What would a childbirth scene at the movies be without screaming, drama and maybe a life threatening haemorrhage? But what makes for gripping viewing can create a picture of emergency and trauma around childbirth that makes some women fearful – and fear is childbirth's worst enemy, says Dr Hannah Dahlen, Professor of Midwifery at the University of Western Sydney.
"The effect of high levels of fear on childbirth is massive. Fear is linked to more caesarean sections and more post-natal depression. When women are fearful there's less of the hormone oxytocin which is needed to make contractions work but there are also fewer endorphins which means more pain," she says. "With anxiety there's less blood flow so the muscles don't work as well."
Childbirth might be safer than ever but women's fear of it is thought to be increasing – and a reason for rising rates of caesarean births, says Dahlen.
But scary scenes of childbirth on the screen aren't the only culprits. Other women's horror stories, our expectation of quick fixes for relieving pain of any kind – and a fragmented and over-medicalised maternity system – are also driving this fear, says Dr Jennifer Fenwick, Professor of Midwifery at Griffith University whose research in Australia found that around 26 per cent of women were highly fearful of giving birth.
"Australia has one of the world's highest rates of medical intervention in childbirth – and it sends a message that childbirth is dangerous and women can't manage without it. Women are very good at growing and having babies but our system isn't very good at supporting them to do this," she says.
The sharp end of childbirth fear has a name: tocophobia, meaning a severe dread of giving birth.
"For women with tocophobia, just thinking about giving birth is enough to make their heart pound," says Dahlen who recalls the actress Helen Mirren once saying that her decision to never have children stemmed from watching an educational film on childbirth when she was at school.
"It can also affect women who've already had a bad experience in childbirth and are frightened of having another – women who have had a difficult birth may have long gaps in between children. What upsets me is the attitude that says women should just 'get over it' – but fear is a big issue in childbirth. "
There are ways to tame this fear – but the Australian health system doesn't always make the best use of them, say Dahlen and Fenwick. If you're pregnant, fearful and happen to live in Sweden, for instance, there are specialist services staffed by midwives and psychologists to help – which may be one reason why Sweden's rate of caesarean births is only 16 per cent while Australia's is one of the world's highest at 32 per cent.
"In both Scandinavia and the UK women who request a caesarean section because of fear are referred to a clinic for counselling and support," says Dahlen. "In one Scandinavian study many of the women who'd originally asked for a caesarean ended up opting for a vaginal birth and most were pleased they did."
Then there's having the same midwife all the way through pregnancy and birth – known as 'continuity of care' and considered the gold standard of care in low-risk pregnancies.
"It builds trust and confidence and we have overwhelming evidence for the benefits to mothers and babies – for example, there are fewer epidurals, less pre-term birth and higher rates of breastfeeding," says Fenwick who works with women with high levels of fear. "But despite the evidence, most women still have fragmented care. This means women arrive at the birth suite not knowing anyone – no wonder they're fearful."
So what can help women to go into the delivery room feeling confident?
"If you feel scared don't bottle it up, " says Dahlen who suggests talking to a midwife or a psychologist specialising in childbirth fear and trauma.
"Booking into hospital early and requesting continuity of care gives you a better chance of having the same midwife."
Learning birth skills through pre-natal education courses like Calmbirth, Hypnobirthing and She Births can also help, she says. A study by Australian researchers including Dahlen and published in the British Medical Journal Open in July found that a pre-natal program incorporating elements of the She Births program, along with meditation, acupressure, yoga and use of water for pain relief, reduced the epidural rate by almost two thirds and nearly halved the rate of caesareans.
"There's a place for epidurals and caesarean sections but health professionals sometimes forget that women are capable and that we should work like a coach helping them to feel like they can do this," she says.
Paula Goodyer is a Walkey-award winning health writer and twice winner of the Dietitians' Association of Australia Journalism Award.