Chartered Psychologist Dr Katrina Forbes-McKay joins forces with former midwife Mo Tabib to argue that ‘it’s not just knowing what to do, it’s believing you can do it’.
Arriving in early labour, she was visibly afraid. Her muscles were tense, her eyes were wide, and her breathing was rapid. She appeared overwhelmed, disconnected from her body, and uncertain of what lay ahead.
That was one woman, Jagoda, who I (Mo) supported in my previous role as a practising midwife. But there were many others who were vulnerable, helpless and distressed during labour. Sadly, for many pregnant women, childbirth is a frightening prospect.
What should be a period of joy and flourishing is often overshadowed by a fear of injury, pain, and complications for themselves and their infants. This fear tends to escalate throughout pregnancy, peaks in the third trimester and is most common amongst first-time mums. In extreme cases, it leaves women fearful and avoidant of pregnancy altogether.
As researchers who are passionate about women’s health, we set out to explore the roots of this fear and consider how our work might help alleviate it.
Traumatic and terrifying
In interviews conducted during our first study, pregnant women repeatedly shared that their fears stemmed from negative birth stories narrated by friends, family or the media – stories that portray birth as traumatic and terrifying. I still remember the dread in one participant’s voice as she said, ‘I always thought, childbirth sounds horrendous… friends tell me absolute horror stories, I just feel nauseous and fearful.‘
Unsurprisingly, this negative portrayal leaves women questioning their ability to cope during labour. As one woman noted, ‘I sort of thought, oh god, how am I gonna do this? You hear stories of how painful it will be and, you know, how terrifying it is‘.
For some, the fear was so overwhelming they chose not to think about it at all: ‘…Ignorance is bliss. I didn’t think about it too much, quite deliberately‘.
These narratives matter; they shape expectations and instil fear in so many.
Unfortunately, these examples are all too common. Globally, as many as 60 per cent of women experience a specific fear of childbirth, with approximately 16 per cent experiencing it at a severe clinical level. And it’s not just an emotional burden; it’s linked to longer labour, increased caesarean section rates and poorer postpartum mental health. The World Health Organisation even suggest that fear of childbirth is contributing to the global rise in caesarean section rates, many of which are medically unnecessary and carry risk for both mother and baby. Despite this, we know very little about what we can do to ease or prevent this fear.
Much of the previous research on fear of childbirth has taken a pathogenic approach focused on what can go wrong in terms of risks, complications and clinical outcomes. But this often overlooks the factors that may reduce it. As a psychologist and a midwife, we’ve long been interested in what helps women feel confident, calm and supported during pregnancy and birth. We want women to thrive and flourish during this transformative time in their lives.
Self-efficacy
Evidence suggests that enhancing well-being in terms of feeling positive, purposeful and connected can reduce worry and anxiety whilst improving pregnancy outcomes. Inspired by Sociologist Aaron Antonovsky’s Salutogenic model, which focuses on health-promoting factors, our research explores what supports women to feel less fearful, rather than what causes it.
We are especially interested in the resources pregnant women can draw upon to feel capable and in control during labour. One key resource is self-efficacy, the belief not only that certain behaviours will help during labour, but the belief that you can actually perform them. According to Albert Bandura, this confidence plays a crucial role in how we respond to stressful or threatening situations. When we believe in our ability to cope, fear loses its grip, opening the door to real change and growth.
Using a Salutogenic lens, our UK-based study explored the factors that help ease childbirth fear among 88 pregnant women in the third trimester of pregnancy, using the Warwick Edinburgh Mental Wellbeing Scale, Childbirth Self-Efficacy Inventory and the Wijma Fear of Childbirth Scale. Worryingly, most of the women showed a moderate fear of childbirth, with 12 per cent showing a severe fear. Despite this, we found that lower childbirth fear was closely linked to positive mental well-being, belief in birthing techniques, and crucially, confidence in using those techniques.
What stood out was that mental well-being was the strongest predictor. Women who felt emotionally more positive, purposeful, and connected to others were less fearful of childbirth. The second key predictor was child-birth self-efficacy expectancy. It wasn’t just about knowing that breathing, visualisation, or relaxation could help; it was about believing that they could actually use these strategies when it mattered. That distinction is crucial. When women doubted their ability to use them effectively, fear crept in. This means that antenatal education must go beyond teaching techniques; it must empower women to believe they can use them.
Building belief
Our follow-up research reinforced these findings. We explored the impact of attending an antenatal education class informed by Self-efficacy theory, which incorporated vicarious learning, positive birth stories, and relaxation practice. What we found was striking: when women had time to practise and master techniques such as breathing, visualisation and relaxation, watch others successfully use them, and share positive birth stories, their confidence grew, their fear of childbirth and anxiety reduced, and their mental well-being improved. These improvements lasted well beyond birth, remaining stable 4-8 weeks post-birth.
That’s a stark reminder that preparing for birth isn’t just about receiving information; it’s about building belief in one’s ability and promoting positive emotions. Indeed, by doing so, we may also influence women’s intentions to use pain relief medication such as epidural. We found a significant shift in the intended and actual use of epidural following attendance at the antenatal relaxation class.
What was most inspiring was witnessing the shift in mindsets among women after attending the class. Their reflections spoke volumes. Many described a newfound confidence, a sense that they were ‘born to do this (childbirth)’. One woman shared how she no longer saw birth as something to fear but felt the class had left her ‘empowered, quite excited for my birth, kind of I want to labour, I want to birth my child’. For her, the education ‘gave me the tools to be able to cope with labour’. Others echoed this sentiment, expressing reassurance from practising techniques and seeing others succeed, ‘If people have done it, and I’ve practised, you know, then I should be okay‘. These moments of realisation and self-belief are at the heart of what it means to support women by building confidence and connection.
By fostering positive emotions, confidence and purpose, antenatal education can play a key role in reducing childbirth fear. Which in turn, can potentially reduce medical interventions and lead to more positive outcomes for women and infants. And that, we believe, is a change worth making.
Changing the narrative
In light of our findings, we call for antenatal programs that shift from a medical model to one that promotes a sense of purpose and self-belief. Specifically, we propose that childbirth education should;
- Foster confidence in the use of labour techniques such as emotional regulation, breathing, visualisation and relaxation;
- Enhance psychological well-being by supporting meaningful social connections and promoting a sense of purpose and satisfaction;
- Embrace an approach that focuses on wellness rather than risk.
Rather than asking, ‘Do you know what to do during labour?’ antenatal care providers should be asking, ‘Do you believe you can do it?’ That subtle shift opens space for reflection, reassurance, intervention and growth. This approach also aligns with WHO priorities to provide antenatal care that focuses on both physical and mental health and well-being, and offers a new direction for improving maternal care and birth experiences. It’s a unique opportunity to change the narrative, from one of fear and uncertainty, to one of confidence and calm.
This piece is reproduced with the kind permission of the British Psychological Society, where it was first published in The Psychologist: https://www.bps.org.uk/psychologist/childbirth-fear-and-uncertainty-confidence-and-calm
Suggested citation: Forbes-McKay, K. & Tabib, M. (2025) Childbirth – from fear and uncertainty, to confidence and calm, SLSS Research Blog (RGU), 2025/12. Available at: https://rgu-slss.blog/2025/12/22/childbirth-from-fear-and-uncertainty-to-confidence-and-calm/
