Hamish Holewa: Hi and welcome to IPP-SHR Podcasts, I’m Hamish Holewa and for today’s podcast I’m talking to Christina Nilsson; Lecturer, mid-wife and doctoral student in the School of Health Sciences, University College of Boras at Vaxjo University, Sweden. I am speaking with Christina today about her study and article titled, “Women’s Lived Experiences of Fear of Childbirth”, published in Midwifery and co-authored with others mentioned on our website. Hi Christina, thanks for speaking with us today.

Christina Nilsson: Thank you

Hamish Holewa: Do you want to start this podcast by providing our listeners with some background information about what is known about the fear of childbirth?

Christina Nilsson: Yes, well research shows that about five to ten percent of pregnant women suffer from severe or intense fear of childbirth. This means that the fear affects the women’s everyday life with mood swings, difficulties in concentrating, sleeping problems and anxiety. Fear of childbirth can mean that women avoid pregnancy or make an abortion. It is also one of the main reasons for wanting and having a cesarean section. This fear differs from the more natural or normal fear women can have occasionally during pregnancy which can be seen as a part of women’s normal progression when facing childbirth. Most studies about fear of childbirth are from a medical or psychological perspective and describes the causes, the effect and the treatment. The research shows that the fear is associated with a lack of social support as well as histories of anxiety or depression. Socio-economic factors such as unemployment as well as traits in the women’s personalities have also been found. However, the most common reason for fear of childbirth is a previous negative childbirth experience. When it comes to treatment, research shows no concept of how, where and by whom it should be provided but in most Swedish hospitals, treatment is provided by specially trained mid-wives. The sessions are of a supportive and instructive nature and some teams employ a cognitive approach. They focus on the woman’s fear, how she experiences it and how it affects her. There are few qualitative studies that describe the phenomenon from the woman’s perspective and this is the main reason why we did this study.

Hamish Holewa: Sure, and you indicate that the essential meaning of women’s lived experiences of fear of childbirth is to lose oneself as a woman into loneliness. Do you want to explain those dual notions of losing oneself as a woman and the association notion of loneliness?

Hamish Holewa: And your findings also refer to a feeling of danger that both threatens and appeals. Do you want to explain those notions?

Christina Nilsson: Yes, the experience of fear of childbirth was expressed as a condition that both threatens and appeals. The women for the forthcoming birth expressed a danger that got closer every day. This resulted in a state of tension that affected the women in their daily lives. On the other hand, the women expressed a strong inner desire to be able to experience a good birth. The danger that appeals describes a strong inner driving force to be able to give birth normally. This was described by the women as a way to try to restore the trust in them as childbearing women and in that way decreased the feeling of loneliness.

Hamish Holewa: Right, and lastly your findings point to the mothers’ feeling trapped, feeling like an inferior mother-to-be and being on their own. Do you want to elaborate further on that?

Christina Nilsson: Yes, the women described an experience of imprisonment, that there were no other way out of the pregnancy than to give birth. The longing for the child was described at the same time as the birth felt terrifying. Some women also had ambivalence when having to choose mode of delivery. Feeling like an inferior mother-to-be describes an experience of not being good enough. Women that had a previous negative birth experienced - described feelings of helplessness and failure. Surprisingly, these feelings were not directed towards the staff of the maternity ward but rather inwardly towards the women themselves. As one woman said, ‘the birth meant that I felt less of a person, it rocked my self-esteem a little bit’. Being on your own entails primarily a feeling of loneliness in connection to others and a lack of support and understanding for the fear from those around. The women described that it can be difficult to talk about the fear because they perceived themselves as abnormal in relation to other women. They also described the pervasive attitude that you must not complain. The women experienced that society does not respect the fact that a woman can be afraid of giving birth. The women also described a feeling of loneliness in relation to mid-wives and doctors. They described the support and understanding from these professionals as minimal but the sense of loneliness can be broken down by feeling support for other mothers or members of staff.

Hamish Holewa: Very interesting, and what are the practical implications of your study?

Christina Nilsson: Well one important thing as I see it is that women with an intense fear of childbirth should be taken very seriously and some kind of expert support should be available. So as a professional mid-wife you can’t just tell the women to shape up, these women are exposed and the fear affects them at a deep level and the women described the mid-wife support as important and that understanding and support can break down the feeling of loneliness and restore the women’s trust in them as childbearing women.

Hamish Holewa: Excellent, well Christina thank you very much for speaking with us today on IPP-SHR Podcasts.

Christina Nilsson: Okay thank you for asking me and having this interview.