Sunday 9 March 2014

Fear seems to have a huge impact on women and their experiences of labour and childbirth. My blog today explores this topic. Your feedback is always much appreciated, so do get in touch.


Some stress is good in our life otherwise we wouldn’t have the motivation to get out of bed in the morning! However, too much stress, fear or anxiety has a huge impact on our wellbeing and especially on our birthing body during labour. Stress happens when we feel that we cannot cope with the unknown, or events beyond our control, which result in fear, and a hard-wired reaction to perceived threats for your survival and that of your unborn child. The life coach and author Robert Holden describes it as ‘fear experienced as reality’. It doesn’t matter if the fear is real or perceived our physiological responses are the same, and are known collectively as the ‘fight or flight’ response.

At times of danger, the body’s innate intelligence automatically takes charge by triggering a set of changes that bypass our rational thoughts. Priority is given to the physical functions which are essential to either face our enemy or to flee. To understand why such fear and tension can have a negative impact on labour and childbirth, you must first understand the physiological changes that occur within your body during the ‘fight or flight’ response.

Dr. Grantly Dick-Read observed this effect in the 1920’s and wrote about it in his book, ‘Childbirth without fear’. His theory was called the ‘fear-tension-pain syndrome’ and he found that when fear was missing during labour the body worked efficiently and easily without tension. He became a strong advocate of deep relaxation techniques to promote an easy and pain-free birth.

What is Stress?

Definition: a state of mental or emotional strain or tension resulting from adverse or demanding circumstances.

The endocrinologist Hans Selye first used the term ‘stress’ in the 1930s to identify the perceptions and responses of human beings reacting to the challenges of everyday life. Selye divided stress into ‘eustress’ and ‘distress’. Eustress enhances function both mental and physical through different activities. Distress is the result of an alarming experience either real or imagined, which activates an automatic response within the mind and body.

Simply put, stress is an ancient response within our body to get us out of danger. When we think we are in danger (real or perceived) our mind and body is put on red alert which is our ‘flight or fight’ response. All this happens instantly, allowing us to deal with the situation and then return to our natural state of homeostasis (a state of balance). For example, if we are driving along minding our own business and suddenly another car pulls out of a junction in our path within an instant we have taken evasive action and avoided a collision because of this ‘flight or fight’ response. Often for a short while afterwards we feel a bit shaken but gradually our body returns to normal again.

What actually happens to us in a stressful situation? When we are fearful or in a potentially dangerous situation as we perceive it, our body automatically switches on our ‘global alarm system’ and activates survival behaviours, or our ‘flight or fight’ response, activating the sympathetic nervous system (which provides the rapid response to stress) and de-activating the parasympathetic system (balance and harmony).

Once action has been taken and the body is no longer in danger the response to stress is terminated by inhibitory feedback and bodily functions return to homeostasis and harmony (The parasympathetic system is reactivated, digestion etc. returns to normal function).

We don’t need to understand the highly complicated functions of our nervous system to be aware of the effects the ‘flight or fight’ response has on us. I am sure at some time in our lives we have all experienced the symptoms of this ancient survival instinct. So what are the symptoms?


SYMPTOMS OF STRESS:
• A rapid heart rate
• Rapid and shallow breathing
• Cold clammy skin
• Dilated pupils
• A rise in blood pressure
• A decrease of blood to non-essential internal organs including the uterus
• A decrease of activity in the digestive system
• An increase in blood sugar levels

So how does Stress affect a woman in labour?

Mother nature in her infinite wisdom designed a complex system of hormones to nurture and support us throughout pregnancy and childbirth. A finely balanced flow of hormones enables women to ‘zone” out’ and focus deep within their maternal body, leaving the physical side of labour and birth to nature. If this natural flow of events is constantly interrupted by stress or other external factors, then the ‘fright and flight’ response kicks in, and disrupts the flow of hormones and labour stalls.

The ambience of the birthing environment is crucial to enable childbirth to flow smoothly without interruption. All mammals need a quiet, dark, tranquil and safe place to give birth with ease. This is essential to allow the intricate flow and balance of hormones to facilitate a gentle and easy birth. In nature all things exist in balance. Therefore, if our stress hormones (catecholamines) are released due to feeling fearful, then automatically our hormone levels will decrease as a survival response. It does not matter whether our fear is real or perceived by us, our body will respond the same. Modern hospital environments with their bright lights, noise and professionals rushing about to fulfill their duties, further exacerbate the fears we bring with us into hospital, absorbed from the media, stories we have heard, previous experience of childbirth etc.

I am a midwife, and believe me all this attention is given with good intent, but has changed drastically over the last 30 years. When I trained we had very little technology available, such as scans, monitors, and epidurals. Midwives used their skill to support women in labour, sat quietly with you during your labour, observed, and waited for the baby to arrive! Patience was a key skill to be mastered!

All this activity in labour wards however well intentioned, is adversely affecting the normal process of labour and childbirth, as the body moves from homeostasis (balance) into a state of stress and high alert activating our primeval response of ‘fight of flight’. The hormones released interfere with, and over-ride the hormones involved in labour, stalling and even stopping labour, as our survival instincts will not allow us to give birth in an unsafe environment!





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