Feeding the Fear....

Fear.

Cold. Palpable. Irrational.

Fear.

It's the stuff that little girls are raised on when it comes to childbirth. All the media images, all the horror stories, all their first experiences lead to one end.

Fear.

The first question it brings to my mind is, "Why? Why do we as a culture embrace that childbirth must be a scary, frightening event that we are lucky to survive?".

In my reality, this perception couldn't be further from the truth. Childbirth, even natural childbirth, can be a peaceful, gentle, safe and empowering event. I have experienced it twice myself and know countless other mothers who can attest to the same fact. Sadly, in this country, we are now in the minority. But was it always this way? Were women always conditioned to fear birth?

No. The change occurred as women lost their culture of birthing, as the tradition of women caring for women and supporting each other through birth began to diminish, so did their confidence and trust in birth. As birth moved into hospitals, the wisdom of women was lost. The culture of confidence and midwifery care was lost to fear and medical management of birth as a disease - one to be treated and feared rather than welcomed and trusted.

As the fear continues to spiral unchecked, for many women, this irrational phobia has now led to an increase in maternal request c-sections. Women once deemed "too posh to push" are actually "scared witless" - they have become so conditioned to fear birth that to escape it they select a major abdominal surgery, oblivious of the risks, six weeks of recovery, and ramifications on their future fertility, all hoping to evade their fear of childbirth.

The following is a recent study that examines the role of maternal fear in elective c-section requests:

I Wiklund, G Edman, E-L Ryding, E Andolf (2008) Expectation and experiences of childbirth in primiparae with caesarean section BJOG: An International Journal of Obstetrics and Gynaecology 115 (3), 324–331.

Objective
The aim of this study was to examine the expectations and experiences in women undergoing a caesarean section on maternal request and compare these with women undergoing caesarean section with breech presentation as the indication and women who intended to have vaginal delivery acting as a control group. A second aim was to study whether assisted delivery and emergency caesarean section in the control group affected the birth experience.


Design
A prospective group-comparison cohort study.

Setting
Danderyd Hospital, Stockholm, Sweden.

Sample
First-time mothers (n = 496) were recruited to the study in week 37–39 of gestation and follow up was carried out 3 months after delivery. Comparisons were made between ‘caesarean section on maternal request’, ‘caesarean section due to breech presentation’ and ‘controls planning a vaginal delivery’.

Methods
The instrument used was the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ).


Main outcome measures
Expectations prior to delivery and experiences at 3 months after birth.


Results
Mothers requesting a caesarean section had more negative expectations of a vaginal delivery (P < 0.001) and 43.4% in this group showed a clinically significant fear of delivery. Mothers in the two groups expecting a vaginal delivery, but having an emergency caesarean section or an assisted vaginal delivery had more negative experiences of childbirth (P < 0.001).

Conclusions
Women requesting caesarean section did not always suffer from clinically significant fear of childbirth. The finding that women subjected to complicated deliveries had a negative birth experience emphasises the importance of postnatal support.

43.4% of women requesting c-sections were fearful of birth. The conclusions also showed that a previous negative birth experience from overly medically-managed birth also contributed to their later fears.

We reap what we sow and fear's being sown in spades. It's everywhere, from the mother next door who tells you her birth horror experience to "A Birth Story" on television, to mainstream media coverage and even your friendly neigbourhood OB who tells you "the baby will die if you want a VBAC".

When, oh when, will we start supporting women in birth rather than feeding the fear?