The Relationship Between Fear and Birth
- Ashley Strengholt
- Sep 8
- 4 min read
Childbirth is one of the most profound experiences in a woman’s life, but it is also an event often accompanied by fear. Whether from cultural narratives, past experiences, or uncertainty about the process, fear is a powerful emotion that can significantly shape how labor unfolds. Understanding the relationship between fear and birth allows expectant mothers, families, and care providers to create environments that encourage safety, calm, and empowerment.
Common Fears Associated with Birth
Fear surrounding childbirth is widespread, affecting women across cultures and backgrounds. Some of the most common concerns include:
Fear of pain: Many women worry about how they will cope with contractions and whether pain management options will be effective.
Fear of medical interventions: Concerns about cesareans, epidurals, or other procedures can weigh heavily, especially if mothers fear loss of control or negative side effects.
Fear for the baby’s safety: Anxiety about whether the baby will be healthy or survive the birth process is a deep and instinctive concern.
Fear of bodily harm: Some mothers fear tearing, long-term complications, or even maternal death.
Fear of the unknown: For first-time mothers in particular, uncertainty about what labor will be like, how long it will last, and how they will handle it can be daunting.
Research shows that fear of childbirth, known as tocophobia, affects 14–25% of women globally and is linked with higher rates of elective cesarean section and longer labors (O’Connell, Leahy-Warren, Khashan, Kenny, & O’Neill, 2017).
Effects of Fear on the Labor and Birth Process
Fear is not only an emotional experience but also a physiological one. The body’s stress response can directly influence labor progress and outcomes.
Tension and pain
Fear creates physical tension, especially in the muscles. This tension can make contractions feel more painful and less effective, leading to a cycle of increased fear and discomfort (Dick-Read, 1942/2004).
Stalled or prolonged labor
High levels of fear are associated with slower cervical dilation and longer labors. One study found that women with severe childbirth fear were more likely to experience prolonged labor and require medical intervention (Adams et al., 2012).
Increased intervention rates
Fear often contributes to requests for medical pain relief or elective cesareans. While these interventions can be life-saving when necessary, unnecessary intervention carries its own risks (O’Connell et al., 2017).
Birth satisfaction
Fear negatively affects how women perceive their birth experience. Those who feel unsupported or overwhelmed by fear during labor are more likely to describe their birth as traumatic, regardless of medical outcomes (Fenwick et al., 2009).
The Oxytocin and Adrenaline Relationship
At the core of how fear influences labor lies the hormonal interplay between oxytocin and adrenaline. These two hormones have almost opposite effects on birth.
Oxytocin
Known as the “love hormone,” oxytocin is central to labor. It stimulates uterine contractions, helps the cervix dilate, and supports bonding between mother and baby. High oxytocin levels are also linked with feelings of calm and connection (Uvnäs-Moberg, 2003).
Adrenaline
Adrenaline (epinephrine), part of the body’s “fight or flight” response, increases heart rate, sharpens alertness, and directs blood flow to muscles. While this can be protective in dangerous situations, during labor adrenaline often works against oxytocin. Elevated adrenaline can slow contractions, inhibit dilation, and increase pain perception (Buckley, 2015).
When fear activates the stress response, adrenaline rises and oxytocin falls. This imbalance can stall labor or make it more painful. Conversely, environments that promote calm, safety, and trust boost oxytocin, supporting smoother, more efficient labors.
Interestingly, in the final stages of labor, a surge of adrenaline often occurs naturally. This provides the mother with energy for pushing and helps the baby transition to life outside the womb (Buckley, 2015). The key distinction is whether adrenaline rises due to fear and stress early in labor, which hinders progress, or as a natural end-stage aid.
Reducing Fear and Supporting Healthy Birth
Since fear can profoundly affect birth, reducing it becomes a vital part of preparing for labor. Some strategies include:
Education: Childbirth education helps demystify the process, reducing fear of the unknown.
Supportive care: Continuous support from a doula, midwife, or trusted partner lowers fear and is associated with improved outcomes (Bohren et al., 2017).
Environment: Dim lighting, privacy, familiar voices, and a calm atmosphere help stimulate oxytocin and reduce stress.
Mind-body practices: Techniques such as breathing, visualization, and relaxation exercises help mothers manage fear and stay grounded.
By recognizing fear as both an emotional and biological factor in birth, caregivers and families can create conditions where oxytocin thrives, adrenaline stays in balance, and mothers feel empowered.
Conclusion
Fear and birth are deeply connected, with fear exerting measurable effects on both the emotional and physical course of labor. While fear is a natural response to uncertainty, excessive fear can interfere with oxytocin release, disrupt contractions, prolong labor, and diminish birth satisfaction. On the other hand, calm, trust, and support foster oxytocin, enabling the body to work as designed.
Ultimately, acknowledging and addressing fear- through education, support, and nurturing environments - can transform birth from an experience of anxiety into one of empowerment.
References
Adams, S. S., Eberhard-Gran, M., Eskild, A. (2012). Fear of childbirth and duration of labour: a study of 2206 women with intended vaginal delivery. BJOG: An International Journal of Obstetrics & Gynaecology, 119(10), 1238–1246. https://doi.org/10.1111/j.1471-0528.2012.03433.x
Bohren, M. A., Hofmeyr, G. J., Sakala, C., Fukuzawa, R. K., & Cuthbert, A. (2017). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, (7). https://doi.org/10.1002/14651858.CD003766.pub6
Buckley, S. J. (2015). Hormonal physiology of childbearing: Evidence and implications for women, babies, and maternity care. Childbirth Connection.
Dick-Read, G. (2004). Childbirth Without Fear: The Principles and Practice of Natural Childbirth. (Original work published 1942). Pinter & Martin.
Fenwick, J., Toohill, J., Creedy, D. K., Smith, J., Gamble, J., & Buist, A. (2009). Sources, responses, and moderators of childbirth fear in Australian women: a qualitative investigation. Midwifery, 25(2), 254–262. https://doi.org/10.1016/j.midw.2007.03.006
O’Connell, M. A., Leahy-Warren, P., Khashan, A. S., Kenny, L. C., & O’Neill, S. M. (2017). Worldwide prevalence of tocophobia in pregnant women: Systematic review and meta-analysis. Acta Obstetricia et Gynecologica Scandinavica, 96(8), 907–920. https://doi.org/10.1111/aogs.13138
Uvnäs-Moberg, K. (2003). The Oxytocin Factor: Tapping the Hormone of Calm, Love, and Healing. Da Capo Press.
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