The COVID-19 pandemic has exacerbated fear of childbirth among pregnant women in the United States, according to a new Dartmouth study.
The researchers were particularly interested in understanding, from the US context, the factors that predict fear of childbirth and how the pandemic affected this fear and birth outcomes. The results are published in Evolution, medicine and public health.
Our results showed very high rates of fear of childbirth in our sample. Since there is no pre-pandemic US data, we cannot compare our data in this context but we do know that the rates are very high compared to other international studies on this topic that were published before the pandemic. “
Zaneta Thayer ’08, first author, associate professor of anthropology at Dartmouth
The research team relied on data from the COVID-19 and Reproductive Effects Study, an online survey that examined how COVID-19 affected pregnant women’s well-being and healthcare experiences. From April 2020 to February 2021, they obtained prenatal data from 1,775 female participants and postpartum data from 1,110 female participants one month after their due date, which included information about childbirth experiences and birth outcomes. The majority of the participants, 87%, self-identified as white and 54% of the participants were from families earning more than $100,000 per year.
The results showed that 62% of the participants had high levels of fear during childbirth, also known as tokophobia.
Black mothers have a 90% greater chance of developing a fear of childbirth than white mothers, which, the researchers explain, may reflect experiences of racism during their obstetric care.
Individuals in the lowest household income bracket of $50,000 per year or less who do not have a college degree also have high levels of fear of childbirth.
In addition, high-risk pregnancies, prenatal depression, and a pre-existing health condition were also associated with fear of childbirth.
Individuals with a fear of childbirth have a 91% greater chance of having a premature birth that is less than 37 weeks gestation. However, low birth weight was not significantly associated with fear of childbirth.
Regarding concerns about COVID-19, participants indicated that they were particularly concerned that they would not be able to get the support they wanted during labor and that if they fell ill with COVID-19 their baby would be taken away from them. They were also concerned that if they contracted COVID-19 during pregnancy, they would give it to their child.
“One of the drivers behind this research is that the environment in which people are born has changed over the past 100 years,” Thayer says. “At the turn of the century, most births took place at home and families often had multiple children, so people knew about childbirth much more, but now, almost all births in the United States take place in a hospital.”
“Nowadays, for many women, the first time they experience childbirth is when they give birth themselves, which can contribute to stress and anxiety,” Thayer says.
In the 1980s, researchers in Sweden and Finland began studying fear of childbirth, which includes fears of pregnant women about coping with pain, the risk of harm or death to themselves or their baby, and fear of the birthing process. As a result of the research, pregnant women in Finland are screened for fear of childbirth as part of standard maternal care.
The Dartmouth Study is one of the first published studies measuring tokophobia in the United States
“Our findings show that pregnant women experience stress in the birthing environment in the United States and that they are not getting the emotional support that they need,” Thayer says. “The COVID-19 pandemic has exacerbated those concerns,” he added.
“Our work shows that there is a need to include fear of childbirth as part of maternal health care,” Thayer says. “Previous research has shown that treating fear of childbirth can reduce it and improve confidence in one’s ability to give birth.”
Thayer said she and her fellow researchers also recommend including and measuring fear of childbirth in studies of future maternal health to help inform care and treatment strategies.
Dartmouth principal anthropologist Ale Geisel-Zamora ’23, and former postdoctoral fellows Glorieuse Uwizeye, now at the University of Western Ontario, and Teresa Geldner, now at Washington University in St. Louis, also served as co-authors of the study.
Thayer, Z.M., et al. (2023). Fear of childbirth in the United States of America during the COVID-19 pandemic: key indicators and associated birth outcomes. Evolution, medicine and public health. doi.org/10.1093/emph/eoad006.