Course of childbirth influenced by pregnant women's attitudes and mindsets

Pregnant women's attitudes and mindsets can influence the course of childbirth. This is what psychologists at the University of Bonn established in a longitudinal study with around 300 participants. Women who see childbirth as a natural process are less likely to need pain medication or a cesarean section. The results are now published in the "European Journal of Social Psychology."

Giving birth may be perceived as a more natural process or as a more medical event.

It depends on the mindset. Mindsets can be understood as a kind of mental lense that guide our perception of the world around us and can influence our behavior."

Dr. Lisa Hoffmann, Department of Psychology, University of Bonn

Specifically, this means that childbirth is either seen as a process that the woman giving birth can manage without medical aids, with a few exceptions. Or, in contrast, childbirth may be perceived as a risky event that requires medical supervision and intervention, such as cesarean section, pain relief, and episiotomy.

"Our mindset can influence how we react in certain situations," says Prof. Dr. Rainer Banse from the Department of Social and Legal Psychology at the University of Bonn. Together with their institute colleague Dr. Norbert Hilger, Dr. Lisa Hoffmann and Prof. Rainer Banse discovered that this is also the case in pregnant women. In one study, researchers interviewed some 300 women from the first half of pregnancy to six months postpartum about their attitudes, assumptions and experiences.

Importance of psychological factors

"The study highlights the importance of psychological factors in childbirth," Hoffmann says, summarizing the findings. "The mindset of the expectant mother can have an effect on whether the birth is more likely to be low-intervention or intervention-rich." Women who viewed childbirth as a natural process needed less medical intervention during delivery and, as a result, had a more positive birth experience after delivery. Weeks later, they showed lower levels of depression or post-traumatic stress.

Using an online tool, participants in the study were asked about their personality traits such as anxiety, self-esteem, and self-efficacy, as well as their mindset, during pregnancy. A few weeks before the birth, the researchers also checked whether there were any risks to the pregnancy and where the delivery was to take place. In the first week after delivery, questions focused on the subjective birth experience and whether medical interventions were performed.

As part of a diary survey, the participants also filled out a short questionnaire on their smartphone every day for a few weeks and then weekly, covering topics such as their well-being and breastfeeding. Around eight weeks after birth, the focus was on whether symptoms of depression or post-traumatic stress were present. The final online survey was conducted six months after delivery. The focus here was on the mother-child bonding.

Several steps to a positive birth experience

"However, the mindset cannot predict the bonding to the child six months after birth," Hoffmann explains. "Because there are a lot of steps in between." According to the psychologists' model, the mindset has an effect on the course of labor and birth. When there are fewer medical interventions during childbirth, the result is a more positive birth experience. This in turn impacts the well-being of both mother and child. And all of this together, if positive, can create a more secure mother-child bonding.

"However, this does not mean that there is a 'good' (natural) and a 'bad' (medical) mindset," states the psychologist. The goal, Hoffmann says, should therefore be to support childbearing women in their different mindsets and enable them to have a positive and self-determined birthing experience.

What should be done if women experience pregnancy and childbirth as extreme stress? A wide range of childbirth preparation options are available for this reason. However, the extent to which mindsets can be changed as a possible starting point has not yet been sufficiently empirically tested, Hoffmann says. In further studies, she would like to investigate the link between mindset and birth as a kind of self-fulfilling prophecy in more detail.

Doctoral Award of the University Society

Dr. Lisa Hoffmann was awarded the 2021 Bonn University Society Doctoral Dissertation Award for her outstanding dissertation, "On the Psychology of Birth," which was supervised by Prof. Banse. The prize is endowed with 10,000 euros.