Understanding Fear of Childbirth

A study published in the June edition of Acta obstetricia et gynecologica Scandinavica explored fear of childbirth through maternal surveys.  While the study question was about the effect of counseling for fear of childbirth, several interesting things are revealed in the descriptive statistics (the part of the study where the researchers tell you about the individuals in the study). The authors report this counseling was generally from midwives either with or without specialized training in counseling, or from an obstetrician, and the counseling is never really described as an intervention.  For that reason we won’t dwell too much on the effects of the counseling.

Out of 936 women who completed questionnaires two months post-partum, 70 women reported having counseling due to childbirth fear. This is just over 7% of the women.  But when you break the women into those having their first delivery and those who gave birth before, you find only 6% of the women having their first delivery reported having counseling while 9.5% of the women who gave birth before.  I find this interesting because it runs counter to what I’ve been told about fear and childbirth.

I’ve been told that women fear childbirth because they don’t have experience with it anymore, and because the media portrays birth as something horrible.  But this data turns that around, women with personal experience giving birth were more likely to have fear so extreme they needed counseling.

If we keep exploring the data we learn something interesting about those multips.  Most of the women had normal vaginal births for the previous experience, as we might expect.  If the woman had any instrumental birth or an emergency cesarean, she was more likely to receive counseling. If the woman had an emergency cesarean her odds of having counseling for fear were 5 times higher than a woman who had a normal vaginal delivery. This effect did not exist with planned cesarean.

There are some problems with this study – a big one is that about 1/3 of the women who reported receiving counseling stated they had little or no fear of childbirth.  As far as I can tell, there was no adjustment for this in the analysis (which is another reason why we won’t think too much about their main outcome). If you want to know if counseling reduces fear, you need to start with a group who has fear.  If this had been my data, I would have only analyzed the 100 or so women who reported fear.  But the question for us to ponder now is might we see something different in terms of multip vs. nullip being more afraid if only those who reported fear were reported?


Jennifer Vanderlaan (Author)