Catastrophizing mediates the relationship between fear of pain and preference for elective caesarean section

Fear of childbirth is associated with preference for an elective caesarean section (ECS); however, the role of fear of pain and pain catastrophizing (the tendency to predict the worst case scenario) have not been investigated. The aim of current study was to investigate whether fear of pain and catastrophizing were independent predictors of preference for ECS. We hypothesized that pain catastrophizing and negative affectivity would mediate the relationship between fear of pain and preference for ECS.

Three hundred pregnant women between 4 and 36 weeks of gestation were asked to indicate whether they would prefer to deliver their baby through an ECS or a vaginal delivery. They were also asked to complete a battery of questionnaires assessing demographic details, mood, fear of childbirth, fear of pain and catastrophizing. Consistent with cultural norms, more than half of the women preferred an ECS (58%).

Women who chose ECS were more likely to seek private obstetric care, have had a previous caesarean section and have higher levels of fear of childbirth, fear of pain, more catastrophic cognitions and lower mood. Catastrophizing, but not negative affectivity, mediated the relationship between fear of pain and preference for ECS, as predicted.

Fear of both childbirth and pain were both independent predictors of preference for ECS. Catastrophizing mediated the relationship between fear of pain and preference for ECS. Interventions that target these factors may reduce the trend towards increasing numbers of ECS internationally.