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    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Jun 11
    2006

    Fear and Scheduled C-Section Study

    Archived User
    Hi, Henci - I'm not sure my login info "took" but I am intending not to be "anonymous." My name is Pam and I am an LCCE from Michigan.

    I was puzzled by the conclusions of this study on fear and scheduled C-sections - it says that women who got counseling for serious birth fears chose to have scheduled C-sections more often.

    I am wondering if these women who start out with intense fear of childbirth have a history of sexual abuse, abortion and/or pregnancy loss or some other common factor.

    What do you think about this study? And what do we do about the fear? I find fear so pervasive among women. The whole thread here about big babies is a case in point.

    I had slight blood sugar elevation (I won't call it "gestational diabetes"!) during my last pregnancy and my OB was convinced I would have a too-big baby and shoulder dystocia. I was planning a homebirth and seeing the OB concurrently. I was beset with fear for months. Finally, I discontinued OB care and delivered a perfectly healthy 10 lb. 2 oz. baby after one hour and twenty-three minutes of labor and just 3 pushes. I was on hands and knees and had spontaneously chosen to do pelvic rocking - the baby just shot out! But I had such terrible fear from this one lab test (and I was only a couple of points from the "normal" range on the blood glucose.) Even being a very naturally-oriented birther, the fear from this test and from my OB just pervaded my pregnancy - until labor and delivery went so fast and so well.

    Thanks!

    Pam
    LCCE in MI By: Pam
    Archived User
    Sorry - I forgot to include the URL for the study I referenced:

    http://www.nlm.nih.gov/medlineplus/news/fullstory_34561.html By: Pam
    Archived User
    So I've gotten a copy of the study. First, some background: In Sweden, excessive fear of labor is recognized as being a problem worthy of diagnosis and treatment. Nearly all obstetric departments refer women to clinics for counseling if women express extreme fear of labor. This study surveyed 2662 women at 16 wks of pregnancy and 2 mos afterward. They compared 3 groups: A: 47 women with extremely negative feelings at 16 wks who got counseling, B: 50 similar women who didn't, and C: 193 women who didn't have negative feelings at 16 wks but who had counseling (presumably they developed anxiety later) with group D: 2372 women who neither had negative feelings nor got counseling. Here are the important results:

    * As the news summary noted, women who had negative feelings and got counseling were more likely to have elective c/secs but be more satisfied with the birth than women who didn't get counseling.

    But there's more to it:

    * Women who had negative feelings and didn't get counseling were twice as likely to have c/secs in labor as any of the other groups (16% vs 8%). This did not reach statistical significance probably because the numbers are too small to detect even a doubling of rate.

    * Counselling worked. Significantly fewer women who said they preferred a c/sec at the time of the survey had an elective c/sec. In group A, at 16 wks, 56% wanted an elective c/sec, but only 30% had one. In group C the percentages were 18% vs 14%. In the two groups together, rates were 24% vs 17%.

    * My calculation revealed that c/sec rates didn't change very much in any group. This was a mixed parity group. In group A, 30% of women had a c/sec in a prior pregnancy vs 38% in this pregnancy. In group B, 22% had a c/sec in a prior pregnancy vs 20% in this pregnancy. In group C rates were 19% vs 21%, and in group D the rates were 11% vs 13%. (Note that it was assumed that women with a prior c/sec would plan vaginal birth this time, not at all like it is in the U.S.)

    A thought comes to mind: First, in Group A, 9 of 47 women had a previous c/sec and 14 had an elective c/sec while in group B 34 of 193 had a prior c/sec and 27 had an elective c/sec in this pregnancy. It is possible that the combination of prior c/sec and negative feelings about labor would be more likely to tilt the decision toward elective repeat c/sec.

    I'm not sure what the implications are, but group C, which is much bigger than group A or B, has a different profile. At the time of the survey, only 18% wanted an elective c/sec vs 56% of group A and 42% of group B. Group A then had a 30% elective c/sec rate vs a 14% rate in group C. For comparison, the elective c/sec rate in group B, the negative feelings-no counseling group, was 4%, and it was 5% in group D, the no negative feelings-no counseling group.

    Citing earlier and current studies done in England and Sweden, the authors comment that the incidence of anxiety about labor may be rising. Unlike here, however, they want to treat this problem, not just send women off to surgery.

    Take-home message: Women who have extreme fear of labor should be identified and undergo counseling. They will then be able to make a truly informed decision about birth route.

    -- Henci By: Henci Goer

    All Times America/New_York

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