Addressing the fear of childbirth

The term "'too posh to push” was first coined when celebrities such as Victoria Beckham chose to have their babies by Caesarean section, not for any medical reason but rather for their own convenience. The number of pregnant women opting for Cesarean births today is on the increase. However, to assume that women are choosing major surgery simply to be able to schedule their births conveniently is to ignore the deeper issue at play, namely the growing fear of childbirth.
For those plagued with this fear, you are certainly not alone. In a variety of studies undertaken in different countries over the past 30 years, it has been consistently found that some 25% of pregnant women have a considerable fear of childbirth. This figure increased to as much as 80% in several more thorough Scandinavian studies. Some women are so haunted by this fear that they will postpone or even avoid pregnancy altogether. It is estimated that up to 13% of women have such intense fears.

However, I wonder whether the fear of childbirth might be even more common than our society cares to admit. One could speculate that the most severe cases are the ones that are never witnessed.

In the U.S., the U.K., and many other countries, requests for planned Caesarean deliveries are becoming more and more common, especially since guidelines have now been changed to allow women to make this choice. Israel differs, since Caesarean sections are only permitted here when medically necessary. In the U.K., where as many as one in ten women opt for Caesarean births, it was recently acknowledged that almost half make this request because of a significant fear of childbirth.

Though the phenomenon of childbirth fear is creeping into the press, the specific fears regarding birth are not discussed. What is it that frightens us so much about the birth process? Why do we consider cutting ourselves open or having epidurals to birth our babies? Did nature intend for us to be managing births medically? Perhaps we have simply no longer trust that our bodies were created to give birth.

More importantly, what can we do about this growing fear of childbirth? Is it possible that birth can be a beautiful and empowering experience, or have we become resigned to the fact that we need to go through suffering in order to bring a new life into the world?
Having recently completed some research on tokophobia, the extreme fear of childbirth, some answers to these questions were uncovered. The most common reasons are the fear of pain, damage to their bodies, and the wellbeing of their children. However, the issue is more complex than this, since many fears remain unconscious and the women were less able to articulate what it was they were so frightened of.

Aptly put by Israeli-born psychoanalyst, Prof. Joan Raphael Leff, childbirth involves being “carried along on a roller coaster hurtling in slow motion toward an unknown finish line.” This metaphor sums up two of the most important psychological issues in childbirth, namely the loss of control and the fear of the unknown. Of course, no one knows what turn their birth might take, and this can indeed give rise to anxiety. During birth, women not only fear losing control over their bodies and their behavior, but also of losing control of their environment, as they often find themselves in a clinical environment, exposed to strangers at a time when they are at their most vulnerable.

The “Human Givens” approach to therapy is worthy of mention here. It is based on the premise that if several innately programmed "needs" are not met, people may find themselves in distress.  These "givens" include volition - that is, a sense of autonomy, control, and privacy. In the case of childbirth, these are very relevant. If a sense of control and privacy are required for our wellbeing, it is no wonder that childbirth might be a source of fear and anxiety, certainly within a hospital environment. With the routine procedures that the hospital staff must follow, as well as the obligatory internal examinations throughout, there is a limit to how private childbirth can really be.

When a woman is pregnant for the first time, she often turns to friends or family for guidance, as is usual before embarking on any new experience. Unfortunately, women tend to delight in recalling their "awful" birth stories, almost like war heroes showing off their badges of honor. The effect of the countless negative birth stories cannot be underestimated. Women are further plagued with constant negativity surrounding childbirth in the media, scientific books which dedicate whole chapters to pain-relief, and films and novels depicting birth as something to be afraid of. Since prehistoric times, the anticipation of labor has been associated with fear, and we are all familiar with the idea that having to endure a painful birth is a punishment for Eve's mistake in the Garden of Eden. All in all, birth does not get much positive press, and this adds to the fear surrounding this huge rite of passage.

An often unconscious ambivalence towards motherhood can also be the source of much fear. There are, of course, many changes that occur during pregnancy and beyond: in body shape, lifestyle, role, relationships and work prospects, to name but a few. The birth of a child is indeed the birth of a new identity for the mother or the death of the person she once was, which can certainly feel unsettling.

Another interesting finding was that the knowledge and memory of our own birth stays with all of us unconsciously and affects the way we in turn approach birth. Indeed, being pushed down the birth canal, perhaps also being in distress, the suffocation and the loss of cord, is the first trauma we experience in our lives, and this undoubtedly has its effects. In fact, it is thought that the fear of death, also a reason put forward for fearing childbirth, originates from our very own birth experience.

Coming back to the new trend in birthing that we are witnessing, we can see the appeal in Caesarean birth, which give women a sense of control and largely takes the element of the unknown out of the equation.

Perhaps we can help women feel less threatened so that they can make informed choices which are not governed by fear. With more understanding of women's fears, we can begin to look at some solutions to enable pregnant women to look forward to childbirth and have better experiences.

First, there is no substitute for knowledge. As a woman gains more information about what actually happens during the birthing process, she will immediately feel more prepared. Attending a birth preparation course helps to provide the necessary practical knowledge to approach birthing with confidence. Prenatal classes typically cover a wide variety of subjects, from the physiology of birth and stages of labor to when to go to the hospital and what to take with you.

Hypnobirthing courses, which are increasingly popular, focus more on mental preparation. Here, women are provided with a range of tools and techniques to facilitate a quick and easy birth, such as how to relax on the day, breathing techniques, and pain management tools. Since birth is also a mental process, a lot of importance is placed on the mind. Fear-release exercises based on deep relaxation and guided imagery present a powerful way to clean the mind of any unconscious negative associations or fears, leaving room for positive visualizations, similar to those practiced in the sports performance industry to enhance success. Through learning about the crucial subject of optimal conditions for smooth birthing, as well as the scientific facts on how our bodies are designed to give birth, women can begin to feel more in control of their experiences and start to build faith in their bodies and natural instincts.

Another important factor to help women feel safe, secure, and less fearful is the presence of a birth partner. Often women turn to their husbands for this privileged role, but doulas are now on the increase. A doula is an experienced woman who offers emotional and practical support during birth, enabling the most satisfying and empowering experience for the birthing mother. Once a woman knows she has a “gatekeeper” whom she can trust to follow through on her wishes, she can feel at ease, and birthing will automatically run more smoothly. A birth plan can also be helpful in this respect so that hospital staff is clear on what is desired.

Lastly, since we know that from a scientific point of view fear can negatively affect the birthing process, it can be useful to seek support from a psychotherapist. One should be mindful of whom one chooses to confide in, as talking at length about problems and anxieties can often have the effect of inflating them. The purpose would rather be to understand just how common these fears are, while at the same time gaining the opportunity to off-load the mother’s thoughts and fears. In getting them into the open, women can feel free to move on and prepare themselves for the beautiful experience of the miracle of birth and for receiving a new little life into the world. After all, that's what it's all about.

To read an article on doulas, go online to:
http://www.esramagazine.com/blog/post/doulas-birth-&-parenting