Labour and birth may be a time of anxiety for parents and midwives look to find ways to support them and reduce fear through this time. In this article Emilie Wicks, midwife and Birth without Fear ambassador, discusses fear of birth and a pregnancy course to help birth partners and birth workers support women and birthing people have a more positive experience.
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Fear is a natural emotion which ensures that, within nano-seconds, we can activate our innate survival mechanism, the ‘Fight or Flight’ stress response. This is an absolutely essential part of the survival and continuation of our species, which has as its only aim to keep us alive when there is a threat. This response will prioritise surviving over thriving, at all costs.
This ‘protective’ emotion complicates matters during the hours of labour, which is when the birthing person is at their absolute most vulnerable and has no choice but to shut out the rest of the world, go “into the body” and focus on coping and handling one contraction at a time. Therefore, evolution has proven that we are meant to give birth only when we feel completely safe, as that is how we can ensure the maximum chance of survival of ourselves and that of our baby.
Therefore, our emotions represent our ‘guides’, our ‘look-out tower’ so to speak, which send the signal to the brain to either activate the sympathetic nervous system, i.e., adrenaline and cortisol, or if the ‘coast is clear’, the body’s chosen birth hormone oxytocin, specifically triggered within the parasympathetic part of our highly sensitive autonomic nervous system. There is a very good reason why the body’s chosen birth hormone is activated within the parasympathetic, which is when we feel at peace, safe and secure. It can only be because we are only meant to give birth to our babies when we feel safe. Hence, it is the emotion that is the key to the birthing physiology (Dahan 2021).
The chosen birth partner can also have fear. Fear of the pain they are witness to. Fear of the unknown. Fear of being “useless”. The Swedish ‘Birth Without Fear method’, well-established in Sweden for almost two decades (Heli 2019), aims to train the birth partner and the attending birth professional in how to physically, practically and emotionally support the birthing person. It does this by endowing them with easily accessible and hands-on tools that help them to guide her/them towards the body language of feeling of safe – one contraction at a time via the body language of trust and confidence the green-light signal is sent back to the brain, unlocking the oxytocin to empower the birthing person to experience an emotionally safe birth, regardless of mode, setting or use of pain relief. Why engaging the chosen birth partner (the person they know the best) with hands-on tools works so well is because they are the birthing person’s source of trust and confidence, and provide a bridge to the feeling of safety better than anyone else in the birthing room. The practical tools can be used and applied by everyone else in the birthing room too, which can only enhance the oxytocin and contribute towards the birthing physiology.
I wish I had received this training as a student midwife! When I was on my practical placements on the labour ward and later as a newly qualified midwife, I observed with awe some of those midwives with decades of experience behind them, wondering when will I be able to “know” how to both physically and emotionally support clients with such confidence and what I perceived as a certain professional ‘ease’.
As I came to the end of my preceptorship in a very busy tertiary referral unit in inner city London with over 7,500 births per year, I jumped at the chance to interview for the ‘high-risk’ team. I knew this job opportunity would fast-track me to be able to care for women and people with a variety of complex medical needs. What I was not aware of however, is that 8 years later of having become an “experienced” high-risk midwife, I had learnt absolutely nothing about how to help these women access their innate birthing ability, how to activate their parasympathetic nervous system or how to really help them to give birth without fear.
The majority of their labours were induced for medical reasons, and therefore generally involved a higher amount of interventions. Whilst focusing my attention on the syntocinon pump, the IV lines, the insulin sliding scale and the CTG trace, I completely lost track of the power within the birthing body, and what it can be capable of because these women and birthing people were giving birth when their sympathetic nervous system was dominating. As they lay there like labouring laboratory animals with all these leads and monitors surrounding them, cortisol and adrenaline were pushing away any natural oxytocin that they may have had access to. The obstetric team and our midwifery team unconsciously working to undermine their bodies’ natural capacity to access their own innate birth hormone, accessible only via the parasympathetic pathway. For me, this obstetric-led care became my own safety blanket, as I had little confidence in my ability to have a meaningful impact on these labours and births.
Then in 2019, everything changed. I met the author of Give Birth Without Fear and the founder of the Birth Without Fear method at the London Maternity and Midwifery Forum conference, Susanna Heli. I signed up for the 3-day instructor training later that year and as a result experienced a pivotal moment in terms of my relationship with my profession. What changed was that I had hope again. I could see another way forward in terms of empowering the birthing community to have positive birth experiences even within this highly medicalised birthing arena the majority of us are working within.
I believe it helps a great deal to accept the fact that the medicalisation of birth is not going to go away. The ‘medical model’ has taken pre-eminence over everything and so rather than opting to fight it and go the complete other way, we need to find a meaningful way to work within it. What is also needed is something that facilitates an emotionally safe birth within the parameters of the hospital and medicalised setting. This is incredibly important right now as we know from the evidence that alarmingly increasing numbers of birthing people experience their birth as emotionally traumatic (Leinweber et al., 2022). The East Kent report (Dixon-Woods 2022), Shrewsbury and Telford report (Thornton 2022) and the Black Maternity Experiences Survey (Awe, Abe and Wheeler 2022) all point towards the need to enable women to have an emotionally safe birth no matter how the baby is born in the end.
Physical safety has taken the focus away from emotional safety. However, the WHO has evidenced, amongst other overwhelming research that supports the knowledge that continuous emotional support impacts not only the medical outcome but the whole emotional experience of birth (WHO 2018). Fear of birth is rising at an exponential rate, and this is also a sign of our time of too much media and social media influence. Hospital midwives and obstetricians are experiencing professional fear of litigation (Chalk 2021) and blame as well, and by proxy their fear spills over to the birthing population.
The amazing and really encouraging thing is that by applying the principles of the Birth Without Fear method nobody has to learn anything new! We do not have to re-invent the wheel, because the wheel already works perfectly well as it is. We just need to look to the birthing physiology, as all the answers are already there because the autonomic nervous system is already there, pre-programmed since millennia ago.
We just need to be aware of the opposing forces within the autonomic nervous system when it comes to birth. Fear is contagious. It can permeate a room and spread to every person within it. However, thankfully so is the powerful ‘peace and calm’ hormone oxytocin. By simply going ‘back to basics’: fear is the block on birth vs. feeling safe is the key to unlocking the birthing hormone oxytocin, we can empower not only birthing families but also the midwives looking after them, to not feel “useless” or afraid themselves.
The effectiveness of this method is based on using what the body already has, which is the body language:
By choosing the body language for the emotion that we want to create in the contraction we can positively enhance the birthing physiology and simultaneously gain a sense of positive control (the key to emotional safety). The body language we are aiming for is simply accessed via the four tools:
1) Breathing – soft and silent in every contraction. This is how we breathe when we are not afraid, versus the opposite when we are in fear and when the breathing is forced and audible.
2) Relaxation – the muscles become heavy and go down in every contraction. This is the direction of the muscles when we are not afraid, in contrast to the opposite upward direction when we feel fear.
3) The Voice – the deep pitch. The opposite of when we are afraid and the voice becomes high pitched.
4) The Mind – the positive expectation effect on the physiological response. The placebo effect versus the nocebo effect.
By observing the birthing person, the birth partner and any birth worker in attendance will know when they need to guide them back to the body language of the parasympathetic. Once they are there, the positive feedback mechanism of oxytocin will take care of the rest.
Birth Without Fear method classes can be booked via Eventbrite and are 4 hours, available f2f or live online. Upcoming Birth Without Fear instructor dates are: 27th-29th October 2023 in London. For more details, testimonials and any questions: Emilie Wicks – Birth Without Fear method
Awe, T., Abe, C., and Peter, M., Wheeler, R., 2022. The Black Maternity Experiences Survey: A Nationwide Study of Black Women’s experiences of maternity services in the United Kingdom https://www.fivexmore.com/blackmereport
Chalk, D., How does defensive medicine cause harm to patients in the healthcare environment?. 2021 INSPIRE Journal: created by students for students, 12, p.54. https://inspirestudentjournal.co.uk/wp-content/uploads/2021/12/Inspire-Student-Journal-Daniel-Chalk.pdf
Dahan, O., 2021. Obstetrics at odds with evolution: The consequences of interrupting adaptive birthing consciousness. New Ideas in Psychology, 63, p.100903. https://www.sciencedirect.com/science/article/abs/pii/S0732118X21000520
Dixon-Woods, M., 2022. Learning from maternity service failures at East Kent Hospitals. bmj, 379. https://www.bmj.com/content/379/bmj.o2755
Heli, S., 2019. Give Birth Without Fear, Clink Street. https://givebirthwithoutfear.com/birthwithoutfear/
Leinweber et al., 2022. Developing a woman-centered, inclusive definition of traumatic childbirth experiences: A discussion paper. Birth Issues in Perinatal Care, 49(4), pp. 687-696. https://onlinelibrary.wiley.com/doi/10.1111/birt.12634
Thornton, J., 2022. Ockenden report a “watershed moment”. The Lancet, 399(10333), p.1371. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00655-9/fulltext
World Health Organization, 2018. WHO recommendations on intrapartum care for a positive childbirth experience. World Health Organization. https://www.who.int/publications/i/item/WHO-RHR-18.12
Emilie Wicks
Midwife and Birth without Fear ambassador
March 2023