Women’s birth experience, fear of birth and depressive symptoms – A cluster analysis of participants in Midwifery continuity models in rural areas in Sweden

Women Birth. 2026 Jul 7;39(4):102239. doi: 10.1016/j.wombi.2026.102239. Online ahead of print.

ABSTRACT

PROBLEM: Women who experience fear of birth during pregnancy are more likely to report negative birth experiences.

BACKGROUND: Fear of birth and depressive symptoms may negatively influence women’s birth experiences. Midwifery continuity of care (MCoC) models have been shown to improve satisfaction and may help mitigate fear and mental health challenges.

AIM: To identify profiles of women based on birth experiences and emotional wellbeing after childbirth within MCoC models, and to examine associations with background characteristics, attitudes, and birth outcomes.

METHODS: A longitudinal cohort study was conducted in rural Sweden, including 378 women participating in MCoC models, with high priority on women with fear of birth. Data were collected via questionnaires in mid-pregnancy and two months postpartum. A k-means cluster analysis was performed using the Childbirth Experience Questionnaire (CEQ), Fear Of Birth Scale (FOBS), and Edinburgh Postnatal Depression Scale (EPDS).

FINDINGS: Three distinct profiles of women emerged based on the instruments included in the cluster analysis. The clusters differed in self-reported health, fear of birth, prenatal attitudes, continuity of care, and mode of birth. Women’s attitudes and operative births were the strongest predictors of cluster membership. Continuity with a known midwife distinguished profiles characterised by elevated fear of birth and depressive symptoms.

DISCUSSION: Women’s birth experiences and emotional wellbeing cluster into distinct profiles shaped by psychological, relational, and contextual factors. Attitudes during pregnancy and mode of birth are key determinants, while continuity with a known midwife enhances the perception of professional support.

CONCLUSION: Tailoring MCoC models to these profiles may promote more individualized, equitable, and positive care for diverse groups of women.

PMID:42413178 | DOI:10.1016/j.wombi.2026.102239