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FEARS ABOUT LABOUR AND BIRTH

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EPISIOTOMY (SURGICAL CUT TO THE PERINEUM)

Routine episiotomy is now very unusual practice in hospitals. It is only usually done to hasten birth in an emergency. This is because the baby or mother are becoming distressed or the perineum is so tight that it is delaying the birth. If forceps/vacuum extraction is required to complete birth then it is usual to perform an episiotomy but not compulsory. As the mother, you must consent to any procedures carried out on you or your baby during labour or birth. If you do not give consent then the person performing the procedure are liable for assault. You can always just say NO!

LOSS OF SEXUAL ENJOYMENT DUE TO EPISIOTOMY OR TEARING

There does seem to be a high incidence of women who experience pain during intercourse for months following perineal trauma requiring suturing. This is caused by many factors. We encourage women to speak to their Obstetrician, GP or Midwife in the early period (6 weeks following birth) if they experience problems as there are many ways they can be assisted. The longer the concern is left unaddressed, the harder it is to treat. The biggest hurdle is getting women to seek help with painful sexual issues, however help is very effective once sought.

DEATH OF THE BABY DURING BIRTH (STILLBIRTH)

Almost every mother has this fear at sometime in her pregnancy. It is a normal apprehensive response to the unknown in a situation beyond their control. A lot of women report vivid, sometimes distressing dreams during pregnancy; this is normal and not a negative thing. It is healthy to explore all possibilities, to discuss them with our partners and to think of how we’d cope with the outcome should it occur. Having thought our way through the possibilities prepares us for the event should it arise. When we dwell on the fear or become obsessed about it then we create a negative, stressful mindset. I would suggest consulting a psychologist to help put fears into perspective if they became overwhelming. But certainly some sort of anxiety is absolutely normal and not to be confused with a premonition. According to the perinatal data collection unit in Victoria, in 2005-2006, there were 69,550 births. The percent of those births that resulted in a stillbirth was a low 0.52%. The chances of complications from unnecessary interventions is higher than this number.

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ACCIDENTAL BODILY FUNCTION (BOWEL/BLADDER)

It is a completely normal thing to do when pushing out a baby, that whatever is in front of the babies head will need to come out first. This is simple normal physiology. Should it happen, it wouldn’t bother the birth attendants one bit. However if it bothers you then go and sit on the toilet in the early pushing phase. Midwives usually suggest this anyway and it can help you greatly to just let go and bring the baby down if you aren’t worried about embarrassing yourself and or your partner.

HAVING A C-SECTION

Unfortunately this is a very real fear’; Australia has one of the highest caesarean rates in the world at around 30% – one third of babies is now born via caesarean section. Having a good relationship with whomever is caring for you in labour helps reduce this rate greatly. Those women who have a doula/birth attendant supporting them at birth have consistently been found to have 50% less caesarean sections, based on studies from around the world, due to the care and support they provide. Find out more about doulas here.

FORCEPS / OTHER INTERVENTION

Sometimes consenting to intervention is a choice we must make. Being well informed and choosing your care-giver carefully so they will keep you informed of what is happening during your pregnancy, labour and birth will help. Knowledge is power. Ignorance just makes you vulnerable to emotional blackmail. When you have the facts you can make informed decisions, ask questions and understand the answers. Use the BRAIN’D technique to help you decide which interventions to consent to. When an intervention is suggested to you ask: B – What are the Benefits of this procedure? R – What are the Risks of this procedure? A – What are the Alternatives to this treatment/procedure? I – What does my Intuition say? N – What will happen if I choose to do Nothing? D – Can we please have some privacy to make a Decision This is a very logical and helpful process to work through to help you decide whether or not the intervention recommended is right for you.

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MECONIUM COMPLICATIONS

Meconium in the amniotic waters around the baby is not always troublesome. If your carer detects its presence during labour s/he will look at the big picture (all that is going on) and then act appropriately on it. It is very important to notify your birth attendant if your waters break and the fluid is anything other than clear. You have no control over the presence of meconium, therefore there is nothing you can do except to alert your care giver/midwife of its presence and then discuss the options.

CORD AROUND BABY’S NECK

A high percentage of babies have their cords loosely looped about their bodies somewhere. They play ‘skippy’ in there with it and use it in dress-ups as a scarf! It rarely causes any problems. On the occasion that it is so tight it is causing the baby distress whomever is caring for you will likely detect its presence. Together you then make decisions about how best to deal with the situation.

PREMATURE BIRTH

Premature birth can be prevented in some cases if help is sought early enough. In other cases it is inevitable. There is no blame attached to your baby being born too early in any situation. Some medical conditions imitate labour (urinary tract infections, kidney infections) and once they are treated the contractions stop. Sometimes we can stop contractions with medication if the labour is in its early stages. Sometimes we can’t. Be reassured that prem infants do very well in this present day with the high quality intensive care we have available in Australia. Any contractions, loss of blood or fluid from the vagina, unusual backache or abdominal pain should be checked by your caregiver.

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PAIN

It is helpful if pregnant women can to revise their learned perception of pain. They can alter how they address it by simply remembering that the pain of childbirth is not the pain of injury. There is no damage being caused by the contractions, it is just muscles working really hard to stretch and open for a baby to be born. This is an easy concept to grasp once you cease to think of birth as being an illness. It is a state of health and birth is a normal physical process. There are always methods of pain relief available for women who require them. Choose the people who surround you in birthing carefully, they will support and help you whenever you feel overwhelmed. Positive, loving people in a calm, comfortable environment make a huge difference to how you cope with pain. There are always methods of pain relief available if you request them. Also look at getting a doula – many studies show that couples who use a doula request much less pain relief (and have much less intervention including 50% less caesareans) due to the support and help they have from someone trained and experienced, supporting them continuously, external to the hospital.

NOT KNOWING WHAT TO DO IF SOMETHING GOES WRONG

Being well informed through reading and research helps you to deal with any unexpected events. Trusting the people caring for you is vital, making your needs, feelings and beliefs known to them is very important. Once you have a good rapport established with your care providers you will be able to trust them to do the right thing for you if things are not going as planned.

NOT MAKING IT TO THE HOSPITAL IN TIME

This rarely happens with first babies, almost never in fact, unless the woman chooses to delay going to the hospital for reasons she is unable or unwilling to reveal. In fact, according to the Peri-Natal Data Statistics Collection in Victoria, 0.4% of births are BBA – born before arrival. So you have around 99.6% chance of making it in time. It is more common in subsequent births to be ‘caught short’. These births are almost always uncomplicated and proceed normally. There is no cause for alarm because all will be well if everyone remains calm. There are many books and websites where you can read up on emergency birth. If you have quick labours it is probably a good idea to be prepared.

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PAIN DURING LABOUR

Thanks to Hollywood and hospital dramas, you’re probably expecting to scream through the ‘agony’ of birth. And there’s no denying that delivering a baby could push you to the limits of your pain threshold.

Broadly speaking, early contractions feel like intense period pains and you may also experience pain in your back or legs. The pain intensifies as labour goes on. But the experience does vary from woman to woman, so listening to someone else’s story won’t help. “If you’re told something’s going to be painful, you start to believe it,” says Lorna Phelan, consultant obstetrician at Saint Mary’s Hospital in London. “And a small percentage of women say they don’t feel any pain at all.”

 

BEAT YOUR FEAR OF PAIN

Investigate all the pain relief options available to you in advance so you know what to ask for.

  • Write down the pain relief you’d prefer in your birth plan.
  • Brief your birth partner on the options too.
  • Tearing in labour
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Tears are classed in ‘degrees’ of seriousness, from first (a small tear or graze on the vaginal wall or labia) to fourth degree (involving tearing of the perineum, anus and the rectum). “Third and fourth degree tears aren’t common,” says Lorna. “They can be caused by a big baby coming down the pelvis too quickly, or when forceps are used.”

 

Beat your fear of tearing when you give birth

Stay focused – the more you panic, the more you might push and tear.

Ask your midwife about positions that put less pressure on your perineum, such as standing up.

If you’ve had a bad tear before, you’ll get specialist care before giving birth again. You’re allowed a caesarean if this is the case.

Your vagina will be damaged when you give birth

Your whole body changes after pregnancy and labour, so you can’t expect the major player to come off completely unscathed. “Your vagina will get stretched, but it will go more or less back to normal after a few months, and to the naked eye it won’t look any different,” says Lorna. “The most important thing is to look after your pelvic floor muscles to sort out inside your vagina. The extra weight of pregnancy puts them under strain.”

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Beat your fear of vaginal damage

 

Make sure you do pelvic floor exercises every day before the birth. These also increase blood supply to the area, which aids healing if you have any tears after the birth (check with your midwife when it’s safe for you to start exercising though).

Don’t spend too much time checking out your vagina to see if it looks different once you’ve given birth.

Most women report that sex is still great and they’re not getting any complaints from their partner, so clearly it’s all still working properly.

Pooing during labour

Sorry to disappoint you, but it’s highly likely this will happen! But the good news is, you probably won’t notice. “At nearly every birth I attend, the mum poos or passes wind, but we don’t even bat an eyelid. Your midwife will discreetly wipe it away and it won’t be there when you deliver your baby,” says Lorna.

 

Beat your fear of bowel motions in birth

If you’re really concerned, ask about the possibility of having an enema.

When you feel as if you’re about to go into labour eat light!

Dying in labour

You probably feel foolish and alone worrying about this one, but don’t. If you can face a fact, for every 100,000 births in the UK, around 10 women die. The main causes are thrombosis, haemorrhaging, pre-eclampsia, infection and complications with general anaesthetic. “For the majority of healthy women, pregnancy and childbirth is safe

and low risk,” says Lorna.

 

Beat your fear of dying in childbirth

Speak to your midwife or obstetrician – verbalising your fears can help.

Tell your partner or a non-pregnant friend for reassurance.

TOKOPHOBIA – THE FACTS

Tokophobia is a condition when women suffer a morbid fear of labour. There are two types of tokophobia:

  • Primary, which stems from social learning, like a bad birth story you’ve heard
  • Secondary, which can develop after a traumatic delivery