Dartmouth study links missing birth support to higher stress levels

Most animals, including other primates, give birth alone, but humans require assistance during childbirth due to the physiological complexities of the process.

A new Dartmouth-led study finds that pregnant individuals who were unable to have their desired emotional support persons present during childbirth were more likely to have higher levels of perceived childbirth stress than those who were not missing their support people. 

The researchers found that the higher level of perceived childbirth stress was comparable to the increase in stress associated with a Cesarean section delivery.

The findings are published in Evolution, Medicine, & Public Health.

For most of our history, humans have been supported in childbirth by people, usually women, whom they knew and trusted. Our study highlights the stress that results when people do not have access to that type of support."

 Zaneta Thayer '08, associate professor of anthropology at Dartmouth

Research has shown the benefits of emotional support during childbirth, including shorter labor, less use of medication during labor, and better outcomes such as lower C-section rates. 

"Some of these benefits may stem from lower stress hormones and increased oxytocin levels when people feel emotionally supported in labor," says Thayer.

Oxytocin, a hormone that stimulates contractions, can also have calming and pain-relieving effects. It also plays an important role in breastfeeding and helping parents bond with their infants after birth.

The team utilized data from their COVID-19 and Reproductive Effects Study in 2020, an online survey of 1,100 pregnant persons that examined how COVID-19 affected the well-being and health care experiences. None of those surveyed indicated that they wanted to give birth alone. 

Due to hospital restrictions in place in 2020 during the COVID-19 pandemic, however, many people went on to give birth alone or could only have one birth assistant present. 

Approximately 30% of survey participants indicated that at least one support person that they wanted to be present for their child's birth was unable to attend, and 93% of those participants indicated that this was due to hospital restrictions. Some of the individuals indicated that they had hoped to have their partner, doula, and/or mother present during labor.

Fourteen percent of participants surveyed indicated that their health care providers seemed busy, distracted, or unavailable, which was found to be associated with higher levels of perceived birth stress.

And persons with higher levels of education had significantly higher levels of childbirth stress.

The majority of those surveyed were white participants, so the sample was not nationally representative of the population. But having more support is likely to be even more important for people who experience discrimination or mistreatment within the medical system, according to the study.

"We know that making people feel safe, secure, and supported during labor improves maternal and child outcomes," says Thayer. "So, maintaining access to emotional support during labor and delivery should always be a priority when possible, including in the case of public health or other emergencies."