Birthing Fears (Part Two)
In this second instalment of our blog on Birthing Fears, we’re going to explore a number of other common fears around childbirth, including some things that many women and their partners think about, but rarely voice. Did you miss Part One? If so, be sure to read it first!
Fear is necessary for our survival. In prehistoric times, fear kept us from walking into the lion’s den. Today, fear keeps us from walking into oncoming traffic. The fact is, we live in stressful and anxious times, both personally and politically. Only this past week alone, we have been bombarded yet again with tragic news from Lebanon, France, Israel and Kenya.
Watching the news is enough to put many of us over the edge. Hiding under a rock is not an option, so we learn to live with it.
There are few life changes as dramatic and all-encompassing as having a child. Pregnancy and birth involve enormous change, and with that comes a wide variety of emotions; joy, excitement, fear, uncertainty, doubt…
“Will I have an easy, healthy pregnancy?”
“Will I cope in labour?”
“Will I be a good parent?”
Birth is meant to be overwhelming – in a very positive sense. Giving birth is supposed to shake us to our core, creating enormous personal growth in a very short and intense period of time, which will prepare us to take on the huge challenge of being someone’s parent.
Some degree of fear during the birth is also a physical necessity. Stress hormones (also known as adrenaline) are necessary for labour and birth to progress, and will provide mum with the all-important burst of energy to push her baby out.
Confidence and fear are intimately linked. Think of them as being on opposite ends of a seesaw. When fear is high, confidence is low. When confidence goes up, fear comes down…
It is the negative self-judgement that accompanies that fear that causes much of the damage; “I can’t do this”, “I don’t have what it takes”. Hopefully mum is well supported throughout her labour – by her partner, close family member or friend, a doula or midwife – and she will be constantly reassured and encouraged that she is doing a magnificent job!
Last week, we covered a number of common fears around giving birth. This week I want to delve a little deeper and give voice to some of the things many of us think about (and worry about), but often keep inside.
“I’m frightened of the pain”
Have you ever thought that pain could equal power? Crazy concept I know, but hear me out!
In labour, if a woman has full body sensation, and is able to work with that pain through movement, positioning and the use of a wide variety of comfort measures; she is in control of her labour. SHE holds the power – not her care providers.
On the other hand, if a woman masks that pain through the use of opiate medication or anaesthesia, she will require constant monitoring, which will significantly impact on her ability to work with her labour, effectively handing control of it over to her care providers.
Pain is power mamas!
Remember too, that fear causes muscles to tense, which in turn causes us to feel pain more intensely. We need to remember than pain in labour is normal and functional (as opposed to pain caused by injury, which is abnormal and dysfunctional).
“I’m frightened about the unknown”
This is one of the most threatening things about childbirth. As humans, we like predictability. In this technologically advanced day and age, where we rely on devices like smartphones, iPads and a near constant connection online, to give structure to our daily lives. Labour throws all this up in the air, forcing us to rely on our most basic of human instincts. That can be confronting for many of us, especially those of us who don’t handle unfamiliar experiences well.
It’s important to remember that for labour to progress efficiently, it is essential for us to switch off that active, rational part of our brains, which inhibit the release of oxytocin and endorphins. Ipso facto – Facebook does NOT belong in the birthing room!
“What if people don’t respect my wishes?”
Many women and their partners sit down and spend time carefully creating a birth plan (or birth preference list). While I think we can all agree that birth has the potential to be unpredictable, it is also incredibly important to clearly communicate your wishes. Doing so enables your care providers to better understand your own philosophy of birth and clearly outlines your personal “borders”.
Couples should take the time to go through their birth plan with each member of their care team throughout the labour (don’t assume that one midwife will pass on the information to the next midwife who comes on shift).
Be sure to understand the components of informed decision making, informed consent and informed refusal and feel confident in expressing your own wishes. If you are feeling disrespected, or that your wishes are being ignored – don’t accept this. Ask to speak to a more senior member of staff and stand your ground. You have every right to do so.
What if I tear in the labour, require an episiotomy, or need a Caesarean?
In the good old days (not!) episiotomies were routinely performed on all women (along with enemas and shaving a woman’s pubic hair!). Thankfully, we have come a LONG way, and these invasive and totally unnecessary procedures are a thing of the past.
The episiotomy rate in Australia currently ranges between 12% (public hospitals) and 28% (private hospitals), but in many cases can be avoided all together.
A woman’s position for the pushing stage of labour is critically important in order to reduce the risk of tearing or requiring an episiotomy (Hint: do not give birth lying on your back in bed with your feet up in stirrups!). She should adopt upright and forward leaning positions which allow the pelvis to open up and for gravity to work its magic. Women should push only when they have the instinctive urge to do so, avoiding “directed pushing” at all costs.
It’s important to mention though, that it’s not uncommon for some women to tear naturally in labour (especially a first birth), but the tear may be very superficial, and may not even require suturing.
An unplanned or emergency Caesarean section can be a frightening thing to deal with. Emotions run high and fear and anxiety quickly take over. For this reason, I believe it is essential that women and their partners are well-informed of the process of Caesarean surgery and to even write a second birth plan – their Caesarean birth plan – and if it becomes necessary, the couple are well-informed ahead of time, and have already put some thought into how this altered path can still be an empowering and positive birth experience. There is a global movement towards a more gentle approach to Caesarean birth – both for the mother and her baby. A fantastic video came out of the UK a couple of years ago about a woman-centred Caesarean, and it is well worth taking the time to watch it.
What if there is something wrong with my baby?
Whether they voice this fear or not, women worry about stillbirth, injury, and a less-than-perfect baby. If a woman has experienced pregnancy loss in the past, then obviously she will be carrying a high degree of fear with the current pregnancy, although hopefully she has had the support of a perinatal counsellor to help her deal with her anxiety.
Even if a woman does worry that there is something wrong with her baby, she probably also recognises that it is largely an irrational fear and that the odds are overwhelmingly in her favour that her baby will be perfectly healthy.
“What if I lose control?”
For many women, losing control is probably way up there on their list of ‘Top Fears in Childbirth’. It is a real challenge to accept the fact that there are things we cannot, and, in fact, are not supposed to, control. This is especially difficult for those who have had past life experiences when not having control left them open to harm and hurt. In particular, women who have experienced past abuse and trauma may be emotionally triggered in labour and ideally her caregivers have been informed in advance, in order to be able to care for her with compassion and sensitivity. Some women however, are unable to reveal their trauma (especially to strangers) or have potentially buried their trauma subconsciously, only to find it re-emerges during labour.
Those of us fortunate enough not to have been subjected to abuse and trauma can still find the prospect of losing control utterly terrifying. How can you overcome this fear? Being cared for by known and trusted care providers is essential. If you cannot find a caseload midwifery program, then seek out a private independent midwife to care for you throughout pregnancy. Together, you will build a relationship and a level of trust that cannot be achieved in mainstream maternity care where a woman is cared for by multiple stranger midwives. The only people in the birthing room (apart from mama!) are those few people she intimately knows and trusts. Her birthing space should be treated like a private and sacred sanctum. In this safe space, a woman can find it much easier to let go and allow her body to give in to the surges of labour.
We have to remember what birth is fundamentally all about. It’s about love. The famous American midwife, Ina May Gaskin once said, “The energy that gets the baby in, gets the baby out.”
Love is stronger than fear. Love for the baby, for her partner, for herself. Love is the most powerful force there is. The stronger the love becomes, the weaker the fear becomes. It is love that will help her find the courage to birth. The word “courage” comes from the French word coeur, which means heart. It takes courage to give birth. It takes heart.
So let love be the dominant emotion in the birthing space. Not fear.
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.