labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Monday, March 16, 2009

Getting Rid of the Fear

The editorial in the most recent Journal of Midwifery and Women's Health got me thinking: what can I do as your nurse midwife to make labor and birth as fearless event?

So many women fear childbirth. And with good reason. We are told it is the worst pain ever, that it will feel like you are being ripped in half, that you can't do it unless you get boat loads of drugs or a dense epidural, that it causes women to lose total control of themselves and scream bloody murder, or it is better to just schedule your c-section because you can avoid labor altogether. At least, this is what our culture makes it out to be.

And I am not saying that having fear is wrong. I think its only natural. I mean, this is what I do- this birthing business- and even I have my fears. Specifically, I fear two things: perineal lacerations and lack of options requiring me to give birth in an environment riddled with needless interventions and an attitude that birth is a pathological process that needs to be "cured".

Now, I understand there are women who have a history of sexual trauma can have major anxiety and fear about childbirth- I am not referring to this root cause of the fear in this post. That is a whole other can of worms that deserves special attention outside of this.

I am just talking about your everyday woman who fears birth.

One of the things I stress when I teach childbirth classes is how fear plays a big role in perception of labor and birth, and for many will actually heighten the pain experience. I truly believe this, and have cared for many women who are so frightful that active braxton-hicks contractions has them tearing up the walls and pleading for death.

I try to help alleviate fears when I get the sense that a woman I am caring for is anxious or fearful. I do this by being calm (you'd be surprised how much difference it makes when a nurse or other provider comes into a room very high strung, loud, or abrupt, among other ways, can make a woman in labor more fearful or anxious). I listen to what she is saying. I validate what she is saying. I try to reground her when she spirals into her fears. I give encouraging, positive words when needed.

Prenatally, outside of listening, educating, encouraging the woman to further educate herself, I don't know what else to do. So, as I asked earlier, what can I do to help alleviate these fears?

(And a congrats to Rixa for the publication of her article Staying Home To Give Birth in the same issue of JMWH)


Amber said...

I had my third baby 10 months ago with the help of a wonderful midwife. My first two children were attended by a regular OB. I can say that I had such a better experience with the Midwife. She was so, so helpful. She was such a cheerleader for me, from the first visit, she told me "you can DO this" I built a relationship with her, I trusted her, she helped me believe in myself, that I could do it. I had the most beautiful birth, yes, it felt like I was ripping in half, but I was able to handle the pain, and was so happy I ended up without drugs. With my first two children, my OB told me "you CAN'T do it, it hurts too bad, you'll just end up with the epi", and I did end up with the drugs. Go figure!! I loved my midwife, and it turns out she wasn't even there for the birth, (another midwife was on call) but she had built me up with confidence enough, that I was sure of myself. She didn't lie to me, she explained what I would be feeling, but she assured me I would be OK.... and I was.

Megan said...

I think education alleviated a lot of my fear. Learning about what was happening biologically in the different stages of labor was very helpful. The only time I felt scared during labor was when my extremely strong contractions were very irregular, and so I (and the doctor) thought I was making no progress. I thought, if it hurts this much in latent labor, how the $%@$^ am I going to get through the real thing? The OB relented and let me come to the hospital, where I was found to be at 6 cm. At that moment, the fear disappeared, even though the pain was unchanged. The OB encouraged me to go unmedicated if I wanted to, but I ultimately had a C-section after hours of pushing and no progress. Giant baby head. Anyway, for me, knowing what was going on, and knowing that the pain was doing something useful, took away much of my fear.

anjie said...

I enjoy your blog. I think what you wrote about supporting the mother is great. I had one provider who didn't get it when I told him fears or concerns. He would offer medicine or tests.
I host a "powerful birth group" each month and we recently discussed fears. I wrote the highlights on my birth blog.

Renee said...

My natural birth ended with all the interventions including a c-section. I did go 24 hours before, being 4 cm, asking for pain meds. I know that going that long was only possible because of the support that I had. My husband, doula, and nurses were all calm and grounding to me. If had people around me projecting panic or doubt I'm sure I would have hit the wall much sooner. It sounds like you have this down already!

Anonymous said...

This book has some touching OB stories in it which you may find inspirational. Finally, one of our fellow nurses took the time to write a book which acknowledges nurses and gives them the credit we so deserve. I'm so glad to see this heartwarming, inspirational account of what nurses go through and the caring forces which drive them to continue on in their work. It's a great read: Nurses Are From Heaven: Nursing Through Eyes of Faith by C. Feist-Heilmeier, RN.

Nicole said...

Hello Labor Nurse,
I love your passion for helping women and your desire to seek out the truth. I too am a truth seeker :-)

In my experience as a labor nurse and midwife, the calm/support role has seemed to be the best way to help alleviate a woman's fear.

I also like to ASK a woman what her specific fear is. For each woman it is different. I have been surprised at some of the answers I have gotten. For many it is the pain or her fear that she can't do it. For these women, I will often provide reassurance with true stories of other women who had fast and easy labors as an example of the long continuum of the childbirth experience.

I may ask them about other things they have done that they thought they couldn't do and compare that in someway to their birth experience. I had a patient once who had run 3 marathons and was afraid of birth. WOW....I helped her see how strong she was through that.

For many woman pain as nothing to do with their fear. I had a woman who told me her biggest fear (and it was HUGHE for her) was pooping on the delivery table. I was able to alleviate her fears by offering her an enema before her induction started. It calmed her nerves completely :-)

Labor Nurse said...

Nicole, you remember me of something I find myself saying often: "This is normal". I often say this in response to a women who is fearful of what is happening, or what she is feeling. Sometimes this is all that it takes.

Nicole said...

You are EXACTLY right.... This has worked for me lots of times. Simply letting them know something is normal can be all the reassurance they need. Yes it is normal to feel like your bottom is rippin in half!! Even when its' not. Thanks for reminding me of that!! :-)

Anonymous said...

Part of my fear was knowing that having a helpful nurse, dr, etc, would make it easier, but also knowing I had no control over who would attend my birth. My HMO only covered one group and it consisted of 15 doctors who rotate. I would have given anything for a kind, familiar face that night.

I know people say knowledge alleviates the fear, but the more I read about the horrors of hospital births, the more panicked I became. I felt like a lot of the info out there describes how bad things can go if you don't have a midwife or good nurse/OB. I almost wish I would have gone in with no info so I wouldn't have been so disappointed.

Sarah B. said...

As a total newcomer to this field, I offer these thoughts with utmost respect for you and the many others who are wise in their years of experience. (I am just finishing my certification as a CCE with Birthworks, Intl.) And please forgive me if this is stuff you already know!!

I find it fascinating that Birthworks is really big on the process of expectant moms (and dads) uncovering what their beliefs are surrounding birth. This is often not a quick process, as a person's beliefs about birth are often shaped even in childhood, so a good childbirth ed class should be prepared to address this issue more than once. Often times in this process, moms and dads will discover that their beliefs about birth are greatly influencing their current fears about birth. For example, "When my mom had me, she had a really traumatic, long labor that ended in a difficult forceps delivery." Or "Growing up, I was always led to believe that my body was 'gross' or 'dirty.'" Once a woman (and partner) are able to identify some of their beliefs, it often leads to them being able to address their current fears. Unfortunately, I sense that the importance of such exploration of one's fears is often dismissed, or glossed over, by many childbirth professionals.

Also, what about helping a woman to incorporate a positive thought process to counteract the fear she's struggling with? Something like, if a mom is afraid of her body failing her during labor/birth, she could begin mentally (or even verbally) saying to herself, "My body is designed to give birth." I know of women who's fears have greatly diminished after practicing these types of excersizes.

Just some thoughts. Thanks for your wonderful blog.

TracyKM said...

ONe of my favourite sayings is "What you fear, you create". And, "What you focus on, expands".
I watched a birth show and prenatally the mother went on and on about being afraid of an episiotomy or tearing. She never seem to hear her midwife. She was shown in the hospital, still being afraid. Then, according to dad, she made it to "9 and 3/4cm" and didn't get to 10cm so 'had' to have a c-section. As she's being wheeled out, she says to him, "At least I didn't have an episiotomy". She had been 'educated' and listened to, but she couldn't take it in.
I read a book recently, the title was something like "Painless Childbirth" and the writer was Italian-American. It was about doing an internal emotional journey through the pregnancy--even involving hypnosis to release any subconscious fears/pain often from our OWN birth.
If a woman doesn't want to get rid of her fear, there's nothing you can do. I'd ask her directly why she wants to hang on to a fear that will not benefit her. Ask her to dig inside and find out why she is resistant to letting go of fear.

Joy said...

I love labor and giving birth! Yes, I'm one of those oddballs. But I do have fears, mostly that the doctor will want to do something and not even give me a choice (episiotomy, for example).

Anna said...

"I try to help alleviate fears when I get the sense that a woman I am caring for is anxious or fearful. I do this by being calm (you'd be surprised how much difference it makes when a nurse or other provider comes into a room very high strung, loud, or abrupt, among other ways, can make a woman in labor more fearful or anxious). I listen to what she is saying. I validate what she is saying. I try to reground her when she spirals into her fears. I give encouraging, positive words when needed."This is SO important! I had planned a home birth with the twins, but Reagan (baby A) was transverse, so ended up having a c-section. Rather than scheduling, I waiting until I was in labor. I always dilate early - often weeks before labor begins - so it was no surprise that although I went to the hospital as soon as labor started, I was 5cm when I got there (I'd been 4cm at my prenatal visit the day before). The L&D nurse was running around like a madwoman, making me crazy! I knew I would have a c-section, but meanwhile, I still had contractions to contend with, nevermind that I was very nervous about the impending surgery. I finally stopped her, looked her in the eye and said, "I promise you, these babies are not going to fall out. Please calm down and move more slowly; you're making me very nervous." Amazingly, she did! I'm really surprised at how many health care providers don't realize the effect their actions and attitudes (or perceived attitudes) have on the people in their care.

- Anna
Mama to Jonny (7/02), Gracie (11/03), Levi (2/06), Reagan & Sera (7/08)