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, fear.
Then she asks if any of the students have ever seen a woman give birth. Most don’t.
Curious about how cultural attitudes and expectations influence the physical experience of childbirth and its outcomes, Dr. Thayer conducted a study to assess the prevalence of tokophobia, the medical term for a pathological fear of childbirth.
While tokophobia has been well studied in Scandinavian countries, some of which screen pregnant women and offer treatment for it, little research has been done on it in the United States. From the online research of Dr. Thayer among nearly 1,800 American women found that tokophobia may have affected the majority of American women in the early days of the pandemic: 62 percent of pregnant respondents reported high levels of anxiety and worry about childbirth.
The results were published last month in the journal Evolution, Medicine, and Public Health.
Other scientists who study childbirth said levels of anxiety in the United States were higher than those reported in Europe and Australia, which are lower than 20 percent. But they noted that birth conditions in the United States are different and pandemic conditions may have exacerbated fears.
A certain level of concern about childbirth is universal. According to Karen Rosenberg, a professor of anthropology at the University of Delaware, it may be evolution-favored adaptive behaviors that drive women to seek help and emotional support during childbirth.
“Other animals can give birth in a social context, but humans are the only primates that actively seek and routinely seek active help at birth,” said Wenda Trevathan, a senior scientist at the School for Advanced Research in Santa Fe, NM, an anthropologist. thinktank.
However, extreme pathological anxiety can be maladaptive, leading some women to have unnecessary caesarean sections or to avoid pregnancy.
The new study has limitations. The prenatal and postpartum data were collected during the first 10 months of the pandemic, when the healthcare system was under extreme pressure. The sample was not nationally representative and consisted of a disproportionate percentage of white and higher-income women.
Half of the women had never given birth and more than a third had experienced high-risk pregnancies.
More than 80 percent of women said that because of the pandemic, they were afraid they wouldn’t have the supportive person they wanted in the hospital during labour, that their baby would be taken away if they were diagnosed with Covid or that they could infect their baby if they had the virus.
Black mothers, who are nearly three times more likely to die from pregnancy-related complications, were nearly twice as likely to have a strong fear of childbirth as white mothers.
“Black women are more likely to have complications or die during childbirth,” one pregnant woman said in response, adding that her concern was greater because she wasn’t sure she would have a family member or lawyer in the hospital due to Covid . . “Who’s going to record it for me?”
Women with tokophobia were nearly twice as likely to have a preterm birth, or a baby born before 37 weeks of pregnancy, the study found. Babies born prematurely are more likely to have health problems and a greater risk of disability and death, and often spend time in neonatal intensive care.
The association does not prove a causal relationship between anxiety and preterm birth. But the risk of preterm birth in women with high levels of anxiety and worry remained high even after adjustments were made for other factors, such as caesarean deliveries.
The study also found links between anxiety and higher rates of postpartum depression and the use of bottle feeding in addition to breastfeeding. It found no link between tokophobia and a higher caesarean section rate or low birth weight in newborns.
Dr. Thayer said fear of childbirth could be “an underappreciated contributor to health inequality.”
“People who fear unfair treatment and discrimination in obstetric settings are likely to have a greater fear of childbirth, which could increase complications during the perinatal period,” she said.
In the United States, black women experience more preterm births than any other race or ethnic group; the rate is about 50 percent higher than that of white women. About 14 percent of black babies are born prematurely, compared to just over 9 percent of white and Hispanic babies.
Previous studies have linked preterm birth to psychosocial stress, but this study is the first to find an association with tokophobia, said Dr. Thayer.
Fear of childbirth was greater among all socially disadvantaged women, including those with lower incomes and those with less education, she found. Women who were single, women who received care from a midwife and women who had their first child were also more afraid.
Women with high-risk pregnancies and those suffering from prenatal depression were also more afraid of childbirth, Dr. Thayer.