Birth Professionals, Understanding Pain

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.

Consider the differences in reported fear for women who have never given birth, and women who are giving birth for the second or third time.  For the woman who has never given birth, labor is an “unknown.”  For the woman who previously gave birth, she knows what she is in for.

So the woman preparing to give birth for the first time can be compared to the general public.  To her, labor is a complete unknown and she is likely to assume it is worse than a woman who has actually been through labor.

The woman who has been through labor can remember what she did to manage labor, what gave her strength and comfort as she labored.  She considers the work and potential pain she has ahead of her, but she also has confidence from her previous birth.

It made me wonder if it was the confidence the woman had from her previous birth that allowed her to have a good, easier, birth. But I couldn’t find evidence that lack of fear makes for an easier birth.  I did find evidence that measures of fear are associated with more negative birth experiences, regardless of the mode of delivery (Elvander, 2013).

As we’ve seen earlier this week, although there is fear among women preparing to give birth the first time, there doesn’t seem to be a large difference between in current measures of fear for those we might hypothesize are different groups of women (Stoll, 2014). More importantly, differences in reported fear level do not correspond to differences in mode of birth (Elvander, 2013). So what is going on?

According to the theory of planned behavior, the intention to behave in a particular way is determined by both the individual’s attitudes toward the behavior, and the societal attitudes toward the behavior. The individual attitudes are based on beliefs about the behavior and prior experiences with the behavior or similar behavior. The society attitudes are based on the normative beliefs and the degree of motivation the society provides to comply with that behavior.

So it is possible that fear of childbirth is a generally common event for women, and unless the woman’s level of fear is extremely above the norm, it is societal norms that drive her decisions about how to manage birth.  This seems to fit with the importance of family experiences driving fear strong enough to lead to a request for primary cesarean – in these cases the societal pressure encourages the woman’s fear instead of negating it. This theory also supports increased fear in a second birth for women who experienced a traumatic first birth.

I’m hardly an expert on fear theory, but this reading has been interesting so far. What do you think?

Jennifer Vanderlaan (Author)