Birthing and stress

Giving birth is clearly a high-stress experience. But usually it involves positive stress, which helps the woman cope with the exigencies of delivery and prepares the baby for a life outside the mother’s womb.” These are the words of Siw Alehagen from Linköping University, Sweden, who has written a dissertation about fear, pain, and stress hormones in women giving birth. Among other things, she has performed studies during actual delivery, a method that few researchers have dared to attempt anywhere in the world.

Siw Alehagen’s dissertation work started with the construction of an instrument of measurement–a series of questions–to measure the degree of fear women experience in giving birth. She then used this instrument and combined it with urine and saliva samples at the end of pregnancy, each hour during delivery, and on three occasions after delivery.

The stress hormones metered in the samples were adrenalin, noradrenalin, and cortisol. Adrenalin and cortisol, which mark mental stress, increased by up to 1,000 percent in some women during phases of delivery. Noradrenalin content, which above all marks physical stress, did not increase nearly as much. According to Siw Alehagen, this indicates that birthing stress is not primarily physical but mental.

Siw Alehagen also found that pain and cortisol levels rose in the course of delivery in women who did not receive epidural anesthesia. Women who did receive this anesthesia initially experience less fear and pain, and evinced lower hormone levels. However, in the final phases of delivery, pain and fear also increased among these women.

Those women who were most frightened before receiving anesthesia were those who had the most negative impression of birthing afterward. Women who were truly frightened viewed birthing as a threat, experienced it negatively while it was happening (regardless of anesthesia), and saw it in retrospect as something unpleasant or terrifying. Siw Alehagen sees this as a justification of efforts in maternal care to identify women who are afraid of their approaching delivery and to offer them support and treatment. Care during delivery should be flexible and individual, geared to bolstering the self-confidence of the woman, thereby reducing her fear.