In the many years I’ve been teaching prenatal yoga and childbirth preparation workshops discussions around fear arise from time to time. It may be fear of the unknown, inability to cope with contractions, losing control, or worries about something happening to the baby. Women find it difficult to reveal their fears as it goes against the narrative of the radiant, happy, pregnant mother. One way to ease an expectant mother’s concerns would be to provide information and tools around comfort in birth.
Here are a few practical suggestions that may be considered during pregnancy and birth:
Breathing practices can help de-stress and help us re-centre when we feel unsteady. When the body is in fight or flight mode, it goes through several changes which may affect labour: heart rate increases, body/muscles tense, mind becomes unsteady. However, breathing exercises provide a relatively accessible tool for coming down from this heightened state of alert. Some of the relief comes just from taking a moment to pause and notice what's going on in our bodies. There are several breathing practices that can help expectant mothers. Let’s start with a simple one - inhale deeply through the nose, exhale through the mouth (Golden Thread Breath). Imagine that your blowing your birthday candle as you exhale by opening the mouth slightly to let the air pass through. It's normal for the exhalation to be longer than the inhalation. Start with a few rounds and observe how you feel after. Practice daily and see how it changes your mind state.
Most of the yoga postures practiced in class can support mothers during labour, from early labour to birthing. Not everyone might be able to move during birthing but if you wish to, whether you’re at home or in hospital, movement can serve as positive distraction during this time. It can help facilitate contractions, move baby into a more ideal position, and allow you to interact freely with contractions. How can you move? You might find yourself on the hospital bed and you may come into a supported tabletop position with your eyes gently closed. This creates more space within the pelvic outlet, which provides relief from lower back pressure as baby's head is away from sacrum, and when the labouring mother’s eyes are closed it provides a sense of warmth and internal focus away from bright lights and people possibly moving in and out of the room. Another way is by sitting on a "birth ball" or "exercise ball" where you can sway your hips from side to side.
Remember that there are so many ways to move - walking, dancing, going on all fours, and many more. It is important to get comfortable with movement and by attending a prenatal yoga class you may explore these various movements that can help release tension in the body during pregnancy and birth. What’s most important is that you move in ways that feels supportive for you during your yoga classes, exercises and during birth and delivery.
Not everyone is comfortable labouring in water but if you are, it could bring a sense of relief and warmth. Apart from submerging in a bath/tub you can use the shower or be offered a drink of water. Studies link dehydration to labour dystocia (long labour). In the book "Labor and Delivery Nursing" by Michelle L Murray and Gayle M Huelsmann, they state “Hydration affects the duration of labor. A well-hydrated woman should have a shorter labor than a dehydrated woman. Dehydration is not just too little body fluids: it also includes an electrolyte deficiency. Dehydration is related to maternal fatigue, which may have an impact on her pain tolerance and ability to push her baby out. During labor, it is suspected that a dehydrated uterus will not contract well, and may even result in poor labor progress” (pg 35).
If water brings you a sense of calmness and it feels good for you in pregnancy, start speaking to your care provider about the availability of a bath/tub or shower in hospital. Be open to the possibility that it might not feel right for you on the big day, know that you have a choice to come out of the water and use other techniques that may bring a sense of ease.
The power touch is meaningful. Gentle stroking of the hair, back, shoulders, or a massage can bring comfort and a sense of safety for the birthing mother as she births at home, in hospital or in theatre (c-section).
Also know that some women might dislike being touched especially during active and transition phase of labour. If you are a birth support person reading this, don’t take her request for distance personally. Every woman responds differently. It’s important to remember that senses are heightened during labour. Give her space and ask if there’s anything else she might need.
Meaningful touch extends to baby through skin to skin contact immediately after birth. It helps regulate baby's breathing, temperature and heartbeat. It fosters connection and a sense of safety for baby. "It's an essential channel of communication with caregivers for a child," says San Diego State University School of Communication emeritus professor Peter Andersen, author of Nonverbal Communication: Forms and Functions. A mother's touch enhances attachment between mother and child; it can signify security ("You're safe; I'm here") and, depending on the type of touch, it can generate positive emotions.
UNICEF’s research on The Baby Friendly Initiative showcases a selection of studies exploring the impact of skin-to-skin contact on infant and maternal health. This research cites:
“This study of neonates born via elective cesarean delivery and their fathers investigated the effects of paternal skin-to-skin contact (SSC) on newborns and fathers after cesarean delivery. Newborns who received SSC shortly after delivery had a more stable heart rate and forehead temperature, less duration of crying, and started feeding behavior earlier. The duration of breastfeeding after SSC in the treatment group was longer as well, with statistical significance, than the control group. In addition, fathers in the treatment group had lower scores of anxiety and depression and better role attainment than those in the control group, with statistical significance.”
Having those I trusted around me during labour helped me feel more confident. There are studies that shows the benefits of support and its correlation to interventions and women's experience:
"Research shows that women value and benefit from the presence of a support person during labour and childbirth. This support may include emotional support (continuous presence, reassurance and praise) and information about labour progress. It may also include advice about coping techniques, comfort measures (comforting touch, massage, warm baths/showers, encouraging mobility, promoting adequate fluid intake and output) and speaking up when needed on behalf of the woman. Lack of continuous support during childbirth has led to concerns that the experience of labour and birth may have become dehumanised."
"Modern obstetric care frequently means women are required to experience institutional routines. These may have adverse effects on the quality, outcomes and experience of care during labour and childbirth. Supportive care during labour may enhance physiological labour processes, as well as women's feelings of control and confidence in their own strength and ability to give birth. This may reduce the need for obstetric intervention and also improve women's experiences."
A chat between you and your partner, or whoever it may be present during the big day, regarding your wishes and concerns may open the doors to discussion around birth preferences that is personal, giving you ample space to make informed choices. If you and your partner feel that extra help might be needed it might be worth considering having a doula. Doulas nowadays support women during pregnancy, birth and post partum. What is it they do? They may attend your perinatal checks, will be present during labour helping you in ways that feel right for you (holding your hand, offering water, supporting your partner and many others), and they may be there to support you in the first few weeks postnatally (bringing food, hearing you out, holding baby so you can have a break/rest, and many more). However, your doula will not be making decisions for you, she will be there to assure you and your partner that you are supported no matter what.
From personal experience I felt completely supported by my husband and doula. It made a big difference in the way I felt after I delivered. Events didn’t go as planned but I did not feel alone, and still felt in control as I weaved through the unexpected in my own journey.
Birthing can be physically, emotionally and mentally exhausting regardless of how one has their baby, therefore resting before the big day and during labour is encouraged. The months or weeks leading up to labour maybe uncomfortable. Taking regular naps, practicing yoga or gentle exercises can help women ease into rest, feel centered.
During labour there might be times when rest calls. It can be in between contractions, or if one is going through long labour rest in essential in preparation for the actual birth. Bring your own pillows, blankets, yoga mat, birth ball, massage balls, or anything that you feel can make you comfortable and relaxed. At times birth is quick, other times long. Maternal fatigue prolongs the labour process and increases the rate of caesarean section.
It is recommended that women rest prior and during labour. When she feels safe and nurtured during labour then rest might be accessible for mothers during this time whereas if she’s unsure, on guard, then it would be challenging to relax and rest during the different stages in labour.
As human beings we are constantly interacting with our environment. We are affected by what goes on around us. It is the same in birthing. If women feel unsafe, disconnected and stressed by what’s happening around her, by how people speak to her, the lights too bright, too cold, impersonal, it may slow down labour down and cause worry and stress, or it may be more challenging to rest and make decisions.
How can we foster a nurturing environment?
In a gentle c-section birthing environment women may request to make this medicalised procedure gentler for baby and mother by bringing her own music , requesting for a kind and supportive interaction in theatre, support person holding her all throughout, mother watching her baby being born, and skin to skin contact with mother / support person and baby. It is the same in hospital or home setting. Think about the many ways you feel relaxed and see if you can bring these elements into your birthing environment - music, how your birth attendants interact with you, you might want consider brining your own pillows, blankets, your own clothes, oils that invites calmness, dimming of lights, massage balls. Also consider aspects in labour that might distract you – people coming in and out of the room, cold room, sterile environment, what your partner is doing or not doing (support) , and others. Have this discussion with your support person and see how it evolves.
INFORMED CHOICE AND OPENNESS TO EXPERIENCE
There are many other factors that may affect labour and birth which makes birthing unpredictable. If we keep informed and make choices that feel right for us, actively partaking in the unfolding of events, if we feel honoured and respected during pregnancy and birth, then the experience can be an empowering one. We gain valuable insight about ourselves that can help us navigate motherhood, and wisdom that comes from the depths of experiences we meet with courage, which may guide us as we traverse life as women.
Explore these suggestions together with your birth support person. Approach the journey with curiosity, and self-compassion.
Sources - Fear of Birthing: (Sheen, 2016)
Rest: Study of correlation between maternal fatigue and uterine contraction pattern in the active phase of labour. Ebrahimzadeh S1, Golmakani N, Kabirian M, Shakeri MT.
Unicef The Baby Friendly Initiative :
Touch: Effects of paternal skin-to-skin contact in newborns and fathers after cesarean delivery. Journal of Perinatal & Neonatal Nursing 2019, 33 (1): 68-73 Xiaoli Huang, Liling Chen, & Li Zhang, (2019).
Support During Labour: https://www.cochrane.org/CD003766/PREG_continuous-support-women-during-childbirth
Birthing Environment: https://www.ncbi.nlm.nih.gov/pubmed/26820356