• Katherine Kowalski

Fear in Labour

My clients are each unique, some beautifully complex and beautifully simple. Some have a significant amount of trauma or fear to work through and some feel at peace with the unknown. One common thread that most pregnant woman share is some fear of the labour and birth process, essentially fear of the unknown. Fear is normal! There are a few reasons for this fear. Media often portrays birth as a terrifying medical emergency/crisis. We’ve all seen the movies or TV shows with the woman screaming and swearing as the stretcher is being run down the hospital hallway, dad passing out as the baby crowns and the heroic obstetrician taking total control of the situation while shouting at the woman to push. We are also bombarded by negative and frightening birth stories from others. It felt to me when I was pregnant, like it was almost a competition among women to tell the worst story! If we grow up hearing the negative birth stories of the woman surrounding us, we are more likely to define birth by those stories. During the early to mid 1900’s birth began to transition from the home to the hospital. Many generations of women experienced Twilight Sleep, obstetrical violence, and separation from their babies immediately after birth. Bonding and breastfeeding were discouraged at one point! This horrific treatment of birth-givers in their most vulnerable and powerful state, resulted in generations of women experiencing extremely negative and traumatic birth experiences. Their stories are still told today and we must hear them. This is what propels us to create desperately needed change in a broken maternity care system. Over the past 6 years, I have doula’d many women and I have always had an interest in how fear affects the labour process. Before I get into the science behind fear and labour, I’d like to offer you my anecdotal evidence from my work as a doula… fear absolutely affects labour and birth. Sometimes this fear appears in early labour when we harbour worries around labour actually starting. Sometimes fear shows up in active labour as sensations intensify or in transition when labour’s intensity is at its peak and we experience a total loss of control in our bodies. A fear of pushing is quite common (specifically being afraid of the baby’s size, fear of tearing or damage to the vagina, fear of having a bowel movement, etc). Sometimes if a woman has experienced sexual abuse in her past, fear can appear at any point in the labour process.

Fear is not all bad, and it can actually serve us very well as human beings, particularly in a threatening situation. Our body’s sympathetic nervous system is activated (often called the “fight or flight’ response). Our pupils dilate, adrenaline is released, blood is shunted from our internal organs, including the uterus, and sent to the skeletal muscles to help us run away from the threat. Our sweat glands stimulate secretion, digestion is inhibited, blood sugar increases, and heart rate and blood pressure are elevated. In a threatening situation this a perfect response! However, in labour, this response is not beneficial and can actually lead to additional interventions. Catecholamines are a group of hormones released into the bloodstream in response to physical or emotional stress. In labour, excessive catecholamine levels reduce blood flow to the uterus, reduce uterine contractions, increase the length of labour and reduce blood flow to the placenta. The increased levels of catecholamines in the mother increase the levels in the baby as well. In response to this, the baby begins to conserve oxygen and may experience fetal heart rate decelerations.

In order for the labour process to unfold naturally, we MUST feel safe in labour. We must feel that our surroundings are safe and that the people around us are safe. We must work through our fears and limiting beliefs in pregnancy, so that we go into labour in the most peaceful and confident state possible. Sometimes there is deep work to be done and finding a good therapist can be extremely beneficial. Being aware of all that we expose ourselves to is also imperative. The things we watch, the books we read, the people we surround ourselves with and the stories we choose to listen to, all have the ability to shape our birth experience too. Choosing a maternity care provider that shares our philosophies on birth can be very beneficial in helping us to dispel fears and build trust in our bodies. A doula can help you work through fears surrounding the labour process and help ensure that you feel safe, respected and supported in labour. As doulas, we act as an advocate and guardian of your space, body and experience. There are many things that can be done in labour to create a safe and calm environment. Dim lighting, limited interventions, soft voices, soothing aromas, and lots of nurturing touch and connection can help increase the safety a woman feels in labour. When we experience loving touch during labour, we release more of the hormone oxytocin, which helps to reduce pain and encourage progression in labour! Safety can also be felt when the maternity staff uses informed consent and respects our wishes. If you are pregnant it is well worth your time to explore any fears or concerns that you have surrounding labour and birth. I want every woman to have the best possible birth experience and working through her fears is a great way to start! There are so many fabulous books, movies and websites but the following are some of the resources I’ve found most helpful:

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katherine kowalski 

certified birth doula + registered massage therapist