birth fears

Why the pregnant psyche imagines the worst


During her pregnancy last year, Carrie Cramer was haunted by one fear. “I was thinking, ‘How is a 6-pound human going to get out? This is not an exit,’” says Cramer, 33, of Gaithersburg, Md. “I was not afraid of becoming a mother; I was afraid of how badly it was going to hurt.”

Many women suffer from a profound fear of childbirth at some point in their pregnancies, and for one simple reason: Anxiety flourishes in the absence of personal experience. How will I survive the pain? women may wonder. Will I spit profanities at my partner during labor? Will I humiliate myself? And, most important: Will the baby be OK?

Fear of the pain, the mess and the great unknown

For the first-time mother, the birth experience is the great unexplored territory, the mysterious biological rite of passage she must pass through before she will, with baby born and safely in arms, be christened mother.

Pregnant women have months to contemplate, prepare for and worry about childbirth, and for many, fear of pain takes center stage. External influences don’t necessarily help: Movies and television, for example, often portray the birthing mother as a screaming banshee — hardly a comforting or realistic image. But many first labors take hours, with many of those hours spent walking the hospital halls, napping and chewing on ice chips.

This fear of pain prompts many pregnant women to make an early and firm decision to rely on pain-relieving medication during labor. In fact, the percentage of women choosing epidurals or spinal injections during labor in large hospitals tripled from 22 to 66 percent between 1981 and 1997, says Joy Hawkins, M.D., who gathered these figures and is director of obstetric anesthesia at the University of Colorado School of Medicine.

Women are increasingly gaining control over their birth experience, according to Hawkins. “For some women, labor is like climbing a mountain,” she says. It is seen as a challenge taken on with a sense of adventure. Others imagine a humiliating, out-of-control experience. “We now can individualize the anesthesia a woman wants,” Hawkins adds. “She might say, ‘Give me enough to take the edge off’ or ‘I don’t want this.’ It’s a choice.”

Another reason for fear: “Our lifestyle doesn’t expose us to the birth of babies,” says Leslie Hartley Gise, M.D., a clinical professor of psychiatry at the John A. Burns School of Medicine at the University of Hawaii at Manoa in Honolulu.

Not knowing exactly when childbirth will occur can add to the anxiety. Tilda Richardson, 40, of Phoenix welcomed delivery by scheduled Cesarean section because she would know when the birth would occur and would also be able to avoid what she considered the messiness of labor.

For some women, fear of embarrassment can reach unbearable proportions as the due date nears. “I feared that my body would take control and I was not going to be able to stop it and this baby was going to have to come out,” says Cramer. This fear was compounded by friends’ tales of loss of bowel control on the delivery bed. Three days before she was scheduled to be induced (she had lupus and her amniotic fluid was low), Cramer began drinking only clear liquids and taking Metamucil and, finally, she asked for an enema.

Such practical solutions, as well as reading up on pain-management choices, requesting appropriate fetal tests and talking to other mothers, can ease the fear of childbirth.

Ultimately, women learn that it doesn’t matter so much how you get through labor, but that you do — and that there is a baby waiting for you at the end. “When I heard her cry and the pediatrician say she was perfect, I thought, ‘Oh, thank God,’” recalls Cramer.

“After all that, that is all I wanted to hear.”

Childbirth fears: some comforting words

Fear of losing control “It’s actually good to lose control,” says Jeanne Waldman, R.N., a Trenton, N.J., certified nurse-midwife. “Particularly in the first part of labor, I tell women to breathe and let go, to let labor take over so the body can do its best.”

Fear of pain “There is definitely pain with childbirth,” says Susan Catalanello, a Plains, Mont., mother of four, “but the beauty of this kind of pain, which is followed by such profound joy, is that it’s gone minutes after the birth.”

Fear of something going wrong in labor “If a woman gets early and complete prenatal care,” says Richard Schwarz, M.D., chairman of obstetrics and gynecology at New York Methodist Hospital in Brooklyn, “the chances of a negative outcome for herself or the baby are extremely small.”

Fear of peeing or pooping “Care providers are very sensitive to a woman who might find this degrading,” says Waldman, “and will clean her up right away. But most of the time the urge to get the baby out is so strong during delivery, women couldn’t care less if they’re pooping or peeing.”

Fear of the baby being deformed Remember that most babies are born healthy. The March of Dimes reports that of the nearly 4 million babies born each year, about 96 percent are born free of serious birth defects.