INTRODUCTION:

Tokophobia is the fear of childbirth, sometimes referred to as parturiphobia or maieusiophobia. Given the unpleasant and unpredictable nature of the experience, it can be regarded as a typical human occurrence to some extent. However, extreme forms of tokophobia that interfere with a woman's ability to operate on a daily basis are classified as abnormal versions. It is a terrifying and highly specialized condition. The lack of suitable psychological measures has made it challenging to investigate the incidence and effects of tokophobia. Given the intricacy of delivery anxiety and its implications for obstetrics, anesthesia, psychology, and psychiatry, it is both urgent and desirable to establish a multidisciplinary approach to the problem¹.

A major life event, childbirth is frequently accompanied by strong emotions. Although it is frequently linked to excitement and expectation, it can also cause intense fear—a condition known as tokophobia. Tokophobia affects many women not only during pregnancy but also throughout childbirth and in their general mental health after giving birth². Fear of giving birth can result in longer labor, a higher chance of postpartum depression, and a higher propensity to choose an elective C-section. Therefore, in order to improve mother outcomes and well-being, it is imperative to identify and address the factors causing this concern³.

This review aims to evaluate the various factors associated with tokophobia by categorizing them into domains: psychological, social, cultural, obstetrics and informational. Each domain captures unique aspects of fear of childbirth, from personal history and cultural attitudes to medical and informational barriers. Understanding these factors can help in developing comprehensive strategies to reduce childbirth fear, providing a foundation for better healthcare practices and supporting women in their childbirth experience⁴.

MATERIALS AND METHODS:

A thorough literature search was carried out using electronic databases like CINAHL, PsycINFO, PubMed, and Scopus. Using terms such as "fear of childbirth," "tokophobia," "psychological factors," "cultural influences," "obstetrics factors," "prenatal anxiety," and "childbirth education," the search was limited to research that were published in the last 20 years.

Data Collection and Analysis:

Data extracted from studies included participant demographics, research design, assessment tools and primary findings related to factors influencing childbirth fear. A thematic analysis approach was employed to categorize findings into psychological, cultural, social, obstetric and informational domains.

RESULTS:

A number of important elements are identified by the systematic review as contributing to the fear of childbirth. Higher levels of dread were consistently associated with psychological variables such anxiety, a traumatic birth experience, and a lack of control. Women's perspectives were greatly impacted by social and cultural variables, such as cultural narratives surrounding childbirth and a lack of support. Fear was strongly predicted by obstetric variables such as primiparity and difficulties during pregnancy. Lastly, higher anxiety levels were linked to both inaccurate and insufficient information. These results emphasize the necessity of a multifaceted strategy to alleviate delivery anxiety.

DISCUSSION:

Childbirth Process and Place of Delivery:

Fear of Childbirth Process (28.96% of variance): Fear of childbirth-related health risks to the partner. Fear when the spouse gives birth. Fear of having to undergo risky medical procedures. increased anxiety as the time for labor draws near. Fear of the dangers of childbirth. feelings of powerlessness after giving delivery. uneasy sensations during labor. worry that the child's well-being will be jeopardized. concerns over the quality of postpartum sex with the spouse. Fear brought on by the suffering of the partner during childbirth. Fear brought on by the spouse's anxiety over giving birth. Fear that you won't be able to help your partner during childbirth⁵.

Fear of Hospital (21.86% of variance): Fear that hospital employees would not be equipped to deliver babies safely. Fear that the hospital would not have enough equipment and facilities. Fear that the spouse won't receive the right treatment from hospital professionals. Fear that the pair won't receive respectful treatment from medical staff. Fear that the infant might end up in the neonatal intensive care unit (NICU) at the hospital. Fear of having to pay for hospital bills. Collectively, these variables account for 50.82% of the variation in fathers' anxiety of labor⁵.

Healthcare System-Related Fears: Lack of trust in healthcare providers: Concerns about competence. Fear of inadequate hospital facilities. Concerns about mistreatment: Or lack of respect from staff. Financial burden of hospital expenses: Significant factor⁶.

Complications to Self and Foetus:

Fear of Harm to the Baby or Self: Mothers also fear that something might happen to themselves or their baby during childbirth. These fears include complications such as haemorrhage, fetal distress, or other medical emergencies. 60% of women with FOC mentioned fear for their own safety and the safety of the baby during childbirth. Women were concerned about possible complications like cord prolapse, haemorrhaging, or the baby’s wellbeing⁷.

In a similar study that was conducted in the year 2018 at selected municipal corporation hospital in Pune revealed that fetal outcome and fear of childbirth (FOC) were found to be significantly correlated (P<0.0001). Additionally, there was a strong correlation (P<0.05) between maternal outcome and fear of childbirth (FOC). Additionally, there was a strong correlation (P<0.0001) between complicated labor and fear of childbirth (FOC)⁸.

Factors Associated with Fear of Childbirth in Women

Fear of Personal Complications During Pregnancy and Childbirth (31%): Fear of medical complications during pregnancy/childbirth. Anxiety about the type of delivery (e.g., cesarean vs. vaginal). Worry about experiencing pain during childbirth. Fear of medical interventions during delivery⁹.

Fear of Fetal Complications During Pregnancy and Childbirth (16%): Concern that something terrible might happen to the baby. Anxiety about pregnancy risks affecting the fetus. Worry about potential birth defects or complications⁹.

Psychological Factors:

History of childhood abuse: Strongly linked to severe FOC. History of physical or sexual violence: Significantly increases risk. Depression (before/during pregnancy): Higher incidence of FOC. Anxiety disorders: Commonly associated with FOC. Previous psychiatric treatment: Major contributing factor⁶.

Personality Traits:

General anxiety and neuroticism: More common in women with FOC. Low self-esteem and vulnerability: Increases susceptibility. Short-tempered or pessimistic personality: Higher likelihood of childbirth-related fears. Previous Traumatic Birth Experiences⁹.

Twenty-five publications in all were considered suitable for the meta-analysis and systematic review. The initial analysis revealed high heterogeneity (I2 = 99.43%, p = 0.00) and a global pooled prevalence of 0.10 (95% CI: 0.09–0.11). Ten studies with a cut-off score of ≥85 on the Wijma Delivery Experience Questionnaire (W-DEQ) Part A and fifteen additional studies were the focus of additional analysis. Using the random-effects mode, the global pooled prevalence was 0.10 (95% CI: 0.09–0.11) with significant heterogeneity (I2 = 99.43%, p = 0.00)¹⁰.

Studies indicate that prior unpleasant experiences can result in post-traumatic stress disorder (PTSD), and women who have experienced a traumatic birth in the past frequently have an increased fear of childbirth. Studies indicate that PTSD significantly exacerbates tokophobia, particularly in women with the history of emergency interventions¹¹.

Previous Negative Birth Experiences:

Women who had previously experienced traumatic or unsatisfactory births were more likely to develop FOC in subsequent pregnancies. Memories of pain, medical interventions, or lack of support during previous deliveries contribute to this fear. 38.2% of women with FOC had a history of negative birth experiences. Postpartum counselling and debriefing after traumatic births can reduce FOC in future pregnancies¹².

Previous Negative Birth Experience:

One of the strongest factors in developing FOC is having a traumatic or unsatisfactory previous birth experience. For many women, negative experiences such as pain, complications, lack of control, or poor care during labor and delivery can lead to heightened fear in subsequent pregnancies. 31% of women with FOC reported having a negative experience in a previous childbirth. Women who had a traumatic first birth often feared similar experiences in subsequent births, increasing their anxiety⁷.

Pregnancy and Birth-Related Factors:

Previous traumatic birth experience: Strong predictor of FOC. Long period of infertility: Higher fear levels. Fear of medical interventions: Such as caesarean section, episiotomy, anaesthesia. Fear of complications: Like perineal tears, maternal/infant injury, or death. Fear of losing control: During labor and delivery. Exposure to negative childbirth stories: Contributes to FOC⁶.

Anxiety and Depression:

Mental health conditions, including generalized anxiety and depression, are predictors of childbirth fear. Research has shown that women with pre-existing anxiety perceive childbirth as more threatening and addressing general mental health can alleviate some fear. In addition to the findings that indicated nulliparous women had higher W-DEQ and VAS ratings than parous women, the interaction between general anxiety and fear related to childbirth implies that treating more general mental health concerns is essential in controlling tokophobia. Women who were over 21 weeks pregnant scored higher than those who were under 21 weeks. Fear scores were greater for those who preferred a caesarean section (8.1%) than for those who preferred vaginal delivery. Fear scores were higher for women who had previously had a cesarean section than for those who had not. Likewise, fear scores were higher for those who had previously had vacuum extraction (VE) than for those who had not¹³.

Fear of childbirth was not significantly correlated with gestational age, but it was adversely correlated with age, wealth, and education. Fear of pain was positively correlated with episiotomy and assisted vaginal birth in a prior pregnancy. Higher ratings on every facet of childbirth fear were associated with a self-reported history of a traumatic vaginal birth. Anxiety symptoms in the early stages of pregnancy were predictive of childbirth fear later in pregnancy, suggesting the need for early psychological interventions. Women who self-reported having a traumatic caesarean birth were more afraid of future caesarean births, but a history of caesarean birth was not generally linked to increased fears¹⁴.

Behavioural Responses to Fear (16%):

Avoidance of conversations about pregnancy/childbirth. Frequent checking for pregnancy-related symptoms. Nightmares related to pregnancy or delivery. Total variance explained: 63%⁹.

Antenatal Anxiety:

Anxiety during pregnancy was identified as a primary psychological factor contributing to FOC. Women with antenatal anxiety often experience heightened worry about the pain of labor, complications, or uncertainty surrounding childbirth. 42.8% of women with FOC were found to have significant levels of antenatal anxiety. Psychological support, such as counselling or relaxation techniques, can help alleviate anxiety and reduce childbirth fears¹².

Personality Traits and Coping Styles:

Certain personality traits and coping styles increase the likelihood of experiencing FOC. Women who have a tendency to be anxious or worry excessively may be more likely to fear childbirth. No exact percentage was provided in the study for this factor, but women with high levels of anxiety or negative coping styles were more likely to experience FOC. Women with a tendency to catastrophize or imagine the worst-case scenarios were at a higher risk of developing FOC⁷.

Lack of Control:

Many women perceive childbirth as an uncontrollable event, leading to heightened fear. Empowering women through prenatal education and shared decision-making can reduce anxiety related loss of control. Women who feel they lack control over the birthing process are more likely to experience heightened anxiety¹⁵.

Women were more likely to report controlling their own behavior (61.0%) than controlling staff (39.5%). A fifth or so felt in control in every aspect, while another fifth felt in control of none at all. Consequently, women who experienced a sense of control during childbirth expressed less worry and fear¹⁶.

Fear of Pain and Loss of Control:

Pain during childbirth and the loss of control are significant contributors to FOC. Women often fear the intensity of labor pains and the lack of control over the birth process. This fear is often related to the unpredictability of pain and the labor experience. 40-50% of women interviewed cited fear of pain and loss of control as key components of their FOC. Many women expressed concerns about the ability to cope with the pain and their lack of control over the situation during labor⁷.

Factors Associated with Fear of Childbirth in Men:

Emotional Responses during Partner’s Childbirth (25%):

Feeling of helplessness and restlessness. Fear due to witnessing the spouse’s pain. Worry about not being able to support the spouse effectively⁹.

Concerns About Hospital Environment (23%):

Fear that hospital staff lacks necessary skills for a safe delivery. Concern about the hospital’s lack of proper facilities/equipment. Fear of the child needing neonatal intensive care (NICU)⁹.

Perinatal Health Concerns for Partner and Child (20%):

Fear of harm to the child due to childbirth complications. Concern about the spouse’s health risks during delivery. Worry that medical interventions may lead to negative outcomes. Total variance explained: 68%⁹.

Social and Cultural Factors:

Cultural Beliefs and Attitudes:

Cultural attitudes profoundly influence how women perceive childbirth. in some cultures, childbirth is associated with pain and risk, leading to fear. Studies comparing cultures suggest that culturally sensitive care can mitigate tokophobia. The results demonstrated that most women expected and desired a normal birth prior to their first caesarean section (CS), highlighting the influence of cultural perceptions on childbirth anxiety and the necessity of culturally appropriate care. Due to medical discourse that promoted caesarean sections as the safest option, many people who had caesarean sections (CSs) started to perceive vaginal birth as uncertain and dangerous. Consequently, they came to see CS as an acceptable, safer alternative that allowed better preparation and convenience for them and their babies¹⁷.

Cultural narratives surrounding childbirth can deeply influence a woman’s expectations and fears. In a comparative study, a study was conducted to examine the differences in childbirth fear between Swedish and Italian women, they found out that the cultural context played a crucial role in shaping their fears and expectations¹⁸.

Social and Cultural Influences:

Pregnant women who lacked support from their partners, family members, or social circles were more likely to experience FOC. Emotional and practical support during pregnancy has been shown to buffer stress and anxiety. 30.5% of women with FOC cited inadequate social support. Involving partners and families in prenatal care and creating a supportive environment can help alleviate fear¹².

Influence of Media and Societal Norms:

Media portrayals and societal expectations significantly impact women's perception of childbirth. Stories about difficult or traumatic births in the media, or negative stories shared by others, can create a distorted view of childbirth, leading to increased anxiety and fear. 30-40% of women cited media stories and societal views as contributing to their FOC. The portrayal of childbirth in TV shows or movies as dangerous or highly medicalized can contribute to unrealistic fears⁷.

Sociodemographic Factors:

Foreign-born women: Higher prevalence of FOC. Low educational status: Associated with increased fear. Unemployment: Linked to higher FOC. Poor social support: Significant risk factor. Dissatisfaction with partnership: Common among those with FOC⁶.

Support Systems:

According to a study, women who don't feel supported are more likely to be afraid of giving birth¹⁹. These anxieties might be allayed by providing ongoing assistance throughout pregnancy and childbirth. According to a systematic review, women who got ongoing assistance throughout labor were less likely to report feeling afraid and to have negative sentiments about giving birth (average RR 1.08, 95% CI 1.04 to 1.12; 21 trials, 14,369 women; low-quality evidence)²⁰.

Lack of support from family, friends or healthcare providers is a major predictor of childbirth fear. Research highlights that woman with a strong support network experience less fear, underscoring the importance of continuous emotional and practical support²¹.

Lack of Social Support:

A lack of support from partners, family, and healthcare professionals can exacerbate FOC. Women who feel isolated or unsupported during pregnancy or labor are more likely to experience fear and anxiety. 30% of women indicated that the lack of emotional and practical support contributed to their FOC. Women who lacked supportive partners or family members during their pregnancy reported feeling more anxious about childbirth.⁷

Socioeconomic Status:

Socioeconomic disparities impact access to resources, which in turn affects childbirth fear. Women from lower socioeconomic backgrounds often face additional stressors and have limited access to quality care, contributing to their anxiety²².

FOC was linked to higher rates of CS (3.3-fold and 4.5-fold higher, respectively) and a lower incidence of low birthweight (<2500g), small for gestational age babies, preterm birth, and low Apgar scores at 1 minute. Fear of

childbirth in nulliparous and multiparous women was attributed to limited access to healthcare resources, lack of education, and overall higher levels of stress²³.

In a Canadian sample, higher levels of tokophobia were associated with lower levels of education, financial stress, and lack of access to high-quality prenatal care²⁴.

Obstetric Factors:

Primiparity:

A research study was conducted in Sweden, found that the unknown aspects and unpredictability of the first childbirth contribute to this fear²⁵. The findings indicated that the desire for a caesarean section was linked to fear of childbirth (OR 11.79, 6.1-22.59 for nulliparous women and OR 8.32, 4.36-15.85 for parous women), and that this fear could be considerably reduced for parous women who had previously had a caesarean section (OR 18.54, 9.55-35.97), or an instrumental vaginal delivery (OR 2.34, 1.02-5.34)²⁶.

First-time mothers are mothers likely to experience tokophobia, largely due to uncertainty and lack of prior experience. Studies suggest that comprehensive prenatal education can reduce fear in primigravida women.

Primiparity (First-time Mothers):

First-time mothers (primiparas) are at greater risk of FOC due to fear of the unknown. Women who have never experienced labor may feel apprehensive about pain, complications, or their ability to cope during delivery. 44.3% of primiparous women reported FOC, compared to 20.8% of multiparous women. First-time mothers require additional emotional support and education about the childbirth process to build confidence¹².

First-time Mothers (Primiparas):

First-time mothers tend to have more fear of childbirth because they are uncertain about what to expect. The unknown nature of labor and the potential for complications contribute to their anxiety. 50-60% of first-time mothers expressed significant fear related to the unknown aspects of childbirth. First-time mothers were especially anxious about the pain, the labor process, and the fear of complications because they lacked experience⁷.

Pregnancy Complications:

According to a study, the prevalence of birthing anxiety remained constant throughout the study period, highlighting the need for specialist treatment for these women. Pregnancy problems were also shown to be a strong predictor of delivery anxiety. In early pregnancy, 7.6% of women reported being afraid of giving birth, and in late pregnancy, 7.4% did so. In both interviews, only 3.2% of the women said they were afraid of giving birth²⁷.

Women with gestational diabetes reported higher levels of childbirth fear, emphasizing the need for specialized support for high-risk pregnancies²⁸.

Complications such as gestational diabetes mellitus or pre-eclampsia heighten childbirth fear, as women with high-risk pregnancies are more concerned about adverse outcomes. Tailored support for high-risk pregnancies can help manage this fear²⁹.

Medical Interventions

Anticipations of medical interventions, including C-Sections and use of forceps, is a source of fear for many women. Education women about these interventions, when appropriate, can help in reducing their anxiety.

A study was conducted to find out the factors associated to gear of childbirth and found that the potential pain and complications associated with these procedures can be daunting³⁰. A qualitative study was conducted in the year 2010 and explored women's experiences with caesarean sections and found that lack of control and unexpected interventions were significant sources of fear and anxiety³¹.

Medicalized Views of Childbirth:

Some women develop fear due to a medicalized approach to childbirth. Overly medicalized perceptions, where childbirth is viewed as a clinical event requiring interventions such as C-sections or other medical procedures, can increase anxiety. 20-30% of women with FOC expressed concerns about being treated as a patient rather than an active participant in the birth process due to over-medicalization. Women worried about interventions like induction or caesarean sections, which they feared might be unnecessary or unhelpful⁷.

Informational Factors:

Inadequate Information:

Women who lack knowledge about the childbirth process are more likely to experience fear. Studies that well-constructed childbirth education classes reduce anxiety by providing realistic expectations³².

A study was conducted among the Canadian university students and noted that women who are not adequately informed about what to expect during labor and delivery are more likely to be fearful³³.

A randomized controlled trial was conducted in the year 2008 and demonstrated that women who attended childbirth education classes reported lower levels of fear compared to those who did not receive structured information³⁴.

Lack of Knowledge or Education:

Lack of understanding or misinformation about the childbirth process was strongly associated with FOC. Women who are unfamiliar with labor and delivery often feel unprepared, which exacerbates fear. 35.7% of women with FOC reported limited knowledge about childbirth. Antenatal education classes and evidence-based childbirth information can empower women, improve confidence, and reduce fear¹².

Low Educational Levels:

Women with lower levels of formal education tended to have higher FOC. This is often linked to reduced access to reliable health information and difficulty understanding medical processes and terminology. 25.6% of women with FOC had low educational levels. Tailored educational programs and simplified communication from healthcare providers are essential to address this disparity¹².

Misinformation:

A study among the Australian and Swedish women, emphasized the importance of providing accurate, balanced information to counteract these negative influences³⁵.

A study, highlighted the impact of sensationalized media portrayals of childbirth on women's fear levels, stressing the need for balanced and factual information dissemination³⁶.

Studies Related to Mental Health on Different Categories

The following studies are based on the mental health of different categories however; these studies are not related to Fear of Childbirth.

A study that was conducted in the year 2016 in Maharashtra, based on the mental health and wellbeing during transition to parenthood in which the study revealed that the men's mental, physical, social, emotional, spiritual, and intellectual well-being levels throughout the transition to first-time motherhood were found to be significantly correlated with certain demographic factors. Additionally, a substantial correlation was discovered between a few demographic characteristics and the degree of women's mental, physical, social, and emotional wellbeing as they transitioned to first-time parenthood. Additionally, there was no discernible correlation between intellectual and spiritual wellbeing and certain demographic factors³⁷.

A study that was conducted in the recent year of 2025 in Kolkata based on the effectiveness of relaxed listening on depression, anxiety and stress among nursing students, Kolkata, West Bengal revealed that the majority of students (34.78%) are experiencing extreme stress throughout the pre-test exam. The majority of students (34.78%) reported having typical levels of stress throughout the post-test exam. The corresponding "t" values for stress, anxiety, and depression are 1.54, 1.45, and 3.27. Stress is considerably reduced following intervention when comparing the pretest and post-test, although anxiety and sadness do not significantly improve. It was discovered that music therapy works well for stress but not for anxiety or depression³⁸.

A study that was conducted in the recent year of 2020 based on revealed that the group's pre-test value was 13.28 (SD = ±3.67), and its post-test value was 33.31 (SD = ±5.33). 20.03 is the mean difference value. At the "P"-value of 0.00, the t-value for the 59 degrees of freedom was 2.00. It was important. Therefore, an organized educational program on mental health issues in children was successful in raising the level of awareness among Anganwadi staff. The pre-test knowledge level of the samples and sociodemographic factors like age were statistically significantly correlated. According to the study's findings, Anganwadi workers' understanding of mental health and its issues in children was improved by the structured instruction program³⁹.

A study was conducted in the year 2022 based on the impact of online education during COVID-19 Pandemic on mental health among college students of selected nursing college at Kottayam district, the study's main conclusions were that, out of the 40 samples, 20 (or 50%) had a severe negative impact, 13(32.5%) had a moderately negative impact, 5(12.5%) had a mildly negative impact, and 2(5%) had a critically unfavorable impact. College students' mental health is discovered to be significantly impacted by online learning during the COVID-19 epidemic⁴⁰.

A study was conducted in the year 2018 based on the Family Resilience and Perceived Social Support among care givers of Children with Autistic Spectrum Disorder, in Punjab showed that the overall resilience and perceived social support among families were good with mean±SD score of 238±17.40 for family resilience and 72.15±13.95 for perceived social support correspondingly. "Optimism" (Moral Compass, 79.23%), Faith and Spirituality, 77.21%, humor/Entertainment, having a Role Model, 83.11%, Social Support, 72.32%, Facing Fear, 82.39%, Meaning in Life, and 74.69% were the components of resilience among families. The social support and family resilience of families with children with autism spectrum disorder were found to be positively correlated (r=0.30). Social support was found to be substantially correlated with family income and the mother's drug use during the prenatal period (P=0.05), whereas family resilience was highly correlated with the functional disability of children (P<0.018)⁴¹.

A study was conducted in the year 2022, Descriptive Study to Identify the Cultural Beliefs related to Pregnancy among Antenatal Mothers in Rural Areas, Chakeisiani, BBSR, Odisha in which the study revealed that 18(60%) of the 30 pregnant moms in the sample were between the ages of 26 and 30.(30) All pregnant women were Hindu. Graduates made up the majority (16)53.3% of prenatal mothers. Out of the 30 samples, 11.36.6% of the pregnant women were younger than 12 weeks. The majority of pregnant women—23, or 76.6%—were housewives. Nuclear families made up the largest percentage (21)70% of expectant mothers. Prime Para was present in more than half (19, or 63.3%) of the pregnant women⁴².

A study was conducted in the year 2014 based on the Effectiveness of Vajrasana on Physical and Mental Health among Adolescents at Selected PU Colleges in Mysore, in which the results showed that the experimental group's mean post-test physical and mental health scores were significantly lower than those of the control group, as indicated by the "t(58)" values of 2.81 and 2.0 at the 0.05 level of significance. Teenagers' chosen personal factors and their degree of physical and mental health do not significantly correlate at the 0.05 level. Adolescents are more likely to suffer from mental and physical illnesses. Adolescents' mental and physical health improved with yogic asana. Yogic asana should be administered by nurse educators and administrators in order to improve the physical and mental well-being of young people⁴³.

A study was conducted in the year 2017 based on the Sexual Abuse of Children and Mental Health Problems: A Study among Doctoral Students in a University, the study revealed that the majority of respondents are aware that child sexual abuse has an impact on the victim's mental health; nonetheless, some respondents were found to be ignorant of the subject. By including information on child sexual abuse through campaigns and symposiums, the institution's authorities handling student welfare activities can raise awareness and sensitize students to preventative techniques for child sexual abuse⁴⁴.

CONCLUSION:

Tokophobia is a complex, multifactorial issue that can negatively affect maternal and neonatal outcomes. This review underscores the complex importances of addressing psychological, social, cultural, obstetric and informational factors. Healthcare provides should adopt a holistic approach, incorporating psychological support, culturally sensitive care and comprehensive prenatal education to help reduce childbirth fear. Future research should focus on developing and evaluating targeted interventions for at-risk groups to improve childbirth experiences and outcomes.

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Received on 14.05.2025 Revised on 30.06.2025

Accepted on 06.08.2025 Published on 27.10.2025

Available online from November 08, 2025

Int. J. Nursing Education and Research. 2025;13(4):294-302.

DOI: 10.52711/2454-2660.2025.00058

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