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ORIGINAL
For some women a fear of childbirth can overshadow their whole pregnancy. Many of
these women will have experienced a previous negative or even traumatic birth which has
triggered or exacerbated the fear (Saisto et al 1999, Rouhe et al 2009, Strksen et al 2012).
In a primigravid population this is not the case and understanding the roots of the fear
acquisition is both interesting and challenging. As health care professionals it is important
that we seek to understand and address ways of reducing fear and find ways of supporting
women to feel confident in their ability to navigate the journey to motherhood.
This article outlines the role played by the cultural framing of birth and how it impacts on
the beliefs and fears of primigravid women. Maternal characteristics and personality traits
are also explored and how as health care professionals we can support primigravid women
who present with a primary fear of childbirth.
Key words: Fear, anxiety, primigravida, childbirth, self-efficacy, caesarean section
Introduction
It is generally accepted that fear of childbirth affects
about 20% of women and that 610% of women
experience a severe fear of childbirth (Saisto &
Halmesmaki 2003). Studies suggest that it is more
common amongst nulliparous women than parous
women (Zar et al 2001, Rouhe et al 2009).
There is considerable evidence linking a previous
negative or traumatic birth experience with an
increased fear in subsequent pregnancies (Saisto et al
1999, Rouhe et al 2009, Strksen et al 2012,). The
presence of fear in this group seems logical, they have
had exposure to an event that has caused emotional
trauma and possibly physical trauma. This can be
linked to tangible events such as medical problems
and unexpected complications in labour (Areskog et
al 1982, Rouhe et al 2009, Strksen et al 2012). The
fact that women encounter obstetric problems is not
however predictive of fear in subsequent pregnancies
in Strksen et als (2012) study, 80% of women
who experienced obstetric complications did not
view their birth as negative and did not develop a
fear of childbirth. This leads us to consider the more
subjective elements, including the attitudes of the
staff delivering care and the perceived level of support
in labour, both of which can have a huge impact on
how a woman views her birth experience and both
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Conclusion
Women with a primary fear of childbirth can present
with a complex picture which IS unique to each
woman. If left untreated high levels of anxiety and
fear during pregnancy can negatively affect both
mother and baby. Understanding why primigravid
women are fearful and how best to support them is
a challenging but important part of antenatal care.
Health care professionals need to work together
to support these women to have a positive birth
experience.
Alison Brodrick, consultant midwife, Sheffield Teaching
Hospitals NHS Foundation Trust.
References
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