XXXX and risk of cesarean delivery: a cohort study in six European countries.

@entity1 @entity15892
BACKGROUND: Few studies have examined the mode of birth among @entity1 with @entity15892 , and the results are conflicting. The objective of this study was to assess the association between @entity15892 and cesarean delivery in North European @entity1 . METHODS: A longitudinal cohort study was conducted among 6,422 pregnant @entity1 from Belgium, Iceland, Denmark, Estonia, Norway, and Sweden. @entity15892 was measured by the Wijma Delivery Expectancy Questionnaire during pregnancy and linked to obstetric information from hospital records. RESULTS: Among 3,189 primiparous @entity1 , those reporting severe @entity15892 were more likely to give birth by elective cesarean, (OR, 1.66 [95% CI 1.05-2.61]). Among 3,233 multiparous @entity1 , severe @entity15892 increased the risk of elective cesarean (OR 1.87 [95% CI 1.30-2.69]). Reporting lack of positive anticipation, one of six dimensions of @entity15892 , was most strongly associated with elective cesarean (OR 2.02 [95% CI 1.52-2.68]). A dose-effect pattern was observed between level of fear and risk of emergency cesarean in both primiparous and multiparous @entity1 . Indications for cesarean were more likely to be reported as "nonmedical" among those with severe @entity15892 ; 16.7 versus 4.6 percent in primiparous @entity1 , and 31.7 versus 17.5 percent in multiparous @entity1 . CONCLUSION: Having severe @entity15892 increases the risk of elective cesarean, especially among multiparous @entity1 . Lack of positive anticipation of the upcoming childbirth seems to be an important dimension of fear associated with cesarean delivery. Counseling for @entity1 who do not look forward to vaginal birth should be further evaluated.
