Taking the fear out of birth
The morning after Jax's birth Nov 2011
Originally published here August 4, 2016. I'm reposting today as with the Duchess of Sussex - aka Meghan Markle - choosing to homebirth, it's shone a global spotlight on this birthing choice.
If there was one thing I would love every pregnant woman to know it is this: fear affects labour and birth. The stalling of labour that leads to inductions. The pain that leads to epidurals. The cascade of interventions that lead to emergency c-sections. So much of this can be linked to a woman not feeling safe for whatever reasons, and not being supported the way she needs to be. Do everything you can to address your fears, and feel supported as you journey through pregnancy, labour and birth.
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Years before I was even in a relationship with Christian, I remember thinking I really need to get over my fear of birth, particularly my fear of birthing in a hospital, otherwise I'm going to have real problems when I get around to having a baby. One day my aunt said to me: "You know you can have a homebirth?" At the time, strange as it sounds now, it hadn't occurred to me that I could give birth at home. My dad was born at home along with everyone in his family, but that was back in a little Serbian village. My then 20-something Australian-born self didn't know anyone who had given birth at home here - very different to now where lots of my friends, my cousin and myself have all now homebirthed. I instantly felt my whole body relax and exhale with relief. My body knew so much more than my mind could comprehend at the time.
Around that time I read Naomi Wolf's book Misconceptions which started opening my eyes to the extreme medicalisation of birth, how much that contributes to unnecessary interventions (different to the necessary ones) and how it doesn't have to be like that. Wanting a more natural birth, benefiting both mother and baby, is behind a lot of women's decisions to birth at home, especially in the absence of an adequate number of birthing centres, and understaffed hospitals. When I finally got pregnant with Jax I knew homebirth was the way for me.
During my pregnancy I had an awesome homebirth midwife Robyn (my main one) along with a second midwife Melanie. They were part of a homebirth team of midwives, so they made sure there would always be extra support available in case either of my midwives couldn't make the birth. Robyn spent an hour with me each and every appointment, to inform me about what my body was doing at that particular pregnancy stage, and toward the end, what it would do at certain stages of labour and birth. She took the scariness out of birth and turned some appointments into Biology and Anatomy class 101. Wondering how on Earth a baby is going to come out of such a small space becomes so much easier to deal with when you know that during birth your cervix and vagina are like rubber bands, your bones, joints and ligaments become loose and move as needed, to allow the baby to come on through. Put those visuals in your mind Mama's to be!
Over the months, Robyn had me address all my fears: what if this or that happened? what if I had to transfer? She got me to discuss everything from my sexual history to how I felt about my mother and about becoming a mother myself, because "it will all come up in labour in some way", especially when it is unaddressed. After every appointment she sent me home with yet another empowering, conscious birthing book, and I read every positive birth story online and off that I could find.
Christian and I also did a Hypnobirthing course where we first learned about the direct link between fear and pain during labour. When you hear about women having no pain relief, it is often because the woman's fear response has managed to be eradicated or switched to super low. When this happens, helped along by her feeling supported in her birth environment, when she feels informed about what her body has been designed to do, when she trusts the team around her, the natural labour-induced, morphine-like hormones can do their job along with other natural pain-relieving support.
Giving birth was still a fricken intense experience, but rather than seeing it as terrifying or unbearable, you can liken birth to a marathon. Your body is going to feel it, it is an endurance event like no other, but prepping your mind and body beforehand makes all the difference. Pre-birth prep gave me a sense of calm that little by little overtook the fear. It wasn't a guarantee that things would go a certain way - it just helped me to know okay, whatever happens, I feel so much more at ease now. My midwife also helped me understand that wherever I ended up, home or hospital, I could still take this feeling of calm with me. What a massively different headspace this was for me.
Like a lot of women, I used to have a huge fear of childbirth, and I especially had a fear of giving birth in a hospital. For most women that is where they feel safest, and if that's the case then that is the best place for you (1). However, I knew that I don't respond well to time pressures or to lots of people I don't know well telling me what to do which was, accurately or inaccurately, the scenario I imagined waiting for me in a hospital. Somehow I knew that, given my feelings, this would affect my labour/birth in some way - and this was long before I knew about the fear-tension-pain link (2) in labour/birth.
Dr Grantly Dick-Read, an English obstetrician in the early 1900’s whose work Hypnobirthing is based on, wrote extensively about this link. He observed that when fear was absent during labour, so was the pain. He was ahead of his time, as decades later scientists discovered that during labour, a woman’s body is designed to release hormones that are 200 times more powerful than morphine! A lot of people roll their eyes at birthing without pain-relief, asking: would you have your teeth pulled out without pain relief? It is not the same thing. In the dental chair our body does not release these same hormones (although with certain meditative practices you can actually induce them, but that's another article for another day).
Now here's the catch: fear blocks the release of these morphine-like hormones. Fear creates muscle tension which blocks their release, directly contributing to increased pain and unnecessary interventions. So reducing fear is key: feeling safe and supported, having continuity of care with a consistent midwife team, being as informed and physically/emotionally prepared as possible ALL play a part.
Lots of women have great, positive, wonderful and of course life-saving births in hospitals every day. I can only speak from the perspective of my body that felt a cascade of interventions would be the result if I went there: the time pressures (perceived or otherwise) would lead to a stalling of labour, which would lead to being induced; the pressures (real or otherwise) would lead to my body tensing up which would amplify the pain, which would lead to an epidural - the thought of which terrified me. Both these roads increased the chances of an emergency ceasarean. I had no idea how I 'knew' these things, I just remember strongly feeling and fearing that this is what a hospital birth would mean for me. Not for everyone, but for me, due to my strong fears at that time.
I now know that this cascade of interventions is a common path for too many women (3), so much so that it's now associated with being a normal part of birth. Australia has a c-section rate of 32%, among the highest in the world. For how many women does her body respond the way it does during labour, or how often is she directed the way she is, because of the strong fears that are so deeply embedded within our collective consciousness, Western mindset and culture around birth?
To be clear, this isn't an anti-hospital-birth post, or anti-necessary, life-saving interventions. It is about the fears we as women hold around birth, and how this fear affects our birthing process on a physical level as well as mental and emotional. It is a post about the benefits of doing all we can to relax those fears, in order to give our body a chance to do what it was designed to do, and reduce the frequency of birth trauma.
Research (4) suggests that a third of women describe their birth as traumatic. We always hear that all that matters is that we end up with a healthy, alive baby at the end. Absolutely that is the number one priority. However, baby needs a mama that is physically, mentally and emotionally healthy at the end and beyond, not an attitude from society that a traumatic birth is almost normal. Mama and baby both deserve a birth free of unnecessary interventions where possible, and where intervention does happen for it to happen in a respectful, informed way. Why? Birth can affect mother and baby long after the event itself, especially where trauma and unnecessary interventions are involved. There are things in birth we can't control. We aren't talking here about perfect zen-like births. Rather, whatever your body, birth and baby have in store for you, and that will be different for every birth, we at the least can influence the way we go into it and who we have around us, which has a massive effect on how our mind and body works with the different stages of labour, birth and post-birth - which has a domino effect on things like breastfeeding, baby bonding, and post-natal depression.
This is not about blaming or shaming our personal birth processes. It is about learning from our births, and each others, and recognising that we should be doing all we can to support women so that they enter and emerge from the birth experience feeling informed, heard and respected. Having done a tonne of inner work, research and getting myself informed about my birth fears, as well as now having gone through my first birth, I now know that more important than where you give birth or how you give birth, is the mindset and emotional space you enter birth with, plus the team you have around you. Feeling safe and supported is key, as is being informed about the birth process and your birth preferences. A birth we feel good about is possible, regardless of where or how we give birth, when we do things to help us release our fears - with the help of the natural design of our bodies, good information and a supportive birth team.
On 10 November 2011 I had an 18 hour labour at home with Christian and my two midwives, plus my sister Jelena helping pour hot water on my back and my sister Krisi who was living in London at the time supporting via Skype. Most of the time I felt like I was gone in another world. After waking around dawn with the first surges, they quickly came closer and closer together. Robyn arrived around 8am, and I remember thinking it's going to be a quick birth. Hahaha!
Christian started putting the birth pool together, and I think it was around 10am when I asked if I could get in. After what felt like half an hour, I was so confused to look up and see the sun moving low in the sky telling me it was at least 4pm! Robyn crouched down next to the pool and asked me, "Would you like to change position, you've been in that same place for about 4 hours now." Whaaaaat??
At some point a bit later, she came to me again asking what I was still afraid of? My labour had slowed, and bless her socks she had gone outside to meditate on why. She said to me gently but firmly "Dana, it is time to let go of Maiden and step into Mother." 38 years of being just 'me' was apparently proving to be hard to let go of as far as my body was concerned. I said "I'm happy to step into my Mother self now.” Whose midwife takes a few minutes to meditate on your behalf mid-labour? But, what if this was a more common practice? How often might that replace the need for inductions?? Well, guess what, the surges resumed.
It still took several hours later for me to get the hang of the pushing, but once I finally did, wooshka, out came our little Jaxon! I’m not going to pretend it was a walk in the park. It was the most raw, intense 18 hours of my life and I was so grateful to my midwives for their constant monitoring, patience and guidance. I can honestly say that at no point did drugs even enter my mind, I was too far gone into whatever place the natural body morphine hormones had taken me, down into the core of Mother Earth herself so it felt. There was no fear, thanks to the unwavering presence of my midwives and without a doubt all the prep beforehand.
Tips for a fear-free birth:
- Read as many positive birth stories and books as you can
- Do a Hypnobirthing or Calmbirth course, ideally with your partner
- Enrol in a holistic pre-natal yoga class
- Have some therapy sessions around any fears you hold related to birth or parenting, and to work through issues related to sexual history, relationships, childhood, your own birth
- Choose a birth environment and birth team that makes you feel safe and supported
- Get informed about labour and birth, and write out your birth preferences. This is not a birth plan – we can’t plan birth. Preferences simply indicate what you would prefer to have happen if possible eg delayed cord-clamping. It is good for your partner to be aware of your preferences way before the birth, because you will not be in the mental space to be able to make these sort of decisions during labour. Asking a labouring woman to make decisions takes her out of ‘the zone’, and pauses those vital pain-relieving hormones!
(c) Dana Mrkich 2016
(1) Published studies reveal that for low risk women attended by a midwife, within easy access to a local hospital, a planned homebirth is as safe as a planned hospital birth, with similar birth outcomes.
(2) Fear-tension-pain syndrome is a concept formulated by Dr Grantly Dick-Read, MD, (1890-1959) to explain the pain commonly expected and reported in childbirth.
(3) Australia and the US have two of the highest c-section rates in the world. WHO recommends that c-section rates anywhere should be no more than 10-15%. In Australia and the US it is 32%. Research and published studies reveal that a planned homebirth has a reduced rate of interventions both for mother during labour/birth, and for baby post-birth.
(4) The Australian Birth Trauma and PTSD Treatment Centre
Interesting reading
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