So far we have explored the idea that fear of childbirth is normal, and that fear of childbirth is taught. Today, we will explore the idea that fear of childbirth is driven by fear of pain. What do we assume if we hold this belief, and what might we be missing?
My original training as a childbirth educator (wow, 15 years ago!) was centered around the teachings of Grantley Dick-Read and the Fear-Tension-Pain cycle. we can talk about this theory later in the series if you like, but I want to focus today on how I mis-interpreted this theory. You read that correctly, I mis-interpreted this theory.
It is not that I missed Dr. Dick-Read’s point — excessive fear causes excessive tension which increases the pain of childbirth. It is that in my mind this theory was also proof of the reverse — if women didn’t expect pain in childbirth there wouldn’t be tension and there wouldn’t be fear. And so in my mind the fear of childbirth was all about the pain of childbirth.
I doubt I’m very unique in this mis-interpretation, it is an easy mistake to make when you are just beginning to be a childbirth educator. And certainly the fact that everyone who comes to your classes is looking for techniques to manage the “pain” of childbirth reinforces the belief. But the families pursuing childbirth education are not representative of all expectant families — especially the portion who specifically pursue natural childbirth education. When I stopped offering classes, only 30% of expectant families pursued any type of childbirth education.
Families who have other concerns about having a baby are looking to other sources to handle their concerns. I began to learn this when I started working as a volunteer doula with low-income single women. I asked a few to participate in interviews to help train other volunteers, and of course I asked them about their fears as the birth of their child approached. To my surprise not one of them was even thinking about contractions or how painful they would be. Instead they were afraid about the realities of having a baby — of not having a home when their baby was born; of managing a job when they couldn’t afford any type of child care; of the risk they may fail as a mother. I asked each of the women I interviewed when they first thought about contractions, and their responses were basically when labor began. But for these women contractions were just something they had to get through, and then the thing they feared would happen.
As I expanded the families I worked with I found similar patterns of non-pain related fear. Families who had experienced loss were afraid of losing another baby, not pain. Families with other medical conditions were afraid for mother’s health and the ability to have a baby, not pain. Families in conflict were afraid of the consequences of and for the child, not pain. Families who lived where women and babies more frequently die were worried about surviving, not pain.
To Think About
I now think about childbirth fear in a sort of extension of Maslow’s hierarchy of needs. The women who dwell on fear of pain in childbirth in general have taken care of all the other needs. For many other women, the fear will result from conflicts in other areas — need for shelter or food, safe relationships, physical health. When I think of it this way, being free to fear pain almost seems like a luxury.
I can accept now that pregnancy and childbirth are a time of transition for families, and the nature of that transition has an effect on the fears that surround childbirth. One of my favorite birth authors, Gayle Peterson, deals with this concept in many of her books.
You might never have made the mistake I did, or you might have already corrected it. Here are some things to think about when you consider how this philosophy may affect the way you care for women.
First, are you assessing the nature of the fear women experience, or do you assume it is due to pain?
Second, does the preparation you do with women go beyond comfort measures?
Finally, do you keep a list all the resources for women in your area – so you are ready no matter what her concerns about having a baby may be?