Too much pressure is put on women to avoid fear and anxiety during pregnancy.
“Trust birth!” some say.
Others say “trust your doctor, just do what he tells you to do”
The result is the same every time. The woman’s fears are invalidated, and possibly made worse. We need to acknowledge that fear is a normal part of pregnancy, and we need to help women to use their fear to guide them. Fear in pregnancy can be important, and even helpful, it’s fear in birth that must be avoided.
Proponents of unhindered birth are frequently guilty of brushing aside women’s concerns, suggesting that they “trust birth” rather than heeding fear. Conversely, those who ascribe to the obstetric model, are often so completely convinced that birth is beset by emergency, that we must trust doctors implicitly to feel safe. Neither is realistic. The bottom line is that both deny women the freedom of simply being where they are at on their journey. We need to find the balance between the two.
Women have always feared birth, fearing the unknown is an unavoidable aspect of humanity. What’s interesting is how our fears have changed. Over time our fears have changed to reflect the advances in maternity care, and the social beliefs around birth.
Whilst we can surmise that our prehistoric sisters feared death, or stillbirth, nowadays women fear those things, but they also fear loss of dignity, and invasion of privacy. They fear that people will hurt them during labour, that they will have no control over the process. It’s worth noting that in tribal communities around the world women don’t fear the pain in the same way westernised women do.
According to an article by Andrea Robertson, found on Birth International:
“This view of labour pain as an affliction seems most prevalent among western women. In many cultures, pain in labour is accepted as a necessary, if uncomfortable part of birth, and is not seen as an insurmountable problem. Perhaps the fact that these women are usually cared for by other women, who understand birth and its mysterious benefits for the female psyche, is the central reason why pain is not feared but accepted.”
Unfortunately modern self help gurus have given fear entirely too much power, and women have come to fear, fear itself. Being afraid of birth can NOT cause a poor outcome. Biology is a far more powerful force, and the belief that fears can create outcomes is just that: A belief. However if we are to believe this theory, that fear can alter the future, then we must examine the thoughts of the other unforgettable participant in equation – the baby. The baby does not fear birth. The baby – driven by biology – has one purpose and one purpose alone; To be born, and to be held at its mother’s breast.
Fear can not create your most most feared outcome, despite what self help has told us for the past few decades. Fear can however, cause women to make foolish, and spontaneous decisions, without thoroughly informing themselves first. Telling women to ignore their fears, and simply “trust” either a care provider, or birth itself, leads to poor decision making. Poor decisions fuelled by fear, lead to poor outcomes, fear itself can be a powerful guide, but not some kind of magical creator of disaster. .
Although fear in pregnancy can be harmful, fear in labour is where the biggest danger lies.
When humans are fearful they produce adrenaline. Adrenalin is vital to our survival as a species, but unfortunately for modern women, it blocks the release of the hormones oxytocin (which helps women feel calm in labour) and endorphin (the hormone that helps women cope with the intensity of contractions). Adrenaline can also cause labour to stop completely.
For newly evolved humans giving birth, this was a safety feature. It gave them time to run away from danger, before labour recommenced. In a hospital stalled labour is perceived as a problem – which is ironic given that it is commonly fear of obstetric management, or hostility towards women and their birth plans, that causes the fear and adrenalin rush.
According to Ask Dr Sears:
“There is a connection between fear and pain during childbirth. The efficiency of the magnificent uterine muscle depends upon your hormonal, circulatory, and nervous systems all working together. Fear upsets the balance of these three systems, causing your body to produce excess stress hormones that counteract the helpful hormones your body produces to enhance the labor process and relieve discomfort. This results in increased pain and a longer labor. Fear also causes physiologic reactions that reduce blood flow and thus oxygen supply to the uterus. An oxygen-deprived muscle tires quickly, and a tired muscle is a hurting muscle.”
The more women learn about how birth works, the better they are able to seek out the right conditions for labour. Constructively utilising fear in pregnancy to seek out information and true support can go a long way towards reducing fear in labour. When the venue and the birth team are chosen very carefully, it is more likely that the right hormone balance will be released. This increases safety, and aids pain management.
Whenever a woman is fearful during pregnancy she needs information, validation, and support. The natural birth community provides far more of that than the obstetric model of care and its fan club, however neither has found the perfect balance between trust, information, and support. The balance between telling women what to do, and aiding their decision making capacity. Too many people are telling pregnant women what to do, instead of simply hearing them speak about their fears.
When we tell women to simply trust birth, and belittle their fears as “insufficient trust” we deny them the opportunity to learn more, and often leave them not only fearful but alone. They come to feel as if they are foolish to be fearful, so they struggle to find trust, or they misplace their trust. When we tell women to simply trust their care provider to handle the scary things we deny them knowledge that could alleviate their fears, and the ability to participate in informed decision making.
The reality is that if we don’t explore our fears in pregnancy they carry over into birth, and that is where we run into trouble. Telling women to trust birth, or care providers, without supporting them as they analyse it, may leave them up the proverbial creek without a paddle. There are two main reasons for this. The first is that fear may lead women to choose an unsuitable care provider and venue for their birth, and then encounter hostility that blocks their hormone production. The second is that blindly trusting birth can also lead women to make unsafe decisions, with little knowledge of the true process, but plenty of false bravado.
Women need to be able to trust both care providers and birth, in order to give birth safely, and to maximise their ability to cope with the intensity. It’s normal for women to be afraid of birth, it’s even SMART, and anyone who is fearful deserves compassion and understanding not the patronising dismissal that is so common. We all know that stress in pregnancy is harmful to both women and babies, but we cannot force it to go away by preaching blind trust. When we do this, we simply adjourn the fear until a time and a place when it becomes even more unsafe, the birth space.