The cesarean birth rate in the United States is at an all-time high. The cesarean section rate in California now stands at 32.9%, which is almost the same as the national average of 33%. According to a new study, one of the factors driving this increase is a fear of childbirth. Researchers at the University Hospital in Linkoping, Sweden compared the pregnancy outcomes of women with a fear of childbirth with those who were not. Their study suggested that the fear of childbirth can become a self-fulfilling prophecy, with cesarean section rates higher among those who dread giving birth. The researchers compared data on prenatal care and delivery method for 353 women who received psychological counseling for fear of childbirth with data for 579 women with no such fear. Of the fearful women, 16.5% had cesarean sections compared with 9.6% of the non-fearful women.
According to the researchers, possible reasons for fear of childbirth include concerns about pain, loss of self-control, harm to or loss of the child, pelvic floor injury, and incompetency of the medical staff. Studies have shown that women who fear childbirth are more likely to have had a previous child and are more likely to have had previous cesarean sections, forceps deliveries, and/or induced labor. Studies place the prevalence of fear of childbirth at about 10%.
The investigators offer three possible explanations for the difference in cesarean section rates: (1) The fact that induction of labor was more common among the fearful women could mean that this is a risk factor for a cesarean delivery; (2) Women who have already had a cesarean section are more likely to have another than women who have only delivered vaginally or are nulliparous (no previous deliveries); (3) The one best supported by a plausible biological mechanism, is the concept that increased anxiety is associated with increased plasma adrenalin, which can decrease the rate of uterine contractions, providing the rationale for surgical intervention. Although the study was comprised of a large number of women,, the authors note that it may have been limited by reliance on past records. They conclude that “fear of childbirth is a predisposing factor for emergency and elective cesarean section even after psychological counseling.”
Take Home Message:
If you have a strong fear of childbirth, inform your obstetrician and/or seek professional counseling—it might help.
Cesarean birth rate at an all-time high
Vaginal birth after cesarean––are you a candidate?
New ACOG guidelines to reduce pregnancy-related fatalities
Alarming new report: Pregnancy-related strokes on the increase
Cesarean birth rate on the rise in the U.S.