Knowing how much pain comes with giving birth can lead to severe levels of fear for pregnant women. (Photo by Gorodenkoff on Shutterstock)
In A Nutshell
Women believed in the usefulness of labor techniques but lacked confidence in using them during childbirth.
Mental well-being was more strongly associated with fear of childbirth than any other factor measured.
12% of women surveyed showed severe childbirth fear, despite average mental well-being.
Findings suggest prenatal care should focus on building both emotional resilience and self-efficacy.
ABERDEEN, Scotland — Most expectant mothers spend months preparing for childbirth, learning breathing techniques, relaxation methods, and pain management strategies. But a troubling pattern has surfaced: while women believe these techniques will help them during labor, they often doubt their ability to actually use them when contractions hit.
A new study from researchers at Robert Gordon University in Scotland shows this confidence gap is strongly associated with how much fear women experience when it comes to giving birth. Even more striking, a woman’s overall mental health, that is, her sense of purpose, positive emotions, and meaningful relationships, was more strongly associated with childbirth fear than anything else researchers measured.
The findings, published in the Journal of Psychosomatic Obstetrics & Gynecology, suggest that prenatal classes may need to move beyond simply explaining techniques to also focusing on building confidence in using them when labor begins.
What the Scottish Study Found About Childbirth Fear
Researchers from Robert Gordon University surveyed 88 pregnant women in their final trimester who were signed up for hospital relaxation classes. Most were first-time mothers (86%), college-educated (79%), and working full-time (83%).
Each woman completed psychological assessments measuring their mental well-being, fear of childbirth, and confidence in handling labor. A clear pattern emerged: women scored much higher on believing that coping strategies would work than on feeling capable of actually using them during delivery.
The study found that 12% of participants had severe childbirth fear — a level of fear that previous research has linked to requests for planned or emergency cesarean births, longer labors, and increased risk of postpartum depression. Fear of childbirth affects anywhere from 10% to 60% of pregnant women, depending on how it’s measured, and typically peaks in the third trimester.
Feeling confident and supported during childbirth can help a woman overcome strong fears that crop up during pregnancy. (Photo by Gorodenkoff on Shutterstock)
Why Mental Health Is Closely Linked to Birth Fear
Mental well-being was more strongly associated with lower childbirth fear than confidence in labor techniques. Women who reported higher levels of life satisfaction, positive emotions, and sense of purpose were significantly less likely to develop intense fears about giving birth.
The confidence gap was equally telling. Women consistently showed they understood what would help during labor (breathing exercises, relaxation, positive self-talk) but doubted their ability to execute these strategies when pain and intensity peak.
Consider this comparison: someone might know that deep breathing helps manage stress but still panic during a job interview. The knowledge exists, but confidence in performing under pressure doesn’t.
How This Changes Prenatal Education Approaches
Current prenatal classes focus heavily on teaching techniques but may miss a key step: building actual confidence in using those techniques. The Scottish researchers suggest that antenatal education could benefit from incorporating strategies designed to improve self-efficacy, such as reinforcing personal capabilities and addressing psychological barriers to action.
Supporting overall mental health during pregnancy could be equally important. Instead of waiting for problems to develop, healthcare providers might focus on building psychological resources that prevent difficulties from occurring.
The World Health Organization has emphasized that prenatal care should address mental and emotional well-being alongside physical preparation. These findings provide new evidence supporting that approach.
Healthcare System Impact of Childbirth Fear
The effects reach beyond individual women to entire healthcare systems. Severe fear of childbirth is associated with more medical interventions, extended hospital stays, and increased postpartum mental health problems—all of which strain resources and affect outcomes for mothers and babies.
Most prenatal education appears to be teaching women the right techniques while leaving them psychologically unprepared to use those techniques when they need them most. Closing this gap between knowledge and confidence offers a clear opportunity to reduce one of pregnancy’s most common fears, with benefits flowing through families and healthcare systems alike.
Paper Summary
Methodology
Researchers conducted an online survey of 88 pregnant women in their third trimester who were on a waiting list for antenatal relaxation classes at a hospital in northeast Scotland. Participants completed three psychological questionnaires measuring mental well-being, fear of childbirth, and childbirth self-efficacy. The sample was predominantly first-time mothers (86%), white British (77%), college-educated (79%), and employed full-time (83%).
Results
Twelve percent of women showed severe fear of childbirth. Mental well-being explained 25% of the variance in childbirth fear. When childbirth self-efficacy expectancy was added to the model, the total variance explained rose to 32%. Women scored higher on believing coping behaviors would help than on confidence in performing those behaviors, showing a gap between knowledge and confidence.
Limitations
The study had a small sample size limited to one geographic location with predominantly well-educated, white British women, limiting broader applicability. The design prevents determining cause-and-effect relationships, and participants from an antenatal class waiting list may not represent all pregnant women.
Funding and Disclosures
The research received no specific funding from public, commercial, or not-for-profit agencies. The authors reported no conflicts of interest.
Publication Information
Title:Â Predicting fear of childbirth during pregnancy, the positive role of self-efficacy and mental well-being: a cross-sectional study
Authors:Â Katrina E. Forbes-McKay, Mo Tabib, Tracy Humphrey
Journal:Â Journal of Psychosomatic Obstetrics & Gynecology (2025)
DOI:Â 10.1080/0167482X.2025.2527658