Study: Fear of childbirth affects decision to opt for c-sections

If you enjoy watching soapy medical shows, you may have noticed that they tend to portray childbirth as an intense and painful ordeal. Rare complications, stressful scenarios and a whole lot of screaming don’t exactly paint the best picture of birth.

Pushing a human out of your body is scary enough before you add in the high-stakes Hollywood drama.

According to new research from UBC, the fear of pain and damage associated with childbirth may be pushing women towards unnecessary c-sections.

Dr. Kathrin Stoll studied young women and men from eight countries to find out how many preferred c-section in a healthy pregnancy and why. The 18-40 year old university students were polled via an online survey where they answered questions about preferences, attitudes and knowledge about birth.

The study controlled for anxiety, depression and stress. Analysis focused on women age 18-25 who were born in the survey country and did not study health sciences. There were 3,116 respondents, highlighting the need for a more representative sample in future studies.

Stoll found that one in ten women in the study opted for c-section. Preference for c-section was lowest in Iceland at 7.6 per cent, highest in Australia at 18.4 per cent and 14.7 per cent in Canada.

“Childbirth fear really was the driving factor [in the women’s preference for c-section], in particular fear of labour pain and fear of physical damage — worries about vaginal stretching, vaginal tearing, just body damage in general,” said Stoll.

“In the media they tend to dramatize pregnancy and childbirth; they over represent complications and they hardly ever show a normal birth.”

One in five women who preferred c-section believed it was safer than vaginal delivery. In reality, the procedure can result in increased risk for both mother and baby due to infection and other surgery-related complications.

The Society of Obstetricians and Gynaecologists of Canada recommends that c-sections be performed only if medically necessary. They believe that vaginal birth is the safest option in a healthy pregnancy.

The healthcare sector can impact women’s decision to pursue a c-section, said Stoll.

“In countries like Chile and Australia where you have the option of accessing a private hospital and private obstetricians, the c-section rate is much higher. As soon as there is a for-profit aspect in the healthcare system, the intervention rates go up, as there is a financial aspect … Because we only have public hospitals in Canada, that helps with keeping the rate down.”

According to a study of c-section births in British Columbia from 2004-2007, only two per cent were requested by the patient. Another study found that maternity care providers’ attitudes towards birth may affect their medical decision making.

For example, obstetricians were more likely than family physicians and midwives to believe that women had a right to request a c-section, even if it was medically unnecessary. In Canada, it is required that physicians provide a medical reason for a c-section.

However, efforts to change hospital policies and culture — including attitudes and beliefs — have been largely ineffective.

Stoll believes the biggest revelation of the study is that women who prefer c-section also self-report knowledge gaps when it comes to childbirth education. Those with an increased knowledge of childbirth were less likely to fear it and less likely to prefer c-section.

Filling those gaps is the best way to reduce fear of childbirth, according to Stoll.

“All of our interventions have been focused on pregnant people, and at that point it’s too late. We need to start with some quality education early on,” she said.

She advocates for an evidence based approach starting in primary school. “We need to create some educational workshops … that address some of [children’s] fears and allows them to talk about their concerns and worries.”

Stoll hopes to pursue future studies in Germany, where childbirth education begins in the primary school classroom with the help of trained midwives. She intends to translate the program into English and adapt it to the Canadian context.

“When they evaluated the program they found that young kids were less worried about childbirth afterwards,” she said. “I think if we had education — even a total of 10 to 15 hours during primary and secondary school — that would go a long way in making people less afraid of childbirth.”