Fear of Birth - The Second Time Around

"Giving birth should be your greatest achievement not your greatest fear" ~ Jane Weideman

Combing through research articles this last week, I came across an interesting study conducted in Norway earlier this year that looked at the association between a woman's fear of childbirth and her previous birth experiences. The study utilized questionnaires given to pregnant women at both 17 weeks and 32 weeks into their pregnancy, which measured their overall birth experience from a previous birth, as well as considered obstetric complications (if any) from their previous birth. Obstetric complications listed in the questionnaire included: emergency cesarean section, instrumental vaginal delivery, extensive blood loss, retained placenta, serious maternal infection during labor, thrombosis, and anal sphincter tears. The questionnaire utilized in this study, The Wijma Delivery Expectancy/Experience Questionnaire is a frequently used tool to assess "fear of childbirth." While one might assume that obstetric complications would foster a negative birth experience and thus a fear of birth in future pregnancies, this was not the case in this study. In fact, 80% of the women surveyed who faced obstetric complications in previous labors neither considered their labor experience to be negative, nor did they develop a fear of childbirth as a result of the complications. On the other hand, the association between a previous labor considered to be a negative experience by the mother and that mother's fear of childbirth in future pregnancies was high.

What does this tell us? Well, I think that this leads us to multiple conclusions. First, this study beautifully highlights the need for positive support and childbirth education within the multiparous population. All pregnancies and labors are unique and so much of the experience of childbirth is tied to factors that the woman and those around her can influence. Even if a woman's first pregnancy and labor proved to be a negative experience, there still exists an opportunity to create a positive experience with future labors. This study shows us how negative birth experiences can easily translate into a fear of childbirth, which can drastically affect the outcome of future births. For these women, their second or third pregnancy is a crucial time to become educated about childbirth and surrounded by support so that any fear may be dealt with, allowing these women to enter their labor experience with optimistic confidence and excitement, rather than dread and anxiety. In addition, this study highlights an important point - not all labor experiences that include obstetric complications are negative experiences. When a woman is fully educated on what complications may occur during labor, can trust her caregiver, and enters her labor confidently, she can walk away from her labor experience with a positive memory. Fear does not necessarily creep into the world of pregnancy and labor simply because of obstetric complications in labor and delivery. Fear is much more complex and its effects on future birth experiences are wide reaching. Fear leads to tension, which in turn leads to pain. This vicious cycle is what leads a laboring woman into a scenario where she ends up fighting against her own body and its instincts. A woman in fear is neither confident nor ready to tackle the experience of labor, and it is in this fear that many complications arise.

What can we do about it? It is important never to assume that just because a woman has been through childbirth before that she is fearless and prepared for future childbirth. Education is always golden and support is always needed. When a woman is able to overcome her fear of labor, she can let go and ride the wave of the completely natural and miraculous event that is childbirth.

Størksen HT, Garthus-Niegel S, Vangen S, Eberhard-Gran M.The impact of previous birth experiences on maternal fear of childbirth. Acta Obstet Gynecol Scand. 2013;92:318–324.

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