Although the problem is believed to affect up to one in ten women, the true figure may be much higher, with a lack confidence in maternity care providers, warn scientists.
Most women feel a little anxious about giving birth, especially for the first time, but for some childbirth can be intensely frightening and traumatic - a phenomenon known as tokophobia.
Rather than looking forward to the arrival of their baby, they have a morbid fear of pregnancy and the birth process.
Labour wards can feel like ‘torture chambers’ and they feel their only option is to have a Caesarean section.
But Professor Lee Roosevelt, of the University of Michigan, said while some fear in expectant mothers is normal and helpful in planning and asking questions, excessive fear can lead to complications during pregnancy and birth.
Her researchers polled 22 women who took part in three small, diverse focus groups and were pregnant or had recently given birth.
It found they were as concerned about their healthcare providers and their place of delivery as they were about pain or complications.
Prof Roosevelt, who is also a midwife, said: “Women who have significant fear of childbirth are more likely to have C-sections, longer labours and to need induction or augmentation. They are more likely to have postpartum depression.”
Tokophobia is not well recognised by doctors and midwives and is caused by various factors including a fear of pain, past experience of a difficult childbirth, depression and even sexual trauma.
Women are not only more afraid than previously thought, but their fears extend far beyond common worries about pain or birth complications, she said.
One of the greatest fears is being abandoned by the clinician. They worry their clinicians won’t treat them respectfully or listen to their concerns, or won’t attend the actual birth.
Co-author Prof Lisa Kane Low said: “The results say a lot about how we do maternity care in this country.”
Women also reported being worried they would be expected to bear the brunt of decision-making responsibility, or their decisions would not be respected.
Prof Roosevelt said: “I knew as a clinician and midwife, myself, that the relationship that I have with my patients is so essential, but I didn’t really realise how key it was to women’s fears.”
Prof Kane Low says a better way for clinicians to address fears is to pose open-ended questions about how women regard their pregnancy and childbirth, rather than asking specific questions about common fears.
She said: “Women want to be in a discussion with their provider about their fears. They don’t want to be patted on the back and told, ‘Oh, that’s normal, you’re having a baby.’”
The researchers hope to develop a survey tool to accurately assess a woman’s fear of childbirth and examine how it affects the physiology of pregnant women.
The study was published in the Journal of Obstetric, Gynecologic and Neonatal Nursing.