“Relaxing” the fear of childbirth away

childbirthFearEarlier this week we looked at research that both supported and refuted the idea that you could teach away the fear of childbirth. Today I want to focus on another tactic for managing fear of childbirth, relaxation.  This discussion is a little more theoretical, a little more about defining what things mean than the last few posts which focused on research.

Just like education, the first place I learned of the value of relaxation for childbirth was in Dick-Read’s Fear-Tension-Pain cycle.  The basic concept was that fear caused tension, and the tension caused pain.  So if I learned to relax during labor, I could stop the effects of the fear. Dick-Read is not alone in this assertion, Penny Simkin wrote a fabulous piece on the physiological effects of stress on labor. This is often used to support the importance of physical relaxation to promote comfort during labor. So the question is, what does relaxing do to the fear?

To begin, let’s think try to define relaxation and fear.  What are these two distinct phenomena, and how are they related?

Relaxation is perhaps the easier of the two terms to define.  In this context relaxation is a physical process used to counter the physiological effects of anxiety or stress. Relaxation involves calming activities such as paced breathing and actively working with muscle groups to avoid muscle tension.

Fear may have a physical component, but it begins emotionally.  Fear is a response to the  self-prediction of harm. Some fear is a quick response to the unexpected — for example when a friend jumps out from around the corner and shouts “boo!” In this quick response your body immediately responds with tension, gasping, and maybe even a scream.  Usually this fear is also gone quickly, sometimes melting into laughter if your friend’s surprise was in good-natured fun.

Other fear is not a quick response, it is a slow process of undulating emotions.  Some things trigger us to think about the concern, and some times we move about the day without thinking about the concern.  Fear of childbirth is more like this second type of process.  We don’t think about how it is affecting our body because we are not feeling particularly different most of the time.

Where relaxation and fear interact in preparation for labor is at anxiety.  Anxiety is a physical state of arousal in response to a fear or concern (or other stress). With anxiety you may be a little more tense than usual for a long time, but you may not notice it.  Anxiety also has a chemical component, and stress hormones can be affecting your body even if you are not aware you are particularly anxious. Relaxation can help your body restore its normal function during times of anxiety — but relaxation won’t really change the thing you are anxious about. This means relaxation during pregnancy can help you manage a fear of childbirth, but it will not remove a fear.

During labor the relationship between fear and relaxation may be different.  Relaxation can still help manage anxiety, but for most women fear in labor is a response to immediate events. Often fear is due to the pain, “this hurts too much to be normal, something must be wrong with my baby.”  But fear is also the response to the prediction about what labor will be like, “if it hurts this bad already, I know it is going to be terrible before long.” So what we see is pain increasing fears of the immediate outcome – at this point both Penny Simkin and Dr. Dick-Read agree the fear causes a physiological change in the labor process.

If relaxation during labor  is able to restore the normal physiology of labor, it is possible it can make a difference to the process of labor — in this case it would encourage normal, physiological labor. But again I am wondering about the relationship between the relaxation and fear.  We know relaxation does not necessarily remove the pain of labor, instead it allows the woman to feel she can do something about that pain — it increases self-efficacy. We know this from women’s self-reports.  Women use terms such as, “it allowed me to stay on top of the contractions,” or, “it made the contractions manageable.”

So if we theorize it is the pain causing the fear then relaxation doesn’t seem to be intervening.  But if we theorize it is the inability to do something about the pain, what we can call a lack of self-efficacy, that is causing the fear  then relaxation does seem to have a direct impact on the fear. In other words it isn’t the pain itself that causes the fear, but the idea that she cannot prevent the pain from getting out of control. Relaxation in labor does allow the woman to feel that she can prevent the pain from getting out of control.

Of course, this is all complicated by the fact that not every woman has the ability to successfully use relaxation during labor.  But this isn’t a problem if we consider it is not the relaxation that is mattering, but the self-efficacy that relaxation provides.  Why?  Because a woman who successfully uses dancing, singing, or any other non-relaxation method to manage her contractions is also increasing her self-efficacy.  She is experiencing a situation that shows her she can make a difference in how she experiences contractions.