Ina May Gaskin addresses Tocophobia

I love Ted Talks and I especially love this one.  Ina May made this during the summer of 2013. Ina May Gaskin, MA, CPM, PhD (Hon), is founder and director of the Farm Midwifery Center in Tennessee. The 41-year-old midwifery service is noted for its women-centered care.

FEAR - contributing to labor interventions and PTSD

It is called tocophobia .  

It affects 1 in 10 women.

And it seems to be ignored by maternity care literature.

Yet, an amazing study done between 2006 and 2007 in Sweden's Karolinska Institutet, shows that psychoprophylaxis does help in some cases.

What is tocophobia?  From the Greek word tokos meaning childbirth and phobos, meaning fear, tocophobia is the fear (irrational) of childbirth.  Women and men can experience tocophobia and can experience a fear of dying, fear of pain, fear of lack of pain relief and fear of deformity of the newborn.  Occasionally tocophobia is culturally associated, such as when negative feelings toward childbirth are passed from mother to daughter or after seeing a film depicting childbirth early in life with no support or educational explanation.

In the medical literature, tocophobia or severe fear of childbirth (SFOC) is seen addressed more in

psychological journals or those from Europe than in the North American continent.  Maternal confidence and self efficacy are common threads in discussions of tocophobia or SFOC.  From the Nethersole School of Nursing in Hong Kong, the author writes that the efficacy-enhancing educational intervention should be further developed and integrated into childbirth education interventions for promoting women's copying ability during childbirth. Not only did the educational intervention promote a woman's self-efficacy but also reduced their perceived pain and anxiety in the first two stages of labour.

Further research in the literature demonstrates that prenatal anxiety was significantly related to self-efficacy for childbirth in late pregnancy, labor pain, number of hours at home in labor and admitting cervical dilation, and interventions used during the labor.


Kathy McGrath demonstrates that fear has its place in birth and new mothers can benefit from it:

Giving birth is meant to shake us right down to our roots so that we come out of it changed and ready to take on the daunting tasks of mothering a new baby. When birth goes well, from an emotional as well as a physical perspective, we come out of it empowered, awed, and humbled. When it does not go well, we can enter motherhood feeling disappointed, disillusioned, and disempowered. The stakes are high.

As childbirth educators and doulas, we need to approach this fear with caution and respect.  Not only does fear of childbirth result in extended length of labor, arrested labors, increased using of induction or augmentation, cesarean delivery, instrumental delivery but SFOC can affect mothers during the postpartum period as well with an increased risk of post-traumatic stress disorder (PTSD).  Fear and lack of control are elements contributing to PTSD.

SFOC is not addressed in the typical office visit.  Childbirth education classes are often discouraged.  Why are women's fears being ignored?  Why do we send new mothers, traumatized by a difficult birth that validated their prenatal feelings of fear, home alone with little or no support?

Give expectant mothers an atmosphere where they can feel safe in sharing their fear(s), where they feel they are heard and not judged.  Acknowledge the fear and share with them psychoprophylaxis!

What is psychoprophylaxis?  Based on a method of preparing women for childbirth with education, psychological and physical conditioning and breathing, psychoprophylaxis soon became synonymous with Lamaze, after Dr. Fernand Lamaze brought the Russian style of childbirth preparation to the West in the mid 1950s.  Quite simply, psychoprophylaxsis (psycho means mind and prophylaxsis means prevention) gives expectant mothers the educational and practical techniques to understand the careful hormonal orchestration of birth and be empowered to use simple techniques to produce effects that are not only healthy for both mother and baby but truly define self-efficacy for birth and the postpartum period.

As Barbara Hotelling so brilliantly put it: 
We once lost touch with a caring model of birth, and we are fortunate to have that knowledge and the availability of that model again. Childbirth education must evolve from the technological curriculum to a physiologic study of how well women's bodies are created, not for being delivered, but for giving birth.

With physiologic birth as our guide, we can reduce or eliminate tocophobia.


References:

Bergstrom M. et al.  Fear of childbirth in expectant fathers, subsequent childbirth experience and impact of antenatal education: subanalysis of results from a RCT.  Acta Obstetricia et Gynecologia Scandinavica 2013 Apr 16.

Harris, R., Ayers S. What makes labour and birth traumatic? A survey of intrapartum 'Hotspots'. Psychology and Health 2012; 27(10): 1166-77.

Hotelling, B. Considerations when using videos in Lamaze Classes.  Journal of Perinatal Education 2012 Summer; 21(3): 189-92.

Hotelling, B.  From Psychoprophylactic to Orgasmic Birth.  Journal of Perinatal Education 2009 Fall; 18(4): 45-48.

Ip, W et al. An educational intervention to improve women's ability to cope with childbirth.  Journal of Clinical Nursing 2009 Aug; 18(15): 2125-35.

McGrath, K. The Courage to Birth.  Journal of Perinatal Education 2012 Spring; 21(2): 72-79.

Rouhe H. et al. Obstetric outcome after intervention for severe fear of childbirth in nulliparous women, a randomized trial.  British Journal of Obstetrics and Gynecology.  2013 Jan; 120(1): 75-84. 

Saisto T., Halmesmäki E. Fear of childbirth: A neglected dilemma. Acta Obstetricia et Gynecologica Scandinavica, 2003 82(3), 201–208 

2013 Childbirth Education Blog Carnival: My Story ~ Why Childbirth Preparation Matters....

Welcome to Day #7, the last day of the Blog Carnival honoring

 the International Week for Respecting Childbirth.  

We are focusing this Blog Carnival on the importance of childbirth education.

My Story~ Why Childbirth Preparation Matters...

By Patty Brennan

As I approached the birth of my first son, I remember thinking “I have a woman’s body—I imagine I can birth a baby.” Birth wasn’t an intellectual experience, I thought. One did not need to read books about it or take classes. I decided to trust my instincts and my abilities and I thought that would be enough.

What I did not appreciate is that birth takes place in a medical-legal-social context. Many influences come into play. If opting to birth in a hospital, one is opting for institutionalized birth. I was not prepared for that. And my husband, allegedly there to help, was, in a word, clueless. The experience was essentially one of endurance, similar to suffering a dental procedure and just knowing at some point it would be over. I was on my own and I felt scared.

What if I had known that …

• I    need not have stayed in bed, on my back, simply because I had IV Pitocin and a fetal heart monitor strapped to my belly?
• the Pitocin was probably unnecessary and would contribute to (if not cause) my son’s jaundice in the early days postpartum?
• movement would not only help with the pain, but also help the labor progress?
• just when I felt I couldn’t do it, I was almost there?
• birthing at home attended by a midwife was a viable, safe option and one that would have been well suited to my “can-do” attitude?

The list (of what I did NOT know and the questions I did not ask) goes on. I experienced everything as a series of events that “just happened.” First this happened, and then that, and then that. It wasn’t until a couple of years later, after a pivotal chance encounter with a midwife, that I began to read about our cultural context of birth and came to understand that these events were, in fact, all connected, that each choice/decision had unintentional as well as intentional consequences.

Childbirth education is about CHOICES. If you don’t know that you have choices, you may as well not have any. You will, by default, give your power over to others. Today, one third of American women are delivered via cesarean section. Since surgery carries increased risks for moms and babies, it is imperative that parents make informed decisions and participate in their own care. Sadly, too many women are experiencing birth as traumatic. We (the educators, midwives, doulas, mental health professionals) know the causes and how to prevent that trauma. Engage in childbirth preparation! Regrets are not necessary.

Patty Brennan is the owner of Center for the Childbearing Year in Ann Arbor, Michigan. She has just completed production of a comprehensive series of multi-media Online Childbirth Preparation classes. http://www.center4cby.com

Taking A Look At Mindfulness Guided Imagery as an Add-on to Relaxation

Research shows that relaxation during labor and birth allows for a dramatic reduction in the stress reaction.  When subjected to stress (of any kind) or fear, be it real or anticipated, body changes take place that trigger a defense mechanism and institutes the fight or flight mechanism.  The fight or flight mechanism is started by the autonomic (or involuntary) nervous system and includes body changes such as an increase in respirations and mild/moderate rapid heart rate.  With this stress response, females have a strong tendency to take flight or flee.  Obviously this is not practical during labor/birth.

Most of us teach about the Fear-Tension-Pain Cycle as first described by Dr. Grantly Dick-Read in the late 1950s.  Fear (due to lack of education and practical knowledge), leads to tension in the body – tension in the muscles of the body uses oxygen that would have normally been made available to the fetus and the uterus.  This, in turn, decreases the efficiency of the uterine contractions and thus slows or in some cases, stops the labor process.  Tense striated muscles contribute to an increased in lactic acid build up that impinges on pain receptors, magnifies pain perception and increases fatigue. Fatigue decreases the pain threshold, further increasing pain perception and reduces the laboring mother’s ability to conserve energy for the expulsive efforts needed during the second stage of labor.

Conscious relaxation and practicing coping techniques may be some of the first items removed from childbirth education curricula when timing in the class becomes an issue.  However, initiating a relaxation response to contractions or pain stimuli can decrease metabolism, slow down the heart rate, calm breathing, reduce blood pressure and relax muscles – all of which has a positive effect on the baby, mother and labor.   Click here to read entire article