Fear In labor

One of the reasons women take childbirth classes and seek a doula for birth is to overcome fear. Childbirth to many woman and men is an unknown. Anything unknown can be frightening. For most of the couples I teach often the only time they have seen birth is on television. TV is entertainment and often the births we see are dramatic. This has done a great job of skewing natural birth and has created a culture of fear around birth. It is healthy to acknowledge fear and work to move through it. The work that I do focuses on helping you move through fear with knowledge. I became a childbirth educator to help families become informed and excited about birth. As a childbirth educator, I work to increase your knowledge about the labor process, help you learn about your body’s response to the stress of labor, and provide you information on how productive labor positions and breathing techniques can increase your comfort and the speed of your labor. As your doula I help you work through the intensity of labor. I can help to put all of the informational pieces into action during labor.

Birth is about more than eliminating pain. It is one of life’s peak experiences that I work hard to protect and make empowering. Don’t get lost in the pain and fear, focus on the power of birth.

This is the article I read this morning that inspired this post. This blog has been in the works for a long time and I hope this is the first of many posts on the subject of overcoming fear in labor.

Fearful Expression In Labor
by Joan M. Smith, MSN, RN, ICCE
Public Policy Director
International Childbirth Education Association

Fear is one aspect of anxiety. It is an affect recognized in a facial expression or heard in a simple statement, “I am afraid.” Coupled with worry it is manifested in actions and behaviors such as hands balled up in fists, clenched fingers clinging to the clothing of a loved one, tears streaming down cheeks, and a furrowed brow. Frequently fearful expressions are recognized when labor and delivery stories are told about searing, burning pain, an “induction of torturous hell.” From a nursing and childbirth educator’s perspective, the manifestation of fear in labor and delivery can be grounded in lack of knowledge. Lack of knowledge about birth as a “natural” process can contribute to fear in labor. Spending time watching and listening to families as they read and talk about what to expect when expecting, sheds so much light upon their fears and expectations.

Fear of labor and delivery is an affect. It is a behavior that should be recognized and acknowledged by the healthcare team as they collaborate with the laboring mother through the frequency and intensity of rhythmic contractions.

Fear, worry, anxiety, and memory are four interrelated concepts. They are conceptualized as factors that are recognized in behavior and action. As components of behavioral health, these concepts and associated actions must be thoroughly assessed to implement care of the mind and the body in labor. Stories shared by family and friends that tell of negative outcomes can add to fear and anticipation of excruciating pain and misery. Outside of an understanding of the mechanisms of labor, recalling these stories can exacerbate fear especially among primaparous women who have no prior personal experience (Shea, 1998).

Fear is considered to be processed in the amygdala, a region in the brain regulated by serotonin. Serotonin is a neurotransmitter believed to mute or deactivate brain circuits involved with processing fear. It works with endorphins and other chemical mediators that mother-nature regulates to maintain a state of equilibrium during periods of stress, anxiety, and fear. Supported by research and therapeutic modalities, neuroimaging techniques have illuminated brain activity during anxiety provoking experiences.

Functional neuroimaging has the potential to allow clinicians to “see” more than malfunctioning circuits in a psychiatric disorder-possibly even see the linkage of genes, symptoms, stress, and treatments with the function of numerous circuits (Stahl, 2008, p. 237). During labor and delivery, fear may not be related to a “psychiatric disorder.” It may simply be a stress response. As a “natural” process stress is recognized as a normal aspect of human nature and a good attention getter signaling a need for change.

Fearful expression should also be considered as a good signal for change. Assessing for and intervening with a variety of fear reducing strategies is an essential factor in nursing and childbirth education. Encouraging comfort measures as regularly as medical intervention may help eliminate fearful expression in labor. Just as we think critically about the advantages and disadvantages of intravenous fluids, continuous fetal monitoring, bed rest, recumbent position, pitocin augmentation, epidurals, and the effects of anesthetic agents on the newborn, we should think about and act upon the disadvantage of fearful expression in labor. Consideration and recognition of the potential risk of ignoring fear is as significant as ignoring the potential risks associated with some medical interventions (Janse, Gibson, Bowles, & Leach, 2013; Knuppel & Drukker, 1993; Lothian & Romano, 2008; Wilson, Effken, & Butler, 2010).

References

Jansen, L., Gibson, M., Bowles, B. C., & Leach, J (2013). First do no harm: Interventions during childbirth.

The Journal of Perinatal Education, 22(2). 83-92. doi: 10.1891/1058-1243.22.2.83.

Knuppel, R. A. & Drukker J. E. (1993). High-risk pregnancy: A team approach, 2nd edition. Philadelphia: W. B. Saunders & Co.

Romano, A. M., & Lothian, J. A. (2008). Promoting, protecting and supporting normal birth: A look at the evidence. JOGNN, 37. 94-105. doi: 10.1111/J.1552-6909.2007.00210.x

Shea, S. C. (1998). Psychiatric interviewing. The art of understanding. Philadelphia: W. B. Saunders & Co.

Stahl, S. (2008). Stahl’s essential psychopharmacology. New York: Cambridge University Press.

Wilson, B. L., Effken, J., Butler, R. J. (2010). The relationship between cesarean section and labor induction. Journal of Nursing Scholarship, 42(2). 130-138. doi:10.1111/j.1547-5069.2010.01346.x

Note: The concept of the “7th P as Psyche,” in labor is the creation of Joan M. Smith, RN, MSN, ICCE