Fear of childbirth

Fear of childbirth

An interview with Karen Rothstein of Sacramento Hypnobirthing

This video is available on Instagram here.

Fear

Sometimes moms will think they have fear, and what they really have is just a little bit of worry and a little bit of anxiety. This (technology changes going Live on Instagram) was fear for me. My heart started racing; I started getting a little sweaty. I was getting ready to go into that fight or flight. And when you said, "Do you want to go later?" I was almost gonna go, "Yeah, that sounds like a really good idea." Oh, boy, that is just a perfect, perfect example of what real fear is for me--just having that visceral reaction.

A lot of women come to hypnobirthing because they are referred by their doula or their physician because they have fear. I don't get a lot of what they call primary fear people--people with tokophobia--that's really a fear of childbirth--because usually those people don't get pregnant. 

Distinguishing between worry, anxiety, and real fear

But what I do get is a lot of secondary fear people, and those are people that they may have had a birth trauma, or maybe they lost a pregnancy, and they have high anxiety, and they have real worries that this time it's going to be just a replay of what happened last time, so they get referred to us. We don't diagnose because we're not therapists or educators, but we need to do an assessment and see if they have worry, if they have anxiety, or if possibly they have real fear. When it comes down to real fear, I would say about 70-75% of women have real worry and anxiety. 

Worry

It's important to make a distinction, because a worry is something you can do something about. So here's an example of a worry. Your sister-in-law gives you her used car seat, and she paid a lot of money for it, but you're just not quite sure it is safe for your baby. You end up doing a lot of worrying about it, and you have double worry right? 

If you get a new car seat. You might risk offending.

If you don't get a new car seat, then every time you put your baby in that car seat, you're gonna have a little bit of angst.

A worry is something that you can do something about. You can bite the bullet. Tell her "thank you very much", and get the car seat that makes you feel comfortable. In the long run, that is going to be far healthier than worrying every time you have to put that baby in the car seat. 

Anxieties

The next thing we get are anxieties. Anxieties usually come up somewhere in pregnancy and it's most likely when you go in for one of those checkups and your doctor, or maybe the physician's assistant, or the nurse says something that you just really don't understand, but you're already a little anxious, or you have that white coat anxiety. You don't have a lot of resources in that moment to make decisions in the executive brain, so you don't ask for clarification. You go away from the room, and what happens to you? You just keep running the conversation over and over and over in your head. So by the time you get to me and you've been running that conversation for a while, it takes a little bit of practice to calm that nervous system down. So that's why we think, no matter how you're going to birth, one of the best things you can do is give yourself hypnobirthing education. Together, we start from the beginning, with little mini exercises that help you to calm your nervous system. I mean just breathing alone—that's what I was forgetting to do when I was trying to get on here. If I only stopped to calm my breath, I would have been able to change my whole physiology. But, you know, I didn't do that. Because all of that blood was going away from my brain. And it was getting ready to help me take flight.

Scary birth stories and what Lara calls “mood spread”

So Lara, have you ever sat in a scary movie and been really afraid?  That’s what we call a movie trance.  Even though you knew that wasn’t real, you still had that reaction, right? Where you started breathing a little heavier, perhaps your heart started beating faster.  The subconscious mind doesn't know the difference between what's real and imagined. Anxiety is really worrying on steroids.  So one of the things that happens when you have anxiety is that you keep replaying it in your mind, over and over and over gain.  And pretty soon your subconscious mind takes it as the truth. So you can have little fear or little worries stacking up, and then what it turns into is what I call scary fear. So even if you're not particularly fearful of birthing itself. You can start running your fear trance. That  takes the whole joy out of pregnancy. And well meaning friends, when you say that you’re going to do hypnobirthing or that you’re going to have a natural birth, they have to give you their advice. They go on to share their scary story, and that causes fear in you.  Or you attend a reveal party and you’re obviously pregnant. And so somebody strikes up a conversation with you, and then before you know it everybody is sharing their scary birth stories.  The people who are saying “I had the best birth experience…” those people usually remain silent.  

What can we do?

Breathing

So what we can do first thing is to harness our breath.  Any time you take a deep breath in and you take a longer breath out, you’re going to be calming your Vegas nerve.  We ask women to take a deep breath in to the count of four, have a pause, and then slowly let it out to the count of eight. Just a few breaths like that—as short as 30 seconds, 45 seconds—and you can change your whole physiology, calm your nervous system down. And you can go about your business. Sometimes you can come up with something brilliant to say.  Blood has not drained from you head, and you’ve stayed off the fight or flight treadmill.  

Counting breaths

Lara:  It gets me thinking about what works.  One of the things that worked well for me in labor was that my husband would hold up a certain number of fingers and I had to take that number of breaths.  

That's just really excellent because what that's doing is it's asking you to focus. You're changing your thought pattern as you focus on that and then you have to execute a task, which highlights a different part of the brain. And although women like to think that we can hold two thoughts at once, we really can’t. So that helps you to get down off that platform of fear and have your own focus, which is really important. 

Stroking & touch

And another thing that we teach that's really easy for people to do is to just stroke yourself softly, allowing yourself to feel this type of movement. It's really nice when your birthing companion does it but if they haven't gone into the appointment with you or if they're not standing there when somebody is telling you a scary birth story. Research shows that stroking your skin will do the same thing as taking those calm breaths. It soothes the nervous system. So just when I'm doing that I just kind of go into a light trance.

Yawning

The other thing that works is yawning and stretching out, because those are things that you do when you’re relaxed.  We are changing the physiology of the body. So if you force them, then you’re going to go into that relaxation response.

Breath breaks

We are so stressed as women. We have busy careers. At the time that we're getting pregnant, it's usually the time that many of us are trying to climb up that corporate ladder. Are we going to say no? No. So we have the stress of the looming deadlines, the stress of all of the hormones changing in our body, and we just don't take time to think "I deserve some self love, I deserve some relaxation." So that's one of the things that we stress in hypnobirthing is that every day you need to take breath breaks--five breath breaks a day where you are mindfully breathing. And then when you come home, you want to practice your self hypnosis, because that's gonna put you in that relaxation, what we call the healing room. Just allow yourself to be in that bliss state. And the more you practice going into that state, the easier it will be to get in that state, and the more natural it will feel. Right now our stress state feels natural. In fact, many of us don't know who we are without stress.  

Get started

Check out Sacramento Hypnobirthing and learn more.

Interview with a pelvic floor physical therapist on having a baby during a pandemic

I have been interviewing parents and professionals about what it’s like to have a baby during the pandemic. Recently I interviewed Dr. Romy Havard (she/her) of Peregrine Physical Therapy. Dr. Havard provides the East Bay Area, CA with orthopedic, prenatal, postpartum, pelvic floor, and wellness services. She went to UC Berkeley for undergraduate and later attended the UCSF/SFSU Joint Graduate Program in Physical Therapy with MS and DPT degrees. She is also Board Certified in the Orthopedic Section (OCS).

While she uses a broad variety of skills, she is most influenced by the Institute of Physical Art and utilizes functional manual therapy for optimal efficiency. She is also enthusiastic to incorporate concepts from Herman Wallace in pelvic health and contribute to advocacy for postpartum, incontinence, and transgender care.

Here is what we talked about (all emphasis mine):

Me: What are some of the challenges that you have experienced serving families during the pandemic?

Dr. Havard:

For the past 6 months, a lot of the major hospitals have ceased doing in person care for the majority of prenatal appointments. Unless you have dire deliveries, even the one postpartum follow-up is done online with OBGYN. So women who are delivering have little to no before or after care according to ACOG (American College of Obstetricians and Gynecologists) standards. Normally you have all of your check-ups.  Everything except the ultrasound and the diabetes test is done online unless you have preeclampsia.  New moms are particularly isolated. Some are traumatized. Resources are few. Normally you would meet other moms in a mom group. They don’t have that extra help. They are wondering if their pain and lack of function are normal. I’ve been extraordinarily busy because I’m doing in-person visits. People are driving 45 minutes to see me because they could not be seen closer to home.  I often have women who cry through their appointments.  I have some days where half of my women are crying through their appointments.  

Two years ago ACOG had an article that they released about how postpartum care in the US is substandard.  That one appointment postpartum is not enough. But they didn’t really define what better care would be.  Pelvic physical therapy should be done with all our moms. And even that isn’t being done.  

Me: What are some of the frustrations that you have experienced serving families during the pandemic?

Dr. Havard:

I’m outside the electronic medical system. Smaller offices are easy. I fax them and they get back to me. If I think that this patient needs something specific, those offices are easy to deal with. But most of my patients come from giant Kaiser or giant Sutter. I write them. I fax them. It’s very hard to get them to get the patient what they need. I’m asking for things that are out of my scope of practice. Their lack of participation is alarming. These are things that I can’t do for them. Way more so during the pandemic. A lot of physicians doing Telehealth are doing it from home. If they are never going into the office. If no one is scanning notes and they can’t get to it… I’m not sure what is happening there. It’s even harder to contact doctors. I’m still in the medical system. I still need medical and surgical consultations from doctors. These people are already being seen by these people. I don’t know what’s going on over there. I don’t know if they have had a COVID breakout or what they are going through, but there’s only so many ways that I can send letters through.

Me: What are your fears for new parents at this time?

Dr. Havard:

I just don’t want something to be missed. In pelvic therapy, it’s not life or death, but there are issues around it that I worry that women not pursuing more medical care for things are going to make things worse later. I’m getting more severe diagnoses than I used to as well. I’m having more fecal incontinence patients than I used to and that’s alarming. They should be having consultations with colorectal surgeons, but these are considered non-essential services. I am worrying about their fecal incontinence long-term. I’m trying to be supportive and educate but not be triggering. I want moms to have all the tools, but I don’t want to say “and you need to do this now.” It’s easier when you are treating within a group of integrated professionals. I am not meant to be doing PT on my own with patients. They should be having medical support, nutritional support, GI support.

Me: What do you wish that new parents knew?

Dr. Havard:

New moms should seek care early and really consider preventative strategies. The more you can do to avoid more acute and serious issues, the better you will do and the more options you will have. Pelvic physical therapy is inseparable from the postpartum experience and should be part of postpartum care. Especially for moms who may not even get physicians to look at their pelvic tears. At 3 months, maybe you want to go back to having sex. At 6 months, you want to go back to running. 

… The women who are crying in my office are months from birth and they have been waiting for things to fix themselves. If they had started earlier, it would be a small thing. It wouldn’t interfere in their marriage. It wouldn’t make them start to wonder if they could have another kid.  There are lots of difficult thoughts. 

OBGYN postpartum just wants to make sure your cervix is closed, you’ve passed the placenta, that you don’t have infections, that you have contraception. They are not addressing the pelvic floor. If you are leaking at 6 weeks, that’s not normal. OBGYNs take care of general health, deliveries, general wellness, infection, venereal disease, contraception. Dealing with preventable testing like pap smears. They are not really treating leaking, prolapse, and pelvic pain issues.  Some of them are so helpful, quick to get back to patients.  

On one hand, just doing postpartum care is a little after the fact. Currently in the US and Britain 85% of women will have a perineal tear, 75% will require sutures.  I have one visit during pregnancy to decrease their chance of injury in delivery.  It’s not the same as childbirth education.  It’s just things that moms can do to decrease their injury. OBGYNs don’t necessarily work from the position of the mother ergonomics. It’s more about the baby. Working on the preventative side is great. I do recommend a visit with pelvic physical therapist before or during pregnancy week 30.  You need to start doing the exercises I prescribe daily easily 6-8 weeks before delivery for them to get maximal benefit.  I just had a mom who went through it and had no tearing. This is where we need to move - to not just care for tears postpartum.  In Australia a lot of people have a pelvic PT during labor so mom doesn’t get hurt.  Pelvic physical therapists in the United States don’t have hospital privileges to attend labor and delivery. The least I can do is to do education with moms about taking care of you to avoid tearing, prolapse, urine prolapse, etc.  and sometimes c-section.  

Me: If you were to look ahead to the future and everything amazing that you can imagine comes true, what would that look like?

Dr. Havard:

In Britain about 2 years ago they voted to add pelvic physical therapy to the standard of practice to be included in national health care.  Now even low and middle income women can have this as part of postpartum recovery.  Our mortality rate is equal to Mexico. A lot of the moms I see are also more into progressive prevention. I recommend if I was doing bare minimum for someone who is doing great otherwise is:

- one visit during second trimester in case you need a C-section or to minimize injury

- one visit at 6-8 weeks.

- Another visit ideally around 3-4 months. There’s a big hormonal shift then and a lot of women their repairs get worse at 3-4 months. 1 of 9 births will have a Hashimoto event.

- A visit around 6 months for women if they’re doing great. If they are fine with walking or jogging, a 6 month visit may be enough.

- For cross fit or heavy runners, another visit at 12 months as well.

I just want to send a big shout out to Dr. Havard and thank her for sharing her wisdom and experience. She serves in the East Bay in California. You can find her at https://peregrinept.org.