Updated October 25, 2023
During my 20 years in clinical practice, I observed a number of common fears women experience during pregnancy.
Since you may have some of these concerns, I thought it would be helpful to discuss them.
Unfortunately, many women avoid discussing their fears with anyone other than their prenatal care provider to avoid being shamed, judged, or confronted with opposing viewpoints from friends, family, and coworkers.
What Are The 9 Most Common Fears During Pregnancy?
The fears are listed as questions because this was how they were presented to me at prenatal visits:
1. Who will deliver my baby when I go into labor?
2. Will I be able to use my birth plan?
3. What if I have to be induced?
4. What do I do when labor starts?
5. Should I have an epidural?
6. What is worse a vaginal tear or an episiotomy?
7. What if I need a cesarean section?
8. What if my baby has to go to the Intensive Care Nursery (NICU)?
9. What if I poop during labor?
1. Who will deliver my baby?
Years ago, doctors and midwives often managed their own patient’s in labor and delivery.
- Unfortunately, it is no longer possible for providers to manage all their deliveries. In fact, there are now state-mandated restrictions on how many deliveries a provider can do per year to ensure patient safety.
- The cost of medical care has made it next to impossible to run a solo practice. A solo practitioner would have to work half of the year just to cover operating expenses, to run a medical practice in compliance with state board regulations.
- Logistics: Societal demands, patient expectations, and sheer volume have made it impossible for a provider to manage all the deliveries in their practice. Regulations were put into place in the interest of maintaining quality and safe medical care. OB/GYN practices involved in obstetric care are faced with a number of constraints.
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- Maintaining office staff coverage for routine and emergent care
- Surgical procedures
- Labor and delivery coverage
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Steps you can take:
- Choose a medical practice whose providers staff labor and delivery 24/7
- Schedule a prenatal visit with each provider in the practice so you will have an opportunity to meet the provider who will be working in labor and delivery when you go into labor
*** If you feel strongly about having your provider be present at your delivery, there are also concierge practices where the clinicians will all but guarantee to be present at your delivery. This arrangement is more costly and there is still a chance your personal provider will not make it to your delivery.
2. Will I be able to use my birth plan?
Writing A Birth Plan
Birth plans have become very common and are encouraged as long as the plan follows the standards of medical care.
Knowing what to expect during your labor and delivery has everything to do with how you feel about your birth experience.
- You want to be prepared and the best way for this to happen is to be proactive and ask questions as you create your birth plan.
- This may require being flexible if your labor cannot follow your birth plan. Your provider ultimately wants the best outcome for you.
- Lastly, be prepared for the unexpected. Your birth experience may not go as planned even though your provider will do everything they can to stick to your birth plan.
Steps you can take:
- Take a childbirth class preferably from a labor and delivery nurse at the facility where you will be delivering and ask questions about any concerns about your birth plan.
- Take a tour of the facility where you will be delivering so you will be familiar with where to access labor and delivery. With the current pandemic, a virtual tour will be in place of
- Talk with others who have delivered at the same hospital/birth center. Every facility is a little different so the more you know the better.
3. What if I have to be induced?
Inductions are done to ensure the health and safety of you and your infant.
There are two types of inductions:
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- Emergent – Inductions are done emergently when fetal testing shows significant concerns about fetal or maternal health. Toxemia during pregnancy is a common reason for induction. It is also the treatment as toxemia resolves after delivery.
- Elective – An elective induction is a scheduled induction. Though there may not be a medical problem, the induction is done to prevent a complication. A common indication for an elective induction is a post-term pregnancy.
The decision to induce labor is based on many factors,
If you are not clear about why you are being induced, ask questions:
- What is done to induce labor?
- Why am I being induced?
- What can I expect as an outcome based on the type of induction I am having?
***Please read our article about what questions to ask at your first prenatal visit, where we discuss how important it is to have a working relationship with your provider from the very beginning.
Expectant moms are involved in this decision-making process.
For this to happen and be in the interest of her health and the health of her unborn child, it is imperative her clinical information is acquired from authoritative resources so she can make an informed decision that is within the accepted standards of medical care.
Some facts about induction every expectant mother should know:
- Though inductions do increase the possibility of having a cesarean section, the potential for a cesarean section must be weighed against the potential maternal or fetal danger if the pregnancy is allowed to continue.
- Emergent inductions are done because medical findings indicate impending fetal or maternal compromise or demise.
- It is important that an expectant mother makes a decision about induction based on her personal desires and “risk tolerance”.
- A 1/100 statistical risk of having a problem may be acceptable to one individual and totally unacceptable to another.
- If your cervical exam notes a long-closed, firm cervix, induction can be long and may not work (failed Inductions). In contrast, a dilated cervix is soft and shows other signs of inducibility (Bishops Score).
- The method used to induce labor is chosen based on a few factors.
For example, based on a woman having her third child, with a very inducible cervix, it may be as simple as breaking the water (clinically known as rupturing membranes).
On the other, a woman having her first child (being induced for severe hypertension/toxemia) with a cervix that is not favorable for induction, will require Pitocin and is at a higher risk for cesarean delivery.
Inductions don’t always go as planned, nor does spontaneous labor.
However, when a cesarean section is necessary, it is not uncommon that it is related to the indication for induction.
***If you have concerns about being induced, discuss your concerns with your provider.
4. What do I do when labor starts?
There are many concerns new moms have about what to do when labor starts.
1. When Do I Call My Doctor/Midwife?
Discuss any questions you have about when to call, during your prenatal visits.
Typically, when you call, you will want to inform your provider of your signs and symptoms of labor and any information that might help your provider decide what to do:
- contractions, how far apart, how long they last, how long you have been having contractions
- breaking water, when, how much
- blood (bright red bleeding or cervical show)
- medical information relevant to your prenatal care (gestational diabetes, toxemia, previous c-section…)
- distance from the hospital
- who is with you and what transportation you have available to go to the hospital
*Remember, there is always someone covering labor and delivery 24/7. If you have a question don’t hesitate to call. The information above will be very helpful when you call your provider.
2. What if I am alone when I go Into labor?
Since there is no way to know where you will be or who will be with you … the best approach to this concern is to be prepared.
- As you get close to your due date, make arrangements with your work so you can leave immediately.
- Have transportation arranged
- Don’t plan to take trips that are far from where you plan to deliver.
- If you need an ambulance, don’t hesitate to call. If you in very active labor the ambulance is going to take you to the nearest hospital.
- Keep your cellphone charged, and have phone numbers easily accessible.
4. What if my water breaks In public?
It is always possible that your water could break in public.
Water breaks before the onset of labor about 10 – 15% of the time.
Often it is not a large amount of water.
In fact, many times an office evaluation is necessary to confirm your water is broken.
***If you have a large amount of water, just remember this often happens and everyone will understand.
5. Will I get to the hospital or birthing center in time?
The information in our article about taking a maternity hospital tour answers this question. Yes, there are precipitous labors that can go very fast…even first labors.
If you have previously had precipitous labor, it is more likely it could occur again.
Most women having their first child will have enough time to get to the hospital.
But for the 3% of women who have a precipitous labor, statistics mean nothing.
Remember! … a provider is always on call… even if it is 2 AM. Call if you are concerned.
***Be assertive when you talk to whoever is on-call. If you have not met the provider in the office, as mentioned above, offer as much information as you can. To review what information is important please check out our article: Your Prenatal Record: Don’t Leave Home Without It
6. Will I be sent home from the hospital?
- Though you may be sent home from the hospital if you are not in labor, the fear of being sent home, should not impact your decision to go to the hospital.
- Labor is defined as regular contractions with cervical change and only a medical evaluation by your provider can make this diagnosis.
***If you are concerned, call your doctor. If you have labor symptoms, without a cervical exam it is not possible to know if you are in labor.
5. Should I have an epidural?
Epidural Placement
Epidural anesthesia is a frequently-discussed topic among expecting moms.
There are many moms who have strong opinions about epidurals and pain management during labor.
*** It is important to make informed decisions that are not based on shame, others’ expectations, or fear of being criticized. Ultimately, decisions such as this are completely up to you.
Reasons why one may decide against an epidural:
- Fear of not following the birth plan
- Fear of spinal needles
- Fear of side effects
- Fear of being criticized or judged by family, friends, and co-workers who do not share your perspective on pain control
- Fear of an epidural increasing the risk of cesarean section
- Fear of complications relating to the epidural
Reasons why one may want an epidural:
- Strong desire for pain control during labor and delivery
- To feel more present and in control during the childbirth experience.
- For postpartum pain relief so you can have quiet time to bond with your newborn.
*** Everyone has a different risk and pain threshold when it comes to a procedure (ie. epidural) or the management of pain in labor.
6. What is worse a vaginal tear or an episiotomy?
- Episiotomies were done more often years ago. They were performed right at the time of delivery to prevent the perineum from tearing. An episiotomy was also performed to prevent a foreseeable tear into the rectum (4th-degree tear).
- Operative assisted vaginal deliveries using forceps most often required an episiotomy.
- After thousands of deliveries, I find the extreme variation in vaginal tears reported online very hard to comprehend. Literally ranging from less than 1% to 95% with first deliveries.
- I always tried everything to avoid a vaginal tear during delivery. There are times when it is going to happen. Making claims of tearing happening less than 1% of the time leads to unrealistic expectations. First-time moms are left feeling they failed if they tore, when, in fact, it is more likely than not, especially when delivering your first child.
Some of the more common reasons for vaginal tearing at delivery:
- First delivery
- Fast labor
- Position of baby
- Operative assisted vaginal delivery (forceps)
- Large Baby
***Tearing decreases with subsequent deliveries. It is not possible to know if a tear will occur until the time of delivery.
Types Of Tears:
- 1st degree: This tear involves just the surface vaginal mucosa.
- 2nd degree: This is the most common tear of the perineum and goes through the mucosa to the submucosa and extends down but not through the transverse perineal muscle.
- 3rd degree: This vaginal tear goes through the transverse perineal muscle but not to the rectum.
- 4th degree: This is a vaginal tear that extends from the vagina to the rectal mucosa
7. What if I need a cesarean section?
Because a cesarean section is a surgical procedure, it is understandable that it causes anxiety.
It is important to remember that from the perspective of your prenatal provider if you need a cesarean section it is because there is a significant health concern for you or your baby associated with a vaginal delivery.
There is no answer that can adequately cover all the concerns and opinions surrounding this topic.
The decision like most medical decisions is made based on the risk versus benefit of one form of management compared to another.
***It’s normal to be concerned about having a c-section, whether it is planned or unplanned. Just remember that a C-section is not a bad outcome if it is indicated and you and your baby are healthy.
8. What if my baby has to go to the Intensive Care Nursery (NICU)?
When a newborn is taken to the NICU, many new moms fear there is a serious problem.
Though this can be the case, it is far more common your baby is being taken to the NICU to be observed for potential problems based on your labor and delivery.
Newborn in NICU
Such as fever, increased respiratory rate, meconium, fluid in their lungs, etc.
Most of the time after a day or two in the NICU your baby will be able to return to your room.
If this is a question on your mind, become familiar with the levels of nursery care prior to your visit. It is important to note that this classification of nurseries has changed significantly.
In-room newborn care with mom has become the standard.
- Well Newborn Care – Level 1
- Special Care Nursery – Level 2
- Neonatal Intensive Care Unit – Level 3
- Regional Neonatal Intensive Care Unit (Regional NICU) – Level 4
For more details about NICU nurseries, CLICK HERE
***If you have concerns about access to an intensive care nursery, especially if you have the potential for needing this care based on your prenatal course, make sure you discuss this before you go into labor and preferably at your first prenatal visit.
9. How can I avoid pooping during labor?
Though this fear is last on the list, it is by far the most common.
It is last because the fear (though very real) does not impact the health of you and your baby.
Many women are very concerned about pooping during labor.
What is most important is to keep in mind how common this is and no medical professional attending your delivery will be surprised.
As your baby’s head moves down the birth canal, it is going to put pressure on the rectum and this frequently causes a bowel movement.
In fact, when pushing, pooping is often a sign that you are about to deliver.
It happens it is no big deal. We clean it right out of the way and proceed on with the delivery.
There is no reason to feel embarrassed about it in front of your provider or nurse.
It is simply a part of the birth process we have seen thousands of times.
So please relax.
