How common is fear of childbirth?

childbirthFearIt turns out that isn’t an easy question to answer.  To prepare for a recent study on the effects of fear on the childbirth experience, the researchers found between 5 and 40 percent of women fear childbirth.  The number varies based on many things like the women’s ages, the cultural perspectives, and what list of questions was used to measure childbirth fear (Elvander, 2013).

For example, in a study of college students who had never given birth, fear of childbirth was measured by responses to 6 questions (Stoll, 2014). In a study of women who were recruited during their first pregnancy, fear of childbirth was measured by responses to a different set of 6 questions (Elvander, 2013).  Qualitative research does not scale fear, but groups the terms women use to try to gain understanding of levels of fear (Faisal, 2014, Fisher, 2006).

The next problem is the aging of the research — it seems more recent literature shows higher levels of fear of childbirth than in the past (Dahlen, 2010). Interestingly, as fear has increased so has the willingness of women to accept medical interventions.

Then we have the problem that fear is measured alongside confidence.  For example, in the study by Stoll, three of the questions are “positive.”  These questions include:

I believe I will have enough confidence to give birth vaginally

I feel that my body is able to successfully birth a child

I think I will be able to handle the pain of childbirth

One of the negative questions even looked like confidence pretending to be fear, “I am afraid that I might panic and not know what to do during labor.” So, while the three negative questions were worded about fear, the three positive were not worded about fear. The researchers did work to ensure an internal consistency of the scale, but in reading the questions I am not convinced this is an accurate measure of fear.  This isn’t unique to this particular paper — how do we define fear, and how do we define the absence of fear.  Is fear the opposite of confidence?  This is such an abstract area that teasing out the intricate relationships as they relate to childbirth is going to take a lot of time and research.

Dahlen also reports research showing women are willing to accept higher levels of risk in childbirth than are clinicians.  Does this mean there is something wrong with obstetricians?  Not necessarily.  Research that looks into how much a disability or illness is “valued” by people consistently demonstrates physicians place a higher value on perfect health and the absence of all problems than the general population.  An actually, the general population places a higher value on perfect health and the absence of problems than people who actually have any particular health problem.  This means, if you have incontinence after childbirth, you are more likely to find it doesn’t interfere with your life than someone who has never had incontinence is to believe it will not interfere with her life.

This is an important concept to think about in terms of childbirth, and we will explore the idea  later in the week.