Women's experiences of intense fear related to childbirth investigated in a Swedish qualitative study
Introduction
Studies report that women's fear related to childbirth is multidimensional and detailed, concerned with pain, obstetric injuries, their own incapability, loss of control, insufficient support and loss of the baby's or their own life (Lowe, 2000; Melender, 2002a; Eriksson et al., 2006). In Western societies, it has been estimated that about 20% of women with low-risk pregnancies experience intense fear related to childbirth (Saisto and Halmesmäki, 2003). For some women, the fear is so severe that being pregnant becomes a less positive experience (Sjögren, 1998).
Besides the emotional distress, intense childbirth-related fear during pregnancy has been associated with more pain and anxiety during labour (Alehagen, 2000), a more prolonged childbirth and an increased risk for emergency caesarean section (Ryding et al., 1998; Johnson and Slade, 2003). Intense fear has also been cited as a reason for the growing number of women requesting an elective caesarean section (Wax et al., 2004). For these reasons, previous research points to the importance of antenatal strategies to identify women with intense fear related to childbirth.
Swedish antenatal care is midwifery-based and characterised by high compliance on the part of women and high continuity of caregivers (Hildingsson et al., 2002). During pregnancy, women make repeated visits to the antenatal clinic, and these visits could provide valuable opportunities to identify and support women with intense fear related to childbirth. As a complement to the antenatal consultations, many hospitals in Sweden have instituted ‘fear of childbirth teams’, which include experienced midwives and obstetricians supervised by a psychologist familiar with the field of obstetrics. The goal of these teams is to help pregnant women (and couples) to manage their fears and to prepare them for the best possible delivery (Ryding et al., 2003).
Although intense fear related to childbirth has become a focus of concern, the National Board of Health and Welfare in Sweden has so far not provided any recommendations for the antenatal-care programmes regarding early assessment and intervention. It is up to the individual midwife to include the topic of childbirth-related fear as part of their care. As a result, some women with intense fear may not be identified. It has also been reported that some women, for one reason or another, may either hide their fears or not wish to have counselling, making fear identification and intervention difficult (Ryding, 1993; Davis, 1996).
During the past decade, a number of clinical studies concerning women's fears related to childbirth have been conducted. In most of this research, standardised questionnaires or psychometric measurements were used for data collection, whereas information gathered from the women's point of view has been more random.
The aim of the present study was to investigate and describe what intense fear related to childbirth may imply for the women themselves. The focus was on how women experience, deal with and communicate their fears.
Section snippets
Methods
A qualitative design was chosen, as it is particularly suited to investigate complex phenomena or processes that are less understood (Lincoln and Guba, 1985).
Participants
The women were aged 24–41 years. All were born in Sweden and spoke Swedish. Six had given birth to one baby, whereas the others had two to five children. The women had grown up both in rural and urban areas and differed in educational level, ranging from basic schooling to university. Nine had sought or been offered expert counselling because of their fear, and five had delivered by elective caesarean section for the same reason. At the time of the interview, all women, except one, were married
Discussion
The overall purpose of the present study was to investigate and describe what intense fear related to childbirth may imply from the perspective of women themselves. Nevertheless, validity problems cannot be neglected, as qualitative research per se is about interpretation. The study was conducted by three researchers from different professions who all participated in the analysis. This approach may strengthen the conformability of the findings — not because of consensus or identical
Acknowledgement
Grants from Umeå Medical District, the County Council of Västerbotten, Sweden, and the national Vårdal Foundation for Health Care Sciences, Sweden funded this study. Our sincere thanks go to all the participating women.
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