‘I know about childbirth. My mum told me. First, you go into labour and it really hurts so you hurry up to the hospital. Then there is some sort of huge emergency and the baby could die at any minute. Then you come home and everything is fine.’
ANNA, 15, NO CHILDREN
SIX USEFUL THINGS TO KNOW ABOUT YOUR BIRTH FEARS
Apart from the fact that it’s turning you into an unreasonable nutcase at 2 a.m., there is a good solid argument for conquering any fears you have about this birth: doing so can really improve your experience.
There are some physiological reasons why fear can affect how your body works in labour. At its most basic, the argument goes like this: fear – particularly when you are in a stressful situation like childbirth – makes your body produce stress hormones (called catecholamines) which trigger your body’s instinctive ‘fight or flight’ response. In this state, your muscles (including your womb) tense up. This, in turn, can inhibit labour, slow your contractions and heighten your sensitivity to pain. If, on the other hand, you are relaxed and relatively calm during labour, your body is likely to produce fewer catecholamines and more hormones called endorphins. Endorphins are as potent – if not more so – than morphine (you’ll hear people claiming authoritatively that endorphins are five hundred times stronger than morphine. This kind of thing is clinically hard to prove, but you get the idea). Endorphins are often called the body’s ‘natural pain killers’. Another hormone you want lots of in labour is oxytocin, the so-called ‘love hormone’ which tells your womb to contract. (Your body produces oxytocin during orgasms and breastfeeding too.)
‘Imagine a rabbit in the field trying to decide if it’s safe to give birth….Her labour starts off slow and tentative, because, if she hears a fox coming, she needs to be able to run away. Human beings are also capable of stopping early labour if we are anxious and nervous.’ Writer and childbirth teacher, Janelle Durham
Recognising where your fears come from, decoding them and doing something about them can help you feel more relaxed when you finally go into labour. This will help you cope with pain, and may also help your labour to progress more smoothly.
THREE HANDY THINGS TO KNOW ABOUT ENDORPHINS
If this is not enough to convince you that giving birth is going to be fun you’re not alone. Studies have found that nowadays we’re more anxious about labour than ever before. Two psychological studies, 13 years apart, found that the proportion of women who reported feeling ‘very worried’ about the prospect of pain in labour increased substantially between the two dates. In 1987 9 per cent of first time mothers felt very worried about pain in childbirth. By 2000, this had risen to 26 per cent.1
Psychologists and birth experts have many explanations for this (we cover the main ones below). But it certainly looks like our increased fear of giving birth is starting to have an impact on how we do it: nearly twice as many of us are now asking for caesareans as we were ten years ago. Rather than being ‘too posh to push’ it could be that some of us are ‘too scared to push’. (See Chapter 6: Surgical Birth). Of course, you can’t put our entire changing experience of childbirth down to heightened fear, but there could well be a link between your fear of birth, and what happens on the day. ‘We know from studies that fear can inhibit the progress of labour,’ says psychologist Professor Josephine Green of Leeds University. ‘In our studies the more worried a woman was, the more likely it was that she would need an epidural.’ Epidurals are associated with more obstetric interventions (including caesareans) and, says Green, ‘not having a “normal” delivery may also be associated with a worse psychological outcome.’ In other words, you may feel more upset by the birth afterwards, and, possibly, feel more worried about doing it next time too.
Where to go for help:
The Active Birth Centre website has information on creating a ‘hormone-enhancing environment’ for birth. www.activebirthcentre.com
In a nutshell, the available evidence suggests that more fear is linked to more interventions which are linked to less satisfaction with the birth. In other words, don’t ignore your fears, however obvious they seem. ‘It is vital to address your fears,’ agrees midwife Jenny Smith. ‘Your midwife can help you work through your specific worries about the birth – whatever they are – or refer you to a counselor if you need it.’
Many of us don’t properly discuss our worries about giving birth with our midwives, either because we think they ‘go without saying’ or because we don’t want to bother her or take up too much of her time. This is a mistake. ‘Any good health professional in this situation will want to know how you feel,’ says Jenny Smith. ‘We are service providers – the more you can communicate with us, the better the outcome will be. In the end, if you don’t discuss your fears with us the only person who will really suffer is you.’ If you’re still feeling shy, you’ll be glad to know that studies reinforce the importance of getting help. One study2 of women requesting caesareans out of fear showed that if they got psychological help with their anxiety during pregnancy more than half (62 per cent) withdrew their request and had normal vaginal deliveries.
In this chapter, we’re going to give you some practical ways to get your head in the right place for this birth. We’ll help you work out what your fears are, where they come from and what you are going to do about them.
First of all, there are degrees of fear. There is a medical name for extreme fear of childbirth: ‘tokophobia’. This level of ‘morbid’ anxiety requires treatment from a psychologist who understands the condition. Tokophobia can be so extreme that some women, who long for children, actually stop themselves getting pregnant because they are so scared of what it would be like to give birth. We’re assuming here that your fear levels are not all-out terror (you were, after all, brave enough to get pregnant). But if they are preoccupying you, discuss them with your midwife or doctor and ask for a referral to a counsellor who knows about fear in childbirth.
Tokophobic or not, there’s an obviously alarming fact staring you in the face every time you try to bend down and paint your toenails: you’re going to have to squeeze a baby out of your vagina. I remember looking down at my humungous belly as Izzie’s due date loomed and feeling a surge of genuine panic. It looked dauntingly huge. I could not conceive of how I’d possibly get all that out of such a small opening. This may sound silly and obvious, but if such thoughts are crossing your mind then it’s worth reminding yourself that much of your belly’s enormity comes down to amniotic fluid, blood, a nice layer of fat (yes, sorry), and a large (but squashy) placenta. It’s not all baby. It’s also worth reminding yourself that, despite what your logical brain might be saying, your body is perfectly designed to do this.
Having said this, the thought of pushing out a seven or eight pounder is still enough to keep many of us up at night. Studies into anxiety and childbirth have found that the following things contribute to our fear:
Birth has become scary, in part, because it’s so ‘other’ to us nowadays. It feels genuinely alien to our largely controllable, pain-free lives. We associate birth with hospitals, risk, illness and crisis. Few of us have ever witnessed a birth in real life (i.e. not on TV). And all our preparation for birth seems to centre on ‘reducing risk’. Medical advances, of course, have their advantages (the decline in infant and maternal mortality springs to mind). But there’s no doubt that we are becoming more neurotic and distrustful about giving birth than ever before. This is somewhat ironic of course since childbirth, officially, has never been ‘safer’. Part of the blame, here, has to lie on the shoulders of the wicked media.
‘I HATE YOU! I HATE YOU!’ screamed Salma Hayek during the birth scene in the movie ‘Fools Rush In’.
‘I CAN’T DO IT!’ screamed Geena Davis during the birth scene in the movie ‘Angie’.
‘GIVE ME DRUGS OR I’LL KILL YOU!!!’ screamed the character Chrissy during the birth scene in the movie ‘Now and Then’.
‘LORDY BE! MISS MELANIE’S GOING TO DIE, AH JUST KNOWS IT! HELP! HELP!’ screamed Butterfly McQueen during the famous birth scene in the movie ‘Gone with the Wind’.
‘Our media images of birth are not about women’s fears of childbirth at all,’ says Rhonda Griffin, a psychotherapist specialising in birth trauma. ‘They’re almost always written from the male perspective and are in fact portraying men’s fear of birth, not women’s.’
Towards the end of my last pregnancy I was watching ER. This is a rash thing for any pregnant woman to do but I thought I’d got away with it as there seemed to be no gruesome birth subplots. But then they chucked in a gratuitous little left-fielder: a perfectly healthy young woman is brought in, 36 weeks pregnant, complaining that she’s having mild contractions (why she’d be there, and not at home or in a maternity unit is not explained). Her waters break while she’s waiting in the examining room, after just a few Braxton Hicks-type contractions. In real life, the doctors would then check to see if she was dilating, and keep an eye on her to make sure her active labour started within 24 hours. On TV birth is different. A maelstrom of medical panic ensues: two doctors and two or three nurses sprint towards the cubicle, sweeping up equipment, pulling curtains round the bed. ‘Don’t PUSH!!’ yells Dr Lewis, ‘I need to examine her!! Abi, get me a fetal monitor!!’
No wonder we think of birth as a crisis.
So called ‘reality’ TV is almost worse. ‘Every woman in labour hates her husband,’ said a woman on a recent US talk show. This type of show makes grimly compelling viewing for a pregnant woman (especially one at home, a week or so away from the birth, feet up in front of Trisha). These programmes appear to be democratic and representative – they show ‘real women’ talking about ‘real’ life. But they’re as skewed as the rest. Producers need viewing figures. They don’t want dull ‘the birth was surprisingly manageable’ stories. Their bread and butter is pain and crisis; emotional ruction; husband-wife estrangement. Julia still has a vivid memory of a TV programme she watched seven years ago when pregnant for the first time. ‘Oprah did a show on “Women Who Won’t Give Birth Again” and I sat glued to it while women told horrific gruesome stories about things that had happened to them – unbelievable things. I couldn’t switch off the TV but when it was over, I sobbed for an hour.’ If this is what telly provokes in a woman, a doula, who had seen many lovely healthy births in real life, what hope is there for the rest of us?
It’s not just about having a bad dream that night. Research in sociology and media studies suggests that TV can affect our perceptions and even our behaviour. And when it comes to violence, bloodshed, trauma and crisis, birth in the media is up there with Reservoir Dogs. You might be able to distance yourself from this on a rational level. But you’d be unusual if the doubt did not creep in somewhere.
The simple truth is that most of the images of birth you absorb day after day from the media are not realistic. One 1995 study3 analysed 92 births shown in one year of television. Out of these births, four babies and one mother died and five babies and four mothers experienced life-threatening complications. This morbidity and complications rate is ludicrously out of step with real life. Labour, in these shows, tended to be depicted as a rapid and unpredictable process, with little or no pain relief, that ends in an unexpected way, such as giving birth in a strange place without a medical professional in attendance, or without the intended birth partner. Getting from this perception to a genuine acceptance that birth is mostly safe and normal, isn’t usually precipitously fast and is something you will cope with very well if you’ve prepared properly for it, can be quite a leap of faith.
So how do you get past these images? The obvious answer is turn off the TV, don’t read the tabloid story about the dead baby, put down that book or magazine, walk out of the movie when she starts tearing her hair out. Of course, you’d have to be pretty obsessed, and dare I say it anal, to block out all negative images of childbirth from your life like this. But do try to recognise what’s going on around you, and deal with it consciously.
SIX TIPS FOR MANAGING THE MEDIA
On a brighter note, birth images in the media may be gradually changing. In the Friends episode where Rachel is in labour, she lingers for hours in the ward having contractions and watches in growing despair as other women come and go, having had their babies. Long first labours are certainly a reality for many of us. Rachel also – radically for a TV show – moves around, makes noise and keeps a sense of humour during labour (though unlike the rest of us, she continues to look fabulous while she’s at it).
It’s not just the media that will affect your attitude to birth. Since the day you first lisped ‘but mummy, how does the baby get OUT?’ your own mother has probably been influencing your preconceptions. If not your mother, then it could be some other influential older woman in your life – an aunt or grandmother perhaps. I remember the wild-eyed look my own mother used to get when I asked her what giving birth was like for her, first time around. Her first experience of childbirth was a 48-hour labour, addled with sleeping drugs given to her by the hospital and ending in forceps (no epidurals in 1964). She thought my brother was dead for several hours after the birth and no one told her otherwise. This, 40 years later (and hardly surprisingly), can still bring a tear to her eye. When I was pregnant the first time she’d say breezy things to me like ‘you’ll be fine’. She really wanted to reassure me. She told me my sister’s ‘good’ birth story (her second child) as many times as she told me about my brother’s birth. She told me that my own birth had been long and ‘difficult’ but not horrendous. But my brother’s birth – the horror story – was the one that stuck. This is not meant to be a critique of our mothers – what else can they do, after all, you did ask – but it’s worth recognising that your mother (or aunt, or whoever) may be passing down some pretty hard-core memories. These stories will affect, in some way, your idea of birth. It can be immensely helpful, then, to recognise your preconceptions, understand where they come from and do something about them before you’re in labour.
If you are squeaky clean on this one – if all your family stories are lovely positive ones – then this is fantastic news. These empowering stories are the ‘normal’ things you should cling to when you are hearing from friends, women in the street, online or in magazines, that childbirth is dangerous and awful. But remember that even the positive stories are not about you. No two births are the same, shared gene pool or not.
‘When I knew I was pregnant for the second time,’ Julia remembers, ‘the first thing I did – before I even told my family I was pregnant – was see a counsellor. We went through the births I’d seen as a doula, and separated them from my life. I had to remember that I’d not made the marriage, nutritional, emotional and hospital choices other women had. In fact, just talking about those births relieved me. Once I got over my initial feelings of shyness it took only two visits to release my fears.’
FOUR STEPS TO SANITY:
HOW TO HANDLE OTHER PEOPLES’ BIRTH STORIES
If you’re adopted, or your mother never said a word about birth to you, you’ll have no familial birth stories to get hung up about. This can be an advantage – it is harder to make assumptions about your own genetic incompetence – but it can also be worrying. Betsy, who was adopted as an infant and is now the mother of two says: ‘There was always a big nothingness about birth for me. Perhaps being adopted and not hearing many birth stories contributed to this blank feeling, but I possessed nothing less than sheer determination to meet my first biological connection [her daughter Selah] on my terms. I researched endlessly, for both births. I read and asked question after question. My anxiety, I think, was far greater than it would have been if I had had something genetic to go on.’
Coming to terms with your blank sheet – what fears or issues it raises for you – can be just as important as dealing with the horror stories.
If you go through the zillions of popular pregnancy books out there you’ll find that hardly any discuss fear of childbirth properly. As Mary, a doula from California, puts it: ‘What’s scarier than fearing something and then feeling like you’re the only one?’ You are not the only one. Doulas are often privy to women’s deepest fears (it’s their job, after all, to get this information out of a client and then do something to help her handle it) and any midwife will tell you that pregnant women are capable of worrying pathologically about any aspect of birth.
THE TOP FIVE FEARS
The doulas we interviewed for this book say their clients are most often afraid of:
Some health professionals may not be brilliant at dealing with your fears. It is worth preparing yourself for this, and finding alternatives if yours proves unhelpful. Julia experienced this in her first pregnancy.
‘I once attended a childbirth class (not run by Kim, my midwife!) aimed at women who wanted a home birth. One night was set aside for what would happen if you have to go to the hospital. A woman in my class left during the film of a very clinical hospital birth. We heard sobs from the hall. Her fear of childbirth was huge. Our midwife/childbirth teacher went to the hall with her, calmed her, helped her to her car and returned to us – pale faces and freaking out now ourselves. She then said NOTHING to us. Nothing about fear of labour. Nothing about why it was good/bad that this woman had broken down. Not even just a question about how we were all feeling about labour. We just never saw that woman again. If this midwife didn’t know or didn’t want to deal with our fears, how were we supposed to?’
SIX GOOD WAYS TO COMBAT YOUR FEARS
SIX REASSURING THINGS ABOUT LABOUR PAIN
Most of us are, to varying degrees, anxious about pain. But few of us know that labour pain can actually help labour to progress. ‘The cervical nerves, pelvic floor muscles and vagina transmit a stretching signal with the pain. That then tells the pituitary to produce more oxytocin, which in turn kicks-up the labour’s intensity, helping the cervix to dilate and giving that blessed urge to push,’ explains midwife Kim Kelly. Labour pain is not, then, as women were told until as late as the 1940s, merely a punishment for our natural sinfulness.
This may not stop the prospect of pain being scary. The most difficult thing about labour pain, for first timers, is probably that it’s unknown. Nobody can tell you how you will experience pain because every one of us feels it differently. ‘The pain of birth is like a huge wave,’ says Adrianne, 40, mother of three. ‘It knocks you down while you’re in it, but, like a wave, it passes. It’s finite. Knowing this, while you are in labour, can make contractions do-able.’ This is certainly true of a ‘normal’ labour, but sometimes labour may not be ‘do-able’ at all. Your mindset, body, baby, surroundings – everything – will influence how the contractions feel to you. But most women would probably say that labour pain is like nothing they’ve ever encountered.
My own experience of unmedicated birth was that the pain was always manageable, though sometimes extreme. I’m not a masochist and in every day life I am utterly lily-livered about any physical discomfort. I would certainly have had an epidural if I’d needed one. But I never thought that I would die and I never panicked. Labour hurt but my entire body and soul was somehow focused on coping with it. It felt a bit like surrendering to something far bigger than me. (I used relaxation, breathing, movement and solitude, the room was dark and quiet, I felt safe and both times had fantastic professional and emotional support.) I was lucky enough to have no complications and in these conditions, my body got on with giving birth, and it felt triumphant.
Julia felt pain very differently in her unmedicated birth. This shows how unique and contradictory labour pain can be:
‘My labour with Larson, my second baby, went perfectly. Except for one thing: I knew I was not going to live through the pain. At one point I was moved out of the tub so my progress could be checked. As I lay there on my own couch I had a very calm thought about my impending death. I thought about how my husband would raise our sons in this house, and how hard that would be with the memory of me in every room. I then saw my four-year-old’s favorite train pulling over me, and, as it did, I dilated from 5 to 10 cm. Recently my mother-in-law remarked on how lucky I was to have such “pain free births”. The pain of Larson’s birth was exquisite.’
Labour pain doesn’t really make sense. And this is, perversely, the point. When people say things like ‘you wouldn’t have a tooth pulled without pain relief’ they’re right. You’d have to be bonkers. But this statement has nothing to do with how your body might manage the pain of a straightforward, healthy labour – a pain it was designed to withstand. Now, of course, the reality is that your birth may not be simple. You may want, and need, drugs. You may panic. You may feel you can’t cope. Things may become obstetrically complicated. You will need a mechanism to deal with this and that mechanism could well involve hefty doses of analgesia. If you’re thinking you’re going to breathe the baby out, and the baby happens to be in the wrong position, or your cervix happens not to be dilating, or you end up with some difficult medical interventions, or it just hurts too much, you may want drugs. We cover all this (there are always pros and cons to different kinds of medication) in Chapter 5: Your Options.
The crucial thing about pain in labour is that you should – as far as possible – be realistic about it. Labour hurts. ‘If we downplay labour pain with the idea of protecting those we love from distress, we’re actually sending expectant mothers into a realm that they have no means to define, accept, or use to their advantage,’ writes Gayle Peterson in An Easier Childbirth.4 For most of us, accepting we might experience pain is a huge challenge. But you will be more likely to cope with pain in labour if you’re expecting labour to be painful.
Most of us are not used to pain in our lives. We think of pain as ‘bad’, ‘scary’ or ‘dangerous’. We hear women’s stories of childbirth ‘agony’ and can’t help but conclude that birth (without an instant epidural) must be an appalling ordeal. When I was trying to work out what I was most scared of before my second birth, I was surprised to find that it wasn’t the thought of another caesarean that worried me most, or even the thought of my caesarean scar rupturing during the birth (which I knew was incredibly unlikely); it was the notion that I would have to pass through some ‘dark continent’ of agony in order to produce my baby. I just didn’t know how I would survive this unknown, horrendous place. I’d only made it to 3 or 4cm with my first labour and that had been very painful indeed. The notion of what real labour pain could possibly mean filled me with dread. I eventually liberated myself from this by realising that if I wasn’t coping I’d just have drugs and accept any side-effects as part of this informed decision. Labour pain, then, is something about which you have to keep a certain perspective: you’re living in the 21st century and you don’t need to martyr yourself in the name of any childbirth goal.
‘First time around I’d got myself into such a positive mind frame about birth,’ says Beverley, 37, mother of three, ‘that I genuinely thought it was hardly going to hurt if I just did my yoga positions and stayed focused. I was horrified by the reality. I ended up with an epidural at 5cm, and a forceps birth. The second time I was much more prepared for how hard it might be. I’d done much more research about how to handle contractions, and I had a very supportive and helpful midwife. This made me far more able to handle the pain. I could cope with it mentally in a way I couldn’t the first time.’
Many women, particularly first time around, find that labour slows or stops or becomes more painful when they get to hospital. The unfamiliar surroundings and anxiety about what’s ahead (even the noises of other women giving birth, which can sound scary to the untrained ear) can all trigger tension. This tension can in turn produce more of those adrenalin type hormones, which can inhibit labour and may stop you coping with the pain so well. In short: now is the time to get on top of your fears.
FOUR MORE THINGS TO REMEMBER ABOUT LABOUR PAIN
As you can see from these responses, we all feel it differently:
‘My contractions were an intense clenching feeling round my middle, overwhelming while they were happening, but not what I would describe as painful.’ Tina, 38, mother of Michael (1)
‘It felt like an acute period pain, a gripping feeling. When my labour was at its peak the gripping felt overwhelming but most of the time it was manageable. The pain when pushing was completely different. Far less onerous. I felt I was controlling it, pushing the baby into the right position to crown. With my first baby, the midwife told me to keep going – that I would feel like I was splitting apart. Funnily enough, this helped – I wasn’t scared by the feeling because I knew it was OK.’ Sarah, 35, mother of Margaret (18 months) and Thomas (6 weeks)
‘I found the pain of early labour the toughest to handle. My labour started very slowly – I had painful, regular contractions for three days with no dilation. On day four I was going out of my mind with boredom, sleeplessness and the relentlessness of the pain. When labour got going I found it easier rather than harder: the pain became intense but I knew it was going somewhere at last.’ Lilian, 38, mother of Jacob (4)
‘Each contraction felt like nothing I had ever known, but the feeling of coming through each one was exhilarating. I kept visualising a mountain – getting to the peak and down the other side.’ Susan, 34, mother of Lorelei (3)
‘I remember wanting to curl my toes and thinking “this is what ‘toe curling’ means”. It was an unbearable ache – not a sharp pain, though a short lived one – like someone squeezing your insides, like a really intense period pain. Pushing was a really positive pain, quite productive and when the head crowned it was an intense burning pain, but one that seemed more bearable than the contractions. Despite this, it’s incredibly fulfilling – it’s the best feeling in the world when the baby is born.’ Lucy, 35, mother of Harry (2) and Emma (1)
‘It was a gripping feeling round the middle – intense and engrossing, like a highly magnified period cramp with backache – and, with my second baby, pains running down the front of my legs. There was something tingly about this pain, like my nerves were on end. When it came to pushing I thought it wasn’t supposed to hurt any more and was surprised how much it did: the pain was the same kind, but lower, more grinding, and more controlled. I was also surprised that after the baby was out, the contractions continued to get the placenta out: somehow I hadn’t anticipated that. They were weaker, but still painful.’ Freda, 35, mother of Annaliese (2) and Joshua (3 weeks)
‘My pushing stage was extreme; totally instinctive – it felt like my body was literally vomiting out the baby – I had to just give in to it. On one level I was steamrollered by the pain, but on another I was totally rational – feeling really excited that I was going to meet my baby any minute.’ Polly, 30, mother of Finn (4 months)
‘My first labour was uneventful – gas and air helped. The contractions were squeezing, tight like you can’t breathe, but OK. My second was a back labour; it was agony – constant back pain, shooting pains down my legs, no let up… I had an epidural as soon as I could.’ Margot, 29, mother of Arnauld (3) and Amelie (5 months)
‘Though it was the most extreme pain of my life, I can’t say it felt ‘bad’ exactly, or even really out of control. It’s pain for a reason. You know it’s OK and you get through it somehow – however you can – and the result is so worth it.’ Clara, 30, mother of Rosie (1)
Since pain is so subjective in labour, and women are often in a state where they say and do odd things, Julia uses a special ‘code’ with her clients when it comes to communicating about pain in labour (specifically, the need for pain relief).
‘This tactic can be incredibly useful if you are keen to avoid unnecessary interventions, but want to know that if you’re not coping, drugs will be forthcoming. My clients pick a word that would not regularly be heard in a delivery room – one client used the word “Pickle”. During labour women sometimes ask for medication or an epidural. But these can become general words – words that mean she’s asking for help of some kind – not necessarily medication. Not until she uses her code word do we really know she is coming close to her limits. This agreement empowers her to know that:
If she says the other words – the words women so often say in labour – then we still listen and talk to her but we take those words to mean she needs general help and comfort measures, not hard core medication!’
A WORD ABOUT PAST SEXUAL ABUSE | For some women past experience of sexual abuse is inseparable from the fear of losing control. Julia has heard countless stories of sexual abuse from the women she has worked with. If this has happened to you, it is worth knowing that your experience could affect – profoundly – how you experience childbirth. As Julia says: ‘The women I’ve worked with often continue to carry feelings of shame, guilt and embarrassment without telling their midwife. Childbirth roars through us with a powerful energy. It is really important to choose caregivers you trust and to tell these people what has happened to you. If you don’t you could be setting yourself up for some powerful images to be revisited when you are giving birth.’
‘We really, really need to know,’ says midwife Jenny Smith, ‘about issues like past sexual abuse. They can deeply affect how a woman gives birth. And unless we know, we cannot take the steps necessary to make the experience of childbirth as untraumatic as possible for you.’
Julia had one client who is a great example of how positive it can be to talk about your past:
‘A week or so before the birth, Patty told me she was raped aged 15 and hadn’t mentioned it to the midwife. We talked it over calmly, and eventually she decided to phone her midwife. We then focused on the pain code (mentioned above) and I assured her that no one in her labour room would be expecting this revelation to cause any problems at all – but now that we knew, we would be prepared if it did. She had a ten-hour straightforward birth, with a long pushing stage that the midwife handled very sensitively. She told me later that the pushing stage was the single biggest surprise of her life: we talk about it as being so painful, but for her, it was her chance to reclaim her body, revisit its power and heal herself in a very poignant way. Patty did two things very right: she had counselling before she became pregnant. And she told those that would be caring for her in labour. When the time came, she felt safe and protected and so she was able to separate the experience of giving birth from her past rape. I have worked with young girls who did not have the advantages of counselling and time that Patty did. (These are young girls who have been raped, and are pregnant as a result.) These are the gut wrenching births – they have no time for separation from rape to birth. Patty used her labour as a surprising reclamation of her body. But a woman whose rape was recent, no one should expect her to be empowered or healed so soon. She needs to cope, to be reassured and to be heard. If you have been abused tell your midwife as early in pregnancy as you can.’
Where to go for help:
Rape Crisis A non-profit organisation that has groups across the UK and Ireland offering support and information. This website has local helpline numbers, but you can look in your local phone book if you can’t get online. www.rapecrisis.org.uk
The Rape and Sexual Abuse Support Centre Support and information for women and girls who have been raped or sexually abused, however long ago. Call their local rate helpline 0845 1221 331 (Mondays to Fridays 12 p.m.–2.30 p.m., 7 p.m.–9.30 p.m., weekends and bank holidays 2.30 p.m.–5 p.m.).
NAPAC (The National Association for People Abused in Childhood) provides support no matter how long ago the abuse took place, helping people to take control of their own recovery. Call their free helpline 0800 085 3330 (Mondays to Fridays 9 a.m.–1 p.m.). Also check out their website at www.napac.org.uk.
Further reading:
When Survivors Give Birth: understanding and healing the effects of early sexual abuse on childbearing women by Penny Simkin and Phyllis Klaus (Classic Day Publishing, US, 2004)
‘The worst thing for me first time was the sense that I had no control whatsoever over my body, or what was being done to it,’ says Francoise, 30, mother of Maude (3) and Pierre (1). ‘They nominally asked me before they did things, but I had no idea how to make these choices – I was scared, immobilised by the epidural, totally overcome. I felt really violated afterwards.’
Psychological studies have found that a major factor in how we cope with birth is not so much what happens to us, but whether or not we feel consulted and ‘in control’ of what happens to us. It’s not the actual intervention that’s a problem. It’s how you feel about it. Feeling that things are being done ‘to’ you, that you don’t understand why, and that you are not being respected or consulted, can lead to what psychologists call ‘negative psychological outcomes’. These can range from just feeling upset by the birth, to feeling downright traumatised by it.
THINGS YOU CAN DO TO MAXIMISE YOUR FEELINGS OF CONTROL
This is a complicated issue, but not one to fear. If this is something that scares you, don’t dismiss it. There is a lot you can do to tackle this worry and to maximise your chances of avoiding an unnecessary caesarean. (We discuss this fully in Chapter 6: Surgical Birth. We also discuss coping with interventions in Chapter 5: Your Options, page.)
An episiotomy is a surgical cut to your perineum that allows the baby to be delivered quickly. It used to be virtually routine but is far less common nowadays because the thinking is that a tear generally heals better than a cut. Episiotomy is most commonly used when forceps are necessary, or when the baby is showing signs of distress and needs to come out very quickly. In this situation, which is relatively uncommon, you will just want the baby out safely. Again, there are ways to cope during this intervention (see Chapter Five, page), and many ways to soothe your perineum when it is healing (see Chapter 10: Frozen Peas and Pyjamas).
WAYS TO AVOID EPISIOTOMY | Put on your birth plan, clearly, that you do not want an episiotomy unless it is a medical necessity (this way, even if one is necessary you will be consulted, and will fully understand the reason). Stay upright and move as much as you can during labour to use gravity to help your baby descend and to maximise the efficiency of your contractions.
TEARING | Many women have minor tears to the perineum when they push the baby out. This sounds awful in advance, but usually the tear happens and then the baby is out, and you’re utterly distracted and elated. Tears like these heal quickly and are rarely a problem. More complicated tears do happen. These can be harder to handle but, again, there are things you can do to minimise the chances of this happening to you, and tons of things you can do to cope afterwards.
THINGS YOU CAN DO TO AVOID TEARING
This is something virtually all of us worry about at some point during pregnancy, and often during the birth too. It can be a concern even if you have absolutely no reason to suspect anything may be wrong. My first words, on giving birth to Sam, were, ‘Has he got Down’s?’ I just couldn’t believe that the birth had gone so well: something had to be wrong. If you already have had a baby with a birth defect, have been through the trauma of a stillbirth, or have had a baby that has had to go to intensive care, this fear becomes very real, and very pressing.
THINGS YOU CAN DO
Where to go for help:
Birth Defects Foundation, UK BDF Newlife, BDF Centre, Hemlock Business Park, Hemlock Way, Cannock, Staffordshire WS11 7GF 01543 468888 www.bdfcharity.co.uk
If you’re an ‘alternative medicine’ sceptic, don’t skip this section. Remember the documented physiological links between fear, tension and pain. Midwife Jenny Smith encourages her patients to explore all kinds of alternative techniques: ‘Many women I work with find alternative therapies, like visualisation, yoga, aromatherapy or hypnobirthing incredibly calming and helpful, both when pregnant and during childbirth.’ Sue Macdonald of the Royal College of Midwives agrees: ‘In my experience as a midwife, women who are relaxed during labour do not experience pain in the same way as women who are tense. Techniques like self-hypnosis, relaxation and yoga can be very useful indeed in managing the pain of childbirth.’
Julia is a trained hypnotherapist, and many of her clients (including me, your average sceptic) have found the techniques she teaches really useful for dealing with both fear and pain. See Find Out More for simple self-hypnosis/relaxation methods.
EIGHT ALTERNATIVE THERAPIES THAT MANY WOMEN FIND USEFUL
For the best recommendations of experts working with a pregnant body, start with your midwife. (We have details of how to find practitioners in Chapter 5: Your Options, page.)
(N.B. Save these results for writing your birth plan)
STEP 1: IDENTIFY YOUR FEARS | Make some quiet time for this, get a pen and paper and switch off the phone. It might help to set a timer – then you’ll know there’s a beginning and end. If this is not your first birth and your last birth was traumatic you might find this exercise too upsetting. If you get distressed, stop. Go back and talk to your midwife about the fears you have left over from that birth.
STEP 2: TALK ABOUT IT | Now you need to get comfort and answers. Hopefully this book will arm you with information. But talk to your midwife (and doula if you have one) now, taking your list of fears to your next appointment. Also, talk to your partner about his idea of birth (he can even do this exercise himself).
STEP 3: MOVE ON | Easier said than done but by now you should understand your feelings more. The next thing to do is get practical and start making good choices so that this will be a positive birth. Ask yourself:
The idea here is that you ‘re-programme’ your own mentality about birth by saying positive things to yourself over and over again, when you are in a ‘suggestible’ (i.e. relaxed, safe, quiet) state. Studies have shown that a woman’s attitude – positive or negative – to birth can be an important factor in how she experiences it. So this really is worth a go. You will feel silly at first, but persist. Your partner, of course, may also laugh at you when he finds you doing this. Try explaining the rationale but if he’s still going to chortle away distractingly, just do these affirmations when he’s not around.
Start tonight and continue for the next seven days.
‘I know my body is strong enough to give birth’
‘My body knows how to give birth and I will let it’
‘Childbirth is a normal, healthy event’
While you are saying it to yourself, imagine – in any way you can – feeling strong, safe and powerful in labour (or whatever matches your suggestion).
The idea is that you establish a habit pattern and ‘programme’ yourself to think more positively. Gradually, you’ll find yourself reacting more positively to your affirmation.
After you’ve practised your affirmations for seven days, you then start learning how to relax. Continue with your affirmations every night before bed, too. But add this:
Twice a day – before breakfast or lunch, say, then once after dinner – you practise relaxing yourself and staying in that relaxed state for two to three minutes, then waking yourself up.
Here’s how:
Once you’ve mastered Step 2 (try doing it for seven days) and are good at getting yourself quickly relaxed, you can move onto this step. Once you start this step, you no longer have to do Step 2.
For this step you need a small card that you can carry with you. Write your affirmation on this card (or go to www.bloomingbirth.net for affirmation cards ready for you to print and use).
It can take a couple of weeks, or more, for you to start feeling the affirmations are believable, or having any affect on your mentality.
Practise these repeatedly during pregnancy, make them second nature and use them when you’re in labour: both between contractions and during them – whenever you need a way to let tension go.
BODY SCAN | You can do this alone, but it’s easiest to get your partner to read these instructions to you while you do it.
N.B. Pay special attention and time to your shoulders, heart, back, and if you previously had a caesarean give extra time to visualise your scar ‘healing’. Of course your scar has healed, but really try and ‘feel’ or ‘believe’ that it has indeed healed. Don’t neglect your poor perineum and vagina – you wouldn’t think it, but it’s surprising how tense they can be!
Many pregnant women fall asleep during this process, so don’t worry if you nod off. At least it shows you are relaxed.
MEDITATIVE BREATHING | This is used in transcendental meditation but you don’t have to be a spiritual guru to benefit. Many antenatal yoga teachers use similar methods to enhance relaxation through controlled breathing.
Variation: using a simple affirmation and image Do the same meditative breathing exercise using an affirmation and visualising yourself actually doing it (e.g. feeling really powerful while giving birth/having a calm, safe birth etc.). You can also do this exercise while looking at a photo or picture that you love (anything will do). This is a good idea, because you can then take that picture with you to the labour room and focus on it while you are actually in labour: it can be a kind of comforting ‘trigger’ for your relaxed state.
Coping with Labour Pain: A Comprehensive Guide to the Best Ways to Alleviate It by Nicky Wesson (Vermilion, UK, 1999)
Mind over Labor: A Breakthrough Guide to Giving Birth by Carl Jones (Penguin, US, 1988) (includes meditation techniques)
An Easier Childbirth: A Mother’s Guide for Birthing Normally by Gayle Peterson (Shadow and Light, US, 1993). Helpful for getting past previous childbirth experiences.
Having a Baby: Mothers Tell Their Stories (A Celebration of the Joys of Childbirth) by Patricia Bernstein (Simon and Schuster Pocket Books, US, 1993)
Childbirth without Fear by Grantly Dick-Read, foreword by Michael Odent (Pinter & Martin, UK, 2004). This classic contains much that is still relevant today.
British Association for Counselling and Psychotherapy has a ‘find a therapist’ function on its website www.bacp.co.uk. BACP House, 35–37 Albert Street, Rugby, Warwickshire CV21 2SG 0870 443 5252