Childbirth fears

We have prenatal classes, epidurals and The Birth Channel -- but giving birth is still a mysterious, powerful and often painful experience. It's normal for expectant parents to have some fears. So how do you manage them?

It was a beautiful summer morning, just after eight o’clock. Although the August sun was shining in Shira Farber Brook’s Toronto neighbourhood, inside her home the shades were drawn and the light was dim. Shira soaked in the bath while Justin, her partner, moved around the bathroom quietly, lighting candles and cueing the stereo.

Shira had gone into labour at around four that morning, but the couple waited several hours — until Shira’s contractions were good and strong — before picking up the phone. Still, the hospital nurse told Shira her contractions were too far apart, and to stay put. Emily, Shira’s doula, said she would have a shower and then come over to the house to be with them until it was time to go to the hospital. Everyone was pretty relaxed. They all thought Shira had a long way to go.

So, Shira and Justin spent a couple of hours in their candlelit bathroom, calmly breathing, not really speaking. While Shira concentrated on making her body open up like a lotus flower, Justin rubbed her back and fed her ice chips.

At around 10:30 am, Emily showed up and let herself in to the quiet house. She found Shira and Justin in the bathroom and suggested they move to the bedroom. But as soon as Shira settled onto her king-sized bed, Justin could see that the baby was crowning. “I saw Justin mouth to Emily, ‘I can see the head,’” Shira recalls. Moments later, Kaleb Alon Brooks was born.

If you think all this sounds too good to be true, consider the back story: Before Kaleb arrived, Shira, our blissed-out, accidental-homebirth-sans-doctor-or-midwife mom, was afraid of having a baby. She was afraid of the pain, she was afraid of needing a C-section, she was afraid of losing control, afraid of epidurals and drugs and episiotomies and, yes, afraid of giving birth at home.

If you’ve chosen to read this article, you know that Shira is not alone. Almost every pregnant woman — even the ones who are truly excited about giving birth — feel at least a little bit afraid of the birthing process. Other women are downright terrified. And although there is always someone who will remind you that women have been giving birth since before the dawn of civilization, and that in some countries women stop working in the fields only long enough to push their babies out, there are a lot of valid reasons to fear childbirth. After all, giving birth hurts, sometimes terribly. Labour can go on and on. There are pain relief options but you might not like them. Problems can arise. And you can never be sure exactly what to expect.

For Vanya Yeung, the unknowable aspects of labour and delivery were probably the worst part. “Because the experience was so new and everyone’s situation is different, there was no telling what could happen,” says the Toronto mom who is currently living in London. Her baby, Ryan, is six weeks old. Like Shira, Vanya anticipated the worst. “Honestly, giving birth was my number one fear, followed by public speaking,” she says. “I was also afraid of pain, pain and more pain.”

In addition to being a psychological burden, research shows that fear of childbirth can actually make matters worse. Consider a 2001 study of 280 women in their third trimester of pregnancy. Researcher Nancy Lowe, an associate professor of nursing at Ohio State University, found that women who reported low confidence were so anxious about the event that they often felt incapable of using the relaxation and breathing techniques that would make labour more bearable.

“Most women fear childbirth to some extent,” said Lowe when the study came out. “Fear of the unknown is normal, and a little anxiety may help women mentally prepare for the event. But when a woman has high fear and low self-confidence, she starts to doubt her ability to give birth.” In earlier studies, Lowe also found that a woman’s confidence in her ability to cope with labour was one key to the individual variation in the pain of labour and birth.

Part of the problem is that Western medicine tends to reinforce negative attitudes toward childbirth and labour. “Western women are bombarded with messages that undermine their beliefs in the ability of their bodies to give birth successfully,” said Lowe.

Overcoming fear
So what’s a fearful Western woman to do? Clearly the key is to somehow face our own fears, sidestep those negative societal messages and, instead, head into childbirth with confidence. But how?

One step at a time, says Sylvia Miedinger, a registered midwife in Hamilton. In her practice, Miedinger often begins by simply reframing some of the most difficult aspects of birth for her clients. Pain, for example. “The pain is productive pain, not pain that damages,” she says. “And it is not constant, it comes in waves. You might have 20 or 30 seconds of pain, and then a break.” In prenatal visits, Miedinger encourages women to get used to thinking of those breaks as their friends. “If you focus on the contractions, you spend the whole break bracing yourself for the pain instead of relaxing.”

Miedinger is also a firm believer in prenatal classes, especially for first-time parents-to-be. “The class should cover the whole range of experience — coping techniques for labour and delivery, breathing exercises, and what you can expect during the entire process, as well as early care and breastfeeding.” Miedinger adds that prenatal classes are often a fun social experience, which can’t help but make you see your approaching birth in a happier, more positive light. Yoga can also be a great help, says Miedinger. “If you’re able to take the whole notion of relaxation in yoga poses and apply that to the way you feel during a contraction, it will be great,” she says. And getting into better shape before labour never hurt anyone.

Vanya, who took both prenatal classes and prenatal yoga, says that these preparations probably didn’t affect her actual labour, but they definitely changed how her labour affected her. “It didn’t make it less painful, it just helped me deal with the fear and anxiety by giving me the tools to cope. The breathing techniques really helped, some of the other stuff didn’t, but it didn’t matter,” she says. In the end, Vanya’s birth, while not exactly a walk in the park, was much more manageable and positive than she expected.

Since Shira Farber Brooks doesn’t like to be afraid, she went even further in conquering her fear by finding a hypnotherapy program like the one her sister had taken in the US (see Hypnotherapy). Still, Shira doesn’t attribute her incredible birth experience to what she learned in those classes alone. She feels that any kind of prenatal preparation makes a difference. “I think the more women arm themselves with knowledge, the better the experience. The more information I had, the more secure I felt.” She adds that having a doula was wonderful and would recommend hiring one to anyone looking for a bit of extra support. (And who isn’t?)

But Shira also recognized the huge role luck can play in the birth you get. How else could she account for the difference between her first child’s birth (which was so easy that people still tell each other the story of how her baby just fell out of her) and her second (a posterior presentation) which was really tough?

“Everything wound up working out, but I needed a lot of support, both physical and emotional, from the midwives, doula and Justin,” says Shira of four-month-old Elijah’s birth.

For some women, taking the right course and buying a good book will be enough. But a few are going to need more help. That’s where someone like Dr. Shaila Misri, medical director at BC Women’s and St. Paul’s Hospital in Vancouver, comes in. As a reproductive psychiatrist, Misri only sees women who have been referred to her by their doctors or midwives. In other words, Misri sees women with major prenatal fears.

For example: “I had a woman here yesterday,” says Misri from her Vancouver office. “Her ob/gyn was picking up on unusual signs of anxiety and referred her to me.” It didn’t take Misri long to learn that the woman had a history of sexual abuse. “Now she is really afraid of childbirth because she is afraid that the birth will bring back flashbacks of the horrible things that were done to her.” In such a case (and Misri sees many of them — a history of sexual abuse is quite a common cause of serious childbirth fear), Misri feels a C-section can be the best solution.

Some of the other women Misri sees have given birth before, but have been scarred by bad experiences — “women who have had unexpected C-sections, a long traumatic labour, a woman who had a twin delivery and lost one during the birth or some other kind of birth trauma,” she says.

As a third group, Misri also sees women who have serious body image issues and worry excessively about tearing, loss of sexual function and loss of attractiveness. Psychotherapy and other techniques can go a long way toward helping all of these women, she says.

Whether a woman has a fear factor of two or 10, one thing won’t help her: listening to other mothers’ terrible tales and delivery disasters. “I found that women tend to swap labour stories the way veterans swap war stories. As soon as you tell someone you’re pregnant, she’s just dying to tell you her horror stories. I don’t know why women do this to each other,” Shira says.

Cindy* can’t figure it out, either. At 40, she has put off having a baby for about as long as she can. “Most of my friends have gone through it. They all say it’s the most awful pain. They all say get the epidural as quickly as possible. I want children, but I’m terrified.”

For a long time, Cindy let her fear hide in a dark closet of her mind. She wasn’t really thinking about becoming a mother, so it didn’t really matter whether she was keen on childbirth or not. She even wonders if her anxiety might have sabotaged some of her earlier relationships. But now? “I’ve met someone and he’s incredible and I think he’s the one, so it’s time. He wants kids and I love children. I can actually see myself having them,” she says, with real excitement in her voice.

The only question is how. Cindy has had only casual conversations with her doctor, who has told her not to worry about labour and delivery until the time comes. But, of course, that hasn’t stopped her from worrying. “I always thought, Oh I can just get a C-section if I want to, but now I think the experience of giving birth naturally is far more attractive. I would love to do it.”

If Shira and Vanya did it, Cindy, it’s definitely worth a try. Good luck!

Hypnotherapy
“When I first heard about it, I got so excited,” says Shira Farber Brooks about hypnotherapy. “I thought, ‘Oh this is great. Someone is going to hypnotize me during my labour and I won’t feel anything,” she says with a laugh.

Needless to say, that’s not exactly how the program works. Rather, the mom-to-be and her partner attend a series of lessons where they learn a variety of exercises, from relaxation and breathing to hypnotic visualization. They also get a set of audiotapes to listen to at home. It doesn’t seem that different from ordinary prenatal classes, except for the homework.

Basically, says Shawn Gallagher, an Ontario midwife who became a certified hypnotherapist after 13 years of midwifery, hypnotherapists help women get into a state hypnotists call a trance. “When they’re in that state, they are more receptive to new information. Then you give them the information to reduce their fear or even let go of their fear.”

Shira was skeptical. “At the first session, she had us pinch ourselves after reading some visual imagery.” The thinking was that the visual imagery would offset the sensation of the pinch. “I went home and told my husband there is no way this is going to work.” But, gradually, the techniques began to have an effect. “Part of the program is that you listen to the relaxation tapes twice a day for 15 minutes. There was a tape of affirmations — your body is prepared for this, your body knows what to do. I found I was really starting to have less fear and I thought, even if this doesn’t help in labour, it’s helping me now.”

That’s the idea, says Gallagher. “There are a few things that frighten women and pain is at the top of the list.” In North America, we’re rather pain phobic. We tend to feel that in order to deal with pain, we need medication.”

But, Gallagher says, the body has its own way of taking care of that pain. “The safest way anybody can have a baby is with something like hypnosis. Mom is getting drugs in labour, but she’s getting drugs her body makes. There has been research to show that this is not only safe for mom, it’s beneficial for the baby.”

Before labour:
• Talk to your caregiver about your feelings.
• Look for books and videos that give realistic descriptions of what to expect.
• Sign up for prenatal classes and prenatal yoga.
• Explore breathing and visualization techniques.
• Look for a midwife, and perhaps a doula, who inspire confidence in you.
• Research drug and non-drug pain relief options.
• If your fears continue to be overpowering, ask your caregiver to refer you to a therapist who can help.

During labour:
• Listen to music that relaxes you.
• Practise breathing, relaxation and visualization techniques.
• Explore hydrotherapy. Try a shower or a bath which will, according to midwife Sylvia Miedinger, provide a different sensation for your nerve endings and allow you to cope better. In addition, hot water relaxes muscles.
• Experiment with counter-pressure and position changes.
• Ask your caregiver about sterile water injections if you’re experiencing back labour. “It stings going in,” says Miedinger, “but it provides quite a bit of relief.”
• Consider pain medications, such as Demerol and morphine, which Miedinger says are safe if you are more than four hours away from delivery.
• Consider an epidural, which will numb you from the waist down, but will also prevent you from getting out of bed for several hours.

*Name changed by request

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