Therapy increases elective cesareans.

A recent study published in the British Journal of Obstetrics and Gynecology (B JOG) (1) explored the relationship between fear of childbirth, participation in therapy, and the childbirth.

The objective of the study was to explore the association between fear of childbirth and the cesarean section rate. The authors designed a prospective study that used postal questionnaires at 16 weeks gestation and two months postpartum to survey a group of 2,662 women from a number of antenatal clinics in Sweden who were recruited to participate in the study. The study compared women with fear of childbirth, indicated by "very negative" feelings when they thought about birth, to those in the reference group who did not report those feelings. The outcomes measured were elective and emergency cesarean sections and women's overall childbirth experience.

The results of the study reported that 97 women (3.6 percent) had very negative feelings and half of that group underwent therapy related to their fear. Additionally, 193 women (7.2 percent) who had initially reported no negative feelings about their pending birth experience did undergo counseling later in their pregnancy. The study found that in the group of women who underwent counseling, fear of childbirth was associated with a three to six times higher rate of elective cesarean delivery but not a higher rate of emergency cesarean section or of a negative birth experience.

The authors conclude that "at least 10 percent of women in Sweden suffer from fear of childbirth. Fear of childbirth in combination with counseling may increase the rate of elective cesarean sections, whereas fear without treatment may have a negative impact on the subsequent experience of childbirth." While the subject of elective cesarean section remains somewhat controversial and some medical experts believe that cesareans should only be performed when medically indicated, Waldenstrom says that the higher cesarean rate is justified because the counseling and the rate of cesarean section was associated with a more normal birth experience.

It turns out that Sweden is one of just a few countries that actually recognize fear of childbirth as a potentially serious pregnancy complication. Women are routinely referred to counseling with a midwife, psychologist or psychiatrist to address their fears.

The study found that 30 percent of women who received therapy for their fears of childbirth elected to have a cesarean, compared with 4 percent of women who expressed fear of childbirth but did not participate in any therapy.

The study also found that the women who had fear but no counseling had a higher rate of emergency cesarean section and a more negative overall view of their childbirth experience. Thirty percent of these women said that they had negative or very negative feelings about their births while 5 percent of women who received counseling felt that way.

The study did not indicate what kind of therapy was actually provided or how women were helped to deal with their fears of childbirth. It may come down to something as simple as letting the women know that they did not need to be afraid of childbirth because they did not need to experience it! This is purely speculation, but it seems to be a strong possibility, given the 30 percent elective cesarean rate among women receiving therapy.

The only real truth that can be taken from this study is that women tend to have a more positive birth experience when they receive more support and when their fears are heard, validated and addressed. It seems highly possible that if women are given space to express their fears and anxieties around the birth process, receive appropriate education and support that highlights the normal and safe aspects of birth as well as the woman's ability to work through the process, using a variety of pain management techniques, that women could look forward to a normal vaginal birth and a positive childbirth experience.

U Waldenstrom, I Hildingsson, EL Ryding; Antenatal fear of childbirth and its association with subsequent caesarean section and experience of childbirth; B JOG: An International Journal of Obstetrics & Gynaecology, June 2006, Volume 113, Issue 6.