1. Forget your fears. There is a connection between fear and pain. The efficiency of the magnificent uterine muscle depends upon your hormonal, circulatory, and nervous systems all working together. Fear upsets the balance of these three systems. Fear and anxiety cause your body to produce excess stress hormones that counteract the helpful hormones your body produces to enhance the labor process and relieve discomfort. This results in increased pain and a longer labor. Fear also causes physiologic reactions that reduce blood flow and thus oxygen supply to the uterus. An oxygen-deprived muscle tires quickly, and a tired muscle is a hurting muscle.
2. Address your fears. What specifically do you fear about birth? Do you fear the pain, for example, having had negative experiences with pain in the past? Do you fear having a cesarean or needing an episiotomy? Are you afraid that you will lose control midway through labor? Do you have fears about problems with the baby? List all your fears and alongside each one write what you can do to avoid having the fear come true. Realize, too, that some events and outcomes are beyond your power to change, and resolve not to worry about things you cannot change.
3. Be informed. The more you know, the less afraid you will be. While no two mothers’ labors are alike, and each birth a woman experiences is different from the last one, childbirth does follow a general outline. There are sensations (aka “pains”) that will always occur between the first contraction and the final delivery of a baby. If you understand what happens and why, and what it probably will feel like, you will not be taken by surprise. Having a sense of what to expect – and when it will end – helps most mothers feel confident that they can handle labor and delivery. A good childbirth class can help you understand what happens and why. There is no class that can tell you what it will feel like specifically to you, because this will depend on each woman’s particular situation and her ability to cooperate with the forces of labor. Women can easily be taken by surprise at the intensity of labor. Some decide they do not like it one bit and wind up resisting the forces when fear takes hold.
4. Employ a professional labor support person. An experienced woman, called a PLA, will help you interpret your sensations during labor, offer suggestions for managing your pain, and help you understand and participate in any medical decisions.
5. Surround yourself with fearless birth attendants. Fear is contagious. Be sure you do not allow any fear mongers in the labor room. Don’t think that this is the time to finally prove something to your mother; if she has a fearful attitude about labor, better she watch your birth on video afterward than be in the birthing room infecting you with her fears. (Many men, including fathers-to-be, are afraid of birth. They don’t understand it, and they find it very upsetting when their mate hurts and they can’t “fix” it. It helps to inoculate your mate against fear so that he won’t pass the bug onto you. Prepare your partner for the normal sights and sounds of labor. Tell him what may happen if events don’t go as planned. A calm birth attendant can give your mate a much-needed break and help him keep focused on his job, which is to support you and share in the birth experience, not to protect you from this perfectly normal process. )
6. Avoid fearful replays. Don’t carry scary baggage from your past into the delivery room. Birth has a way of stirring up uncomfortable memories of previous traumatic labors or even of a past sexual assault.
7. Take responsibility for your birth decisions. While a painless childbirth is as rare as a sleep-through-the-night newborn, most pain in childbirth is under your influence – if you are ready for it.
8. Choose your practitioner wisely. Does your doctor or midwife take an active role in teaching you about the birth process and helping you to trust your body to give birth? After each visit do you leave believing your birth will go right? Or does this person create a fearful mindset about birth, filling your mind with all the possibilities of what could go wrong?
9. Understand labor and the birth process. Do you know what happens during contractions, what it is those “pains” actually do? Do you understand how being upright and changing positions during labor can influence how you experience contractions?
10. Understand which technological tools (such as electronic fetal monitoring) are likely to be used during your labor. Are you confident that you are knowledgeable enough to participate in decisions about the use of technology in your labor?
11. Be aware of the options available for medical pain relief, such as drugs and epidural anesthesia.
12. Understand the importance of releasing and surrendering to your body during labor. Are you determined to assume whatever position works for you rather than tensing up, resisting the labor process, or becoming a passive patient and spending a lot of time in the horizontal position?
13. Learn to relax your birthing muscles. Relax is more than just an empty word for helpless bystanders to throw at a mother who is experiencing the most intense physical work of her life. But relax is what you must do to help the work progress. Relaxing all of your other muscles while only your uterus contracts eases the discomfort and speeds the progress of labor. If there is tension anywhere in your body, especially in your face and neck, this tension will spread to the pelvic muscles that need to stay loose during a contraction. Tense muscles hurt more than relaxed ones and they tire sooner. Chemical changes within an exhausted, tense muscle actually lowers the muscle’s pain threshold, and you hurt more than if the muscle were working unopposed. When tight muscles resist the relentless, involuntary contractions of your uterus, the result is pain. Exhausted muscles soon lead to an exhausted mind, increasing your awareness of pain and decreasing your ability to cope with it.
14. Learn to relax to balance your hormones for birth. Two sets of hormones help you labor efficiently. Adrenal hormones (also called stress hormones) give your body the extra power it needs in situations that call for tremendous effort, like labor and birth. These hormones are often referred to as the “fight or flight” hormones, and are there for the body’s protection. During labor your body needs enough of these stress hormones to help you work hard, but not so many that your body becomes anxious and distressed, causing your mind and muscles to work inefficiently. Stress hormones may even divert blood from the hardworking uterus to the vital organs of the brain, heart, and kidney.
15. Relax to boost endorphins. Another kind of hormone also works for you during labor – natural pain-relieving hormones, known as endorphins. (The word comes from endogenous, meaning produced in the body, and morphine, a chemical that blocks pain). These are your body’s natural narcotics, helping to relax you when you’re stressed and relieving pain when you’re hurt. These physiologic labor assistants are produced in the nerve cells. They attach to pain receptor sites on the nerve cell, where they blunt the sensation of pain. Strenuous exercise increases endorphin levels, and endorphins enter your system automatically during the strenuous exercise of labor, as long as you don’t do anything to block them. (Tensing up blocks endorphin release. ) Levels are highest in the second stage of labor (pushing) when contractions are most intense. Relaxing will allow these natural pain- relievers to work for you. Fear and anxiety can increase your levels of stress hormones and counteract the relaxing effects of endorphins. Endorphins stimulate the secretion of prolactin, the relaxing and “mothering” hormone that regulates milk production and gives you a psychological boost toward enjoyment of mothering. Studies have shown that endorphin levels are increased by laughter.