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Fear of Childbirth Causing Increased C-Sections

WebMD Health News

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 reliably."

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."

Vital Information:

  • 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 extraction.
  • Researchers suggest that counseling and education, especially following C-section, may help reduce the number of C-section requests for future deliveries.
  • Better pain control during labor may be another way to help women feel more comfortable with vaginal delivery.

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