Study: Creating and refining tools to assess for childbirth fear

A few months ago, we published an article featuring an interview with Dr. Katherin Stoll regarding her research about how the fear of childbirth in women — especially concerning irreparable body damage and pain tolerance levels — can lead to them requesting for c-sections during delivery, which can then lead to unnecessary complications.

Both Stoll and her research partner Dr. Nichole Fairbrother have invested immense amounts of time and energy in their perusal for this information. After their initial research was published, The Ubyssey sat down with Stoll to reflect on the primary research, and to find out their next steps.

Identifying those most in need

Stoll is a research associate at the department of midwifery in UBC, and she has been researching the attitudes of young people towards birth for the past 10 years.

Stoll and Fairbrother’s primary research surveyed young women from across eight high income countries (all OECD countries) and proposed a question to them: when they were pregnant and about to deliver, would they choose a natural delivery or non-medically required c-section?

The results indicated that about 10 per cent of their total surveyed population would opt for a medically unnecessary c-section.

Stoll’s research has always been focused within the midwifery realm, informed particularly by her background in psychology. Fairbrother is a prenatal psychologist, so the two collaborators have mutual goals to enhance the maternal and psychological aspects of childbirth, which is what fueled their project.

The goal of their primary research, as Fairbrother stated in a CBC interview, was to begin developing an effective screening tool for childbirth fear in order to distinguish between the more general fear of childbirth — which most women experience in their pregnancy at some point or another and which is relatively easily alleviated — versus one that calls for clinical attention.

Following the insight and data that they gained from their research, Stoll and Fairbrother have designed a new study, which surveys pregnant women in Canada — about 500, most of which are from BC — regarding their fears of childbirth. The assessment takes into consideration “9 dimensions of fear,” developed by Fairbrother, which include “fear of embarrassment, pain, and harm to the baby.”

The second aspect of the study features the surveyed women being interviewed by a psychologist. The goal is to create a clinical cutoff range, such as a survey score of 75 per cent or 50 per cent, which will suggest a clinical consultation for the patient focusing on interventions, therapy or any other additional support.

Of course, women below the cutoff range are welcome to request the service of additional facilities, but ideally, the clinical cutoff survey will allow specific phobias to be highlighted.

Diversity in study design

Stoll elaborated on how the specific countries for the first survey were selected. The project was presented at conferences and from there on, communication took place with professionals and hosts from those eight countries who could gather the information required for the study.

Interestingly enough, although most of the countries were English speaking countries, there was quite a variation in results: Iceland had the lowest opting rate for c-section and Chile faced the highest levels.

Although the study was not conducted in Asia or Africa, Stoll mentioned that a Chinese graduate student is using their first study’s research questions to gain insight about the statistics of China. Stoll estimates the rate might be quite high due to cultural beliefs.

On the other hand, low income areas such as Africa, where the focus is more on mortality rates, might not have high rates for c-section selection. Stoll’s research is also being conducted in other nations, including Portugal and Italy, and she hopes that with more data, further accuracy within the statistics can be achieved, and more provisions to aid women can be created.

Childbirth education systems

Stoll also discussed her wish to be able to travel to Germany to observe and learn from their childbirth education system that takes place in grades three and four, led by a maternity care professional, featuring games and evaluations. Stoll notes the lack of education that takes place in Canadian schools, as it occurs mostly at higher age levels, at which point many stereotypes and misconceptions about childbirth have already developed, and are only solidified by videos of childbirth without any follow-up discussions, ultimately leaving the students more confused and concerned.

Stoll emphasizes the need for more rounded and accurate material regarding childbirth to be introduced at younger ages and then revisited in grades 10 and 11.

Earlier discussions will allow awareness about proper healthcare for childbirth to go up and media-fostered concerns of childbirth to be reduced. This will hopefully eradicate requests for c-sections in cases where they are not required.

Stoll ultimately stresses the need to recognize how important a proper education plan regarding childbirth issues would be, as it would significantly raise awareness about the reality of pregnancy, reduce qualms generated by media and facilitate further discussion regarding both physical and mental health.