In this two-part blog, we are going to explore the topic of fear in childbirth. It’s a BIG topic, so to do it some justice, we are going to split it over a couple of weeks.

Fear of childbirth is not something new. Since time began, women have always had some level of fear or apprehension about giving birth – and for good reason. Giving birth was not always as safe as it is today (although for millions of women around the world living in developing and Third World countries, childbirth is still fraught with danger).

Many of us have come across the biblical quote from the Book of Genesis where God chastised Eve after she ate from the Tree of Knowledge; “I will greatly multiply your sorrow and your conception; in pain you shall bring forth children.”

So the concept of pain in childbirth is clearly not a new thing!

As a bit of an interesting side note, the word in the original Hebrew bible was “etzev” which does not mean pain, it means (among other things) “labour” as in “work”. Pain in Hebrew is “ke’ev” – I am a Hebrew speaker!) Etzev was incorrectly translated when the King James Bible was printed in 1611! What the biblical quote was really saying is that women will labour in order to bring forth children.

Back in 1942, a ground-breaking book was published by a British doctor called Grantly Dick-Read. It was called “Childbirth Without Fear” and it was revolutionary. Many of today’s childbirth education classes are based on Dick-Read’s philosophies and his work is as relevant today as it was more than 70 years ago.

Studies today show that approximately 40% of women have a moderate fear of childbirth and around 23% have a high level of fear. A small percentage (usually less than 5%) will experience an overwhelming pathological fear of pregnancy and childbirth, called tokophobia.

How much fear a woman will experience depends on a number of factors including whether she is expecting her first baby, or a subsequent baby (if her first birth was traumatic in any way then this will absolutely influence her in her second pregnancy). Cultural background also plays a role. One study interestingly showed that Australian-born women were more likely to report higher levels of fear and experience higher rates of caesarean section than participants of non-Australian origin.

So why do women fear birth?

First of all, it is normal to feel a degree of fear or apprehension about childbirth, particularly if you are expecting your first child. For most women, it is fear of the unknown. What will the pain be like? Will I manage the pain on my own (without drugs)? How long will the labour last? Will I end up needing a Caesarean or an instrumental delivery (forceps or vacuum)?

The problem arises when that normal level of fear develops into an abnormal level of fear, when the fear paralyses us and ultimately impacts on labour progress. To understand how fear impacts on labour progress, it is helpful to understand some basic hormonal physiology. Hormones play a crucial role in labour.

Oxytocin is often called the “hormone of love”. During labour, it causes the uterus to contract, which in turn helps the baby to move down into the pelvis and labour to progress. Oxytocin can only be released if the woman feels safe, supported and cared for. If, on the other hand, she feels the opposite (frightened, observed, unsupported), oxytocin levels will drop dramatically and instead, adrenaline levels will rise. Adrenaline causes the muscles to harden, the uterus will not contract efficiently and labour will slow down, or even come to a grinding halt. High levels of adrenaline also trigger our ancient “fight or flight” response which mammals in the wild must use in order to survive. However – it’s important to remember that we are still mammals, and at the end of the day, our bodies don’t behave all that differently to any other mammal.

After a period of time, if the labour does not pick up again, her care providers will usually want to speed the labour up artificially, which typically involves putting the woman on a drip of synthetic oxytocin, which in Australia is known as Syntocinon.

Contractions brought on by Syntocinon do not mimic natural contractions, and are usually stronger, more frequent and last longer than natural contractions. For this reason, we commonly see Syntocinon and pain medication (frequently epidural anaesthesia) going hand-in-hand.

When a woman experiences fear, her body will naturally tense up. That, in turn, will cause her to feel pain more acutely. This is commonly referred to as the Fear-Tension-Pain cycle, something else Dr Dick-Read was writing about more than 70 years ago. Once a woman is caught up in this cycle, it can be very hard to break out of it.

If, on the other hand, a woman feels safe and protected during labour and is producing high levels of oxytocin and low levels of adrenaline, her body will also produce something called beta-endorphins, which are basically nature’s painkillers and they will actually help to decrease the perception of pain that she is experiencing and allow her to enter a dream-like state.

So why do so many women today have unhealthy levels of fear about childbirth?

First off, we live in an era of information overload. There is literally nothing that can’t be looked up online today and pregnant women are some of the worst offenders when it comes to checking out “Dr Google”. Add to that the endless websites devoted to pregnancy and birth, the online forums, Facebook groups, friends and family feeding pregnant women horror stories and worst of all – reality television shows such as “One Born Every Minute” which portray childbirth as a medical emergency waiting to happen, with women writhing on their backs in bed suffering unbearable levels of pain.

It’s no wonder that this generation of women are terrified at the prospect of giving birth!

So let’s put it out there. What are the things that women fear about childbirth?

What if I poo?

THE REALITY

The reality is that many women will pass a bowel motion during the pushing stage of labour. It’s normal, and in fact, unless your bowel is completely empty prior to going into labour, you are unlikely NOT to do it.

The other reality is that you are unlikely to know that you have even done it and no one will tell you or give you any indication that it has happened. Midwives are incredibly professional and discreet and will clean it away immediately without you even knowing it has happened. It is a normal part of vaginal birth and not something women should be concerned about.

Enemas used to be routine in labour, but have not been for many years now because studies showed they did not improve outcomes and in fact only caused discomfort and embarrassment for women.

HOW TO CONQUER THIS FEAR

It’s really important to know that passing some faecal matter during labour is normal, not uncommon and a woman should not for a second, feel embarrassed about it. Labour is messy. There is blood, amniotic fluid… and yes, sometimes poo. It’s part and parcel of giving birth and most of all – it’s NORMAL.

Will my partner ever see me as sexy if he looks ‘down there’?

THE REALITY

A LOT of women worry that a vaginal birth will stretch their vagina permanently and that if their partner sees them giving birth, that the sight will forever put them off and they won’t be sexually attracted to her in the future.

I think it’s important to acknowledge that there are some men who don’t want to look “down there” during the labour – but that’s most likely because they’re squeamish and freaked out by the whole idea of a baby emerging from a woman’s vagina. It’s not because he’s thinking “oh my god – I will never be able to look at my partner’s vagina again.”

HOW TO CONQUER THIS FEAR

Having had the experience of teaching childbirth classes to hundreds of couples, I think what happens far more frequently is that partners are in awe of women and the miracle of giving birth. Most dads I have spoken to see their partners in an entirely new light after witnessing first-hand the birth of their child. Far from being put-off, men view their partners, and the mother of their child, with the greatest level of respect. I think most men are quite simply, blown away by the power of a birthing woman.

What if I can’t go through with it?

THE REALITY

Although there might be times during the labour when a woman feels like it will never end, the reality is that it will. One way or another, that baby will come out and labour will be over!

It’s important that a women feels supported and cared for throughout labour and that she is well prepared for it too. Attending a great childbirth preparation course (ideally taught by an independent childbirth educator) will really help a woman and her partner to understand how labour progresses, help her to open up about any concerns or fears that she might be feeling and give her the tools she needs to make confident and empowered decisions about her care.

HOW TO CONQUER THIS FEAR

It’s important to remind ourselves that women have been giving birth for millennia. Our mothers did it, our grandmothers did it… and they survived and so will we! Our bodies were designed to give birth, but sadly many women today really don’t believe that they can give birth naturally without a lot of medical intervention. All the intervention we do see in labour today has increased risk for mothers and babies, and so sadly it has all become a bit of a self-fulfilling prophesy.

Intervention can be life-saving. There’s no question about that. However, if medical intervention was restricted to the mothers and babies who truly required it and the vast majority of healthy mums and bubs were left to labour without all that unnecessary intervention, then we would see a lot less complication in labour and delivery and a lot less anxiety and fear in women as a result.

Once again, a good childbirth education course will cover these topics and help inform a couple to make good, evidence-based decisions.

I don’t want everyone seeing my lady bits!

THE REALITY

Most of us are naturally quite modest. We don’t walk around naked, especially around strangers. Being in labour often sparks concern in a woman who is worried about being exposed and that’s a normal concern.

The reality however is that your professional care providers see “lady bits” all day, every day! And yours are no different to anyone else’s! Are they looking at your vagina, your pubic hair (or lack of pubic hair!)? Nope! Do they care? Nope! They are watching your labour progress and when the time comes, helping your baby to come out slowly, while doing their utmost to protect your perineum (the area of skin between your vagina and the anus).

HOW TO CONQUER THIS FEAR

As hard at it might be for some women, try not to think about it. The more you do (and the more you worry about it), the harder it will be for you to relax (which is critical). When your muscles tense because of fear and anxiety – ALL your muscles will tense up, including your cervix, which is a muscle. A tight cervix equals slow or no dilation which will result in a slow and more difficult labour.

The best thing a woman can do is to ensure that she has people with her in the room that she feels safe and protected by. People who protect her space and support her – not observe her. In addition to having her partner there, a woman should also think about hiring a doula (a professional birth support attendant), or perhaps a private midwife – someone she has developed a close relationship with throughout the pregnancy and therefore someone she trusts absolutely.

What if I groan and scream?

THE REALITY

Many women will quite unconsciously groan and moan in labour. It’s instinctive and can be extremely beneficial. That sound resonates in the body and those vibrations will loosen and relax tight muscles. In turn they will help to relax the pelvic floor.

Some women feel the need to scream and roar – and that’s okay too! It’s almost a primal urge to make big sounds and it’s the body’s way of getting rid of excess tension, which is a really good thing to do! “I am woman – hear me roar” should be your mantra!

HOW TO CONQUER THIS FEAR

Screaming because of fear and excessive pain is not productive or conducive for labour, so it’s important to differentiate between the two. When pain turns to panic, you can see it in a woman’s face and in how she’s breathing (usually erratically, almost hyperventilating).

If this is the situation, the most important thing a partner can do is try and get her attention back, get her to focus on you – make eye contact. Hold her hand (if she wants to be touched) and help to get her breath back on track. Help her to breathe deeply and evenly, which will in turn lower her heart rate and blood pressure. Remind her that you are there for her and that she is doing an amazing job!

**Partner Tip: Check out Penny Simkin’s Take-Charge Routine for some great tips to help mum stay calm and focused.

In Part Two next week, we’ll delve into some of the deeper fears that many women and their partners have about childbirth and ways that we can conquer those fears.

Tanya Strusberg is a Lamaze Certified Childbirth Educator (LCCE) and founder of birthwell birthright, an independent childbirth education practice based in Melbourne. In 2015, Tanya was inducted as an FACCE (Fellow of the Academy of Certified Childbirth Educators) in recognition of her significant contribution to childbirth education. Through her internationally accredited Lamaze Educator Training program, she is very excited to be training a new generation of Australian Lamaze educators.

Last, but absolutely not least, she is also the mum of two beautiful children, her son Liev and daughter Amalia.