Childbirth Fears and Long Labors

Fear of childbirth linked to longer labors and higher risk of C section

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) The discovery that you're carrying a child inside you brings along a range of emotions. For about 5 to 20 percent of women, those emotions include a fear of childbirth.

A recent study has found an unfortunate irony: being afraid of childbirth is correlated with a longer time spent in labor.

"Talk to your OB/GYN or midwife about ways to overcome your fears."

A study led by Samantha S. Adams of the Health Services Research Centre and Institute of Clinical Medicine at Norway's Akershus University Hospital in Oslo aimed to find out whether any link existed between women's fear of childbirth and the time they spent in labor.

During 2008 to 2010, Adams and colleagues followed 2,206 women who were pregnant with a single child throughout 32 weeks of their pregnancies. About half the women were first-time mothers.

At the start of the study, each woman answered a standard clinical questionnaire that was used to assess their level of fear regarding childbirth, and 165 (7.5 percent) of the women had high enough scores to be identified as having fear of giving birth.

The researchers gathered data on how long each woman spent in labor, whether she used an epidural for pain relief and whether she had a vaginal delivery or a cesarean section.

Labor was counted from the time the women achieved 3 to 4 cm in dilation of their cervix, accompanied by three contractions per 10 minutes that lasted at least a minute.

The average length of labor for the first-time mothers was 8.2 hours; it was 4.9 hours for the mothers who already had children.

On average, the women who were fearful of giving birth had labors lasting 1 hour and 32 minutes longer than the other women in the study. The fearful women's labors lasted an average 8 hours, compared to an average 6 hours and 28 minutes for the women who were not afraid of childbirth.

This extra time was reduced to 47 minutes, on average, after the researchers took into account a wide range of factors, including the mother's age and the babies' weight.

The other factors considered included whether the women had had children before, whether they had received counseling about their fears, whether they used an epidural, whether their labor had been induced or supplemented and whether they required an emergency C section or an instrument during delivery (such as forceps).

Also among the findings were that women with a fear of childbirth were more likely to end up delivering their babies via an emergency C section or with the use of an instrument.

A total of 6.8 percent of the women without fear required emergency C sections compared to 10.9 percent of the fearful women. Likewise, 10.6 percent of the women without fear required instruments during vaginal delivery compared to 17 percent of the fearful women.

Since a longer labor is associated with a higher risk of needing a C section or another obstetric intervention, the longer overall average labor could have at least partly accounted for the higher rate of C sections and instrument use among the women with a fear of childbirth.

Only a quarter (26 percent) of the women fearing childbirth gave birth without any interventions whereas 44 percent of the non-fearful women did.

Both groups of women, however, had high rates of vaginal delivery as they had planned: 89 percent of the fearful women, and 93 percent of the non-fearful women.

The findings of the study were not surprising to Camran Nezhat, MD, a professor of surgery obstetrics and gynecology at Stanford University Medical Center who was not associated with this study. Dr. Nezhat said that there are a number of studies supporting the fact that anxious patients have poorer outcomes in surgery and other interventions.

“In my experience, those patients who are really worried or extremely anxious don’t do as well," Dr. Nezhat told dailyRx. "In fact, their outcomes can be worse if you compare two women with the exact same procedure.  Childbirth is no exception.”

Dr. Nezhat said he will cancel a surgery if a patient arrives feeling exceptionally nervous because of the possible poorer outcomes and complications associated with high anxiety, but of course, with childbirth, "canceling" the procedure isn't an option, so he recommends several ways to help calm a woman's fears.

"One or two sessions of yoga or meditation or acupuncture works very, very well for my patients," Dr. Nezhat said. "If you are able to sit down and quietly meditate about 5-10 minutes a day, I have seen significantly better outcomes."

He said it also helps when a woman receives support, both from her caregiver and from her family.

"Her physician should acknowledge that he has seen this before and that it's very common and very normal to be anxious," he said. "A little anxiousness is okay. The family is a good source of support, and if the family is very supportive, the patient usually does very well. Sometimes all you need to do is talk to them."

Dr. Nezhat also pointed out that, once again, knowledge is power.

"Patients anticipate a lot of joy with childbirth, but the pain of the labor itself is bad," he said. "If a patient is educated going into the process, anxiety normally goes away in any kind of intervention, childbirth or any other surgery."

The authors of the study cautioned that a woman's fear of delivering her baby does not mean she needs to abandon plans of a vaginal delivery.

"It is important to note that a large proportion of women with a fear of childbirth successfully had a vaginal delivery and therefore elective cesarean delivery should not be routinely recommended," Adams said.

The study was published June 27 in the journal BJOG: An International Journal of Obstetrics and Gynecology. The research was funded by the Norwegian Research Council. The authors declared no conflicts of interest.

Reviewed by: 
Review Date: 
July 10, 2012
Last Updated:
December 30, 2012