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“Ignoring” fear of childbirth

childbirthFearThis week we’ve been looking at ways childbirth educators think about managing women’s fear of childbirth.  We talked about education and relaxation, but today I want to talk about ignoring the fear. If you can’t think of any natural childbirth theories that support the use of ignoring fear, it is because there are not any.  But that doesn’t prevent this method from being used.  Continue reading

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“Relaxing” the fear of childbirth away

childbirthFearEarlier this week we looked at research that both supported and refuted the idea that you could teach away the fear of childbirth. Today I want to focus on another tactic for managing fear of childbirth, relaxation.  This discussion is a little more theoretical, a little more about defining what things mean than the last few posts which focused on research.

Just like education, the first place I learned of the value of relaxation for childbirth was in Dick-Read’s Fear-Tension-Pain cycle.  The basic concept was that fear caused tension, and the tension caused pain.  So if I learned to relax during labor, I could stop the effects of the fear. Dick-Read is not alone in this assertion, Penny Simkin wrote a fabulous piece on the physiological effects of stress on labor. This is often used to support the importance of physical relaxation to promote comfort during labor. So the question is, what does relaxing do to the fear? Continue reading

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“Teaching” away fear of childbirth

childbirthFearWe’ve been talking about fear of childbirth, and last week we spent some time in the research looking at sources of fear.  Today I’d like to change gears and begin looking at ways childbirth professionals think about dealing with women’s fears. First method to review — education.

The concept that you can teach away childbirth fear first appeared in the philosophies of Grantley Dick-Read.  His philosophy, dubbed the Fear-Tension-Pain Cycle, claims that through education about birth the fear of birth is removed and therefore the tension and pain are reduced.  Is he correct?

Continue reading

References

  • Fisher C1, Hauck Y, Fenwick J. How social context impacts on women’s fears of childbirth: a Western Australian example. Soc Sci Med. 2006 Jul;63(1):64-75. PMID: 16476516.

  • Fenwick J1, Staff L, Gamble J, Creedy DK, Bayes S. Why do women request caesarean section in a normal, healthy first pregnancy? Midwifery. 2010 Aug;26(4):394-400. PMID: 19117644.

  • Stoll K1, Hall W2, Janssen P3, Carty E4. Why are young Canadians afraid of birth? A survey study of childbirth fear and birth preferences among Canadian University students. Midwifery. 2014 Feb;30(2):220-6. PMID: 23968778.

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Fear, Pain, and Childbirth

childbirthFearLast week I introduced you to the idea of the value of perfect health.  If you remember, a physician places a higher value on perfect health than the general public; the general public puts a higher value on avoiding a condition than the people who live with that condition.  This comes from economic research into what is generally termed as “utility.”  These studies measure how much people are willing to do to avoid certain conditions, or for the chance for complete recovery of a condition.

The fact that the value of not having the condition is reduced when reported by someone who has the condition is an interesting phenomenon. I suppose once you have a condition, like diabetes or hypertension, you learn how to live with it.  It becomes your new normal.  I began to wonder how this might be reflected in childbirth. Continue reading

References

  • Stoll K1, Hall W2, Janssen P3, Carty E4. Why are young Canadians afraid of birth? A survey study of childbirth fear and birth preferences among Canadian University students. Midwifery. 2014 Feb;30(2):220-6. PMID: 23968778.

  • Elvander C1, Cnattingius S, Kjerulff KH. Birth experience in women with low, intermediate or high levels of fear: findings from the first baby study. Birth. 2013 Dec;40(4):289-96. PMID: 24344710.

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Childbirth Fear: Family or Media?

Oct 15th, 2014 Working With Clients

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childbirthFearWhen I began working in the birth world I was told women were afraid of childbirth because of the media portrayal of birth. Television, movies, and magazines were teaching women to be afraid by their unrealistic labors and horror stories.

So, is this true?  Maybe, but maybe not.

Stoll’s (2014) survey of college students found an association between media as a source of birth information and higher fear scores.  But two things stand out to me in this sample of college students.  First, the mean fear score between those who got information from media and those who didn’t was less than two points different on a 36 point scale — basically one was just below 18 and the other just above. The difference between those who used only the media and only family was less than three points.  Second, less than half the students reported using media as a source of information about childbirth.

Another problem to consider is that this is only an association.  We don’t know the order of events and so we cannot say it was the media that caused the fear of birth.  What if the media use is in response to the fear of childbirth — young men and women trying to find out if their fears are founded? In this scenario those without a fear might not bother using media because there is no perceived need for information.

I have two other studies to share with you on this topic.

Let us begin with  Fenwick, 2010.  This was a study of women who requested a cesarean  in a normal, healthy, first pregnancy.  These women reported concern that vaginal birth would result in physical injury to themselves or their baby. Two things stood out to the researchers as unique for these women.  First, they couldn’t conceptualize how a baby could be expelled safely from the body — as if the vaginal canal couldn’t accommodate the baby’s head. Second, the women did not seem to derive any personal meaning from birth, it was just a process to get the baby or a means to an end.  The women used language that said they were “getting” a baby not “having” a baby.

A similar study is Faisal, 2014.  This was a study of Iranian women who also requested a cesarean surgery for a normal pregnancy. These women also reported fear of vaginal birth being too difficult.  It was not only the pain, but concerns about pelvic floor disorders and other physical damage to themselves and the baby. They reported believing a cesarean was safer and less traumatic for the baby.

What was similar between these two studies, besides the fear?  It was the influence of family on their decision to request a cesarean. It seems the experiences of close friends and family played a major role for these women in conceptualizing what childbirth would be like.  These women reported a bad birth experience for a close friend or loved one which served as their “prototype” birth — what they expect all births to be like.

All this to say I’m not quite sold on the theory that media drives fear of childbirth anymore.  What do you think?

 

 

References

  • Faisal I1, Matinnia N2, Hejar AR1, Khodakarami Z3. Why do primigravidae request caesarean section in a normal pregnancy? A qualitative study in Iran. Midwifery. 2014 Feb;30(2):227-33. PMID: 24055288.

  • Stoll K1, Hall W2, Janssen P3, Carty E4. Why are young Canadians afraid of birth? A survey study of childbirth fear and birth preferences among Canadian University students. Midwifery. 2014 Feb;30(2):220-6. PMID: 23968778.

  • Fenwick J1, Hauck Y, Downie J, Butt J. The childbirth expectations of a self-selected cohort of Western Australian women. Midwifery. 2005 Mar;21(1):23-35. PMID: 15740814.

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How common is fear of childbirth?

Oct 13th, 2014 Working With Clients

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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). Continue reading

References

  • Elvander C1, Cnattingius S, Kjerulff KH. Birth experience in women with low, intermediate or high levels of fear: findings from the first baby study. Birth. 2013 Dec;40(4):289-96. PMID: 24344710.

  • Fisher C1, Hauck Y, Fenwick J. How social context impacts on women’s fears of childbirth: a Western Australian example. Soc Sci Med. 2006 Jul;63(1):64-75. PMID: 16476516.

  • Stoll K, Hall W. Vicarious birth experiences and childbirth fear: does it matter how young canadian women learn about birth? J Perinat Educ. 2013 Fall;22(4):226-33. PMID: 24868135.

  • Stoll K1, Hall W2, Janssen P3, Carty E4. Why are young Canadians afraid of birth? A survey study of childbirth fear and birth preferences among Canadian University students. Midwifery. 2014 Feb;30(2):220-6. PMID: 23968778.

  • Faisal I1, Matinnia N2, Hejar AR1, Khodakarami Z3. Why do primigravidae request caesarean section in a normal pregnancy? A qualitative study in Iran. Midwifery. 2014 Feb;30(2):227-33. PMID: 24055288.

  • Fenwick J1, Staff L, Gamble J, Creedy DK, Bayes S. Why do women request caesarean section in a normal, healthy first pregnancy? Midwifery. 2010 Aug;26(4):394-400. PMID: 19117644.

  • Dahlen H. Undone by fear? Deluded by trust? Midwifery. 2010 Apr;26(2):156-62. PMID: 20096490.

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Free Course about global issues in childbirth

Oct 12th, 2014 Global Midwifery

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I meet many childbirth professionals who are interested in global health. I often find their understanding of the issues facing women globally is based on old data or common myths.

Here is an opportunity to learn about maternal and newborn health in low and middle income countries.  Check it out.

Childbirth: A Global Perspective | Coursera.

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Global Perspective on Childbirth Fear

Oct 10th, 2014 Working With Clients

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childbirthFearBefore I became involved in global health, the idea that fear of childbirth was about anything other than fear of pain was basically an afterthought.  Sure women used to die in childbirth, but that was long ago and didn’t really affect women’s views today.  Sure some babies die, but not many so that didn’t really affect women’s views today.  In my uninformed philosophy, it was easy to discount the objections I read to home birth and and the praises of cesarean because in my world the problems of childbirth were rare and relics of the past. As my knowledge grew, I began to see some basic conditions of  that existed that made my philosophy seem true only existed because I lived in a place where women have access to quality health care.

Faulty Logic

The first problem was that I failed to understand or accept that bad outcomes do happen, and are not as rare as I think.  Globally, 1,000 women die daily during pregnancy or childbirth – only 15 years ago this number was 1/3 larger. Continue reading

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Childbirth Fear is about “Pain”

Oct 8th, 2014 Working With Clients

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childbirthFearSo far we have explored the idea that fear of childbirth is normal, and that fear of childbirth is taught.  Today, we will explore the idea that fear of childbirth is driven by fear of pain.  What do we assume if we hold this belief, and what might we be missing?

My original training as a childbirth educator (wow, 15 years ago!) was centered around the teachings of Grantley Dick-Read and the Fear-Tension-Pain cycle. we can talk about this theory later in the series if you like, but I want to focus today on how I mis-interpreted this theory.  You read that correctly, I mis-interpreted this theory. Continue reading

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Chilbirth Fear is “taught”

Oct 6th, 2014 Working With Clients

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childbirthFearLast week we looked at the philosophy that fear of childbirth is normal. Today we have an equally interesting exploration… what does it mean to believe fear in childbirth is “taught.”  What assumptions do we make when we believe this. How does this belief affect the way we react to women?

Making Assumptions

If we believe fear of childbirth is “taught,” we probably make the  assumption that feelings about childbirth are culturally derived, and result from the experiences of other women rather than the experiences of the expectant mother. We can dig a little deeper into this idea.  What other things about childbirth are taught to the woman by her community? It is not only attitudes about the process, but also specific behaviors and her changing role within the community. Just like the fear, these behaviors and roles my be beneficial or harmful. Continue reading

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