Understanding anxiety, worry and Fear in childbearing

123

A Resource for Midwives

and Clinicians

Kathryn Gutteridge

Editor

Understanding Anxiety,

Worry and Fear

in Childbearing

Understanding Anxiety,

Worry and Fear in Childbearing

Kathryn Gutteridge

Editor

Understanding Anxiety,

Worry and Fear

in Childbearing

A Resource for Midwives and Clinicians

Editor

Kathryn Gutteridge

NHS Trust City Hospital

Sandwell & West Birmingham Hospital

Birmingham

UK

ISBN 978-3-030-21062-5 ISBN 978-3-030-21063-2 (eBook)

https://doi.org/10.1007/978-3-030-21063-2

© Springer Nature Switzerland AG 2020, corrected publication 2020

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v

Foreword

Fear is corrosive, relentless and contagious. It limits our potential and prevents us

from doing our best as mothers, midwives and obstetricians. Fear can cast a dark

shadow over pregnancy and birth and inhibit optimal hormonal function. At a time

when birth has never been safer, it is sadly ironic that we are only just becoming

aware of the tragic impact of fear upon mothers and all those involved in birth. Fear

around birth is increasing, and this book makes an important contribution to our

knowledge in this neglected area. It contains some outstanding chapters.

Birth takes place within a culture, and our culture is focussed on economic

growth that requires ever developing technologies, products and markets and pro￾motes growth by advertising which is often fear inducing. Birth is about relation￾ships and trusting relationships can resolve fear, but the organisation of maternity

services on an industrial model does not allow relationships to flourish. In some

cases, institutional safety procedures play a considerable part in creating and sus￾taining fear.

Different chapters bring out the long-term impact on women of not being

believed, whether as abused children or women in early labour, and the bodily mem￾ories which can be reawakened by “care” during pregnancy and birth. So much fear

has its roots in women’s past experiences of loss of control and the abuse of power

when they were at their most vulnerable. Sadly, for many this abuse was by profes￾sionals in their previous experiences of maternity services.

Positive birth can be healing, and an argument for continuity of midwifery care

runs through this book. Where a trusted midwife can hold safe space for a mother,

it is possible for her to feel sufficient confidence in her carers and her body to let go

and give birth and then hold safe space for her baby. This is an empowering experi￾ence, which is not achieved where women feel they are being processed on a con￾veyor belt and midwives are micro-managed. Chapter authors from very different

backgrounds make strong arguments for listening to women and trusting them and

show how this can transform women’s birthing experience. This is vitally important,

but difficult for midwives who feel that their own voices are not heard and they are

not trusted by management.

The authors explore the complexity of the causes and experiences of fear. There

are no easy answers, no edict, medicalised answer or product, which will solve the

problems created by the abuse of power, medicalisation and the market economy.

vi

There are helpful tips and suggestions for carers to help them protect the woman’s

agency, communicate well and be kind. The importance of listening and trust is a

powerful theme.

This timely book addresses worry and anxiety around birth as well as differing

levels of fear. It brings together recent research, innovations in service provision and

compassionate insights from different fields of work around birth. In a number of

chapters, the issues raised are illustrated with relevant and illuminating stories, a

traditional and memorable way of teaching about birth. So much is conveyed where

the words of suffering women are quoted. There is much here of relevance to moth￾ers, partners, midwives, obstetricians, managers and those who plan and fund

maternity services. This is a book well worth reading.

Mavis Kirkham

Professor Emerita

Sheffield Hallam University

Sheffield, UK

Foreword

vii

Preface

This book has been on my mind for many years. The women I have encountered

throughout my clinical career both as a midwife and then as a psychotherapist

remind me of the vast amount of work to do in recognising the phenomenon of

fearfulness in our childbearing populations. How does a clinician differentiate

between a worried or anxious woman compared to one who is secretly terrified of a

pregnancy before it has even begun? This book does not claim to answer all the

questions but it does start the narrative and brings the subject matter from within the

hidden corners of women’s lives.

When you begin to read this book, you will note that the authors are in the main

midwives, but there are contributions from an obstetrician, psychiatrist and also a

doula. Whatever the difference in roles, the central experiences of these authors are

that they have encountered, witnessed, and understood the issues they have written

so carefully about. This collaboration is important because women present in many

ways and to various people in their quest to be understood. The style of writing is

largely academic but has a sense of being rooted in the experiences of women. In

every chapter there are references to women’s experiences and in others there are

vignettes or case studies that will elucidate the many ways that women suffer with

their anxieties and fears. Some of the chapters are written with very personal obser￾vations and in the first person that reaches out to those of us who wish to hear the

story.

In deciding how to use the book it may be that student midwives will wish to

understand the nature of the problems and dip in and out of chapters. For women

who are searching for answers to their anxieties this may suit some of those readers,

particularly when looking for answers to approaching future pregnancies and birth.

For maternity clinicians and doulas, this book will provide a comprehensive

analysis of anxiety, fear and in some rare cases tokophobia or morbid fear. The

authors have approached their chapters with an enlightened approach giving insight

into the problems and scenarios that women find themselves facing during their

pregnancies and births. There may be some cross over from chapter to chapter but I

make no apologies for this as it is important in terms of education and encouraging

a deeper understanding.

The chapters themselves give a cultural overview that appreciates the universal￾ity of birth today in our diverse and multicultural societies. Although many of the

authors are working in the United Kingdom, there is a determination to represent

viii

birth from other healthcare systems such as Ireland and Australia. Of course, this is

a small comparison but what the authors show is that this phenomenon is not culture

exclusive and may be found in a wide cultural variance.

Fear as an extreme human experience is a rare event in general adult life.

However, where it is associated with a normal human experience such as child￾bearing then it takes on a more secretive or shameful persona. This is likely to

become a taboo subject and one which is hidden in everyday life. Add into this

another deeply buried secret such as sexual abuse—then the woman is less likely

to disclose her fears. It was important in this book to cover this subject matter as

these women were found to be highly represented in a seminal paper investigating

tokophobia. Maternity clinicians are unlikely to make this association and if they

do, they are often unaware of how to offer care in a sensitive way that reduces

retraumatisation.

Education for psychological well-being, trauma presentations and acute panic/

fear within maternity settings are not mandated. Clinicians will often choose to

attend training or education events such as these because they are interested rather

than their service or professional organisation requires it. A book that covers this

subject matter and is available to a wide clinical and non-professional audience will

serve to educate and inform.

The intention in writing this book is not to give every answer to all of the prob￾lems or to provide a best clinical pathway to offer care to childbearing women. It is

a start to the dialogue; it gives the subject matter importance and thus allows women

to apply a name to their emotions and feelings that may be worrying them. In pro￾ducing a book that begins to give credibility to previously hidden or dismissed anxi￾eties is a leap of faith that cannot be underestimated.

I hope that this narrative is work that will gain strength and inform those provid￾ing care for childbearing women. I also hope that it serves to do justice to the many

women who have suffered their fears in silence and isolation. This is a book that I

wished I could have read many years ago before embarking on the unknown.

In memory of my daughter Rebecca Marie Mistry; she taught me so much watch￾ing her as a mother to both of her sons and I am indebted to her for her intelligent

and mature observations of our healthcare systems. She was the mother I wished I

could have been.

Birmingham, UK Kathryn Gutteridge

Preface

ix

Contents

1 History of Fear and Childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Maeve O’Connell and Rhona O’Connell

1.1 Early Modern Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

1.2 Twentieth Century and a New Era . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

1.3 Biomedical Model of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

1.4 The Choice for Caesarean Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

1.5 Respect and Human Rights in Childbirth . . . . . . . . . . . . . . . . . . . . . 6

1.6 Tokophobia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

1.7 Drivers for Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

1.8 Fear of Childbirth and the Risk Discourse . . . . . . . . . . . . . . . . . . . . . 10

1.9 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

2 Global Perspectives of Childbirth Fear Including the

Relevant Evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Helen Haines

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

3 Understanding Fear, Physiology and Finding an Explanation

of How the Mind Influences Us During Childbearing . . . . . . . . . . . . . . 31

Kathryn Gutteridge

3.1 Defining Anxiety and Worry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

3.2 The Brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

3.3 Memory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

3.4 How Do We Know Who Will Be at Risk of a Traumatic Events . . . . 38

3.5 Pregnancy: An Emotional State . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

3.6 Dreams and Fantasies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

3.7 During Sleep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

3.8 Neurochemistry of the Brain and Hormones . . . . . . . . . . . . . . . . . . . 42

3.9 The Nature of Fear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

3.10 How Do We Deal with This? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

3.11 Phobia and Avoidance Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

3.12 Unremitting Fear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

3.13 The Formation of Terror. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

x

3.14 The Concept of Body Awareness . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

3.15 Final Thoughts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

4 Fear of Birth and Modern Maternity Systems of Care . . . . . . . . . . . . . 53

Geraldine Butcher and Clare Willocks

4.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

4.2 Fear of Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

4.3 Primary Fear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

4.4 Secondary Fear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

4.5 Request for a Planned Caesarean Section . . . . . . . . . . . . . . . . . . . . . 59

4.6 Maternity Services and Fear Disclosure . . . . . . . . . . . . . . . . . . . . . . 59

4.7 Fear Disclosure and Health Professional’s Attitudes . . . . . . . . . . . . . 60

4.8 Challenges to Individualised Care . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

4.9 Best Intentions Can Lead to Disaster… . . . . . . . . . . . . . . . . . . . . . . . 63

4.10 … But When We Do Well We Are Brilliant! . . . . . . . . . . . . . . . . . . . 63

4.11 Place of Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

4.12 Dealing with Strangers and Vulnerability . . . . . . . . . . . . . . . . . . . . . 66

4.13 Poor Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

4.14 Survivors of Sexual Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68

4.15 Interventions Which May Help Reduce Fear of Birth . . . . . . . . . . . . 69

4.16 Birth Preferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

4.17 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

5 Gathering Storm–Birth in the Media . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Tracey Cooper and Laura Godfrey-Isaacs

5.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

5.2 How Pervasive Is the Media? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

5.3 Definition of, and Theories of, ‘The Media’ . . . . . . . . . . . . . . . . . . . 77

5.4 Dominant Media Messages About Birth . . . . . . . . . . . . . . . . . . . . . . 77

5.5 Analysis of Media Images of Birth . . . . . . . . . . . . . . . . . . . . . . . . . . 78

5.6 Birth Is Not Porn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

5.7 Evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

5.8 The Safety Agenda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

5.9 Research Studies About the Influence of Media on Women . . . . . . . 84

5.10 A Social Model of Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

5.11 The Midwifery Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

5.12 A Challenge to Mainstream Media? . . . . . . . . . . . . . . . . . . . . . . . . . 88

5.13 How to Respond to Media Depictions of Birth . . . . . . . . . . . . . . . . . 89

5.14 Moving Forward with Positive Media Messages . . . . . . . . . . . . . . . . 89

5.15 Final Word . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

Contents

xi

6 Childhood Sexual Abuse, Sexual Assault, Rape and Its

Relevance to Childbearing Fear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Kathryn Gutteridge

6.1 Developing into ‘Me’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

6.2 Adverse Life Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

6.3 Childhood Sexual Abuse and Childhood Sexual Exploitation . . . . . . 100

6.4 Impact of CSE on Cognitive Development . . . . . . . . . . . . . . . . . . . . 102

6.5 How Many Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

6.6 To Tell or Not to Tell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

6.7 What Has This to Do with Maternity? . . . . . . . . . . . . . . . . . . . . . . . . 105

6.8 Stranger in the Birth Room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109

6.9 What Is to Be Done? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

6.10 Disclosure of Sexual Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

6.11 Advice for Disclosures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

6.12 Antenatal Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113

6.13 Advice During Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

6.14 Labour Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

6.15 Advice During Labour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

6.16 Postnatal Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

6.17 Advice for Postnatal Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116

6.18 Finally . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116

7 ‘Who’s Afraid of the Big Bad Birth’: Childbirth Trauma,

Fear and Tokophobia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121

Kathryn Gutteridge and Yana Richens

7.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121

7.2 Into the Deep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122

7.3 The Pregnancy Confirmed and Fear Is Realised . . . . . . . . . . . . . . . . 125

7.4 Primary Tokophobia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126

7.5 Vignette 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

7.6 Vignette 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128

7.7 Vignette 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131

7.8 Vignette 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133

7.9 Trauma: ‘An Extraordinary Event That Happens to

an Ordinary Person’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135

7.10 The Manifestation of Birth Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . 135

7.11 Risk Factors for PTSD in Childbirth . . . . . . . . . . . . . . . . . . . . . . . . . 138

7.12 Vignette 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139

7.13 Fear Associated with Body Image and Function . . . . . . . . . . . . . . . . 140

7.14 Vignette 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140

7.15 Challenges: Request for Caesarean Section . . . . . . . . . . . . . . . . . . . . 142

7.16 Vignette 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142

7.17 Finally . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143

Contents

xii

8 Working with Worry and Inspiring Hope: Relationships

with Anxious and Fearful Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147

Hannah Dahlen, Alison Teate, Simone Ormsby,

and Virginia Schmied

8.1 What Is Anxiety and Worry? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148

8.2 Which Women Are More Likely to Experience Worry or Anxiety? . 149

8.3 The Impact of ‘Good Mother’ Discourses . . . . . . . . . . . . . . . . . . . . . 150

8.4 Our Health Systems Are Manufacturing Worry . . . . . . . . . . . . . . . . . 152

8.5 Asking Women About Worry Is Exposing the Worry . . . . . . . . . . . . 152

8.6 Dealing with Uncertainty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153

8.7 How Coercion Can Result from Marketing of Fear . . . . . . . . . . . . . . 153

8.8 How Do Relationships Impact on Worry/Anxiety . . . . . . . . . . . . . . . 154

8.9 Working with Worry in the Antenatal Period . . . . . . . . . . . . . . . . . . . 157

8.10 Creating a Sense of Hope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158

8.11 How Midwives Use Time to Work with Worry . . . . . . . . . . . . . . . . . 159

8.12 How Can Complementary Therapies Help Moderate Worry? . . . . . . 160

8.13 How Can We Work Positively with Worry/Anxiety? . . . . . . . . . . . . . 161

8.14 Working with Fear and Not Against It . . . . . . . . . . . . . . . . . . . . . . . . 163

8.15 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164

9 ‘Getting it Right First Time’: The Effects of Anxiety

and Fear on a Birthing Woman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171

Helen Shallow

9.1 Freya’s Story: A Case Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171

9.2 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172

9.3 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183

9.4 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187

10 Maternity Policy and a Generation of Anxiety and Fear . . . . . . . . . . . 189

Julia Lidderdale and Kathryn Gutteridge

10.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189

10.2 In the Beginning: Julia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190

10.3 In the Beginning: Kathryn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191

10.4 The Impact of the Peel Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197

10.5 The Evidence Breaks Through . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198

10.6 The Winterton Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198

10.7 Changing Childbirth: Choice, Control and Continuity . . . . . . . . . . 199

10.8 Caesarean Section in Ascendency . . . . . . . . . . . . . . . . . . . . . . . . . . 200

10.9 But in the Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200

10.10 And Yet More Evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202

10.11 Morecambe Bay: Kirkup 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203

10.12 Better Births 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203

10.13 Women’s Choice and Policy Today . . . . . . . . . . . . . . . . . . . . . . . . . 204

10.14 Women: Being Informed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204

10.15 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207

Contents

xiii

11 Never Safer; Never More Afraid: Women’s Voices

and Stories of Childbearing and Fear . . . . . . . . . . . . . . . . . . . . . . . . . . . 211

Cathy Williams

11.1 Pre-existing Anxiety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213

11.2 Sexual Assault Survivors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215

11.3 Fear and Anxiety About Labour and Birth . . . . . . . . . . . . . . . . . . . . 215

11.4 Fear of Baby Dying . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216

11.5 Pre-existing Fears About Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217

11.6 Choosing an Elective Caesarean . . . . . . . . . . . . . . . . . . . . . . . . . . . 218

11.7 Previous Difficult Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218

11.8 Other Individual Situations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220

11.9 Going into Labour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220

11.10 Pain of Labour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221

11.11 Other Fears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222

11.12 Experiences of Maternity Care/Antenatal Care . . . . . . . . . . . . . . . . 223

11.13 Experiences of Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225

11.14 Antenatal Classes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227

11.15 Late Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228

11.16 Labour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229

11.17 Postnatal Ward . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231

11.18 Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232

11.19 Meera’s Story . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232

11.20 What Would the Future Look Like? . . . . . . . . . . . . . . . . . . . . . . . . . 233

11.21 Continuity of Carer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233

11.22 Support for Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233

11.23 Individualised Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234

11.24 Language . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234

11.25 Working with Women Who Have Fear and Anxiety . . . . . . . . . . . . 236

11.26 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237

12 Shifting Tides—from Storm to Salvation . . . . . . . . . . . . . . . . . . . . . . . . 239

Sheena Byrom and Anna Byrom

12.1 Shared Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239

12.2 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240

12.3 Country-Level Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241

12.4 Service-Level Shifts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245

12.5 Individual Maternity Worker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248

12.6 Top Tips to Support Change. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252

Correction to: ‘Getting it Right First Time’: The Effects of

Anxiety and Fear on a Birthing Woman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C1

Contents

© Springer Nature Switzerland AG 2020 1

K. Gutteridge (ed.), Understanding Anxiety, Worry and Fear in Childbearing,

https://doi.org/10.1007/978-3-030-21063-2_1

M. O’Connell

School of Nursing and Midwifery, Royal College of Surgeons Ireland in Bahrain,

Muharraq, Bahrain

The Irish Centre for Fetal and Neonatal Translational Research (INFANT Centre),

University College Cork, Cork, Ireland

e-mail: [email protected]

R. O’Connell (*)

The Irish Centre for Fetal and Neonatal Translational Research (INFANT Centre),

University College Cork, Cork, Ireland

e-mail: [email protected]

1 History of Fear and Childbearing

Maeve O’Connell and Rhona O’Connell

The greatest battle that ever was fought—Shall I tell you where and when?On the maps of

the world you will find it not:It was fought by the Mothers of Men. (Joaquin Miller

[1837–1913])

Childbirth has undergone considerable change over the past few centuries. Outcomes

have improved due largely to improvements in the health and well-being of women

and babies, but also to the increase in knowledge about pregnancy and childbirth.

Unfortunately, standards of maternity care are variable; there are concerns about

levels of intervention in childbirth in many parts of the world, while there is a lack

of resources to ensure safe childbirth in many low resource countries (Miller et al.

2016). Sadly, mainly in low to middle income countries, there is widespread neglect

and abuse of childbearing women by health care professionals (Bowser and Hill

2010). Women report a positive childbirth experience when they are treated with

respect and feel safe. Unfortunately, many women also experience fear of childbirth

and this is not always recognised (O’Connell et al. 2019). In this chapter, firstly we

will explore birth and how it is documented through the ages, with relevance to the

historical culture of birth and birth workers. Secondly, we will discuss what has

influenced changes in maternity care provision and shaped women’s thinking about

birth and its consequences for today’s women.

2

1.1 Early Modern Period

Since the first recorded births, midwives have accompanied and assisted women

through pregnancy and childbirth. It is likely that married women came to fulfil this

role as required, and, once they assumed it, they gained experience and became known

as the ‘midwife’ or ‘handywoman’. It has been suggested that in the early modern

period there was considerable variation in the practices, skills and competence of

midwives, with some practicing occasionally as the need arose, while others made

their living from this role (Marland 1993). Apart from myths and folklore, childbirth

itself was largely undocumented but it is likely that knowledge and practices of mid￾wives was passed by word of mouth with skills acquired by observation and experi￾ence. Unfortunately, the oral traditions of midwives are largely unrecorded.

Childbirth came under scrutiny by the Catholic Church following the Council of

Trent in 1545. The concept of original sin became central to Christian faith and thus

the Church became interested in the practices of midwives. To ensure salvation, it

was considered vital that any infant thought likely to die should be baptised as soon

as possible, and thus it became a midwife’s duty to baptise the child if required,

even if this necessitated the removal of the infant by caesarean section in the event

of the woman’s death (Donnison 1988). Licences were granted to midwives who

could present evidence of their skills and religious orthodoxy. To obtain her licence,

the midwife was required to swear not to use ‘any sorcery, divination or magick,

incantations, witchcraft or any superstitious, hellish or horrid methods’ (Devane and

Murphy Lawless 2005). By the sixteenth century in Europe, some physicians had

taken an interest in childbirth and began to organise and regulate midwives’ prac￾tice. The municipal authorities took over the licensing of midwives from the church;

these fortunately paid more attention to the technical competence of the midwives

rather than their moral character. Childbirth was women’s business and women

relied on other women for information and support. For the most part, midwives

were probably skilled in straightforward births, and would have had to deal with

difficulties in childbirth themselves, as physicians were concerned neither with the￾ory nor the practice of midwifery until the seventeenth and eighteenth centuries. Not

surprisingly, these midwives generally lacked knowledge, given that few women

had access to education of any kind. While the midwife was a respected member of

the community, both maternal and perinatal mortality rates were high.

Although there was no safe treatment for obstructed labour, puerperal fever,

haemorrhage or eclampsia, maternal death rates declined over time probably due to

improvements in general health and living conditions (Peller 1943). From the sev￾enteenth century on, midwifery practices were mainly recorded by the male domi￾nated medical profession. Early midwifery textbooks were written by doctors based

on the practices learnt from midwives. The midwife was a respected member of the

community and though, later she was often castigated by medical doctors, there is

no evidence that midwifery practices throughout the ages were harmful, in fact,

early lying-in hospitals had high levels of maternal deaths as sepsis was more likely.

Through the eighteenth and nineteenth century, more hospital beds were provided

for childbearing but women were reluctant to attend a hospital for birth and would

prefer to call a midwife of her choice to assist with a home birth.

M. O’Connell and R. O’Connell