Giving birth is somewhere between one of the most gratifying and terrifying experiences a woman can face. For some mothers, labor becomes a deeply empowering moment. It is a profound encounter with the strength of their bodies as they welcome new life into the world. It is a confidence building experience. For others, childbirth feels overwhelming, frightening, or even traumatic. Why do these experiences differ so dramatically?
Of course, medical circumstances and support systems play important roles. But a growing body of research suggests that something less obvious may also matter: how a woman feels about birth before labor even begins. A 2018 study by Victoria Flores, published in the Journal of Prenatal and Perinatal Psychology and Health and titled “Fear versus Trust: The Impact of Fear on Birth Experience and Maternal Outcomes,” explores an intriguing question: does approaching childbirth with fear or with trust in the body’s ability to give birth shape a woman’s birth experience and outcomes? According to Flores’ research, women’s emotional states surrounding birth appear to correlate with the kinds of birth experiences they report [1].
A study on childbirth fears and outcomes
Flores’ study examined the relationship between women’s beliefs about childbirth and their reported birth experiences. The research used a 43-question survey that explored attitudes toward childbirth, including levels of fear, trust in the body’s natural processes, and perceptions of safety during labor. Participants were asked about their expectations of birth as well as the outcomes of their deliveries [1].
A pattern emerged. Women who reported higher levels of fear about childbirth were more likely to report interventions such as cesarean sections and negative birth experiences. Meanwhile, women who expressed lower levels of fear and greater trust in the birth process were more likely to describe calm states during labor and more positive birth experiences [1].
Because the study was survey-based and cross-sectional, it cannot prove that fear directly causes difficult births. Many factors influence childbirth outcomes, including maternal health, healthcare professional practices, and the birth environment. The study itself mentions that further questions need to be asked in this particular area. Still, the association highlighted by Flores aligns with a growing body of research suggesting that fear of childbirth is linked to poorer birth experiences and a greater likelihood of intervention [2].
The association highlighted by Flores aligns with a growing body of research suggesting that fear of childbirth is linked to poorer birth experiences and a greater likelihood of intervention
The biology of fear during labor
Childbirth is not simply a mechanical process, it is also profoundly hormonal. Labor unfolds through a complex interaction of hormones that regulates contractions, pain management, and bonding between mother and baby. Researchers studying the physiology of childbirth have shown that hormones such as oxytocin and endorphins play central roles in guiding labor and helping women cope with its intensity [3].
Oxytocin, often called the “love hormone,” stimulates uterine contractions and promotes feelings of trust and calm. Endorphins—natural pain-relieving chemicals—help the body manage the physical sensations of labor. Together, these hormones form part of the body’s natural system for supporting birth [3].
However, fear can interfere with this system. When the brain perceives danger, it activates the body’s fight-or-flight response, releasing stress hormones such as adrenaline and cortisol. These stress responses can affect how the body experiences labor and may interfere with the hormonal patterns that support it [3].
When the brain perceives danger, it activates the body’s fight-or-flight response, releasing stress hormones such as adrenaline and cortisol. These stress responses can affect how the body experiences labor and may interfere with the hormonal patterns that support it.
Fear of childbirth is surprisingly common
While many women hope to approach childbirth with confidence, fear surrounding labor is extremely common. Research suggests that up to 80% of pregnant women experience some level of fear related to childbirth, although the intensity varies widely [4].
These fears can take many forms: fear of pain, fear of medical complications, fear of losing control, or fear shaped by negative birth stories. Previous research has also found that negative prior birth experiences can significantly increase fear of childbirth in future pregnancies [5].
Fear does not simply influence emotions; it can shape expectations and decisions about childbirth, which consequently shape the experience. Studies have found that women with higher levels of childbirth fear may be more likely to prefer medical interventions or request cesarean delivery [6].
How modern culture may shape birth expectations
Part of the challenge may lie in how childbirth is portrayed in modern culture. For many women, the first images they see of labor come from movies or television, where childbirth is often depicted as chaotic, painful, and medically urgent. (I personally can’t recall ever seeing any births on TV that weren’t accompanied by wild screams of desperation—can you?) These portrayals rarely show calm births or women working steadily with their bodies through labor.
Over time, these cultural messages can shape expectations. Long before pregnancy begins, women may internalize the idea that childbirth is inherently dangerous or unbearable. Researchers studying childbirth fear have noted that negative stories, anxiety, and lack of familiarity with the birth process can contribute to heightened fear among pregnant women [4].
In earlier generations, women were more likely to witness births within families or communities. Today, many women enter labor having never seen childbirth in real life, and their only point of reference is dramatized media portrayals.
In earlier generations, women were more likely to witness births within families or communities. Today, many women enter labor having never seen childbirth in real life, and their only point of reference is dramatized media portrayals.
A Tale of Two (Positive) Births
By way of an example, two friends of mine gave birth recently. Their positive stories illustrate how their prior expectations and experiences impacted their births in surprising ways.
Rachel: A story of generational confidence in birth
Let’s start with Rachel. She is the second oldest of eight, and grew up with a very ‘crunchy granola’ mother who gave birth to all her children at home. Rachel was present at the birth of her youngest siblings, and vividly remembers seeing her mom working with her body as she delivered at home naturally. When it came time for Rachel to give birth to her first child, she decided to follow her mom’s path. Given that she had witnessed multiple healthy births, Rachel knew exactly what to expect, and even had her mother in the room helping her. Needless to say, Rachel’s fear levels were relatively low, and she had a positive experience.
Veronica: Pleasantly surprised by a different kind of pain
On the other hand, my friend Veronica had planned a vaginal but medicated birth at a nearby hospital for her first child. She had never witnessed a birth, and was simply following medical advice. When labor started, she reported feeling intense back pain, which she managed by showering in hot water and receiving back massages on and off for about two hours. As she felt her labor was progressing, she arrived at the hospital ready to be medicated, only to be told that she was too dilated and it was now time to push!
Veronica shared that since the pain was only in her back, and her water hadn’t broken, she believed she was still in the early stages of labor when she left for the hospital. She was waiting for her pain to intensify and move towards her front (and even to her vaginal area), but she only came to feel this kind of pain as she was pushing—and in two pushes, her baby was out! In other words, she remained calm throughout her labor, thinking that the worst was yet to come—but for her, it never came.
Different stories, both characterized by a lack of fear
These are positive stories and surely, for some women, the experience is not so smooth. But I am sharing these stories because they reflect how beliefs around fear and trust impacted two of my friends’ birth experiences. (And I won’t share the negative ones, since they are often the minority—5% according to Flores’ study—and already receive too much PR. Plus, if you’d really like to read one, you can easily find them online). In fact, Flores proposed that the propagation of negative birth stories is largely what creates fear and lack of trust in the birth experience, and that this in turn increases the chances of a complicated birth [1]. In other words, if one wants to have a positive experience, focusing on the negative ones may be counter-productive.
Building trust in the birth process
If fear can influence birth experiences, the encouraging news is that preparation and support may help shift that mindset toward confidence. Research has shown that education, coping strategies, and relaxation methods during pregnancy can reduce fear and improve women’s experiences of childbirth [7]. Having the knowledge and resources to face the pain, discomfort, and anxiety over the unknown is what prepares mothers to face labor with confidence and have positive experiences.
If fear can influence birth experiences, the encouraging news is that preparation and support may help shift that mindset toward confidence. Research has shown that education, coping strategies, and relaxation methods during pregnancy can reduce fear and improve women’s experiences of childbirth.
Continuous support during labor, whether it is from the baby’s father, a doula, or medical professional, has also been associated with improved birth experiences and reduced anxiety [8]. These forms of support can help women remain calm and engaged with the natural progression of labor.
When women feel safe, supported, and informed, their bodies may be better able to engage the physiological processes that guide childbirth.
Birth is both physical and emotional
Flores’ research highlights an important truth: childbirth is not only physical. It is also deeply psychological and emotional. The beliefs a woman carries into labor, especially around fear or trust, can shape how she experiences one of life’s most profound transitions.
Of course, every birth is different, and medical interventions are sometimes necessary to protect mothers and babies when complications arise. But research increasingly suggests that emotional wellbeing during pregnancy and labor plays an important role in shaping birth experiences.
What if, instead of teaching women to fear childbirth, we spent more time helping them understand the remarkable design of their bodies?
When women enter labor informed, supported, and confident, birth has the potential to become not merely something to endure, but something deeply beautiful and meaningful. And perhaps the first step towards birth starts long before the first contraction. It starts with the decision to face one’s fears and concerns and replace them with knowledge and trust.
References
- Flores, V. (2018) Fear versus Trust: The Impact of Fear on Birth Experience and Maternal Outcome. The Journal of Prenatal and Perinatal Psychology and Health, 32, 220-241.
- Stoll K, Hall WA. Attitudes and preferences of young women with low and high fear of childbirth. Qual Health Res. 2013 Nov;23(11):1495-505. doi: 10.1177/1049732313507501. Epub 2013 Oct 9. PMID: 24108088.
- Buckley SJ. Executive Summary of Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care. J Perinat Educ. 2015;24(3):145-53. doi: 10.1891/1058-1243.24.3.145. PMID: 26834435; PMCID: PMC4720867.
- Dal Moro APM, Soecki G, de Fraga FS, Petterle RR, Rückl SZ. Fear of childbirth: prevalence and associated factors in pregnant women of a maternity hospital in southern Brazil. BMC Pregnancy Childbirth. 2023 Sep 2;23(1):632. doi: 10.1186/s12884-023-05948-0. PMID: 37660013; PMCID: PMC10474709.
- Størksen HT, Garthus-Niegel S, Vangen S, Eberhard-Gran M. The impact of previous birth experiences on maternal fear of childbirth. Acta Obstet Gynecol Scand. 2013 Mar;92(3):318-24. doi: 10.1111/aogs.12072. PMID: 23278249.
- Stoll K, Swift EM, Fairbrother N, Nethery E, Janssen P. A systematic review of nonpharmacological prenatal interventions for pregnancy-specific anxiety and fear of childbirth. Birth. 2018 Mar;45(1):7-18. doi: 10.1111/birt.12316. Epub 2017 Oct 23. PMID: 29057487.
- Fenwick J, Toohill J, Gamble J, Creedy DK, Buist A, Turkstra E, Sneddon A, Scuffham PA, Ryding EL. Effects of a midwife psycho-education intervention to reduce childbirth fear on women’s birth outcomes and postpartum psychological wellbeing. BMC Pregnancy Childbirth. 2015 Oct 30;15:284. doi: 10.1186/s12884-015-0721-y. PMID: 26518597; PMCID: PMC4628230.
- Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A.Continuous support for women during childbirth. Cochrane Database Syst Rev. 2017 Jul 6;7(7):CD003766. doi: 10.1002/14651858.CD003766.pub6. PMID: 28681500; PMCID: PMC6483123.
