Exploring mental illness and mode of birth in 525 Swedish women with fear of childbirth

• Mental illness, trauma and medical conditions were more common in primiparas. • Emergency cesareans were nearly twice as common in primiparous women. • Traumatic life events were linked to higher planned caesarean rates in primiparas. • For multiparous women, caesarean rates were highest in those born outside Nordics. This study aimed to explore differences in mental illness, potentially traumatic experiences, and sociodemographic factors between primiparous and multiparous women with fear of childbirth (FOC), and to identify predictors of their mode of birth. Using a cross-sectional design, we included 200 primiparous and 325 multiparous women who scored above the cutoff of Wijma Delivery Expectancy Questionnaire ≥ 85 and received FOC counselling during pregnancy in 2019. Medical records were reviewed to document mental illness, potentially traumatic life events, pre-gestational medical disorders, birth mode, and other clinical and sociodemographic characteristics. Primiparas showed higher levels of mental illness, particularly anxiety, depression, and eating disorders, as well as more pre-gestational medical conditions and traumatic life experiences than multiparous women. Emergency caesarean births were nearly twice as common among primiparas, although overall rates were similar across groups. Among primiparous women, higher numbers of potentially traumatic life events showed a trend towards an association with caesarean birth, while among multiparas the mode of previous birth was the strongest predictor of the current birth. Caesarean rates were highest among women born outside the Nordic countries, highlighting the relevance of birth country for outcomes. This study identifies primiparas with FOC as a vulnerable group, characterised by higher levels of mental illness and an elevated likelihood of emergency caesarean birth. Parity-specific patterns underscore the need for early identification and tailored support. Higher caesarean rates among women born outside the Nordic countries emphasise the importance of culturally sensitive care. A multidisciplinary approach integrating obstetric, psychological, and cultural perspectives remain essential.