Understanding Fear in Childbirth

A new baby is often welcomed by a family anticipating a “tiny bundle of joy!” So why is it, when a mother contemplates the birth of that same baby, the first feeling that comes up is fear? What are the origins of this fear? How did this fear acquire such a strong hold on our perception of the birth experience? Does this fear serve us?

  We all experience fear of the unknown to some degree, and unfamiliarity with the labour process itself can be a significant source of fear. But why, with the internet offering up information on every topic known to man, would we be unfamiliar with such a well-documented process? Part of that answer is the absence of experience. 

  In less developed countries, where the idea and practice of community is still valued and embraced, girls as young as 3 years old attend births with women of the village or tribe who are supporting the laboring mother. In this context, a woman of childbearing age may have already witnessed a dozen or more births; and so, is familiar with the cultural and physiological “norms” of the process. In contrast, conventional North American culture emphasizes privacy and personal space, and bodily functions are dealt with discreetly. An expecting woman in Western culture may have never discussed birthing even with her own mother, let alone having witnessed a birth first-hand. Imagine how frightening the experience of vomiting would be if you didn’t understand what your body was doing, or why it might be doing it. You can see how this would be cause for concern and even panic; labour even shares similar characteristics to losing one’s lunch, in that your body innately knows what it needs to do, and it operates primarily on autopilot in this process. If an expecting woman wants to know what she’s up against, she may turn to experienced friends or family members for some sage advice: then come the horror stories. 

  It seems that mothers who report “surviving” horrific deliveries earn a certain status, with the longest labours and heroic tales of “pushing for days on end” garnering the most admiration from other women. You need only to eavesdrop on the nearest Mom-and-Baby group to see that this is true. The woman who dares share the fact that she had a relatively painless birth will soon find herself on the receiving end of resentful glares from other mothers in the room, and thus social conditioning has reared its ugly head, teaching these women to be cautious in sharing their positive birthing experiences, while women with “horror stories” exchange details in what often deteriorates into an exercise of one-upmanship. The woman with the longest, most excruciating birth with the greatest number of painful medical interventions is awarded the respect and admiration of the group.

  For the few women who have not witnessed the social convention of exchanging horror stories, the media happily steps in to fill the gaps where fear has not yet been introduced. Think about the last movie or prime-time show you saw where a woman was giving birth. What did she sound like? How fast was the labour? The challenge with these ultra-dramatized images is that they capitalize on the negative, and then amplify it – after all, they have to depict pregnant-and-calm to laboring hysterics to immediate idyllic nursing in under 26 minutes, to allow for commercials, right? 

  A considerably more subtle influence comes from the medical community itself, where the process of birthing is more often treated as a medical emergency than a natural, physiological process.

  So, does this fear serve us? Do a woman’s feelings of fear or apprehension help or hinder her in the birthing process? The truth is fear plays a very significant and negative role in labour; the simple presence of fear itself can be the determining factor as to whether a woman is able to cope with labour using her own skills and resources, or whether she will require a host of medical interventions. We owe this to the Fear-Tension-Pain phenomenon. If you’d rather not sift through pages of medical journals, here’s the short explanation: psychological fear causes tension, and this tension manifests as significant labour pain, as the uterus is the only muscle in the human body capable of opposing itself. This cycle was once a survival mechanism, much like our fight-or-flight response was there to keep us safe in life-or-death situations. Similarly, neither mechanism is currently relevant to our everyday lives, as it’s not often we have to take on carnivorous animals in hand-to-hand duels to the death, but the physiological mechanisms remain nonetheless. The Fear-Tension-Pain phenomenon is one of the most significant barriers to mothers wishing to have a more “natural” birth experience without medical interventions. So trust your body.

  What can expectant mothers do to overcome this innate physiological response? Firstly, women need to trust their bodies, not merely on an intellectual level, but on an intuitive level as well. An understanding of the birth process itself is a good starting point. Self-education is essential, so find local childbirth education classes, read books (the library has a shelf that would take anyone several pregnancies to get through!), and practice what you’ve learned, whether it’s affirming your faith in your body, doing some daily physical exercises, or rehearsing coping strategies and physical comfort measures for labour. And again, trust your body.

  Support is another key ingredient in proactively managing fear, before it begins to cause problems. Remember that emotional support in labour is just as valuable as conventional medical care, and neither replaces the need for the other. Seek support from someone you trust; this may be your partner, your family doctor, a midwife, an obstetrician, a doula, or a trusted family member. Research has shown that women who receive continuous labour support are less likely to require any of the usual interventions; continuous, nurturing support alone can reduce the risk of needing a C-section by 43%! Have I mentioned that you can trust your body?

  As women, we have been birthing for thousands of years; the more we connect with our bodies’ innate wisdom to carry out this amazing, natural process, the better. Trust your body – it knows how to make healthier moms and healthier babies. 

Tiffany Nelson practices as a birth and postpartum doula, and childbirth educator in Nanaimo.