When I was pregnant, my husband and I would take turns reading Frank Herbert's classic science fiction novel, Dune , out loud to one another. Herbert's child hero, Paul Atreides, is chosen to rise up against an evil empire, but like all heroes must first confront his fears. To that end, his mother teaches him a powerful litany to weaken fear's power over him.
I must not fear. Fear is the mind-killer. Fear is the little-death that brings total obliteration. I will face my fear. I will permit it to pass over me and through me. And when it has gone past I will turn the inner eye to see its path. Where the fear has gone there will be nothing. Only I will remain.
Strangely enough, this quote ended up being a powerful mantra in my own preparations to give birth.
When I tell people that I'm a doula, the floodgates of people's fears of childbirth open. If I ask people what they're afraid of, sometimes they're not exactly sure--Pain? Death? The nebulous unknown? The truth is, many of us are socialized to believe that birth is always dangerous, life-threatening, and pathological, a process that must be carefully managed if mother and baby are to survive, which is more than enough to make birth scary.
This message is reinforced in a variety of ways. For example, pregnant people are magnets for others' negative stories. When hearing those stories, we don't know or understand the context for those parents' experiences, and therefore no way of knowing the how or why of what happened--but the messages about birth come through loud and clear.
Childbirth in the media also provides powerful reinforcement. Movies, television dramas, and even reality tv shows tend to portray birth as dangerous, extremely painful, and high-risk. Medical caregivers themselves unrealistically emphasize birth as pathological, highlighting "what could go wrong" instead of what's going right, thereby reassuring low-risk mothers' that their experiences are normal. And, the vast majority of women have low-risk pregnancies and are capable of having a straightforward labor and birth.
What happens to the brain on fear? The amygdala, the part of our brain that instinctively and rapidly responds to and remembers stressors, short circuits our prefrontal cortex, the area that handles rational decision making. As a result, the expectation of a negative outcome actually makes it harder to make rational and even evidence-based decisions. One 2012 review in Biological Psychiatry describes this decision making process as "maladaptive."
Specifically, anxiety increases the attention to negative choice options, the likelihood that ambiguous options will be interpreted negatively, and the tendency to avoid potential negative outcomes, even at the cost of missing potential gains.
In birth, this can look like parents feeling bullied into interventions, and later they realize they didn't want them.
Without a doubt, fear is an important and useful emotion. Fear has gotten us here, because it helps us recognize danger and respond to it. It's helpful when we respond appropriately to a stressor by focusing our attention and allowing us to react quickly. And, fear is a normal emotion in birth. Midwife Elizabeth Davis calls birth a "blood mystery", an event in our lives that challenges and transforms us. During a normal labor--and most labors are--as the sensations intensify and we reach transition, or when our babies are crowning, we may be afraid. In these moments, my work as a doula is to reassure people (and their partners) that what they're experiencing is normal, that they're safe, and that they're supported.
Certainly, there are moments when the labor process deviates from the norm and needs to be brought back on track, and other times when a genuine emergency arises. And not surprisingly, in those situations, it's helpful not to be overwhelmed by panic but to breathe and maintain calm. What's unhelpful is to go into childbirth simmering with anxiety in expectation of those scenarios, because intense fear can in fact derail the physiological birth process. Like good sex, physiological childbirth is facilitated by feelings of privacy, respect, informed consent, pleasurable and welcome physical contact, emotional support and encouragement, and safety. Adrenaline does the opposite by
- Causing us to tense up our bodies, what's known as the fear-tension-pain cycle. That pain then triggers more fear and tension.
- Reducing circulating oxytocin, the "love" hormone that causes contractions (and also promotes maternal-infant bonding, milk let-down during breastfeeding, and plays a role in orgasm).
- Shunting blood away from our body's core and into our limbs in order to fight or flee, which means less blood is available to oxygenate our baby, which can lead to fetal distress.
- Making us take rapid, shallow breaths, again making it harder to oxygenate our babies and possibly leading to fetal distress.
- And as mentioned, "fear is the mind-killer," impairing our decision making processes by shutting down the rational-decision making centers of our brain, leading us to choose often unnecessary interventions out of fear.
It is possible to let go of debilitating fear. Navy SEALS are trained to remain cool in intensely frightening, life threatening situations, by developing a series of skills that anyone can use to change how we react to stressors.
- Goal Setting - anchoring one's mind on something positive in the near future.
- Mental rehearsal and visualization - seeing oneself mastering the challenge.
- Positive self-talk - Affirming one's capacity or ability to master the challenge.
- Arousal control - Slowing down one's breathing to activate the parasympathetic "rest and digest" nervous system.
These are literally the same techniques I teach in my childbirth classes.
Doula tips to face your fear:
- Surround yourself with positive affirmations of your ability to birth, and your capacity to navigate birth and the postpartum. Read positive births stories (from sites like Positive Birth Stories and Tell Me A Good Birth Story). If someone starts sharing a birth story, ask them whether it was a good experience--if not, set healthy boundaries and say you'd love to hear it after you have your baby.
- Create positive affirmations based on your fears. List your fears, and then write an affirmation to confront it. For example, "I'm afraid that birth is dangerous" could be phrased as "I trust that I am safe." For ideas, check out this list.
- Take a childbirth class that emphasizes the normalcy of birth, instead of listing all the things that can go wrong. Some good options are HypnoBirthing and Birthing From Within.
- Choose a care provider who treats you with respect, answers all of your questions with patience, provides fully informed consent, and views childbirth as a normal event with physical, emotional, psychological, relational, and even spiritual dimensions (and yes, there are very different models of maternity care!). Ask plenty of questions and do the research for yourself.
- Hire a doula for personalized and continuous support before, during, and after your birth.
- Watch positive birth videos, of real births. I have a playlist here.
- Learn arousal control techniques to deactivate fight or flight response and instead trigger a relaxation response. In short, take slow, deep breaths into your belly, and make your exhalations longer than your inhalations.
- And know that the informed decisions you make to feel safe and supported are the right decisions, no matter what your birth looks like, where it takes place, or who you choose to be your provider.
I'll leave you with this, from American Tibetan Buddhist nun Pema Chödrön's wonderful book When Things Fall Apart: Heart Advice for Difficult Times.
Once there was a young warrior. Her teacher told her that she had to do battle with fear. She didn’t want to do that. It seemed too aggressive; it was scary; it seemed unfriendly. But the teacher said she had to do it and gave her the instructions for the battle. The day arrived. The student warrior stood on one side, and fear stood on the other. The warrior was feeling very small, and fear was looking big and wrathful. They both had their weapons. The young warrior roused herself and went toward fear, prostrated three times, and asked, "May I have permission to go into battle with you?" Fear said, "Thank you for showing me so much respect that you ask permission." Then the young warrior said, "How can I defeat you?" Fear replied, "My weapons are that I talk fast, and I get very close to your face. Then you get completely unnerved, and you do whatever I say. If you don’t do what I tell you, I have no power. You can listen to me, and you can have respect for me. You can even be convinced by me. But if you don’t do what I say, I have no power." In that way, the student warrior learned how to defeat fear.