Tokophobia in pregnancy, risk factors and predictors using structural equation modeling: A cross-sectional study

Abstract Background Fear of Childbirth (FOC) in pregnant women is critical because it may affect prenatal outcome and increase the risk of unnecessary cesarean section (CS). This study aims to investigate the prevalence of fear of childbirth and some factors affecting it and its predictors in pregnant women. Methods This cross-sectional study was conducted in 2025 on pregnant women referring to Qom comprehensive health service centers using a multi-stage stratified random sampling method. The sample size was 343 people and the data collection tools included demographic information, knowledge questions, the Wijma childbirth fear questionnaire, and the child attitude questionnaire. Data analysis was performed using SPSS software version 23. The normality of data distribution was examined using the Kolmogorov-Smirnov test. Descriptive and inferential tests were used to assess demographic characteristics, and structural equation modeling was used to assess risk factors for childbirth fear and the model goodness of fit index. 24. Results The mean age was 31.21 ± 3.6, and the mean percentage of the fear of childbirth was 47.36%. Among all participants, 24% had a history of miscarriage. A significant relationship was reported between fear of childbirth and miscarriage, number of pregnancies, and type of pregnancy (p < 0.05). the results of linear regression indicate that three variables: attitude towards childbirth, type of pregnancy, and previous abortion experience explained 51% of the variance in fear of childbirth. The type of pregnancy, number of pregnancies, miscarriage, and knowledge were significant risk factors of fear of childbirth (P < 0.05). Two very important indicators of the goodness of fit of the model (χ2/df = 2.06 and RMSEA = 0.056) were at the desirable and acceptable threshold. The frequency of types of fear of childbirth in pregnant women shows that 44.6% fear of childbirth was pathological and 23% was clinical. Conclusion This study indicates that the variables of attitude were significant as predictors of fear of childbirth, and constructs of type of pregnancy, miscarriage, and knowledge were significant risk factors of fear of childbirth.