pregIf your due date is fast approaching, then you’re probably far from relaxed. I know I was a nervous wreck, especially in the final four weeks leading up to the big day. Not only do you have to give yourself a crash course on the basics of parenting—diapering, feeding, sleeping, keeping a baby alive—but you also have to prepare for the not-so-small-task of gracefully shooting a baby out of your vag hole.

If this is your first baby, that thought alone may be enough to stop you in your pregnant tracks. I spent a lot, a lot of time thinking about exactly what birth was going to be like since no one can prepare you for it. I also don’t do well with a fear of the unknown and had a very difficult time wrapping my mind around just letting “birth happen” as the Good Lord or Mother Nature intended.

If you’re anything like me, and you have a few butterflies or a majorly aggressive moth rumbling in your stomach at the thought of labor, a recent study may give you one more thing to worry about.

A paper published in the journal BMJ Open confirmed that a fear of childbirth can increase the risk of postpartum depression roughly threefold in women without a history of depression. For women with a history of depression, fear of childbirth increases the risk of PPD fivefold.

These conclusions came from a review of birth and health registers in Finland—511,422 single-child births from 2002 to 2010. Out of these cases, 0.3%, or 1438 births, involved postpartum depression. This percentage was similar to PPD rates recorded in US studies.

“As expected … two-thirds of all cases occurred in women with a history of depressive symptoms before or during pregnancy,” wrote lead study author Sari Raisanen, an epidemiologist and visiting scholar at Emory University in Atlanta, and her colleagues.

In fact, a history of depression was associated with a 140-fold increase in risk for postpartum depression.

A third of the PPD cases occurred in women who were considered low-risk without any prior history of depression. Researchers concluded that the “single greatest predisposing factor,” after a history of depression, was an expectant mother that had a fear of childbirth.

To me, these findings are intriguing. I didn’t have postpartum depression, though I did have the baby blues. I didn’t have a crippling fear of childbirth, though I did have anxiety leading up to it.

In my personal story that has absolutely no impact on this research, I had two natural births, one at a birthing center and one at home. Although I was quite nervous about giving birth, I also took a lot of time to mentally prepare for it by focusing on positive outcomes and feeling empowered about my body.

This may sound hippy-dippy to some, but it does jibe with the advice given by many physicians—if you are afraid of pain during labor, your body will tense up, and you will naturally experience even more pain. It’s a vicious cycle. I don’t have any scientific answers for how to address a fear of childbirth, but the subject is worth talking about more openly, especially related to postpartum depression.

(photo: Getty Images)