The Trajectory and Influencing Factors of Fear of Childbirth in Third Trimester Primiparas: A Prospective Longitudinal Study

ABSTRACT Background Maternal fear of childbirth fluctuates throughout pregnancy. However, no studies have investigated the changing characteristics and influencing factors of fear of childbirth. Aims This study aimed to identify the trajectory patterns of fear of childbirth in third‐trimester primiparas and to examine the factors influencing these patterns. Methods This study followed the STROBE checklist for observational research. A prospective longitudinal design was employed, using the Intolerance of Uncertainty Scale, Childbirth Self‐Efficacy Inventory and Childbirth Attitudes Questionnaire as primary measures. Data were collected from 226 primiparous women at 28–29 weeks, 32–33 weeks, 36–37 weeks and 39–41 weeks of gestation. Growth mixture modelling (GMM) was fitted using Mplus 8.3 software to analyse the trajectory of fear of childbirth. Logistic regression was conducted to identify the factors influencing these trajectories. Results The results revealed heterogeneity in the trajectory of fear of childbirth, which could be categorised into six groups: a normal group without fear, a group with no initial fear but increased fear later, a group with mild fear that decreased, a group with mild fear that worsened, a mild fear stable group and a moderate fear stable group. Logistic regression showed that intolerance of uncertainty, childbirth self‐efficacy and childbirth preference were the primary factors influencing these trajectories ( p < 0.05). Conclusions This study highlights the varying trajectories of fear of childbirth in third‐trimester primiparas. Different categories of fear emerge, each following a distinct path of change. Healthcare providers can use this information to create individualised interventions, addressing specific concerns and influencing factors at various stages, to support the psychological well‐being of primiparas during the perinatal period. Implications for the Profession and/or Patient Care Healthcare providers should be vigilant about primiparas' awareness of and response to childbirth fear. This study shows that the fear of childbirth often begins to increase or decrease between 32 and 33 weeks of gestation. Screening and interventions should thus be initiated during this period, with follow‐up mechanisms in place. Providers should also assess primiparas' capacity to cope with childbirth fear, offering targeted guidance and education to reduce uncertainty, enhance childbirth self‐efficacy and ultimately alleviate fear. Patient or Public Contribution No patient or public contribution. Impact Statement This study is of great interest to health care providers, suggesting that health care providers should be vigilant about primiparas' awareness of and response to childbirth fear. This study shows that the fear of childbirth often begins to increase or decrease between 32 and 33 weeks of gestation. Screening and interventions should thus be initiated during this period, with follow‐up mechanisms in place. Providers should also assess primiparas' capacity to cope with childbirth fear, offering targeted guidance and education to reduce uncertainty, enhance childbirth self‐efficacy and ultimately alleviate fear.