The Research
Several interesting studies have recently been published in the Scandinavian journal, Acta Obstetricia et Gynecologica Scandinavica (some of which I will cover in a subsequent post). The greatest one of interest, which has garnered much media attention lately is the study about fear of childbirth which, according to researchers, has a drastic affect on increasing instrumental deliveries (51%), labor inductions (17%), and requests for elective cesarean deliveries (30%) when compared to women not suffering from this intense form of childbirth-based fear termed 'tocophobia.'

The results of this relatively small study (cases=353, controls =579) out of University Hospital in Linköping, Central Sweden, are not necessarily surprising to many of us, but reiterate what many having been talking about for decades: fear has a very real affect on the process of labor and birth. In fact, in the most extreme cases, tocophobia may result in avoidance of pregnancy all together. But for our purposes, as childbirth professionals, we need to be thinking about how we approach the topic of fear pertaining to birth in our interactions with our students/patients/clients.

Take the cascade of interventions, for example: For the woman who is increasingly anxious about what will happen during labor and birth - who asks for an elective labor induction to 'just get it over with,' some of the difficulties she may be most afraid of, become a self-fulfilling prophecy when her labor is complicated by the effects of labor induction (increased pain, intensity and frequency of contractions... potential negative effects of epidural analgesia when assistance with her intense pain is requested... fetal heart rate concerns.... maternal blood pressure concerns... potential advancement to cesarean surgery).

Application for Childbirth Educators
Carefully and sensitively bringing up the topic of fear related to childbirth is imperative for childbirth educators: it gives our students the opportunity to express concerns which they might otherwise keep to themselves - thinking they are 'the only ones' harboring such anxiety. It is not about inducing or encouraging fear, rather it is about presenting the opportunity and encouraging dialogue on this topic- offering positive perspectives and coping strategies that the woman/couple may not have come up with on their own.

Don't be Afraid to Refer
In the event we find ourselves interacting with a woman whose fear pertaining to pregnancy and/or birth is deeper than that which we feel poised to handle in class (or in clinic), referring the woman locally to a trained professional adept at counseling her through this challenge becomes a must. Tocophobia is a very real phenomena. This study published in Clinical Obstetrics and Gynecology, 2004 (47:3) describes tocophobia as occurring in 20% of pregnancies with disabling fear occurring in 6%.

As childbirth educators and maternity care professionals, we may not have the training or skill set to appropriately handle and solve every challenge that faces an expectant woman. And when we don't immediately posses those skill sets, we must invite the assistance of other professionals trained to do so. In the mean time, proactively delivering evidence-based information that empowers (rather than frightens or degrades) expectant women can go a long way toward building confidence and reducing fear.

Posted by: Kimmelin Hull, PA, LCCE, FACCE

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