When Zaneta Thayer, an anthropologist at Dartmouth College,
asks students in her evolution class what words come to mind when they think of
childbirth, almost all of them are negative: pain, screaming, blood, and fear.
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Then she asks if any of the students have ever seen a woman
give birth. Most have not.
Curious about how cultural attitudes and expectations affect
the physical experience of childbirth and its outcomes, Thayer began a study to
assess the prevalence of tokophobia, the medical term for a pathological fear
of childbirth.
Although tokophobia has been well-studied in Scandinavian
countries, some of which screen pregnant women and offer treatment for it,
little research has been done in the US. Thayer’s online survey of nearly 1,800
American women found that in the early days of the pandemic, tokophobia may
have affected the majority of American women: 62 percent of pregnant
respondents reported high levels of fear and worry about childbirth.
The results were published last month in the journal
Evolution, Medicine, and Public Health.
Other scientists who study childbirth said the levels of
fear in the US were higher than those reported in Europe and Australia, which
are lower than 20 percent. But they noted that birthing conditions in the US
are different and that pandemic circumstances may have exacerbated fears.
Some level of apprehension about childbirth is universal. It
may be an adaptive behavior favored by evolution that prompts women to seek out
assistance and emotional support during labor, said Karen Rosenberg, professor
of anthropology at University of Delaware.
“Other animals may give birth in a social context, but
humans are the only primates that actively seek and routinely seek active
assistance at birth,” said Wenda Trevathan, a senior scholar at the School for
Advanced Research in Santa Fe, New Mexico, an anthropology think tank.
Extreme pathological fear may be maladaptive, however,
causing some women to have unnecessary cesarean sections or to refrain from
becoming pregnant.
The new study has limitations. The prenatal and postpartum
data were collected during the first 10 months of the pandemic, when the health
care system was under extreme duress. The sample was not nationally representative,
consisting of a disproportionate percentage of white and higher-income women.
Half of the women had never given birth, and more than
one-third had experienced high-risk pregnancies.
More than 80% of the women said that because of the pandemic,
they were worried that they would not have the support person they wanted in
the hospital with them while in labor, that their baby might be taken away if
they were diagnosed with COVID or that they might infect their baby if they had
the virus.
Black mothers, who face almost three times the risk of dying
from pregnancy-related complications, were almost twice as likely to have a
strong fear of childbirth as white mothers.
“Black women are more likely to have complications or die in
childbirth,” one pregnant woman said in her response, adding that her concern
was heightened because she was not assured she would have a family member or
advocate in the hospital with her because of COVID. “Who’s going to speak up
for me?”
Women with tokophobia were almost twice as likely to go on
to have a preterm birth, or a baby born before 37 weeks of gestation, the study
found. Preterm babies are more likely to have health problems and are at higher
risk for disability and death, often spending time in neonatal intensive care.
The connection does not prove a causal relationship between
fear and preterm birth. But the risk of preterm birth among women with high
levels of fear and worry remained high even after adjustments were made for
other factors, such as cesarean sections.
The study also found links between fear and higher rates of
postpartum depression and the use of formula to supplement breastfeeding. It
did not find an association between tokophobia and a higher rate of cesarean
sections or low birth weight among newborns.
Thayer said that fear of childbirth might be “an
underappreciated contributor to health inequity.”
“Individuals who fear unfair treatment and discrimination in
obstetrical settings likely have greater fear of childbirth, which could
increase complications across the perinatal period,” she said.
In the US, Black women experience more preterm births than any
other race or ethnic group; the rate is about 50 percent higher than those of
white women. About 14 percent of Black infants are born preterm, compared with
slightly more than 9 percent of white and Hispanic infants.
Earlier studies have linked preterm birth to psychosocial
stress, but this study is the first to find an association with tokophobia,
Thayer said.
Fear of childbirth was higher among all socially
disadvantaged women, including lower-income women and those with less
education, she found. Women who were single, those receiving care from an
obstetrician and those having their first child were also more likely to be
more fearful.
Women with high-risk pregnancies and those suffering from
prenatal depression were also more likely to fear childbirth, Thayer found.
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