According to a new Dartmouth study, the COVID-19 epidemic increased expectant women's anxiety about childbirth.

The researchers were especially interested in determining which factors predict childbirth fear in the United States and how the pandemic has altered this fear and birth outcomes.

The research was published in the journals Evolution, Medicine, and Public Health. "Our results showed high rates of childbirth fear in our sample," says first author Zaneta Thayer '08, an associate professor of anthropology at Dartmouth.

"Since there's no pre-pandemic U.S. data, we cannot compare our data to that context but we know that the rates are very high compared to other international studies on the subject that have been published pre-pandemic."

The study drew on data from the COVID-19 and Reproductive Effects Study, an online survey that looked at how COVID-19 affected pregnant women's well-being and healthcare experiences.

They collected prenatal data from 1,775 individuals from April 2020 to February 2021, and postpartum data from 1,110 participants one month after their due date, which included information about delivery experiences and birth outcomes.

The results showed that 62% of participants had clinically high levels of childbirth fear, also known as "tokophobia."

Individuals in the lowest household income category and those without a college degree also had high levels of childbirth fear.

In addition, a high-risk pregnancy, prenatal depression, and a pre-existing health condition were also associated with childbirth fear.

Individuals who had childbirth fear had a 91% higher chance of having a preterm birth of less than 37 weeks of gestation. Low birth weight, however, was not significantly associated with childbirth fear.

Regarding COVID-19-related concerns, participants indicated that they were especially worried that they would not be able to have the support people that they wanted during labour and that if they got sick with COVID-19 their baby would be taken away from them. They were also worried that if they got COVID-19 while pregnant they would give it to their baby.

"One of the motivations for this research was that the environment in which people give birth has changed over the last 100 years," says Thayer.

"At the turn of the century, most births were happening at home and families often had multiple children, so people's familiarity with birth was a lot greater, but now, nearly all births in the US. take place in a hospital."

"Nowadays, for many women, the first time they experience birth is when they are giving birth themselves, which can contribute to stress and anxiety," says Thayer.

In the 1980s, researchers in Sweden and Finland began studying childbirth fear, which includes pregnant individuals' concerns about managing pain, the risk of harm or death to themselves or their baby, and fear about the childbirth process.

As a result of the research, pregnant people in Finland are screened for childbirth fear as part of their standard maternal care. Dartmouth's study is one of the first published studies to measure tokophobia in the U.S.

"Our findings illustrate that pregnant people are stressed in the U.S. birth environment and that they are not getting the emotional support they need," says Thayer. "And the COVID-19 pandemic just added to those fears."

"Our work shows that there's a need for childbirth fear to be included as part of maternal health care," says Thayer.

"Prior research has shown that treating childbirth fear can reduce it and improve confidence in one's ability to give birth."
Thayer said she and her fellow researchers also recommend including and measuring childbirth fear in future maternal health studies to help inform care and treatment strategies.