This article first appeared in Mothering Magazine, Sept./Oct. 1999 issue
Looking Into the Eye's of the Dragon
Working With Fears During Pregnancy
by Robin Sale, CHT, CMT
"Nature needs no assistance, just no interference." - Unknown author
Recently, a father told me about a preschool field trip he had attended with his four-year-old son. They arrived at a farm where a goat was about to give birth. As the children gathered excitedly to watch, it became apparent that with each new arrival the goat grew more agitated. Aware of her audience, her labor seemed to stop. Finally, after several disruptions, she grunted and lifting her heavy body, made her way to the back of the barn. Here, in privacy, she quickly birthed her kids as the children secretly watched through peepholes.
Under normal circumstances, the flow of labor proceeds best without interference. If the above quote does apply to the natural flow of labor, what is it then, that impedes this natural flow? Oftentimes, the answer is fear. Fear, in it's many guises, can significantly slow down and inhibit the body's ability to give birth naturally.
Unlike other mammals, humans have the ability to harbor numerous fears besides those that may present themselves in the immediate birth environment - - fears from past experiences as well as imagined fears about the future.
A woman experiencing excessive fear during childbirth will unwittingly disrupt the progress of her labor. Fear causes the body to release the fight or flight hormones called catecholamines. These hormones are in direct conflict with those that cause labor to progress smoothly, including endorphins, the body's natural pain-reducing hormones and oxytocin, which causes the uterus to contract in a smooth, powerful and coordinated way, urging the baby into the world. As Paula Holtz, CNM, MA., describes it, this internal conflict is like having one foot on the gas and the other on the brake, you just don't go anywhere! Thus, the necessity of pitocin to strengthen contractions and epidurals to relieve pain and exhaustion. Ultimately a cesarean section may be necessary due to a 'failure to progress.'
A friend of mine told me the following story of the birth of her first child: "Labor was going along just fine. I was nearly completely dilated when everything just stopped! No more contractions. We waited a while, puzzling over this abrupt change. At some point, my husband looked at me and asked, 'What do you think is going on?' Just then I burst into tears. I was overwhelmed with the feeling that life was forever changing and afraid that this child would somehow come between my husband and me. We'd been married 10 years. I shared my fear with him. He, too, had similar feelings. As we talked, we came to realize that this baby would bring us to a new level of love that we would otherwise never know. With this realization labor commenced and within an hour we welcomed our sweet baby girl into our family.
Acknowledging fears and working with them prior to birth will mean that much less tension will be carried into labor. Like the proverbial dragon under the childhood bed, often our fears become important resources when invited out into the light of day.
Many women quietly harbor fears that something might go wrong with the birth or the health of their baby. They may keep these fears to themselves out of a superstitious belief that to speak about them may cause them to come true. They may think that telling their partner their concerns may cause their partner to worry as well. Some have a nebulous sense of dread, unsure of exactly what is frightening them. The truth is, holding these fears inside may cause more harm than good. Unspoken fears may fester, grow stronger and more insistent.
The following suggestions are several ideas for working through your fears on your own or with a partner or friend. If, however, after working with these, you still find yourself feeling anxious and fearful it may be important to seek out professional counseling. Choose someone with experience in birth and family related issues.
Talk it out.
"Let yourself be afraid and then you can release your fear" Alan Watts
Sit with a friend or your partner, and take ten minutes or so to talk about your fears. Ask the listener just to listen - - no advice, sympathy or hand holding necessary.
Often when we are given enough time to talk truthfully and openly without interruption, we are able to discover that we have the resolution to our concerns right within ourselves. Even if no resolution comes right away, you may feel freer, lighter and less alone with your feelings
If Fear is There, Embrace it
"Healing is embracing with love and mercy that which has been pushed away." - Steven Levine
Regard your fear as if it were a crying or hurt child. Embrace it with the kind of love and tenderness you would give a child if he or she were afraid. Give it your full attention. Take your time. No need to change it, just hold it in your heart and mind with acceptance and caring. This is a radical change from our first impulse, which may be to push away, get rid of, or be immobilized by our fear. Holding fear this way allows you to move from being a fearful person to being a person who may be feeling fear at the moment but is also capable of feeling a myriad of feelings, even comfort and compassion toward yourself. You may get some insight or deeper understanding about your fear that is useful to you in this way.
"The other side of every fear is freedom" Marilyn Ferguson
This exercise can be helpful when fears are generalized and non-specific. Again, with a friend or partner, talk about what's scary. Have your friend encourage you to follow the fear to the worst possible outcome, and ask how you would cope if this were to occur. This can be surprisingly empowering and helpful. If we look at the worst case scenario we are often amazed to see that we have the inner strength and resources to deal with even our greatest fear. Here is an example:
Alice: "I'm really feeling scared."
Jules: "What exactly are you afraid of?"
Alice: " I worry that there may be something wrong with my baby."
Jules: "What do you think about?
Alice: "Well, since I'm 36 the doctor has told me that I have an increased risk of having a baby with Down's Syndrome."
Jules: "Have you thought about what that would be like?"
Alice: "I think it would be really hard. Although I've heard that Down's babies are especially lovable. It's just that when I envision my child growing up, I think of the wonderful conversations we'll have and ideas we'll share and it would be difficult to have a child that was so dependent for their whole life. I thought about this when faced with the choice of having an amniocentesis. I decided I would have this baby no matter what. I already love this baby so much. I know it would be hard but I talked with a woman once with a child with Down's Syndrome and she talked about that child as her life's greatest blessing. I think I'd be OK."
Jules: "How do you think you would cope with the disappointment of not having those intellectual conversations?"
Alice: "You know, I've always had this abiding faith in life and in myself. I think I would find ways to connect with my child that were equally satisfying."
Can you see how this discussion diffused the fear, opening up the possibility for Alice to reconnect with her intentions and her inner strength? She is released from an imagined and frightening future to live the reality of her life as it is today fully.
Inviting the dragon to tea.
" Face fear, and thereby master it, repress fear and be mastered by it." Martin Luther King Jr.
Our fears may contain important information for us. Maybe we shouldn't be in such a hurry to be rid of them. This exercise requires turning toward our fears with a friendly interest rather than turning away, which is our usual inclination. Relating to our fears as visiting guest rather than as who we are may give us just the perspective we need for their resolution. You may wish to have a friend read this aloud to you slowly, pausing after each question to give you enough time to inquire deeply.
Set aside 15 to 20 minutes when you won't be interrupted.
- Begin by paying attention to your breath, the flow of each inhalation and each exhalation. Breathe in calm with each in-breath and with each breath out release any unnecessary tension, settling into a deeper relaxation with each breath. Let the sensation and the sound of your breathing anchor you into the present moment. Do this for several minutes to clear your mind of unnecessary clutter.
- Next, imagine yourself sitting comfortably in a room and invite your fear to join you for tea. Use your imagination to paint an image symbolic of your fear. You might be surprised at what you see. If your fear were a being, human or otherwise, what would it look like? What color and texture would it be? How does it dress? Would it like some tea and cookies? How does it move? If it could speak, how would you describe the quality of its voice? Gravely? Moaning? Angry? Soft? Male? Female? What would it say? What can you learn about your fear through this observation?
- Regarding your fear with a sincere interest, begin a dialogue. Ask your fear
what it needs? What's its purpose? Does it have any advice that could be of value to you? Again, use your imagination. If you were your fear what would you answer? Sometimes the answer comes through a feeling rather than words. Let this dialogue unfold naturally. Notice if your fear image changes it's form or demeanor during this interaction. It may be that this fear simply needs to be heard and respected for what it is. At other times our fears can point to specific actions we need to take. An example; "I'm afraid my husband won't be there for me." For one woman, the action needed might be to discuss this with her husband and to learn to ask specifically for what she wants. For another it might be to hire a birth assistant or "doula."
Fear of Losing Control
"No one can claim to tame the ocean, but anyone can learn to surf." Swami Satchitananda
"I'm afraid I might lose it" is a fear I often hear from the women I work with. The "it" they speak of is a sense of control. The image that many women have of losing it is of flailing arms and legs, screaming, being a wimp, swearing at their husbands and basically acting very undignified. I imagine they must have seen something like this on television.
Although one might argue that we are never really in control, we live in a culture that puts a high value on being in control at all times, structuring our days around the minutes of the clock and our appointment books. We control our moods, physical comfort and energy to meet the needs of our prearranged agendas with coffee, alcohol and drugs. Women in our culture spend vast amounts of money and energy controlling their appearance, fragrance, the color, shape, and texture of their hair, make up, clothing, etc.
And so, it is no wonder that the perceived, almost animalistic abandon of childbirth is frightening. Birth, being a uniquely feminine act is anything but lady like. At one birth center the nurses posted a sign over the door reading, "NO LADIES ALLOWED!"
Paradoxically, right along side of the fear of losing control, many women are worried about not being able to let go. Not wanting to loose control and at the same time knowing they need to let go puts women in a double bind of sorts.
One way to understand this double bind may lie in the paradox itself. Since one cannot control the energy of birth, perhaps one can view letting go to that energy as a kind of control in itself. Gayle Peterson, Ph.D., author of Birthing Normally and An Easier Childbirth, gives us a wonderful analogy for this in the sport of skiing. In order for someone to ski well, they have to yield and go with the flow of the mountain's curves and dips. This takes a great deal of focus and control, keeping the knees agile and distributing the weight appropriately from one moment to the next. If, for one second, they get distracted and loose their focus or if they become too rigid with control, they may fall. So the control comes from letting go to the terrain and the body's natural self-righting ability.
Learning to ride the waves of contractions throughout labor takes intense focus and concentration - - letting go of trying to make anything happen and being fully with what is happening from moment to moment. This does not come naturally to many women in a culture of control. Some women find the practice of yoga, chi gung, and relaxation or meditation wonderful ways to prepare for this kind of moment to moment awareness. It may be that fears only exist in the past or the future. They may have nothing to do with the present. Rather than asking, "How much longer is this going to be?" or "Will this next contraction be like the last one?" one might ask, "Am I O.K. right now?"
Fear of Pain
"We don't give medication for pain, we give it for fear." -Karen Ehrlich, Midwife
For most women, pain is a given in labor - - but fear may be optional. There is an abundance of what may be called "negative hypnosis" surrounding birth in this culture. Fear is a natural response to this bombardment from the media, and the many horror stories that have an uncanny way of finding their way to pregnant women and their partners. As the above quote suggests, fear itself may cause pain to become unbearable. Working through anticipatory fears ahead of time frees the laboring woman to focus in the present moment on the work at hand.
Like the story of the goat birthing her kids, I have heard many stories of labor stopping when something or someone in the birth environment caused a birthing woman to become fearful or uncomfortable. If birthing away from home, a woman might do well to become familiar with the birth center or hospital rooms and ask questions about policies and procedures ahead of time. As much as possible, the birthing couple should know who will be in attendance. The choice of care providers should be based not only on medical competency but also on good rapport and feelings of comfort.
Many couples today are hiring a labor assistant or doula; someone with professional expertise who is committed to being there throughout the entire duration of labor, delivery and postpartum. Having good one on one support during labor has been proven to significantly reduce the need for pain medication. In controlled tests conducted in a public hospital with the Baylor College of Medicine, the need for epidural anesthesia dropped from 55% to just 8% with the presence of a doula or labor assistant. This takes tremendous pressure off the birthing partner. With a trained birthing assistant the partner no longer needs to feel the weight of responsibility for "managing" the labor. Then he or she is free to fully attend to the laboring woman in much more supportive and caring ways.
Lastly, examining the sources of fears can be very enlightening. Gayle Peterson, Ph.D., says that we are greatly influenced in our perceptions of birth in these three ways; by being born, by giving birth and by what we hear about birth from others (including the media and culture around us.) Exploring how each of these three areas have informed us may give us an idea of any myths we may have adopted as truths about birth. Consider doing the first exercise suggested above with these three topics. Both partners take turns talking for five to ten minutes on each topic while the other listens in silence.
Besides these three ways of knowing about birth, I believe women have an innate understanding of birth within their own bodies, a cellular intelligence inherited by all the women throughout their ancestry. Activities that allow a woman to drop below her thinking mind into her body mind help to cultivate a deeper trust in her natural ability to give birth. Practice of yoga and meditation and spending time in nature are excellent ways to access this inner trust.
Fear of Judgment
Each birth is as unique as the woman giving birth. All too often women judge themselves or each other harshly on the choices or the outcomes of their birth experiences. This is unfortunate. On top of all the other challenges facing a birthing woman, performance anxiety is just added baggage.
After the women in my prenatal yoga and support classes settle into postpartum they like to come back and share their birth stories with the class. While telling her story, one woman shared that on being told she would need a C-section, her first thought of disappointment was that she wouldn't have a good birth story to share with the class. How quick we are to judge ourselves and to fear the judgment of others.
It has been said that we birth as we live. How hard are we on ourselves? How rigid are we in having the perfect birth experience? Do we need to "do it right?" For whom? Perhaps there is no right way, only experiences to learn from what we will. Can we accord ourselves the same compassion and understanding that we would give to another?
It takes courage to walk into the unknown. And who is to say that fear has no place in labor? Like pain, fear itself is perceived in accordance to our relationship with it. Recognize that fear has arrived and acknowledge her respectfully. Looking straight into the eyes of the dragon, you may discover a powerful ally who holds a mirror up to your own strength and unfolding potential.
Robin Sale, CHT, CMT, lives in Santa Cruz, Ca., where she and her husband, Saladin are the lucky parents of Aaron, age 14. A counselor and educator, she teaches classes in prenatal yoga and support, body/mind birth and parenting preparation, and prenatal yoga instructor courses.
©Robin Sale, 1998 Whole Birth Resources