Fear of Childbirth Causing Increased C-Sections
Dec. 1, 1999 (Atlanta) -- Fear of childbirth is leading more women to
request cesarean sections, according to a study in the November issue of the
journal Obstetrics and Gynecology. Doctors say that a woman's history of
emergency C-section or vacuum extraction is the primary cause of such fear.
The study was conducted in a university hospital and included 300 women
preparing for their second delivery, 100 of whom had undergone emergency
procedures during their first deliveries. Participants who requested a
C-section because of fear were compared with participants who reported no such
fear, using the medical records from their first delivery.
The two groups were similar in prenatal education attendance, presence of a
partner, start of pain management, use of additional pain control measures,
incidence of incisions made in the vaginal area to help deliver the baby, age
of the fetus at birth, and outcomes after delivery. The difference between the
groups was largely a function of complications.
Women who were fearful of delivery had significantly more emergency
C-sections and vacuum extractions during their first deliveries. Those that had
a successful vaginal delivery (using the vacuum extraction) had significantly
longer labor and incidence of complications such as placental retention (where
a part or the entire placenta is left in uterus after labor) and vaginal or
rectal tearing. Interviews revealed that 44% feared delivery as a whole, 19%
feared tearing, 15% feared pain, and 12% feared fetal distress.
The chief investigator, Terhi Saisto, MD, PhD, an obstetrician and
gynecologist with the Helsinki University Central Hospital in Finland, tells
WebMD that "women who experience an operative delivery [C-section] may
suffer from anxiety comparable to post-traumatic stress disorder. They should
seek the counsel of their doctor or midwife several months later to avoid fear
of delivery in the future. It's critical that caregivers emphasize that
subsequent children can be delivered vaginally."
Saisto says that such counseling and education may help reduce the
increasing number of women requesting cesarean sections due to fear.
"C-sections should be performed only when it's safer than vaginal delivery
for mother or baby. This is because the rates of morbidity and mortality are
several times higher. Fear of delivery is probably preventable through
education and improvement in the labor process."
Pain control is one aspect of labor management that can be improved, says
Saisto. "More liberal use of [a] patient-controlled epidural ... might help
because pain is subjective and staff are not always able to assess pain
But patient-controlled pain relief for labor pain has been found to have
limited utility, according to William Rayburn, MD, professor and chairman of
obstetrics and gynecology at the University of New Mexico in Albuquerque.
"Often the contractions are over by the time the controlled dose is
administered. It seems to frustrate patients more than anything else. The best
way to decrease requests for sections due to fear is to earn the patient's
trust and act accordingly."
- A fear of childbirth is causing more women to request cesarean section, and
the primary cause of that fear is a previous C-section or vacuum
- Researchers suggest that counseling and education, especially following
C-section, may help reduce the number of C-section requests for future
- Better pain control during labor may be another way to help women feel more
comfortable with vaginal delivery.