Fear of Childbirth among Nulliparous Women: A Cross-Sectional Exploration of Obstetric and Psycho-Social Risk Factors in Sikkim, India

Abstract

Background & Objective: Fear of childbirth (FOC) is a prevalent but often overlooked psychological concern, particularly among nulliparous women who lack prior birthing experience. FOC can significantly affect maternal well-being, decision-making, and birth outcomes, contributing to elective caesarean sections, prolonged labor, and increased risk of postpartum depression. Despite increasing recognition of FOC globally, limited data exist from India’s northeastern states, including Sikkim, where cultural, geographical, and health service factors may shape childbirth experiences differently. Methodology: A hospital-based cross-sectional study was conducted among 418 nulliparous women in their second or third trimester attending antenatal care at a tertiary care hospital in Sikkim. Participants were selected using purposive sampling. Data collection tools included the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ A), Edinburgh Postnatal Depression Scale (EPDS), Multidimensional Scale of Perceived Social Support (MSPSS), and a checklist of maternal concerns. Descriptive and inferential statistics, including chi-square tests and Pearson’s correlation, were used for analysis. Results: A striking 99.3% of participants reported mild to moderate fear of childbirth. None experienced severe or very intense fear. Common maternal concerns included fear of labor pain (94.5%), insecurity during pregnancy (93.8%), and worry about episiotomy (93.3%). Depression was reported by 99% of women, with a mean EPDS score of 15.81. High perceived social support was noted in 95.9% of participants. Fear of childbirth showed a significant positive correlation with depression (r = 0.323, p < 0.01) and perceived social support (r = 0.306, p < 0.01). Fear levels were significantly associated with maternal age, education level, family type, and gestational age. Disturbed self-image and lack of family support were the only maternal variables significantly associated with heightened fear. Conclusion: Fear of childbirth is nearly universal among nulliparous women in Sikkim, despite strong social support and adequate pregnancy-related knowledge. FOC is influenced by psychological and emotional factors more than clinical or informational ones. Routine antenatal care must be expanded to include screening for fear and depression, with targeted interventions such as counselling, birth preparedness classes, and partner involvement to enhance maternal confidence and emotional well-being.