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The mere idea of pushing a fully grown baby into the world the natural way can give even the bravest expectant mother pause. But a small number of women are so terrified of childbirth that it dramatically raises their odds of delivering by emergency or elective cesarean section, according to new research to be published in the international journal Acta Obstetricia et Gynecologica Scandinavica (AOGS).
Swedish researchers looked at 353 women whose fear of childbirth resulted in a referral to a unit for psychosocial obstetrics and gynecology. "These women had severe fear of childbirth," says Gunilla Sydsjo, lead author and a professor in the department of obstetrics and gynecology at the University Hospital in Linköping, Central Sweden. "They were not just fearful or worried. They were afraid to get pregnant, they were constantly thinking about the delivery, thinking they might die. They had nightmares. They were afraid to go to the hospital."
When the fear of labor and delivery becomes extreme, there's a term for it: "When the fear is so intense that a woman dreads childbirth and tries to avoid becoming pregnant, the diagnosis is tocophobia," write the authors.
Women with deep-seated fear are not only apprehensive about pain, but they're also nervous about losing control, being unable to persevere mentally or physically, dying, sustaining pelvic-floor injuries and experiencing harm to the baby. Various studies have suggested that women with extreme fear of childbirth tend also to have little education or support from a partner, and they may be unemployed, smoke and be psychologically unstable.
MORE: Patience, Mom: More Hospitals Say No to Scheduled Delivery Before 39 Weeks
Researchers compared women with significant fear with a control group of 579 women who had no fear of childbirth (or at least no more than the average woman). They found that the fearful women had poorer obstetric outcomes, even after they had received counseling. They delivered vaginally without forceps or vacuum intervention 51% of the time, compared with 75% for the control group. They were 17% more likely to be induced into labor, compared with other women, who had a 10% chance. And they requested elective cesarean sections 30% of the time, compared with 4% for the control group.
Elective C-sections have been on the rise in the U.S., although major medical groups have been trying to turn the tide. While C-sections are common practice, they still carry all the inherent risks of any surgery. Sydsjo says, however, that C-sections are actually advisable for women who are very frightened of giving birth, with the caveat that some women who are scared of childbirth are also terrified of surgery.
Although vaginal delivery is still preferable when possible, very fearful women are more likely to need emergency C-sections — never a desirable outcome. Even fearful women who have already given birth and thus know what to expect often wind up needing emergency cesarean sections. "We should take them through the delivery ward and educate them about pain relief, but if they still want a C-section, they should get it," says Sydsjo.
MORE: Unnecessary C-Sections Cost $3.5 Billion Each Year
It's important to be particularly mindful of the experience of fearful women delivering for the first time, in the hopes that their future deliveries can be less stressful, the study concludes. "We have to be very careful to avoid that trauma for first-time mothers," says Sydsjo.
Bonnie Rochman is a reporter at TIME. Find her on Twitter at @brochman. You can also continue the discussion on TIME's Facebook page and on Twitter at @TIME.
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