Birth without fear

Most women look forward to the birth of their baby with feelings of anticipation as well as excitement. Even if their pregnancy has not been entirely straightforward, thoughts of the baby help to sustain them through the long months of gestation.

But for many women this excitement is tempered with feelings of anxiety and fear. Identifying the exact cause of their concern can be difficult.

Common reasons for mothers to feel afraid about birth

• A generalised fear of the unknown.
• Concern about pain and how they are going to handle it.
• A prior experience with childbirth which did not go smoothly.
• Questions such as -“Will my baby be ok?”, “Will I be ok?” and “What if one of us isn’t?”
• Concern about how their partner will cope with seeing them in pain.
• Apprehension about future changes in their relationship. Specifically, will their partner still find them sexually attractive?
• Worry about embarrassing themselves when they are in labour – sounding or looking unattractive or ridiculous.
• Concern about a loss of control and “losing it”.
• Not knowing what to do and perhaps appearing foolish.
• Concern about the changes to their body and the long term effects that childbirth will have on how they look.

Childbirth fear – what’s too much?

A little benign worry is fine – after all, this is what makes us human. However, anxiety which is all consuming is a marker for concern.

Be aware of:

• Feeling so anxious about the impending birth that your everyday life is affected.
• Worrying constantly about the birth and being unable to think about other things.
• Experiencing sleep disturbances such as difficulty falling asleep, nightmares, trouble “switching off” to drop off to sleep, waking early in the morning and being unable to go back to sleep.
• Changes in your eating and not enjoying food as much as usual. This can often be because of generalised feelings of tension.
• Not enjoying your pregnancy or feeling emotionally disconnected to your baby.
• Feelings of resentment towards the baby and/or your partner.
• Not wanting to consider a vaginal delivery and insisting on a caesarean section. This seems to be a common experience for pregnant women who have uncontrolled anxiety over labour and childbirth.
• Generally obsessing about the birth and not being able to think beyond it.

Some women have an overwhelming anxiety about childbirth and are diagnosed formally with a condition known as Tocophobia (from the Greek origins of Tocos = childbirth + phobia = fear). It is estimated that around 6-10% of pregnant women fit into this category. Research has shown that for this small percentage of women, they also have an increased risk of experiencing mental health problems when compared with other child bearing women of the same age.

Tocophobia is more common in women who have had a previous traumatic delivery. Specialist psychiatric care with supportive counselling during the ante natal and post natal periods is extremely useful in helping women to deal with their birth phobias.

What helps to have a birth without fear?

Preparing for what is to come can help to reduce your anxiety during pregnancy. Finding out as much as you can about labour, childbirth and post-natal recovery can make a huge difference. Looking forward to childbirth rather than dreading it is an empowering process.

• Talking with your midwife, obstetrician or health care professional. Acknowledging your anxiety is the first step towards dealing with it effectively.
• Discuss your concerns with your partner, family and friends. You’ll be amazed about how willing people are to support you and share their similar experiences.
• Avoid listening to other women’s “horror” birth stories. Excuse yourself and make a quick exit – anyone with any sensitivity is not going to share that much information anyway.
• Develop a realistic birth plan, preferably one which incorporates your wishes whilst still allowing for unexpected contingencies. Remember, labour and childbirth is not about absolute control – sometimes it becomes necessary to relinquish our personal control over to health care providers.
• Seeking extra care and support specifically around birth education.
• Have confidence in the health care professionals who are supporting you. They have systems and processes in place which are designed to bring the best and safest outcomes to mothers and their babies.
• Don’t be afraid to ask questions and ask for explanations. If you feel confused, unsure, scared or worried then tell your midwife/obstetrician. Feeling tense will not help your body to labour effectively.
• Reading all that you can on labour, childbirth, pain relief options and post-natal recovery.
• Relaxation classes such as yoga, progressive muscular relaxation, attending childbirth education, meditation and massage classes.
• Psychological support may be useful. Check the New Zealand Psychological Society website http://www.psychology.org.nz/ for local information or speak with your GP.

It can also help to remember that childbirth is a normal, everyday event for the human race. Although as individuals our own experiences of birth are limited, as a process it is completely routine.

No pain, no gain?

Childbirth pain is not without its rewards. No one looks forward to being in situations they don’t understand and cannot control. To an extent, what happens during labour is not ultimately under our control. It is not a time for predictability and guarantees. The only sure outcome about labour and childbirth is that it will end. There is a time frame around when it is safe for labour to have started and when a baby needs to be born to optimise its safety.
Knowing that there is a finite “line in the sand” time frame for labour to end helps to make it more bearable.

Pain relief for childbirth

Some women have very fixed ideas about not wanting to have pain relief when they are in labour. They see this as a more natural, valid way of labouring and don’t want any potential interference with their childbirth experience. Others are not so inclined and plan on requesting an epidural at the first twinge or niggle.

How we interpret pain and deal with it is very individual. What is right for one of us cannot be open to comparison with others. Experiencing birth pain does not make mothers any more real or authentic, just as breastfeeding doesn’t. We are all our own unique selves. Avoid feeling you need to justify your pain relief options to anyone, including yourself.

There is a range of analgesic choices which help to ease labour pains:

• Nitrous oxide gas in combination with air.
• Pethidine.
• Epidural.
• TENS machine (Transcutaneous Electrical Nerve Stimulation).
• Hypnotherapy.
• Water – either in the shower or in a bath.
• Reflexology.
• Acupuncture.
• Hot packs.
• Massage.
• Aromatherapy.
• Deep breathing.
• Visualisation.
• Music.

Birth without fear – during labour

• Do your homework – become as familiar as you can with what’s involved in childbirth and educate yourself and your partner. Remember, we tend to be more fearful about situations we do not understand.
• Keep active – our bodies are designed to move. Unless you have a condition which is preventing you from moving when you are labouring, then being mobile generally helps labour to progress more quickly.
• Do some creative visualisation or mindful meditation – whatever helps you to focus. Many women find themselves in an almost primal state when labouring. Give into the forces which your body is dictating and have faith that it knows what to do.
• Take an iPod or a favourite CD, some aromatherapy oils or perfume into the labour ward with you. We labour with all of our senses and this is a time of acute sensitivity.
• Keep your partner close. Some women like to have more than one birthing support person with them; invite whomever you feel most comfortable with. But first check the hospital policy on numbers of support people allowed.
• Aim to focus on your baby and visualise them going through the labour process with you. Try not to view the pain in an entirely negative way; it is a means to an end.
• Try to relax when you can between your contractions. Feeling tense will only add to your discomfort so take the opportunity to rest when possible.
• Keep focused on your contractions as they come, rather than thinking about how you’ll be coping with them later on. Deal with one contraction at a time. Remember, small steps.
• Don’t feel embarrassed – your midwife and/or obstetrician has seen and heard everything you could possibly do or say a thousand times before. If you need to grunt, scream, swear or pant, or a combination of all of these, then just go ahead and do it.

Remember that for many women their expectations of childbirth are not matched by the reality. There is only so much that planning can do.

Recommended Reading
Birth Skills- Proven pain-management techniques for your labour and birth. Juju Sundin and Sarah Murdoch Arena : Allen & Unwin (2007).