation of childbirth gone too far? BMJ. 2002;324(7342):892–895. doi: 10.1136/bmj.324.7342.892. - DOI - PMC - PubMed
    1. Anim Somuah M, Smyth RM, Jones L. Epidural versus non‐epidural or no analgesia in labour. Cochrane Database Syst Rev. 2011(12). - PubMed
    1. Lobel M, DeLuca RS. Psychosocial sequelae of cesarean delivery: review and analysis of their causes and implications. Soc Sci Med. 2007;64(11):2272–2284. doi: 10.1016/j.socscimed.2007.02.028. - DOI - PubMed
    1. Haines HM, Rubertsson C, Pallant JF, Hildingsson I. Womens' attitudes and beliefs of childbirth and association with birth preference: a comparison of a Swedish and an Australian sample in mid-pregnancy. Midwifery. 2012;28(6):e850–e856. doi: 10.1016/j.midw.2011.09.011. - DOI - PubMed
    1. Ryding EL, Lukasse M, Kristjansdottir H, Steingrimsdottir T, Schei B. Pregnant women’s preference for cesarean section and subsequent mode of birth–a six-country cohort study. J Psychosom Obstet Gynaecol. 2016;37(3):75–83. doi: 10.1080/0167482X.2016.1181055. - DOI - PubMed

Publication types

LinkOut - more resources