COLUMBUS, Ohio - A pregnant woman's fears of childbirth may play a role in how she will handle labor and delivery, a new study suggests.
A researcher found that among first-time mothers, less confident women had a greater fear of labor and birth than did women who scored high on confidence and self-esteem tests. Women who reported low confidence were so anxious about the event that they often felt incapable of using relaxation and breathing techniques that would make labor more bearable.
"Most women fear childbirth to some extent," said Nancy Lowe, author of the study and an associate professor of nursing at Ohio State. "Fear of the unknown is normal, and a little anxiety may help women mentally prepare for the event. But when a woman has high fear and low self-confidence, she starts to doubt her ability to give birth."
The research appears in a recent issue of the Journal of Psychosomatic Obstetrics and Gynecology.
Lowe evaluated 280 women during the third trimester of their first pregnancy. All women were enrolled in childbirth education classes in central Ohio. Each woman answered a series of questionnaires measuring her overall self-confidence and self-esteem. Each subject also answered a specially designed questionnaire that measured her beliefs and attitudes toward labor and delivery.
Lowe found that a woman's beliefs about the value of certain behaviors to help women cope with labor and birth had no relationship to her own fear of childbirth. In other words, while a woman may believe that relaxation would reduce pain during labor, she may feel incapable of relaxing her body, Lowe said. But the greater her confidence in her ability to use behaviors to cope with her own birth experience, the lower her fear.
Lowe wanted a better idea of what made some women more fearful about birth than other women. She separated the women with the highest and lowest test scores into two groups - high fear (52 women) and low fear (49 women) - to tease out the effect of self-confidence on labor and birth.
Women in the high-fear group tended to have lower self-esteem and were more likely to feel that other people - such as doctors and nurses - were in control of their health. Also, a pain-free labor was significantly more important and medication-free labor was much less important to these women. Their most common fears included losing control of their own behavior during delivery, the birth itself and the hospital environment.
As expected, women in the low-fear group had higher self-esteem and were much more confident of their ability to cope with labor and childbirth.
In a previous series of studies, Lowe found that a woman's confidence in her ability to cope with labor was key in explaining the individual variation in the pain of labor and birth.
"A woman may develop a sense of whether or not she can cope with birth by exposure to images and stories of birth," Lowe said. "Also, women with poor self-esteem don't have the same confidence in their inner resources and also have less well-developed coping mechanisms."
But pregnant women who don't relish giving birth can seek help throughout their pregnancy, Lowe said.
"Some women may benefit from counseling," she said. "Helping a woman increase her confidence may help to decrease her fears of childbirth.
"Also, the woman's health care provider should identify the anxiety early in the pregnancy and help a woman cope."
Part of the problem with negative attitudes toward labor and childbirth is that Western medicine tends to reinforce these beliefs, Lowe said.
"Western women are bombarded with messages that undermine their beliefs in the ability of their bodies to give birth successfully, as well as their beliefs in their personal ability to exercise control over their birth experience," she said.