Scan 4I often sit back and wonder if we have as much control over birth as we think we do? I usually tell women that we don’t have much control over any of it. I think that I secretly want to believe this, but know in my heart that it’s not entirely true. The more I do this work; I realize that things are starting to form a pattern and have for some time. It is becoming more obvious that women carry within themselves a culmination of experiences and emotions that cannot be ignored, especially when undertaking a task such as growing and birthing a child.

Birth is a very magical experience whether you are fully aware of it at the time or not. As an outsider looking in, I see a very pivotal moment in a person’s life that is often shaped and perceived by our past experiences, but more importantly by the way a woman and her partner remember it. I often find that the number one predictor of how satisfied a woman is with her birth experience is how much fear she has going into it. I used to think that it was the way she was treated in labour. This certainly plays a part, however it seems to me that birth outcomes have more to do with how women approach birth.

If a woman comes to me with a very intense fear of childbirth (whether they are aware of it or not), I find that she is already on a path towards a less than ideal birth experience. I know you are probably thinking, “But don’t we all have fear of childbirth, does that mean everyone is going to have an unsatisfactory experience?” No, of course not. I know that often we can’t help the fear that we have. How could we when we have negative visions of birth everywhere? How could we when we have a 30% cesarean section rate and in some countries like Brazil- often 50% in some hospitals. How can we not fear birth when many of us are running around telling each other about our negative birth war stories? Why does surviving a traumatic experience like birth become a rite of passage? Like I said previously, this doesn’t apply to everyone, but it is incredibly common in our culture to talk about birth as if it is something that we may or may not be able to do, or may or may not accomplish. It’s like we approach from a perspective of “how can I get through this experience with the least amount of intervention or the least amount of complications?”

Why is fear of childbirth so important? Why should we be trying to eradicate it?

This is because according to Stoll, Edmonds and Hall 2015, young women reporting high levels of childbirth fear are nearly four times more likely to prefer a cesarean delivery. The conclusions of this study indicate that specific fears, such as worries over how pregnancy and birth will affect our bodies, need to be addressed before pregnancy. They also found that fear of birth and type of delivery (vaginal or cesarean) are similar among pregnant and non-pregnant women which suggests that attitudes towards birth evolve in young adulthood.

The reason WHY we care about the number of UNNECESSARY (I’m not talking about the necessary) cesarean sections is so important is because these types of interventions can have real negative impacts on women and their babies. We not only need to eradicate fear in childbirth because we want women to have better birth experiences, but because we NEED to make birth safer for women and babies on a global level. So if we can help reduce fear, we can reduce unnecessary procedures and surgeries which will ultimately lead to better experiences and less harm overall.

So part of my job is to help women sort through their fears, rationalize them, own them, and then work towards reducing their impact. We all have a baseline level of anxiety around birthing a child and this is completely normal. Most women tend to have more anxiety and fear than confidence and excitement.

So what are some ways to decrease fear in childbirth?

One way is to surround you with positive stories and women who are also confident in birth. That doesn’t mean that you should ward off women with “horror stories”, but it just means that you have to understand that birth stories can help shape our understanding and vision of what birth should be like. If all we have is lying on your back in excruciating pain as your reference point, you can almost imagine how tense your body will become and how difficult it will be to visualize your baby coming out in a peaceful and meaningful way.

How can you be an active participant in the birth of your baby if you only have negative, fearful visions of your baby being born?

How can you go into your birth with confidence if all you think about or visualize is lying on an operating table and crying because this wasn’t exactly what you wanted for the birth of your child? How can you enjoy your planned cesarean section if all you are imagining is complete terror and everything going wrong with your delivery? So find a way to expose yourself to inspiring birth information. This doesn’t mean that you shouldn’t learn about potential complications, but I would recommend that you don’t spend the majority of your time and energy focusing on them. I will post a list of resources very soon that I find very helpful for women to inspire them throughout pregnancy and birth.

Also, try to keep track of how frequently you find yourself thinking about your pregnancy and birth from a place of fear or anxiety. I find that women who keep a journal throughout their pregnancy can often keep track of their thoughts which might give them some insight into which areas they may want to focus their research on. Do you focus more on how birth affects your body? Do you focus more on how birth interventions might affect the baby? Are you spending your time worrying about whether you are going to develop postpartum depression? Or are you worrying about whether your partner is going to step up to the plate once the baby is born and be an active participant? These are all real concerns for women and deserve to be discussed and demystified before you are expected to birth.

Another way to decrease fear in childbirth is to have a care provider that you can develop a relationship of trust

Pick a midwife, family doctor or obstetrician that you can show your authentic self. If you can’t find one of these that you can be your true self with, then consider hiring a doula.

Pick someone that you can be vulnerable with, and say what you think, what you feel and fear. This is so important because this person has so much potential to influence your thought process and your confidence level regarding the birthing process.

You want someone who is going to build you up, instead of watch you fall apart

This is one of the most amazing aspects of midwifery. I love sitting with women and listening to them process all of the information, and shape their experiences in their minds. I love listening to them talk about what could happen, or how they felt about their births afterwards. I especially love watching women come out of their fear and into an excited, open-minded state.

It’s easy to blame society and the medical profession for creating such a morbid approach to birth at times, and it’s easy to blame each other for sharing our war stories but…

The truth is, no one can shape your perspective of childbirth more than you can

We as women have a choice. This seems to be a big secret! We can choose to read about birth, ask questions or stay silent and avoid discussion. We can choose to have a midwife or a physician; we can choose to hire a doula, read scary books, or positive books. We can choose to seek counseling for any life events that might be following us into our world as pregnant women or mothers. We can choose a home birth or a hospital birth. There is so much we can do to help ourselves maximize our abilities to birth, but I think we often don’t know where to look or how important it is to do this work.

We have to take responsibility for our role in birthing our babies

We can’t rely on our midwives or physicians to tell us what to do all the time (although this is easier). This doesn’t mean we don’t need to look to them for support and for them to respect our autonomy. We have to speak up when we are scared, or when we aren’t sure. We need to play an active role in our information sharing and continue to build each other up. I know this sounds very intimidating and easier said than done, but if you find you can’t bring yourself to speak up, then we need to find a way to prevent these recommendations or scary thoughts from gaining power over our visualized birth.

We may do “everything right”, and read all of the right things, and take all of the right classes and still feel like we aren’t enough, or our births were traumatic. Unfortunately this happens and sometimes we are attended by people who are not kind to us, or who don’t have the courage to attend us in the way that we need. This always makes me sad when I hear these stories or if I myself was a participant in these births.

I remember when I was pregnant with my first child. I was so busy working that I didn’t really fully address my own anxieties about birth and raising a child until I went on maternity leave at 35 weeks. I remember sitting around in the dead heat of summer feeling my anxiety rising about pushing this baby out. I remember thinking, “What if I can’t birth this baby? What if I need a cesarean section? What if I need an epidural, or won’t be able to birth at home like I said I would. What if I can’t breastfeed?” I remember thinking, “What kind of midwife would I be if I can’t do these things?” Midwives too aren’t exempt from the human condition and still worry about all of the “what if’s”. I kept trying to tell myself to take my own advice. So I read and re-read Ina May’s guide to childbirth, and watched empowering birth documentaries over and over again. This seemed to help and reminded me that none of these pervasive thoughts are important, that I need to trust myself and I owe it to myself to go into my own birth with a positive attitude and to consider that everything just might work itself out. I also needed to have a respect for the things that I cannot control (like my blood pressure, or which obstetrician might be on-call if I needed them) and let those thoughts go.

As the days grew longer and my due date came and went, I could feel my emotions whirling and my anxiety coming and going by the hour. It took a lot of work for me to control the thoughts in my own head because I knew that if I let them run wild that my body wouldn’t work optimally for birth. I knew that I had to get my stress levels under control; I had to stay calm and focused. So I stopped answering my phone, and stayed close to my husband who always seems to keep me grounded, and visualized what I wanted my birth to look like. I wanted it to be in the daytime (so I didn’t lose sleep!), in the water and at home where I could control who came around and what I could eat and drink. Sure enough, I visualized this so many times that I didn’t worry about it anymore. I already “saw it”.

So the morning that my daughter decided to come, I already had a deep sense of how that day was going to. I’m not saying that you can just order your birth like a meal at a restaurant, but what I am saying is that

The only thing we have control over is our attitude and vision going into childbirth. Everything else is open to interpretation

I see this in practice as a midwife daily, and also in my own experience in birthing my children. Everything else (who is there, where you birth-sometimes, how the baby comes out) is all extra stuff that you can’t really control.

I would argue that your attitude and vision is the most influential factor and the one thing I work tirelessly on as a midwife throughout your whole pregnancy. So instead of just arming yourself with facts and a list of things a mile long that you DON’T want to have happen at your birth.

 I would encourage you to dig deeper into yourself and figure out how you truly feel about birth and being a mother

 I would encourage you to consider what you imagine when you close your eyes and think about all of those things. I want you to pay attention to how your body reacts when you imagine your birth, does it tense up? Do you hold your breath? Do you smile with excitement? These physical reactions are just the beginning and what often sets the stage for a much bigger process. So be willing to work on yourself and your relationship so that you can go into the birth of your child with a clear mind and focus to receive your baby in anyway they come because they will be counting on your strength when they look up at you for the first time.

I mean these words with kindness and in no way want to shame any woman about their birth. In no way do I have this all completely figured out but sure hope to find a way to help reduce the fear women feel. I just want to share my thoughts on what I see as I get the opportunity to be a part of these amazing experiences for women and their families. Even if you close your eyes and visualize the most peaceful calm birth, if there is fear attached to those visions, you will have a hard time watching it come to life. Giving birth is about letting go, and surrendering to the uncertainty. This is also often why it is considered one of the hardest things you’ll ever do.

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