Attitudes of Young People Towards Birth and Need for Early Education

Medical anthropologists have observed for some time that people in high-income countries uncritically accept obstetric technology because the use of technology is supported by ideologies promoting ‘modernization’ and ‘progress’. This socio-cultural phenomenon is exacerbated by media depictions of birth as inherently risky, unpredictable, and fraught with complications. Medical terminology such as ‘trial of labour’, ‘failure to progress,’ ‘incompetent cervix,’ and ‘‘inadequate pelvis’’ further erode women’s confidence in childbirth. The cumulative effect of these negative images and labels is the perception that birth is frightening, and a medicalized, high-technology approach to birth is the best and safest way to deliver babies, despite scientific evidence to the contrary.

Between 2014-2019 Dr. Stoll led a national team of midwifery and nursing researchers who study birth attitudes and preferences among young people in 8 OECD countries; to understand how childbirth fear relates to preferences for obstetric interventions, and how best to educate young people about pregnancy and birth.

Dr. Stoll’s interest in understanding the attitudes of young people towards birth began in 2006, when the Division of Midwifery launched a survey, to collect data about attitudes and preferences towards pregnancy and birth among students at the University of British Columbia, Canada (n=3680). We published a paper in 2009, about reasons why young people would choose vaginal birth versus Cesarean section and for her dissertation research Dr. Stoll undertook an in-depth secondary analysis of data. During her postdoc, Dr. Stoll engaged a team of international collaborators, to study attitudes towards birth in eight high-income countries across four continents.

The team collected data from over 4500 young people around the world and published several papers (see below); four papers describing results for the entire dataset and six country-specific papers. We were able to demonstrate that lack of exposure to and less knowledge of birth is linked to increased fear. Fear, in turn, is linked to preferences for unnecessary interventions. This is important because obstetric interventions, like Cesarean sections are overused and linked to an increased risk of maternal and newborn morbidities and increased healthcare costs. Students from the US had the lowest preference for midwifery care and community birth options and the most positive views about obstetric technology and interventions, compared to students from Europe and New Zealand. Young adults who learned about birth through the media and via school-based programs exhibited the highest levels of fear and preferences for interventions.

These findings point to the importance of re-evaluating how young people learn about birth at school and to counteract negative media portrayals of birth. An innovative, four-hour midwife-led education program for school children in Germany has shown both to increase knowledge of birth and to decrease fears among 1000+ elementary school children. Our team is in the process of applying for funding, to adapt the German program and test the midwife-led education modules at 5 Vancouver schools, with the support of an interdisciplinary team of educators, researchers, midwives and public health experts.

See below list of articles about this project.


Stoll K, Downe S, Edmonds J, Gross MM, Malott A, McAra- Couper J, Sadler M, Thomson G and the ICAPP Study Team (2020). A survey of university students' preferences for midwifery care and community birth options in eight high-income countries. Journal of Midwifery & Women’s Health. Open access.

Weeks F, Sadler M, Stoll K (2019). Preference for cesarean attitudes in a Chilean sample of young adults. Women & Birth. E-Pub ahead of print. PMID: 30992177

Stoll, K, Edmonds, J, Sadler M, Thomson, G, McAra- Couper J, Swift, E, Malott A, M.M. Gross, Streffing J, Downe, S, and the ICAPP Study Team (2018). A cross-country survey of attitudes toward childbirth technologies and interventions among university students. Women and Birth. Epub ahead of print. PMID: 30150150 

Stoll K, Hauck YL, Downe S, Payne D & Hall WA (2017). Preference for cesarean section in young nulligravid women in eight OECD countries and implications for reproductive health education. Reproductive Health14(1), 116. PMID: 28893291

Thomson G, Stoll K, Downe S & Hall W. Negative Impressions of Childbirth in a North-West England Student Population (2017). Journal of Psychosomatic Obstetrics & Gynecology, 38(1):37-44. PMID: 27578057

Swift EM, Gottfresdóttir H, Zoega, Gross MM & Stoll K. Opting for natural birth: A survey of birth intentions among young Icelandic women (2016). Journal of Sexual & Reproductive Healthcare, 11:41-46. PMID: 28159127

Stoll K, Hauck Y, Downe S, Edmonds J, Gross MM, Malott A, McNiven P, Swift E, Thomson G and Hall W (2016). Cross cultural development and psychometric evaluation of a measure to assess fear of childbirth prior to pregnancy. Journal of Sexual & Reproductive Healthcare, 8:49-54. PMID: 27179378

Hauck Y, Stoll K, Hall W & Downie J. (2016) Association between childbirth attitudes and fear on birth preferences of a future generation of Australian parents. Women and Birth ;29(6):511-517. PMID: 27233945

Stoll K, Edmonds J & Hall W (2015). Fear of childbirth and preference for Cesarean delivery among young American women before childbirth: A survey study. Birth, 42 (3); 270–276. PMID: 26104997

Edmonds JK, Cwiertniewicz T & Stoll K (2015). A survey of childbirth preferences and attitudes among young women prior to pregnancy. Journal of Perinatal Education, 24(2), 93-101.

Stoll K, Hall W, Carty E & Janssen P (2014). Why are young Canadians afraid of birth? A survey study of childbirth fear and birth preferences among Canadian university students. Midwifery, 30(3), 220-226. PMID: 23968778

Stoll K & Hall W (2013). Attitudes and Preferences of Young Women with Low and High Fear of Childbirth. Qualitative Health Research,23(11), 1495-1505. PMID: 24108088

Stoll K & Hall W (2013). Vicarious birth experiences and childbirth fear among young Canadian women. Perinatal Education, 22(4), 226-233. PMID: 24868135

Clemons J, Payne D, McAra-Couper J, Farry A, Garrett N, Swift E, Stoll K. Gaining insight from future mothers: A survey of attitudes and perspectives of childbirth. (Manuscript is complete, journal TBD)