Author: Sam McCulloch, Published in Pathways to Family Wellness, Issue #53, Spring 2017
If you’re pregnant, you may have typed these words into your favorite search engine: “scared of giving birth.” Most women at some stage will admit to having some (or many) fears about giving birth, especially if it’s their first time. Some women are so worried about birth that it interferes with their enjoyment of their pregnancy.
For most women, the excitement of being pregnant is mixed with feelings of fear and anxiety about labor. This is considered a normal part of the experience of birth, yet each woman’s anxiety may center on different aspects. The highly medicalized approach to birth is creating further fears which often lead women to feel extremely anxious about their birth options.
It is estimated that around 10 percent of women suffer from tokophobia, or an intense fear of birth, and experts say the number is growing. But why is this happening? What do we have to fear about birth?
A History of Birth Fears
There is a commonly held belief that birth is dangerous, and that we’re lucky to have access to medical assistance. People say, “In the old days, women died all the time.” Many women did die during childbirth, but it wasn’t due to some fault of their bodies. Poor health due to lack of nutrition and hygiene were often the main culprits. Childbed fever killed many mothers until it was discovered in the late 1800s that doctors were responsible, due to not washing their hands between patients. (Even after working on dead ones—eek!)
In the last few hundred years, birth has moved out of the home and into the hospital. Medical intervention has become the norm, even for women having healthy pregnancies and babies. Interventions are favored over normal labor and birth. Well-known birth educator and advocate Rhea Dempsey says that we’re in the “labor bypass era.”
TV shows such as One Born Every Minute are popular, but they often depict birth as happening in a highly dramatic fashion. Women screaming in pain, flat on their backs with legs in stirrups, pushing until they are purple…and then the doctor runs in and saves the day. “Thank goodness for hospitals and doctors!” the new parents exclaim—as do the shocked, wide-eyed viewers at home.
Most births reported in the media are shown simply for their shock value. If they weren’t shocking and dramatic, the viewers wouldn’t be hooked on watching them (from on the edges of their seats, of course). Women having babies in the car, in the backs of ambulances, at the shopping center— the focus is on how extraordinary it is that a woman gave birth without any medical assistance and how scary it must’ve been.
Even family and friends contribute to a woman’s fear of birth. If a child’s mother experienced birth as traumatic, she’s likely to grow up believing this to be normal for birth. Horror stories from friends and online sources can increase fear because they overemphasize the pain and drama of birth.
A previous experience of birth ending in intervention or trauma can also heighten fear about any future births. This is especially true if a woman experienced hostility or lack of support from her care providers.
What Is Fear of Birth Doing to Women?
Is it any surprise so many women are scared of giving birth in a culture where birth is still considered the most painful and dangerous thing anyone ever does willingly?
Women who are fearful about labor and birth often say they would far rather be knocked out than go through a natural birth. A 2012 study from Sweden found that women who feared birth were more likely to ask for and to have a C-section.
Fear increases our perception of pain. The same study from Sweden found women who feared birth rated their labor pain as more intense than women who weren’t afraid—even with the use of pain medication. When we are in a fearful state, our bodies release stress hormones. These can cause tension in our muscles and alter the way labor progresses. Our “fight or flight” responses increase the pain we feel.
Fear can also increase the length of labor. A Norwegian study found that labor lasts around 1.5 hours longer in women who are scared of childbirth than it does for those who are not.
In addition, a study published in the journal BMJ Open found fear of birth was associated with an increase in postpartum depression (PPD). Women who had no history of PPD were three times more at risk, and those with known depression were five times more likely to experience PPD.
Some women experience physical symptoms of fear during pregnancy, such as nightmares, heart palpitations, dizziness, shortness of breath, a racing pulse, and difficulty concentrating. These symptoms and ongoing stress during pregnancy can contribute to insomnia, poor eating habits, headaches, high blood pressure, and lowered immunity.
Women with very high levels of stress during pregnancy are more likely to schedule medically unnecessary inductions or C-sections, as well as experience labor complications, such as premature birth and low-birthweight babies.
In a few hundred years we have gone from believing birth is a natural event in a woman’s life to fearing it like an incurable disease.
Women are so frightened by what they have been led to believe, they are more likely to accept interventions during labor. This leads to them having the birth experience they feared and expected. And the next time they give birth, they will more than likely have few expectations that it can be any different.
Birth Support Reduces Fear
Research shows us that women who have continuity of care from known midwives are more likely to have positive and satisfying birth experiences, with fewer interventions. Having the same midwife, or group of midwives, during pregnancy and birth gives a woman the chance to develop trust in the person caring for her. She can discuss her fears and work through how to manage them. Her role as the key decision maker is respected, and she can feel more in control during labor.
Most women give birth in hospital settings and experience shared care. “Shared care” means seeing a different midwife or doctor at each appointment. During labor the woman arrives at the hospital and doesn’t know the staff who is assigned to care for her.
In countries where women have few choices for obstetric care, interventions are likely to be higher. This helps to further the belief that birth is dangerous and medical assistance is necessary.
Birth Preparation Removes Fear of the Unknown
Birth education is often provided through hospitals and tends to focus on what you will and won’t be allowed to do. There is little attention on preparing women for normal birth. Rather, the information is based on what can go wrong and how it can be “fixed.”
Independent birth classes can help provide women with information about normal birth, and about the risks and benefits of procedures and interventions if they are needed. There is generally a focus on informed consent: what it is and how it applies to them in a birth setting.
Knowledge is very powerful for helping women face their fears about birth. It can be daunting to imagine how you will feel in a situation if you’ve never experienced it before. But by being aware of the process of birth and the importance of other factors, such as the choice of birthplace, you can dispel a lot of myths for yourself.
There are a number of ways you can reduce the fear of birth. Be as informed as possible about how to have an undisturbed labor and choose a care provider who supports birth as a normal and natural event.