NEW YORK, Nov 25 (Reuters Health) -- Healthcare professionals should be sensitive to the fact that if an emergency procedure is necessary during a woman's first childbirth experience, she is much more likely to be fearful of vaginal delivery during her second pregnancy, Finnish researchers report.
According to Dr. Terhi Saisto and associates, of Helsinki University Central Hospital in Finland, doctors and other professionals should prepare first-time pregnant women for the possibility of cesarean section or vacuum extraction, in which a suction device is used to assist delivery.
After a woman undergoes one of those procedures, she should be counseled regularly, Saisto and colleagues recommend, so that she can raise questions and concerns and discuss whether any subsequent children could be delivered vaginally.
The researchers note that, according to the results of previous studies, a woman's fear of subsequent delivery may not develop for months or years after the first delivery, and sometimes not until she is pregnant again.
Saisto's team interviewed 100 women, pregnant with their second child, who had requested cesarean section because of severe fear of vaginal delivery. None of the subjects had expressed such marked fear during their first pregnancies.
Fifteen percent of the fearful women said that pain during their first delivery was the principal cause of their fear. Close to half (44%) could not specify the cause of their fear and remembered the entire delivery as frightening.
For comparison, the team interviewed 200 additional pregnant women, also expecting their second child, who were not especially fearful and had not requested cesarean delivery.
Saisto's group found that, during the first deliveries, emergency cesarean had been 26 times more common in the fearful group than in the comparison group, and vacuum extraction had been 4.5 times more common.
"We believe that deliveries that ended with cesarean or vacuum extraction were the most important causes of subsequent fear of delivery, and subjects' own views of the entire labor as terrifying support that belief," the authors write in the November issue of Obstetrics & Gynecology.
There was no difference between groups in the use of epidural anesthesia or other pain relief methods, the investigators determined. In fact, fearful women were more likely than controls to have received an epidural.
Furthermore, fearful women were as likely as nonfearful women to have participated in a childbirth preparation class and to have had a partner or friend present during labor.
"Labor pain, like pain in general, is subjective and can lead to fear of delivery," Saisto and colleagues conclude.
They add that, instead of becoming fearful, women who have had a cesarean or vacuum extraction may feel frustrated or depressed. With modern obstetrics care, the authors point out, childbirth so often goes without a hitch that women who do not have an unassisted vaginal delivery may feel "unsuccessful."
