Fear of Childbirth Can Lead to a Longer LaborCeridwen Morris
Women who are very scared of childbirth tend to spend more time in labor, suggests a new study published in the British Journal of Obstetrics and Gynecology (BJOG). According to the study, conducted in Norway, between 5 and 20% of pregnant women fear of childbirth.
Some factors associated with the fear include: being younger, being a first-time mother, lack of social support and/or a history of psychological problems, abuse or bad obstetric experiences.
This study, which looked at 2000+ pregnant women planning to deliver vaginally, used the Wijma Delivery Expectancy Questionnaire (W-DEQ), a questionnaire designed to measure fear of childbirth. About 7% of the pregnant women scored over 85. About half were first time moms. Then researchers looked at the length of their labor compared with levels of fear. They measured the length of labor as beginning at 3-4 centimeters dilation with 3 contractions every ten minutes and ending at birth. (This excludes early labor that can take 6-18 hours on average for a first time mom).
The average length of labor was about 8 hours for first-time mothers, and 5 for hours for women who had already given birth. (That’s an interesting data point right there!) But researchers also found that women who were scared of birth spent 1.5 hours more in labor than women without fear.
When they adjusted for other factors including epidural, assisted delivery and induction, the difference was still there but it was only about 45 minutes.
To summarize, for first time moms, labor was about 8 hours for women with fear and 6.5 for women without. Fear was also associated with assisted delivery/forceps (17% v 10.6% for women without fear) and c-section (10.9% v 6.8%). Almost half of women without fear gave birth without medical intervention, whereas only about a quarter of women with fear gave birth with no interventions. Of note: the vast majority (near 90%) of women who did fear childbirth were able to give birth vaginally, if that was their intention.
“Fear of childbirth seems to be an increasingly important issue in obstetric care. Our finding of longer duration of labour in women who fear childbirth is a new piece in the puzzle within this intersection between psychology and obstetrics. We found a link between fear of childbirth and longer duration of labour.” study co-author Samantha Salvesen Adams of the University of Oslo, Norway.
John Thorp, BJOG Deputy-Editor-in-Chief said, “There are a number of reasons why women may develop a fear of childbirth. This research shows that women with fear of childbirth are more likely to need obstetric intervention and this needs to be explored further so that obstetricians and midwives can provide the appropriate support and advice.”
Amen! Fear of childbirth is not that uncommon and I would bet that it’s higher in the US where we have a high c-section rate and a culture that generally likes to explore the pathological instead of the normal aspects of childbirth.
Though the study didn’t get into why this might happen I would throw out there that the labor hormone oxytocin slows down in response to fear/fight-or-flight hormones. The midwife Ina May Gaskin has written extensively on this phenomenon.
Whenever this topic comes up I want to be sure to steer the conversation away from blaming women for their intense anxiety and look outwards, instead, to the people who care for us in pregnancy and childbirth. If you’re afraid of childbirth, what you need now is not just a message to “get tough” or “chill out,” but genuine support and good information about how birth works.
We have to work on how care-providers can address fear of childbirth during pregnancy and how nurses, doctors, midwives, doulas and childbirth educators can show empathy for a woman’s birth anxiety but also help her throughout the process of giving birth by giving real support, clear information about medical choices, freedom to move in labor and the authority to participate in their own births and decisions.