I really feel the need to comment on a widely publicised Norwegian study ( published June 27 in BJOG: An International Journal of Obstetrics and Gynaecology) which has found that the fear of childbirth can prolong labour by “about an hour and a half longer in labour than other women (about eight hours compared to six and a half hours)”.
When I first read a report on the study I thought “Great, this is a really important message to get out.”
But as I have read more and more reports I have become increasingly alarmed.
Firstly, the reports all seem to suggest that this is a new, amazing finding. Are doctors and obstetricians really only just becoming aware of how fear impacts on labour?
This is something women centred birthing attendants have always understood. And we now have the science to understand how it happens. Fear releases adrenalin, as in the fight or flight response, and adrenalin can interfere with the flow of oxytocin. Oxytocin is the hormone released by the woman to cause the rhythmic uterine contractions of labour. So it shouldn’t surprise anyone that, according to the study co-author Samantha Salvesen Adams of Akershus University Hospital in Oslo …” high levels of stress hormones may weaken uterine [contractions].”
This following statement also alarmed me …”Fear of childbirth seems to be an increasingly important issue in obstetric care,” said Adams, reported CBS News. “Our finding of longer duration of labor in women who fear childbirth is a new piece in the puzzle within this intersection between psychology and obstetrics.”
Did the medical profession really not understand the this link before?
Another cause for concern about the way this article is being promoted is that it highlights the medical professions obsession with timing labour and birth. How can they possibly know how long any individual woman’s labour was going to be? They are using averages, and the introduction of averages along with “the Active Management of Labour” in the 1950’s, has lead to no end of problems for birthing women.
Finally, and most frighteningly, Dr Adams is quoted as saying …
“We found a link between fear of childbirth and longer duration of labor,” Adams said. “Generally, longer labor duration increases the risk of instrumental vaginal delivery and emergency caesarean section. However, 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.”
I hadn’t even thought about that one. Surely obstetricians wouldn’t use this study to justify more Caesarean sections? Or would they?
So what did I initially like about the highlighting of the fact that fear can slow down labour?
Well it’s true. As I said before fear interferes with the flow of the “love hormone” oxytocin. A woman needs to feel safe during childbirth in order to labour effectively. But understanding this should not be alarming, it should help a woman and her partner think about, plan around and minimise things that might cause fear.
A good childbirth education class will discuss all these issues and help reduce fear around childbirth because the biggest fear of all is probably the fear of the unknown.
Adams, S., Eberhard-Gran, M. and Eskild, A. (2012), Fear of childbirth and duration of labour: a study of 2206 women with intended vaginal delivery. BJOG: An International Journal of Obstetrics & Gynaecology, 119: 1238–1246. doi:10.1111/j.1471-0528.2012.03433.x