As my first due date approached, my lifelong dislike of shots expanded into an all-out dread fear of an epidural. Forget convincing me of its benefits: I was petrified of having a needle in my back—and even more scared that in the heat of delivery, nobody would listen to me and I’d be poked with one anyway.
Extreme? Weird? Slightly ridiculous in the big scheme of things? Nobody ever said fear is rational. It just IS. That includes childbirth-related fears. Make that especially childbirth-related fears.
“Some fears about birth are normal for all women,” says Lee Roosevelt, a certified nurse-midwife and clinical assistant professor at the University of Michigan School of Nursing, who studies fear about labor and delivery.
Excitement is running high. Everything’s new and different. Why wouldn’t a jitter or two be totally natural?
Too bad nobody’s talking about it, finds a new study in Journal of Obstetric, Gynecologic, and Neonatal Nursing by Roosevelt and UM’s Lisa Kane Low. It’s one of the few in the U.S. to explore women’s fears of childbirth and whether they’re being addressed.
Too often in pregnancy, a basic question goes unasked—when the answer could provide the reassurance and confidence that leads to better outcomes for new mothers and their babies, Roosevelt says. It’s this:
“When you think about giving birth, is there something that worries you?”
Simple, right? “But it’s not a subject providers bring up,” Roosevelt told me. “If women do say something, they often get, ‘pat-pat-there’s-nothing-to-worry-about,’ and they’re sent on their way.”
As a result, she says, “Women think, ‘If they’re not listening to me prenatally, will they be responsive during the actual birth?’ There are a lot of internalized fears about providers.”
What we’re afraid of
Overall, childbirth fears fall into six big areas, the research found:
- Fear for the baby’s health: Will the baby be okay? If previous children had been healthy, will that “luck” run out?
- Fear of complications: This includes things like bleeding, tearing, or getting a bad result from all the monitoring and tests.
- Fear of abandonment by the clinician: Women worry, “Will I be ignored or forgotten during delivery?” “Will I be rushed?” “Will staff miss something?” One subject said, “How can you trust that they know everything is all cool if you only see them for like two minutes?”
- Fear of decision-making: Pain relief, inductions, C-sections—birth involves all kinds of decisions that we feel unqualified to make or worry we’ll get wrong—and mess up everything!
- Fear of lacking strength or losing control. This one can take many forms: Screaming too loud. Pooping in front of everyone. Being unable to advocate for yourself or the baby.
- Fear of the cultural experience of giving birth. A sense of birth’s life-affirming joy often goes AWOL, thanks to the movies we see, the horror stories we hear from friends and relatives, the way pregnancy and childbirth have been medicalized, and the excessive testing done to protect providers from litigation. “The way the U.S. feels about birth, everything is an epic disaster waiting to happen—and women sense that and it feeds into their fears,” Roosevelt told me.
Notice how many of these worries involve doctors, midwives, and other care providers. “Pain, something happening to the baby in delivery—those fears are secondary. Women really wanted to talk about how their relationship with their provider impacts those fears,” Roosevelt says.
But if asked, “What’s worrying you?” it’s like a magic door that opens up good communications.
Why that simple question is so important…
Here’s the heart of why Roosevelt was drawn to study a subject that’s barely been looked at by researchers in the U.S. (There’s been much more interest in the subject over the past 20 years in Scandinavia, she says.)
“There’s definitely a physiologic impact on birth,” she says.
Research has shown that women with a lot of childbirth fears are more likely to be induced, to have prolonged labors, to undergo emergency C-section, and to develop postpartum depression. “One study found that women with a severe fear of childbirth are more likely to have babies who wind up in the NICU,” she told me. “That makes sense because fetuses react to cortisol.”
Having attended deliveries for almost 20 years, Roosevelt says she’s seen this over and over in her own patients. Women with lots of prenatal anxiety about birth often have long, drawn-out labors.
Nothing to fear but…not being able to talk about fear!
As personal experiences go, giving birth, especially for the first time, is an Ultimate Unknown because it’s not something we can really rehearse—or avoid.
That requires facing the fears head on, with the help of those around us.
As one study subject put it, “Processing fear should be a part of prenatal care. No one gives you the time to really talk about your fears.”
Find a provider you trust and feel comfortable with. Ideally, your providers should ask about your worries. Failing that, you want someone who won’t dismiss the “what ifs” you bring up and will spend some time exploring why you’re feeling them and what to know about them.
“That can be hard for us providers,” Roosevelt told me. “We see so much birth, and the things women are afraid of get tedious to address. But most women have just one, two, or three births in a lifetime. It’s an incredibly unique, special, and intimate time for a family.”
Many women in the UM study reported having switched providers (often from doctors to midwives) because they felt the previous relationship was making their anxiety worse instead of better.
Find ways to get comfortable with your birth setting. You can’t change a big system. But you can find out ahead of time about practices that relate to certain worries, like a hospital’s C-section rate or whether anesthesia is available 24 hours a day. If you’re worried that your own doctor might not be at your delivery, find out how staff rotate or look for ways to work within that system, like having a doula who will stay at your side.
“When I was pregnant I wasn’t afraid of the birth process, but I was really fearful of the hospital system and so chose to have a home birth with one of my best friends as my midwife,” Roosevelt says. (She’s the mom of a 15-year-old and, via foster care, a 1-year-old.)
“Childbirth fear is a very rational response to a very broken system,” Roosevelt told me. “It may be that women who feel these fears are more in tune with that culture of birth in the U.S. than women who don’t have that fear.”
Collect reliable info about birth—all through pregnancy. Knowledge really is power when it comes to what your own body is about to do for you. Find out what to expect in labor—from your provider, from trustworthy (key word!) readings and videos, from taking a childbirth class.
As you learn, pay attention to which things stick in your craw or make you feel nervous. Those are good signs that you should dig deeper and bring those things up with your provider.
Many pregnant women worry about their water breaking in public, for example, but in reality that happens to only about 1 in 10 to 15 women before labor and is likely to be more a private trickle than a public gush. Another fret: not getting to the hospital on time. But most first labors proceed far more slowly than any rush-hour traffic.
Aim for a spirit of collaboration rather than micromanagement. Logic might dictate that you can meticulously plan for every spooky what-if. But nobody’s going to stop and consult a super-detailed birthing plan in the heat of the moment (not even you). Better for your confidence to agree on a short list of philosophies and goals with your provider in advance.
Confide in others you trust beyond your provider. Clueless coworkers and baby-shower guests who overshare their what-went-wrong tales are not your friends right now. “War stories of birth feed into the fear of the unknown,” Roosevelt says. Find people who will LISTEN, not frighten: From your partner to your best friend to your therapist, you want a team to whom you can say anything (including “Enough with the horror stories!”).
Goal: Not fearlessness but confidence (and a baby!)
I can sheepishly admit that my own anxiety about epidurals and needles dogged me during all four of my pregnancies. In the end, I didn’t need one. But looking back on those experiences through the lens of this new research, I can see that all the talking, trusting, learning, and collaborating I did over my fears did this for me: It set the stage for a great birth experience—defined not as one without needles in my back or with them, but as one where I felt confident that everyone had my back.
That’s where fears dissolve into encouragement, confidence—and joy.