Despite great improvements in health care in the past decades, fear is a prevailing emotion in childbirth. It increasingly influences women's decisions and health care providers' clinical practices, which can result in suboptimal quality of care.

Women and families fear pain, lack of support, disrespect/abuse during labour and childbirth, and adverse outcomes associated with vaginal delivery. Providers are afraid of the uncontrollable nature of childbirth, pressure from families, financial/judicial litigation, loss of practicing rights, reputational damage, and physical/verbal violence from families in case of adverse outcomes in vaginal birth.

Fears motivated by the belief that caesarean section is a safer option that guarantees the best outcomes is one of the factors driving the unprecedented increase of caesarean section use witnessed by contemporary societies worldwide. Although a caesarean is life-saving when needed, it is associated with risks that are higher for women with limited access to obstetric care.

We argue that a constructive dialogue needs to emerge between stakeholders to (i) improve understanding of each other's views, values, and needs; (ii) challenge misconceptions considering the evidence; and (iii) reconcile societies' lower tolerance for negative obstetric outcomes and the uncertain nature of childbirth, where although ideal outcomes cannot be promised, high-quality, evidence-based care should be ensured.

This panel brings together the findings of two projects that aim to improve understanding of fear as a driver for caesarean section decision-making (Re-Judge) and to adapt and implement nonclinical interventions to optimize the use of caesarean section (Quali-Dec).