It’s the most natural experience in the world. It happens 15,000 times per hour. None of us would be here without it. And yet it triggers a feeling of fear in most of us. Whether you sit at the extreme end of the fear spectrum where you are held by a debilitating cold grip of anguish, or at the calmer end, where there is simply a feeling of anticipation accented with flickers of nerves, giving birth is one of those life experiences, (along with leaving school, starting work, getting married…), that we arrive at with preconceived notions.
We can’t prevent that from happening. The very clever part of our mind that keeps us safe and well, our subconscious, collects nuggets of information about the world around us all day every day, storing it away like a squirrel for the moment when you might need it. However, when it comes to labour, the expectations and information your mind has stashed away over the years can be more of a hindrance than a help.
Think back to your first inklings about labour. That video you were made to watch in biology class at a time when the thought of nakedness made you feel uncomfortable, let alone a graphic close-up of a stranger giving birth. Follow this up with scary stories of labours lasting 48 hours, babies being the wrong way around, cords being around necks, emergency Caesareans, emergency episiotomies – even in the good stories babies are held upside down by the ankles like chickens and smacked on the back. And the pain stories – oh, the pain stories! It’s a wonder, given all this, that anybody signs up for it at all. Especially when you consider that our subconscious – the part of our mind that is storing all of this information – is obsessed with keeping us safe and protecting us from danger and pain.
Detached from reality
Gabi Pezo from Love Parenting offers support to parents throughout pregnancy and into parenthood in various ways, including childbirth mentoring, listening to birth stories and Closing of the Bones ceremonies, a post-birth ritual from her home country of Ecuador. She says, “A long time ago we used to give birth in our homes with our families around us. Women supported other women, which meant that from a young age we were in touch with births, breastfeeding and other experiences related to motherhood. Now, because births mainly take place in hospitals, most of us have never seen a real woman give birth. “All we get about birth is the distorted versions of the experience from the television and media. So, being nervous about birth is normal. You have never experienced this before – it’s an unknown experience that you really haven’t seen. In general, us humans fear change and things that we don’t know. This is why birth preparation is important, as it gives you coping techniques to address your fears and also helps you keep calm with breathing and mindfulness during labour and birth.”
Making peace with anxiety
While it is normal for mums and dads to feel nervous about their new role as a parent, and everything that entails, for some people, the prenatal nerves can evolve into something harder to handle. Dr Rose Logan is a consultant psychologist at The LightHouse Arabia, where she heads up the pre- and post-natal programmes. She says, “It’s normal for women, and indeed their partners, to feel a little apprehensive, or nervous, around pregnancy and childbirth. For the majority of women, this is mixed with other feelings, such as excitement and joy – and the apprehension doesn’t become any more serious or troublesome. However, the perinatal period is a time of increased risk for the development of mental illness, including anxiety. Estimates suggest that between 15% and 20%of women experience significant anxiety in the antenatal period and around 11% to 17% postpartum."
Dr Rima Elhindi, specialist obstetrician and gynaecologist at Emirates Hospital Day Surgery and Medical Centre says that, in her experience, it’s very common for mothers to feel nervous about labour – and not just first-time mums. She says, "Many mums are anxious about childbirth, even mothers who have given birth more than once. Most are worried about their baby and his or her well-being. Some are concerned about delivery pains and the possibility of anything that might go wrong during delivery, including C-section. Others are worried about their body image. Some are contemplating the burden of dealing with and taking care of the baby and providing the needed care, especially working mums." According to Dr Elhindi, various factors can trigger the anxiety. Simply the fear of the unknown for first-time mums; conception after IVF; a previous experience of labour-related trauma, miscarriage, or postnatal depression; a lack of emotional support; financial stress; medical-care limitations; false information and misguidance from internet and social media. She continues, "Although we expect the mother to be the anxious one, some fathers can also be anxious about their partner’s well-being and their child, and providing for both. Other husbands are not understanding about the emotional and physical difficulties the mother is experiencing and they are not supportive at all, which adds stress to the situation."
A real phobia
For some women, the situation goes further still and can become a full-blown phobia. Known as tokophobia in the medical world, fear of childbirth is categorised into two main types – primary and secondary. Primary tokophobia starts in childhood (normally because of seeing graphic videos of labour when too young, or from a sexual assault or abuse experience), whereas secondary is normally linked to PTSD following a traumatic birth experience.
A doula and lactation consultant in the US, Brian Salmon, coined the term ‘social tokophobia’ to describe a third form that is not recognised medically, but also develops in adulthood. He says, "Instead of it being true to secondary tokophobia, it is social – because people suck. They tell you the worst stories about their pregnancy, about their breastfeeding; all of these things. "What happens is other people’s stories get ingrained in your head and anticipation of the unknown kicks in. Then people are just so tense, they are fighting every minute and aren’t sleeping, so they show up to their birth exhausted."
Dubai-based hypnobirthing expert Jasmine Collin at Love Parenting agrees with Salmon’s social tokophobia theory, saying that talking to other mums about their birth stories can cause more anxiety than good for pregnant mothers. "I always use the analogy that you wouldn’t put junk in your body when you are pregnant, so don’t put it in your mind either. If you are feeling anxious about childbirth, try not to spend time watching TV shows like One Born Every Minute, or spend time reading other people’s negative labour stories online, as they can often be over-dramatised."
Symptoms of tokophobia include an avid avoidance of pregnancy (even to the point of wanting to avoid sex), or a strong desire to schedule a C-section, despite there being no medical reason for doing so. For secondary cases that have developed because of a previous birth experience, the mother may have an aversion to giving birth in hospital.
Dr Elhindi says that, even without a phobia, many mums can choose a C-section because they think it will be easier, a choice that she would advise people against. She says, "Due to anxiety, a good percentage of mothers may choose to have a C-section thinking it will be safer and easier than a normal delivery. But please keep in mind that you can still have a smooth natural delivery – just have the discussion with your OB-GYN and plan a delivery that suits your medical condition. Natural delivery is superior to C-section unless medically indicated. There is pain during delivery, but you will forget about it once you hear your baby cry. If pain is what you fear most, consider having an epidural or a water delivery. And don’t let other mothers’ stories scare you. Each delivery is unique. At the same time, don’t ignore your fears – they can be dealt with and, if needed, medicated so they don’t turn into more serious disorders like depression or anxiety."
Welcoming in the calm
Obviously there is a long list of very good reasons why being calm throughout your pregnancy would be beneficial to mother and to baby. But knowing that doesn’t always make it possible. Additionally, it can be hard to be objective about how severe your own worrying is and whether it merits talking to a professional about. As a general rule of thumb, as with physical issues, if a mental or emotional disturbance is stopping you from being able to do things like sleep, laugh, plan or leave the house, it’s worth speaking to a professional about.
Additionally, while social media and talking to other mothers can be great resources for information, as mentioned above, every birth is different. So, rather than basing your baby’s birth on what some stranger on Facebook says happened to them, why not consult professionals who can give you advice and information that isn’t tinged with the bias of personal experience and is, instead, based on research from around the world, hundreds of years of knowledge and their experience of supporting hundreds of women through childbirth? Put simply, if you listen to a mother you are basing your decision and choices on one experience; if you speak to a professional you are basing your choices on thousands.
Dina Ghandour is a doula at Little Feather Collective and Jivamukti yoga instructor. She says, "Women who feel fearful about birth should find support. That means psychological support if they have had any previous birth or pregnancy traumas, and regular emotional and education support to learn more about their bodies and childbirth for everyone else. A doula can be all of these things for an expecting mother. I believe that knowledge in this case is power – when women begin to understand, and perhaps trust, that their minds and bodies are designed to work together, some of the anxiety is released. This doesn’t necessarily mean we should ignore bad things, but I do think we need, as a society, to start showcasing and celebrating more positive birth stories, so that the scale is more balanced in how it is discussed and depicted."
Hypnobirther Collin advises mothers to "nourish their minds". She says, "Talk to mums with great birth stories, watch videos on YouTube of positive birth experiences… Know what you want and research and educate yourself on it. Birth is such an important doorway to parenting, it’s important that mothers go through it with dignity and respect, as calm and confidently as possible, regardless of the type of birth you have."
Women supporting women
One of the factors making it harder for pregnant mothers here in the UAE is the absence of the midwife culture. In other parts of the world, these women are recognised as experts in the beautiful, life-affirming experience that is giving birth. According to international research, midwife-led births are less likely to need epidurals, episiotomies and instruments, and are more likely to result in spontaneous vaginal births and breastfeeding. Additionally, the International Confederation of Midwives states that their philosophy includes the following values; that pregnancy and childbearing are normal physiological processes; that pregnancy and childbearing is a profound experience, which carries significant meaning to the woman, her family and the community; that midwifery care is holistic and continuous and grounded in an understanding of the social, emotional, cultural, spiritual, physiological and physical experiences of women; that midwifery care is in partnership with a woman’s choices.
Without these wonderful beacons and advocates of women’s strength and capabilities, childbirth can quickly become less of a natural phenomenon and more of a medical emergency scenario. It’s only natural when faced with this that you might feel fear. If you do, don’t feel embarrassed or sit in silence. Reach out to the professionals here who are filling the midwifery gap – doulas, childbirth educators, hypnobirthers and more. Using evidence-based knowledge and the international best practices, these women can help you quell your fears, make informed decisions and realistic plans, and become active (rather than passive) in the process of your birth so that it is an experience you are guiding, not something that is just going to happen to you. Through birthing techniques, preparation exercises and shared wisdom, they can give you a sense of control over the uncontrollable. And, with the feeling of control, comes the ability to relax into your expectations and look forward to what will undoubtedly be one of the most important days of your life and one of your proudest moments.
After all, your body has been evolving over millions of years to make you an expert at doing this, without any training or previous experience. In the same way that there was an inner part of your mind that knew exactly how to create a perfect little baby within your body, trust that the very same part of your mind knows exactly how to deliver that baby safely. It’s nature.
As childbirth mentor Gabi Pezo says, "Birth is not rainbows and lollipops. Like anything that is worth it, it’s hard work, and you can do it." Trust the wisdom of the generations before you that gave birth successfully with less knowledge and medical support than you have. Your body knows everything that you don’t know. You’ve got this. You really do."
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