Ask an expert about fear of giving birth 

Fear of pregnancy and fear of childbirth are perfectly normal – every pregnant woman, even the most confident - has some degree of concern about what it will feel like, how she will manage, and what might happen. But for a minority of women, the worry is a lot stronger and becomes a phobia.

The condition, sometimes known as ‘tokophobia’, means fear of childbirth. One study estimates that one in every five women is affected to some extent by fear of childbirth, and six in every hundred are so scared of giving birth that it affects their pregnancy and birth choices. Some women avoid getting pregnant, or they opt for termination, or they feel very strongly that they want to have a caesarean section.

Our expert is Yana Richens, consultant midwife. Yana started her nursing career in 1979 and went on to pursue a career in midwifery. She is co-editor in chief of the British Journal of Midwifery, consultant editor of African Journal for Midwives and editorial board member of the Nursing Standard. Yana was awarded an OBE for services to nursing and midwifery in the Queens New Year’s Honours List.

Yana will be here to take your questions about anxiety during maternity and fear of giving birth. The conversation will focus on the findings of Yana’s PhD work which looked at some of the factors that influence fear of birth such as the media and television; family and friends; and fear of the unknown.

Questions may be submitted in advance of the web chat to: webmaster@uclh.nhs.uk

Below is a transcript of the web chat.


1:56 Yana: 
Hello my name is Yana, I am a consultant midwife at UCLH. Recently I completed my PhD examining Fear of Birth. Fear of pregnancy and fear of childbirth are perfectly normal – every pregnant woman, even the most confident - has some degree of concern about what it will feel like, how she will manage, and what might happen during the pregnancy and labour. But for a minority of women, the worry and anxiety is a lot stronger and can become a real issue which can affect her life.

I look forward to answering your questions over the next hour.
 
1:58 [Comment From Janice: ] 
I suffer from bad anxiety and I’m very scared of giving birth. I think it would just be easiest for everyone if I have an elective caesarean – is this the best idea?
 
2:03 Yana: 
Dear Janice, having an elective C/S is never an easy option and a very hard decision for you. An elective C/S is a major operation and not without its complications such as, heamorrhage, infection, delay in breast-feeding. For some women however the fear of birth is so overwhelming that the an elective C/S is the only option for them. You need to discuss this with your midwife and obstetrician to ensure that you are well supported in your decision. Also to make sure that you start to enjoy your pregnancy.
 
2:03 [Comment From Martha: ] 
Does perineal massage really help to prevent tearing and if so how long before birth should you do it?
 
2:11 Yana: 
Dear Martha, a Cochrane systematic review in 2013 which included 4 trials (2497) women showed that perineal massage, undertaken by the woman or her partner (for as little as once or twice a week from 35 weeks), reduced the likelihood of perineal trauma( mainly episiotomies) and ongoing perineal pain. The evidence suggested that it was more effective for women who had a baby before but less clear if it is a second baby. Hope this helps.
 
2:11 [Comment From Maureen: ] 
I have watched “One born every minute” – is every birth this terrifying or are they exaggerating for TV?
 
2:14 Yana: 
Good question, my PhD found that birth stories and the media contribute to why so many first time mothers have increased anxiety and fear during their pregnancy. If you think about it " terrifying stories" unfortunately make good television viewing.. If the programme only showed lovely normal births television ratings would fall. Most births are very special and not terrifying at all.
 
2:14 [Comment From Lydia: ] 
My pregnancy so far has been problem free. But now I am worried that something is going to happen when I go into labour. How likely is it that my labour will go as well as my pregnancy?
 
2:16 Yana: 
It is great to hear that you well, worrying about your labour is completely normal. The best thing you can do is prepare well for your labour so you know what to expect, antenatal classes are very good if you have had the opportunity to attend them. Another good idea is to write a birth plan and discuss this with your midwife. I wish you all the best :)
 
2:16 [Comment From Jeannie: ] 
I'm not looking forward to the future. I'm terrified of being responsible for someone else, of being a terrible mother, of not loving it. I'm terrified of being stuck inside a house with a screaming baby and feeling trapped and unable to escape. I feel sick all of the time. Should I see a professional?
 
2:21 Yana: 
Dear Jeannie, I am sorry to hear how you are feeling at the moment. Transition to parenthood can be a very scary event for most women and a certain amount of anxiety is normal. However from what you describe I would absolutely suggest that you do see someone who can help you. You can talk to your GP or midwife who will sign post you where to go for support and professional advice. It is so important for you to have a good antenatal period, please discuss this with your midwife. Take care
 
2:22 [Comment From Aline: ] 
When a woman suffering from severe primary tocophobia becomes pregnant, is she immediately considered to be a high-risk pregnancy by the physician/obstetrician or midwife?
 
2:28 Yana: 
Hello Aline, tocophobia is fortunately quite rare, and women who have primary tococphobia do benefit from input by a perinatal psychiatrist or psychologist. It is really important to establish the reasons for the extreme fear, also it is equally important that women feel supported in making the right choice for them.
 
2:28 [Comment From Nikki: ] 
My worst fear is that I have to be put under general anaesthetic and operated on because my baby is in distress. Does this happen often and if so why?
 
2:34 Yana: 
Dear Nikki, I can understand why this concerns you, this is an extremely rare event, and only undertaken in an emergency situation. During labour we know when your baby is in distress, this can be the baby telling us by having its bowels open (passing meconium) this changes the colour of your waters. Or if your " waters have not gone" your baby's heart rate may change during labour. This change alerts the midwife and doctors looking after you. So to answer your question we generally have warning signs before.
 
2:35 [Comment From Melissa: ] 
Why can’t you get an epidural from when you start getting contractions? My first child took 27 hours before I got any pain relief (Not counting paracetamol).
 
2:40 Yana: 
Hello Melissa, sorry to hear that you had such a long labour the first time. The reason why we are unable to offer an epidural before you have contractions is that we need to ensure that you are in established labour. Although it is also common for women who are having an induction of labour to have an epidural, the reason for this is because the "drip" syntocinon which is used to stimulate the uterus to contract is very painful. Hope this helps
 
2:41 [Comment From Sheena: ] 
Are you aware of hypnobirthing helping to reduce fear & allow a more natural birth? Do you recommend it?
 
2:45 Yana: 
Dear Sheena, I would absolutely recommend hypnobirthing, women I have spoken to who have used it have had really good experiences. During my PhD I met several women who used it to help them cope with their fears and anxieties. One women had a phobia of needles and used hypnobirthing to cope with having her blood taken, with great effect.
 
2:45 [Comment From Uma: ] 
I am really scared that the labour is going to take so long that I get too tired to push, risking both mine and my baby's health. How long is the average labour and what can I do to prepare?
 
2:53 Yana: 
Dear Uma, please don't be scared, it is a really good idea if you can attend antenatal classes and prepare both mentally and physically for the birth of your baby. By that I mean eat sensibly and take moderate excersise; eg walking and swimming. Ideally the best thing you can do in labour is to stay as active as possible. You will read and hear very different accounts on the length of labour, the best advice is to stay at home for long as you can as we know that that is the best place for mums to be. If your waters break or if you have a change in your baby's movements you must call your hospital and go in and be monitored. It is really important.
 
2:53 [Comment From Tanya: ] 
What worries me...Retained placenta. Is it normal for the placenta delivery to take as long as giving birth to a baby?
 
2:58 Yana: 
Dear Tanya, the delivery of the placenta is referred to as the third stage of labour. The time it takes is influenced on whether the "3rd stage of labour" is actively managed or not. The midwife will discuss this with you.. Active management is where you are given an injection " Oxytocic" as your baby is born. Some women prefer not to have this and the placenta can take longer to be delivered. If you are concerned about this it maybe a good idea for you to discuss this with your midwife and include this in your birth plan. Hope this helps
 
2:59 [Comment From anon: ] 
I am really concerned about bad tearing - can anything be done to minimise the risk?
 
3:01 Yana: 
Perineal tearing is a common concern of most women, as the Cochrane review of studies highlighted perineal massage in the last trimester of pregnancy can reduce perineal tearing during labour.
 
3:02 Yana: 
Thank you everyone for taking part in the webchat it was a pleasure to talk to you all. Please do talk to your midwife or doctor if you have any concerns. Best wishes to all of you Yana.

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