EVE KATUSHABE: Fear of Childbirth

The fear of childbirth (FOC) is a common phenomenon among women. Their confidence and ability to give birth normally is highly affected by the fear of birth. The International Confederation of Midwives (ICM) defines normal birth as “where the woman commences, continues and completes labour with the infant being born spontaneously at term, in the vertex position, without any surgical, medical, or pharmaceutical intervention but with the possibility of referral when needed”. The term childbirth encompasses pregnancy, birth, and the postpartum period. Some women find birth unbearably painful, others don’t experience any pain, while the majority are somewhere in between.

For centuries society has accepted childbirth as a very painful and dangerous experience. Negative cultural beliefs, bible lessons “ The Curse of Eve”, previous experience or witnessing difficult childbirth, the stories from family/friends, Television advertisements, shows, movies which always portray pregnancy and labour as dreadful have influenced how childbirth is regarded, hence giving women pre-perceived reasons to fear birth. This fear has been enhanced by a lack of understanding of the normal physiology of birth, poor preparation, increased use of technology, lack of support from maternity care providers, male partners, relatives, and friends.

Fear can be acquired through suggestion or association and can manifest in terror depending on the personality and type of stimulus. Normally oxytocin hormone initiates and maintains contractions facilitating cervical changes needed for birth.  It is reported that women who are afraid tend to secrete too much stress hormone adrenaline which works in direct opposition of the release of oxytocin thus slowing labour. Fearful thoughts will tighten the woman’s muscles, often clenching her pelvic floor as well as other muscles causing the fear-tension pain syndrome. This state reduces oxygen supply to the uterine muscles leading to more painful contractions, increasing the woman’s level of distress, and may take her pain a notch higher. 

Elevated fear during pregnancy has been associated with an increase in pain perception, painful prolonged labour, women progressively becoming disappointed and tearful, maternal-fetal distress, the possibility of intervention containing: labour augmentation, pharmacological pain relief, and emergency cesarean section, then after delivery all this will significantly affect breastfeeding and maternal-infant bonding.

Maternity care providers should highly prioritize reducing this generic fear since the non-terrified are more likely to secrete in abundance the hormones that make labour and birth easier and less painful. Research suggests various ways of reducing FOC including: Addressing the process of normal physiological birth to women and their spouses for proper preparation, provide continuous respectful, compassionate care while involving women in decision-making at every step during birth. Companionship and support from spouse, close relative, or friend is beneficial. Ensuring a conducive, private, comfortable environment that is free from noise, crowding, coldness, bright light, and one that allows free movement.

Additionally, it’s vital for pregnant women to learn about birth through discussion with health care providers, reading trusted books, magazines, listening to positive birth stories, watching YouTube videos of midwife-led homebirths including warm water immersion and birthing. Notably, more knowledge means fewer surprises and the woman feels in control of what happens henceforth reducing levels of fear and promoting positive birth experiences.

Therefore maternity care professionals’ attention to the fear of childbirth is much warranted. Reducing fear during labour and birth is important. Health training institutions need to incorporate FOC in their curricula. The policymakers should increase the midwifery workforce to ensure continued presence and support during birth, provide in-service training to equip midwives with up-to-date information. 

The author; Eve Katushabe is a RM, BScN, MPH, MSc-Midwife & Child Health Nurse specialist