This blog post was written in 2013, years before I published my book Reclaiming Childbirth. The book has an entire section on Fear, Pain and Losing Control because it is such an important issue in our birth culture. This post is a little overview aimed at reassuring women that it is OK and normal to experience fear about birth, and while giving birth.

In a backlash against the medicalisation of birth, women are beginning to reclaim birth. A counter culture has emerged partly thanks to the availability of information via the internet. Movies, images and stories of empowered birthing mothers circulate through social media. Women birthing in beautiful calm environments (usually in water, surrounded by candles), looking like Goddesses whilst gently and quietly 'breathing' their baby out. Women can see how birth can be, and many are inspired and driven to create a birth experience like those they watch.

While these images can help mothers build self-trust as they prepare for birth, they do not tell the whole story.

Fear and losing control

Labour is hard work, hence the word 'labour'. But the work is not just physical; as women birth their babies, they journey through a life-changing rite of passage into motherhood. At this time a woman is at her most powerful, and her most vulnerable. Historically and globally, childbirth is a time of danger for both mother and baby. Rituals are enacted in an attempt to ensure the safety of mother and baby. The nature of these rituals reflects the culture in which they are enacted. In medicalised cultures these rituals are technological and medical, focusing on surveillance and intervention (which often create danger). Regardless of attempts to ensure safety, deep down, like our ancestors we know we step into the unknown during birth. Fear is a normal part of birth. It is normal to fear for yourself and your baby. It is normal to fear the changes that will come when this new person enters your life. It is normal to fear how you will cope/are coping with the enormous physiological changes and sensations in your body.

It is unusual and unhelpful to be extremely fearful throughout labour, and prolonged high levels of adrenaline can reduce oxytocin release (contractions) and placental blood flow. However, most women experience a point in their labour where they feel out of control, frightened and overwhelmed. Some call this 'transition', and it is usually a sign that birth is close. Victor Turner described the middle phase of a rite of passage as an 'undoing, dissolution' and a 'decomposition' [of the self] which is accompanied by the 'processes of growth, transformation, and the reformulation of old elements in new patterns'. [1] I think this is a good description of the transitional phase of labour. In addition, Michel Odent suggests that the intense fear and sense of ‘losing it’ experienced near the end of labour facilitates the physiological process of birth.

You can learn more about the role of adrenaline and cortisol during physiological birth in my Childbirth Physiology Course, my Understanding Labour Progress Lesson Package, and my book Reclaiming Childbirth.

Most women will verbalise their fear, reach out for reassurance, become loud and/or angry, and often later, apologise for their behaviour. Others remain externally calm, and those around them are oblivious to their turmoil. Women are often judged by how they behave in labour. Women who manage to remain calm and serene whilst birthing are admired for maintaining control. In contrast, those who are loud, and appear to 'lose it' are considered to be out of control. However, appearing calm, and feeling calm are entirely different things. Only the woman knows what is happening inside her head and body.

We have created a culture (and birth culture) that seeks to avoid and minimise extreme emotion and pain, and encourages being in control. We use medications and/or skills, methods and techniques to remain in control and dampen the emotions, or at least the expression of those emotions. In some cases women are told that they should not experience fear, or pain, during birth and that these are conditioned feelings that can be controlled. I think it is a shame that this powerful aspect of the birth experience remains hidden and suppressed. Birth movies rarely include footage of women visibly 'losing control' (are these scenes edited out?). Women seldom share with others their experiences of feeling fearful and out of control (possibly they are worried about being judged, or think that they are unusual).

Getting Real and Acknowledging Fear

I realise that my perspective/suggestions go against many childbirth preparation programs which aim to give women skills and techniques to control their fear (and behaviour). While these techniques can be helpful, particularly during early labour, they are unhelpful for some, particularly during the intense transitional phase of labour. Women have told me they felt like failures because the techniques stopped working for them and they 'lost it'. One woman recently told me that the practitioner who taught her various techniques informed her she had not done them properly because she felt pain and fear! In addition, suggesting that the baby suffers long-term emotional issues if fear is experienced during labour is unhelpful (seriously, women are told this).

An alternative approach is to open up the discussion about fear and losing control during birth. Rather than trying to eliminate fear, it seems more helpful to acknowledge it is part of birth (for most) and to embrace it. Some suggestions:

During pregnancy

• Explore fear - What are you afraid of? Is there anything you can do to help alleviate specific fears (eg, researching, talking, planning)?
• Reinforce that it is OK if fear surfaces during birth, even if you think you have 'worked through' a specific fear during pregnancy, it may resurface.
• If you want to learn relaxation/coping techniques, these may help, particularly in early labour, but don't rely on them to work throughout the process (they might if you are lucky). Also, don't be persuaded that you need to master particular skills to give birth well. You already have everything you need within you to give birth.
• Create/plan a safe birth environment where losing control and feeling fear will be OK. Anyone who you plan to have in your birth space should be able to 'be with' your fear, and support you through it. You should feel comfortable about losing it in front of them without being judged.

During labour

Get on with birthing. As fear arises, let it come, feel it, accept it, and deal with it however you need to (be loud, be angry, be quiet, reach out for reassurance, shut yourself in the toilet, breathe, whatever). It will pass, and you will birth.

Related blog post

• Understanding and Assessing Labour Progress

 References

1. Turner (1987) ‘Betwixt and between: the liminal period in rites of passage’, in LC, Mahdi, SF Foster, & M Little (eds), Betwixt and between: patterns of masculine and feminine initiation, Open Court Publishing Company, Illinois.
2. Odent (1987) The fetus ejection reflex