BACKGROUND:
Women with severe fear of childbirth are reported to choose epidural birth. However,　it is unclear whether epidural birth improves their childbirth satisfaction.

OBJECTIVES:
This study aimed to explore the relationship between fear severity and satisfaction at vaginal childbirth with or without epidural anesthesia (EA).

METHODS:
This cross-sectional study was conducted in Japan. Healthy women after vaginal delivery with or without EA were recruited. Participants were administered the Japanese Wijma Delivery Experience Questionnaire (JW-DEQ) Version B, evaluation tool to assess fear of childbirth, and Short Version of the Childbirth Experience Self-Rating Scale (CESRS). They were divided into their JW-DEQ score ≥85 as severe fear of childbirth and <85 as light fear. Each participant was explained the study protocol and provided written informed consent. It was reviewed and approved by the Ethics Committee of Kyoto University School of Medicine. The authors have declared that no competing interests exist.

RESULTS:
Data from 201 women (light fear group: 123, severe fear group: 78) were analyzed. In the severe fear group, 48 women without EA and 30 women with EA were compared,　30 women received EA were significantly older (p<0.001) and had significantly higher CESRS scores (p=0.026).　In both fear groups, "labor pain coping score" were significantly higher for women received EA than not EA (p = 0.002, p < 0.001). Furthermore, in the severe fear group, women with EA showed significantly higher score of "trust in medical staff score" than the no EA women　(p=0.024), and their total CESRS scores were also significantly higher.

CONCLUSIONS:
It was suggested that psychological support as well as analgesia with EA is necessary for improving childbirth satisfaction among women with severe fear of childbirth.

KEY MESSAGE:
Women with severe fear of childbirth may need midwifery care in pregnant. Labour and birth - evidence