Abstract
Although childbirth is a normative physiological experience, it may be challenging for some women and especially for those who were exposed to childhood maltreatment. The aim of the study was to examine a model underlying the development of fear of childbirth among pregnant women who were exposed to childhood maltreatment. Given that abusive acts are often directed at and experienced through the victim’s mind and body, we proposed a dual-path model, suggesting that these relations are mediated by both self-objectification and a serial mediation of disrupted body boundaries and body shame. A sample of 470 Israeli pregnant women filled out a battery of questionnaires assessing their history of childhood maltreatment, self-objectification, disrupted body boundaries, body shame, and fear of childbirth. Results from Structural Equation Modeling (SEM) indicated that self-objectification and the combination of disruptions in body boundaries and body shame significantly mediated the association between childhood maltreatment and fear of childbirth. These findings stress the integrative experience and consequences of childhood maltreatment among pregnant women. The roles of the two paths in understanding the detrimental long-term effects of childhood maltreatment and in designing effective interventions are discussed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Abrahamsson, C. S., & Simpson, P. (2011). The limits of the body: Boundaries, capacities, thresholds. Social and Cultural Geography, 12(4), 331–338. https://doi.org/10.1080/14649365.2011.579696.
Akaike, H. (1974). A new look at the statistical model identification. IEEE Transactions on Automatic Control, 19(6), 716–723. https://doi.org/10.1109/TAC.1974.1100705.
Akrich, M., & Pasveer, B. (2004). Embodiment and disembodiment in childbirth narratives. Body & Society, 10(2–3), 63–84. https://doi.org/10.1177/1357034X04042935.
Andrews, B., Qian, M., & Valentine, J. D. (2002). Predicting depressive symptoms with a new measure of shame: The experience of shame scale. British Journal of Clinical Psychology, 41(1), 29–42. https://doi.org/10.1348/014466502163778.
Anzieu, D., & Turner, C. T. (1989). The skin ego. New Haven: Yale University Press.
Arbuckle, J. L. (2013). IBM SPSS AMOS 22 user’s guide. Spring House: Amos Development Corporation.
Arnow, B. A. (2004). Relationships between childhood maltreatment, adult health and psychiatric outcomes, and medical utilization. Journal of Clinical Psychiatry, 65, 10–15.
Bayrampour, H., Ali, E., McNeil, D. A., Benzies, K., MacQueen, G., & Tough, S. (2016). Pregnancy-related anxiety: A concept analysis. International Journal of Nursing Studies, 55, 115–130. https://doi.org/10.1016/j.ijnurstu.2015.10.023.
Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T., … Desmond, D. (2003). Development and validation of a brief screening version of the childhood trauma questionnaire. Child Abuse & Neglect, 27(2), 169–190. https://doi.org/10.1016/s0145-2134(02)00541-0
Bohn, D. K., & Holz, K. A. (1996). Sequelae of abuse: Health effects of childhood sexual abuse, domestic battering, and rape. Journal of Nurse-Midwifery, 41(6), 442–456. https://doi.org/10.1016/S0091-2182(96)80012-7.
Byrne, J., Hauck, Y., Fisher, C., Bayes, S., & Schutze, R. (2014). Effectiveness of a mindfulness-based childbirth education pilot study on maternal self-efficacy and fear of childbirth. Journal of Midwifery & Women's Health, 59(2), 192–197. https://doi.org/10.1111/jmwh.12075.
Christiaens, W., Van, S. D. V., & Bracke, P. (2011). Pregnant women's fear of childbirth in midwife-and obstetrician-led care in Belgium and the Netherlands: Test of the medicalization hypothesis. Women & Health, 51(3), 220–239. https://doi.org/10.1080/03630242.2011.560999.
Cussins, C. (1996). Ontological choreography: Agency through objectification in infertility clinics. Social Studies of Science, 26(3), 575–610. https://doi.org/10.1177/030631296026003004.
Davidson, J. (2001). Pregnant pauses: Agoraphobic embodiment and the limits of (im) pregnability. Gender, Place and Culture: A Journal of Feminist Geography, 8(3), 283–297. https://doi.org/10.1080/09663690120067357.
Deave, T., Johnson, D., & Ingram, J. (2008). Transition to parenthood: The needs of parents in pregnancy and early parenthood. BMC Pregnancy and Childbirth, 8(1), 1–11. https://doi.org/10.1186/1471-2393-8-30.
Dworkin, A. (1985). Against the male flood: Censorship, pornography, and equality. Harvard Women's Law Journal, 8, 1–29.
Dworkin, A. (2009). Intercourse. Retrieved from ReadHowYouWant.com. Accessed 21 Feb 2018.
Eriksson, C., Westman, G., & Hamberg, K. (2005). Experiential factors associated with childbirth-related fear in Swedish women and men: A population based study. Journal of Psychosomatic Obstetrics and Gynecology, 26(1), 63–72. https://doi.org/10.1080/01674820400023275.
Fenwick, J., Hauck, Y., Downie, J., & Butt, J. (2005). The childbirth expectations of a self-selected cohort of Western Australian women. Midwifery, 21(1), 23–35. https://doi.org/10.1016/j.midw.2004.07.001.
Finzi-Dottan, R., & Karu, T. (2006). From emotional abuse in childhood to psychopathology in adulthood: A path mediated by immature defense mechanisms and self-esteem. The Journal of Nervous and Mental Disease, 194(8), 616–621. https://doi.org/10.1097/01.nmd.0000230654.49933.23.
Fisher, S. (1971). Boundary effects of persistent inputs and messages. Journal of Abnormal Psychology, 77(3), 290–295. https://doi.org/10.1037/h0031003.
Frederick, D. A., Forbes, G. B., Grigorian, K. E., & Jarcho, J. M. (2007). The UCLA body project I: Gender and ethnic differences in self-objectification and body satisfaction among 2,206 undergraduates. Sex Roles, 57(5–6), 317–327. https://doi.org/10.1007/s11199-007-9251-z.
Fredrickson, B., & Roberts, T. (1997). Objectification theory. Psychology of Women Quarterly, 21(2), 173–206. https://doi.org/10.1111/j.1471-6402.1997.tb00108.x.
Gervais, S. J., & Davidson, M. M. (2013). Objectification among college women in the context of intimate partner violence. Violence and Victims, 28(1), 36–49. https://doi.org/10.1891/0886-6708.28.1.36.
Gilbert, P., & Miles, J. (2014). Body shame: Conceptualisation, research and treatment. New York: Routledge.
Haines, H., Pallant, J., Fenwick, J., Gamble, J., Creedy, D., Toohill, J., … Hildingsson, I. (2015). Identifying women who are afraid of giving birth: A comparison of the fear of birth scale with the WDEQ-A in a large Australian cohort. Sexual & Reproductive Healthcare, 6(4), 204–210. https://doi.org/10.1016/j.srhc.2015.05.002.
Hall, W. A., Hauck, Y. L., Carty, E. M., Hutton, E. K., Fenwick, J., & Stoll, K. (2009). Childbirth fear, anxiety, fatigue, and sleep deprivation in pregnant women. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 38(5), 567–576. https://doi.org/10.1111/j.1552-6909.2009.01054.x.
Heimstad, R., Dahloe, R., Laache, I., Skogvoll, E., & Schei, B. (2006). Fear of childbirth and history of abuse: Implications for pregnancy and delivery. Acta Obstetricia et Gynecologica Scandinavica, 85(4), 435–440. https://doi.org/10.1080/00016340500432507.
Hu, L. t., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118.
James, W. (2001). Psychology: The briefier course. Toronto: General Publishing Company.
Johanson, R., Newburn, M., & Macfarlane, A. (2002). Has the medicalisation of childbirth gone too far? BMJ: British Medical Journal, 324(7342), 892–895. https://doi.org/10.1136/bmj.324.7342.892.
Kjærgaard, H., Wijma, K., Dykes, A.-K., & Alehagen, S. (2008). Fear of childbirth in obstetrically low-risk nulliparous women in Sweden and Denmark. Journal of Reproductive and Infant Psychology, 26(4), 340–350. https://doi.org/10.1080/02646830802408498.
Klaus, P. (2010). The impact of childhood sexual abuse on childbearing and breastfeeding: The role of maternity caregivers. Breastfeeding Medicine, 5(4), 141–145. https://doi.org/10.1089/bfm.2010.9991.
Kline, R. B. (1998). Software review: Software programs for structural equation modeling: Amos, EQS, and LISREL. Journal of Psychoeducational Assessment, 16(4), 343–364. https://doi.org/10.1177/073428299801600407.
Kochan-Wójcik, M. (2011). Experiencing one’s own corporeity vs. the level of differentiation of self. Polish. Journal of Applied Psychology, 9(2), 71–88.
Kremer, I., Orbach, I., & Rosenbloom, T. (2013). Body image among victims of sexual and physical abuse. Violence and Victims, 28(2), 259–273. https://doi.org/10.1891/0886-6708.VV-D-12-00015.
Krystal, H. (1988). Integration and self-healing. Affect, trauma, alexithymia. Hillsdale: Analytical Press.
Krzewska, I., & Dolińska-Zygmunt, G. (2013). Sense of body boundaries survey–construction and psychometric values. Polish Journal of Applied Psychology, 11(3), 93–110.
Laughon, S. K., Branch, D. W., Beaver, J., & Zhang, J. (2012). Changes in labor patterns over 50 years. American Journal of Obstetrics & Gynecology, 206(5), 1–9. https://doi.org/10.1016/j.ajog.2012.03.003.
Leeners, B., Richter-Appelt, H., Imthurn, B., & Rath, W. (2006). Influence of childhood sexual abuse on pregnancy, delivery, and the early postpartum period in adult women. Journal of Psychosomatic Research, 61, 139–151. https://doi.org/10.1016/j.jpsychores.2005.11.006.
Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.
Little, R. J. (1988). A test of missing completely at random for multivariate data with missing values. Journal of the American Statistical Association, 83(404), 1198–1202. https://doi.org/10.1080/01621459.1988.10478722.
LoGiudice, J. (2014). “It was the best of times, it was the worst of times:” The lived experience of childbearing from survivors of sexual abuse (Unpublished doctoral dissertation). University of Connecticut.
Lukasse, M., Vangen, S., Øian, P., Kumle, M., Ryding, E. L., & Schei, B. (2010). Childhood abuse and fear of childbirth—A population-based study. Birth, 37(4), 267–274. https://doi.org/10.1111/j.1523-536X.2010.00420.x.
Lundgren, I., & Dahlberg, K. (1998). Women's experience of pain during childbirth. Midwifery, 14(2), 105–110. https://doi.org/10.1016/S0266-6138(98)90007-9.
MacDonald, K., Thomas, M. L., Sciolla, A. F., Schneider, B., Pappas, K., Bleijenberg, G., … Carr, A. (2016). Minimization of childhood maltreatment is common and consequential: Results from a large, multinational sample using the childhood trauma questionnaire. PLoS One, 11(1), 1–16. https://doi.org/10.1371/journal.pone.0146058
Mercer, R. T. (2004). Becoming a mother versus maternal role attainment. Journal of Nursing Scholarship, 36(3), 226–232. https://doi.org/10.1111/j.1547-5069.2004.04042.x.
Merleau-Ponty, M. (1996). Phenomenology of perception. New York: Routledge.
Miettinen, A., Rotkirch, A., Szalma, I., Donno, A., & Tanturri, M. L. (2015). Increasing childlessness in Europe: Time trends and country differences. Families And Societies Working Paper, 33, 1–68.
Monahan, K., & Forgash, C. (2000). Enhancing the health care experiences of adult female survivors of childhood sexual abuse. Women & Health, 30(4), 27–41. https://doi.org/10.1300/J013v30n04_03.
Morris, T., & McInerney, K. (2010). Media representations of pregnancy and childbirth: An analysis of reality television programs in the United States. Birth, 37(2), 134–140. https://doi.org/10.1111/j.1523-536X.2010.00393.x.
Morris, K. L., Goldenberg, J. L., & Heflick, N. A. (2014). Trio of terror (pregnancy, menstruation, and breastfeeding): An existential function of literal self-objectification among women. Journal of Personality and Social Psychology, 107(1), 181–198. https://doi.org/10.1037/a0036493.
Nerum, H., Halvorsen, L., Sørlie, T., & Øian, P. (2006). Maternal request for cesarean section due to fear of birth: Can it be changed through crisis-oriented counseling? Birth, 33(3), 221–228. https://doi.org/10.1111/j.1523-536X.2006.00107.x.
Nieminen, K., Stephansson, O., & Rryding, E. L. (2009). Women’s fear of childbirth and preference for cesarean section–a cross-sectional study at various stages of pregnancy in Sweden. Acta Obstetricia et Gynecologica Scandinavica, 88(7), 807–813. https://doi.org/10.1080/00016340902998436.
Nussbaum, M. C. (1995). Objectification. Philosophy & Public Affairs, 24(4), 249–291. https://doi.org/10.1111/j.1088-4963.1995.tb00032.x.
Perez-Fuentes, G., Olfson, M., Villegas, L., Morcillo, C., Wang, S., & Blanco, C. (2013). Prevalence and correlates of child sexual abuse: A national study. Comprehensive Psychiatry, 54(1), 16–27. https://doi.org/10.1016/j.comppsych.2012.05.010.
Poikkeus, P., Saisto, T., Unkila-Kallio, L., Punamaki, R. L., Repokari, L., Vilska, S., … Tulppala, M. (2006). Fear of childbirth and pregnancy-related anxiety in women conceiving with assisted reproduction. Obstetrics & Gynecology, 108(1), 70–76. https://doi.org/10.1097/01.AOG.0000222902.37120.2f
Price, C. (2005). Body-oriented therapy in recovery from child sexual abuse: An efficacy study. Alternative Therapies in Health and Medicine, 11(5), 46–57.
Proctor, L. J., & Dubowitz, H. (2014). Child neglect: Challenges and controversies. In J. Korbin & R. Krugman (Eds.), Handbook of child maltreatment (pp. 27–61). Dordrecht: Springer.
Raphael-Leff, J. (2001). Pregnancy: The inside story. London: Karnac Books.
Reiger, K., & Dempsey, R. (2006). Performing birth in a culture of fear: An embodied crisis of late modernity. Health Sociology Review, 15(4), 364–373. https://doi.org/10.5172/hesr.2006.15.4.364.
Rich, A. (1995). Of woman born: Motherhood as experience and institution. New York: WW Norton & Company.
Roberts, T. A., & Gettman, J. Y. (2004). Mere exposure: Gender differences in the negative effects of priming a state of self-objectification. Sex Roles, 51(1–2), 17–27. https://doi.org/10.1023/B:SERS.0000032306.20462.22.
Robohm, J. S., & Buttenheim, M. (1997). The gynecological care experience of adult survivors of childhood sexual abuse: A preliminary investigation. Women & Health, 24(3), 59–75. https://doi.org/10.1300/J013v24n03_04.
Rothschild, B. (2000). The body remembers continuing education test: The psychophysiology of trauma & trauma treatment. New York: WW Norton & Company.
Rouhe, H., Salmela-Aro, K., Halmesmäki, E., & Saisto, T. (2009). Fear of childbirth according to parity, gestational age, and obstetric history. BJOG: An International Journal of Obstetrics & Gynaecology, 116(1), 67–73. https://doi.org/10.1111/j.1471-0528.2008.02002.x.
Rubin, L. R., & Steinberg, J. R. (2011). Self-objectification and pregnancy: Are body functionality dimensions protective? Sex Roles, 65(7–8), 606–618. https://doi.org/10.1007/s11199-011-9955-y.
Ryding, E. L., Wijma, B., Wijma, K., & Rydhström, H. (1998). Fear of childbirth during pregnancy may increase the risk of emergency cesarean section. Acta Obstetrics et Gynecologica Scandinavica, 77(5), 542–547. https://doi.org/10.1080/j.1600-0412.1998.770512.x.
Saisto, T., & Halmesmäki, E. (2003). Fear of childbirth: A neglected dilemma. Acta Obstetricia et Gynecologica Scandinavica, 82(3), 201–208. https://doi.org/10.1080/j.1600-0412.2003.00114.x.
Saisto, T., Salmela-Aro, K., Nurmi, J.-E., Könönen, T., & Halmesmäki, E. (2001). A randomized controlled trial of intervention in fear of childbirth. Obstetrics & Gynecology, 98(5), 820–826. https://doi.org/10.1016/S0029-7844(01)01552-6.
Sakson-Obada, O. (2010). Changes in sensing, the basic function of body ego, as a result of trauma. In A. Widera-Wysoczańska & A. Kuczyńska (Eds.), Interpersonal trauma and its consequences in adulthood (pp. 139–152). Newcastle upon Tyne: Cambridge Scholar Pub.
Sakson-Obada, O. (2014). Body ego and trauma as correlates of comfort in the physical proximity of others. Polish Psychological Bulletin, 45(1), 92–100. https://doi.org/10.2478/ppb-2014-0013.
Sartre, J. P. (1943). Being and nothingness: A phenomenological essay on ontology. New York: Philosophical Library.
Schmidt, N. B., Lerew, D. R., & Trakowski, J. H. (1997). Body vigilance in panic disorder: Evaluating attention to bodily perturbations. Journal of Consulting and Clinical Psychology, 65(2), 214–220. https://doi.org/10.1037/0022-006X.65.2.214.
Schwarz, N., & Sudman, S. (Eds.). (2012). Autobiographical memory and the validity of retrospective reports. New York: Springer Science & Business Media.
Stoll, K., Swift, E. M., Fairbrother, N., Nethery, E., & Janssen, P. (2018). A systematic review of nonpharmacological prenatal interventions for pregnancy-specific anxiety and fear of childbirth. Birth, 45(1), 7–18. https://doi.org/10.1111/birt.12316.
Stoltenborgh, M., van IJzendoorn, M. H., Euser, E. M., & Bakermans-Kranenburg, M. J. (2011). A global perspective on child sexual abuse: Meta-analysis of prevalence around the world. Child Maltreatment, 16(2), 79–101. https://doi.org/10.1177/1077559511403920.
Stoltenborgh, M., Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (2013a). The neglect of child neglect: A meta-analytic review of the prevalence of neglect. Social Psychiatry and Psychiatric Epidemiology, 48(3), 345–355. https://doi.org/10.1007/s00127-012-0549-y.
Stoltenborgh, M., Bakermans-Kranenburg, M. J., IJzendoorn, M. H., & Alink, L. R. (2013b). Cultural–geographical differences in the occurrence of child physical abuse? A meta-analysis of global prevalence. International Journal of Psychology, 48(2), 81–94. https://doi.org/10.1080/00207594.2012.697165.
Stoltenborgh, M., Bakermans-Kranenburg, M. J., Alink, L. R. A., & van Ijzendoorn, M. H. (2015). The prevalence of child maltreatment across the globe: Review of a series of meta-analyses. Child Abuse Review, 24(1), 37–50. https://doi.org/10.1002/car.2353.
Streeck-Fischer, A., & Kolk, B. A. (2000). Down will come baby, cradle and all: Diagnostic and therapeutic implications of chronic trauma on child development. Australian and New Zealand Journal of Psychiatry, 34(6), 903–918. https://doi.org/10.1080/000486700265.
Sweeney, M. M., & Raley, R. K. (2014). Race, ethnicity, and the changing context of childbearing in the United States. Annual Review of Sociology, 40, 539–558. https://doi.org/10.1146/annurev-soc-071913-043342.
Talmon, A., & Ginzburg, K. (2016). The nullifying experience of self-objectification: The development and psychometric evaluation of the self-objectification scale. Child Abuse & Neglect, 60, 46–57. https://doi.org/10.1016/j.chiabu.2016.09.007.
Talmon, A., & Ginzburg, K. (2017). Between childhood maltreatment and shame. Psychology of Women Quarterly, 41(3), 325–337. https://doi.org/10.1177/0361684317702503.
Talmon, A., & Ginzburg, K. (2018a). “Body self” in the shadow of childhood sexual abuse: The long-term implications of sexual abuse for male and female adult survivors. Child Abuse & Neglect, 76, 416–425. https://doi.org/10.1016/j.chiabu.2017.12.004.
Talmon, A., & Ginzburg, K. (2018b). “Who does this body belong to?”: The development and psychometric evaluation of the body experience during pregnancy scale. Body Image, 26, 19–28. https://doi.org/10.1016/j.bodyim.2018.05.002.
Tangney, J. P., Wagner, P., & Gramzow, R. (1989). The Test of Self-Conscious Affect. Fairfax: George Mason University.
Waldenström, U., Hildingsson, I., & Ryding, E.-L. (2006). Antenatal fear of childbirth and its association with subsequent caesarean section and experience of childbirth. BJOG: An International Journal of Obstetrics & Gynaecology, 113(6), 638–646. https://doi.org/10.1111/j.1471-0528.2006.00950.x.
Westhoff, C. L., Jones, H. E., & Guiahi, M. (2011). Do new guidelines and technology make the routine pelvic examination obsolete? Journal of Women's Health, 20(1), 5–10. https://doi.org/10.1089/jwh.2010.2349.
Weston, R., & Gore, P. A. (2006). A brief guide to structural equation modeling. The Counseling Psychologist, 34(5), 719–751. https://doi.org/10.1177/0011000006286345.
Wijma, K. (2003). Why focus on 'fear of childbirth'? Journal of Psychosomatic Obstetrics and Gynaecology, 24(3), 141–143. https://doi.org/10.3109/01674820309039667.
Wilkinson, R. B. (1999). Mood changes in mothers and fathers through childbearing: Are the blues so blue? Psychology and Health, 14(5), 847–858. https://doi.org/10.1080/08870449908407351.
Winnicott, D. W. (1954). Mind and its relation to the psyche-soma. Psychology and Psychotherapy: Theory, Research and Practice, 27(4), 201–209. https://doi.org/10.1111/j.2044-8341.1954.tb00864.x.
World Health Organization. (1999). Report of the consultation on child abuse prevention. Retrieved from http://www.who.int/iris/handle/10665/65900. Accessed 21 Feb 2018.
Young, I. M. (2005). On female body experience:" throwing like a girl" and other essays. New York: Oxford University Press.
Zamir, O., & Lavee, Y. (2014). Psychological mindedness as a protective factor against revictimization in intimate relationships. Journal of Clinical Psychology, 70(9), 847–859. https://doi.org/10.1002/jclp.22061.
Zar, M., Wijma, K., & Wijma, B. (2002). Relations between anxiety disorders and fear of childbirth during late pregnancy. Clinical Psychology & Psychotherapy, 9(2), 122–130. https://doi.org/10.1002/cpp.305.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical Approval
Ethical Approval was given by Tel Aviv University’ Institutional Review Board (IRB) for Professor Karni Ginzburg, the senior researcher.
Electronic supplementary material
ESM 1
(DOCX 109 kb)
Rights and permissions
About this article
Cite this article
Talmon, A., Ginzburg, K. Chased by the Past: The Relation Between Childhood Maltreatment and Fear of Childbirth. Sex Roles 81, 223–234 (2019). https://doi.org/10.1007/s11199-018-0984-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11199-018-0984-7