“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?

We can find some support that Dick-Read’s philosophy is a real phenomenon.  For example, in the Stoll study (2014), we see that fear is high among a group of college students who have never given birth.  As we dive deeper into the data, we find accurate knowledge about giving birth is low among this group.  For example, 45% of the respondents didn’t know if a woman’s body recovers faster from a vaginal or cesarean birth. This paper does not compare the fear scores to the fear scores of women currently pregnant, so it is hard to know what effect education about birth may have on the score.

We can also find support in the Fenwick study (2010), where primigravidae requesting a cesarean without medical reason explained they were unable to conceptualize how a baby could be born safely vaginally.  However, in this study the women requesting cesarean had a relationship with someone who had a bad birth experience, which seems to have affected their understanding of the normal birth process.  So in this case the women had some education, but it was incomplete and provided a misrepresentation of the normal birth experience.

The evidence stays murky in the Fisher paper (2006).  Fisher explained that even multips had a level of fear for the well-being of the baby and the level of pain they might feel in labor. These aspects of fear were constant regardless of the number of times a woman had given birth. This is an interesting finding, since a woman who has already given birth (especially those who have given birth multiple times), may not gain much new information from our traditional childbirth educational programs.

Where does this leave us?  It does seem there are some pieces of information that can help alleviate fears. This may be most important for families who have formed their understanding of childbirth on complicated pregnancies.  But at the same time there seems to be some fears which persist regardless of the level of personal knowledge and experience with giving birth.  It seems no amount of understanding is enough to remove a woman’s concern for the potential for harm to her baby or her worry about how painful this next labor may be. I think this is important for childbirth professionals to understand, and our expectation cannot be that women will enter labor without fear.