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Absolutely, Positively Delivers

Self-confident women have fewer childbirth fears

TUESDAY, May 22, 2001 (HealthDayNews) -- Women brimming with self-confidence seem better able to fend off fears of childbirth than women with low self-esteem, says a recent study.

"There's a certain amount of fear or anxiety about childbirth that's normal, natural and some say even healthy," says nurse-midwife Nancy K. Lowe, an associate professor of nursing at Ohio State University and author of the study. "It would be unrealistic not to experience it."

But American women seem to have more than their share of fear because of the "medicalization of childbirth," Lowe says.

"Because childbirth in the United States has been institutionalized into acute care hospitals, we have a particular style of birth that does not emphasize a woman's control. This doesn't suggest to them that you can trust your body to do this. In fact, we give them lots of messages that their body is very untrustworthy," she says.

Childbirth becomes a world of epidurals, fetal monitoring, Cæsarean sections and inducing of labor, and all that creates a fear of losing control, the No. 1 fear of first-time mothers, she says.

The issue of control affects later birth experiences, as well, says childbirth educator and doula Kristi Ridd-Young, of Alpine, Utah. Doulas are women trained to offer emotional support to mothers during childbirth. Ridd-Young is administrative director of Doulas of North America, the certifying body for doulas.

"Second-time parents' fear is more from the previous experience, reliving a negative experience that they now feel was unnecessary intervention," Ridd-Young says.

"A lot of times things that happen in the birth make [women] feel like they've lost control … , like someone else was in charge of their body in the process. But if they'd had a positive experience, and they felt like they had a lot of control in the decision-making process, fear is not nearly as intensive," she says.

To understand why some women fear birth more than others, Lowe analyzed information on 280 women during the third trimester of their first pregnancy. She focused on 52 women with the most fear and 49 others with the least fear.

The results show the most-fearful women had lower self-esteem and more concern that other people, specifically doctors and nurses, would have more control than they would during delivery.

The least-fearful women had higher self-esteem and more confidence that they'd be able to cope with labor and childbirth, says the study, which was reported late last year in the Journal of Psychosomatic Obstetrics and Gynecology.

Too much fear can spell trouble in the delivery room, says Lowe.

"There's some evidence in the research literature that, in a mother with excessive fear, there's a higher association of problems in labor because of the response of their bodies to the stress," Lowe says. "But probably a small minority of women have an unusual fear of childbirth."

Developing confidence starts with giving out more accurate information about labor and birth and helping women develop coping strategies for childbirth, Lowe says.

Ridd-Young says much of the information and images women have of childbirth stem from horror stories they've heard from friends and from the way births are portrayed in television and film, "with a lot of screaming and thrashing, which is not realistic."

Ridd-Young says she advises women in her childbirth classes to be totally accurate when describing their birth experiences. "If you know something happened in your birth that was unnecessary or that was the fault of the care provider or not enough support, then tell that part."

"It's not that your body couldn't do it. The real story is that you weren't allowed to move in labor, or whatever," she says.

Ridd-Young says couples need to develop labor coping skills, whether they be massage techniques, knowledge of acupressure points to relieve contractions or mental reframing of pain.

"If someone has not done that, then as contractions become more intense, and it becomes more painful, they'll fight the labor. But with coping skills, you can see them work with it, surrender to it, and the birth progresses," Ridd-Young says.

"We don't have a lot of respect for normal physiology in this country," she says.

"Normal, healthy mothers give birth to normal, healthy babies. That process has been meant to work, and has been working, for a very long time," Ridd-Young says.

What To Do

For more information about how to have a healthy pregnancy, go to the National Women's Health Information Center.

For more on the fears of pain during delivery, visit

For more about the role of doulas, check the Doulas of North America Web site.

Or, read previous HealthDay articles on pregnancy and childbirth.

To find out what clinical trials are being done on pregnancy and other reproductive conditions, check Veritas Medicine.

SOURCES: Interviews with Nancy K. Lowe, R.N., Ph.D., certified nurse-midwife, assistant professor of nursing, Ohio State University, Columbus; Kristi Ridd-Young, certified doula, administrative director, Doulas of North America, Alpine, Utah; December 2000 Journal of Psychosomatic Obstetrics and Gynecology
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