Stress and the Labouring Body

I had my first baby at the hospital, but stayed home for the first eight hours of early labour. I chose to be in the comfort of my own home while I waited for my contractions to grow in frequency, length, and intensity. When it felt like the right time to go, my partner and I headed to the hospital, only to have my labour slow right down when we arrived. I didn't know it at the time, but this is quite common with first timers! 

To understand why, remember a time when you needed to lead a presentation, play in a recital, or make an announcement on a microphone at an event. In the lead up, while in the comfort of your own home, you probably felt okay, but then, when you got to the venue, you started to sweat, shake, and desperately wanted to run the opposite direction. Sound familiar?! That’s your body’s hormones creating a biological and evolutionary response to fear – it’s a response that makes sense when it’s a caveman chasing you with a fire stick, but it doesn’t help us much when the thing instilling fear is something that a) we absolutely have to do and b) doesn’t have a fire stick!!!

This hormonal fear response is a pattern frequently seen after a labouring person arrives at the hospital - a place that feels cold, clinical, and unfamiliar. Our cultural approach to birth exacerbates fear in relation to childbirth. In other human cultures, and in other members of the animal kingdom, birth and fear are not intertwined in this way.

So how can we alter our perceptions and prevent stress from negatively affecting the labouring body?

First, a high-level biology lesson. During labour, a delicate balance of hormones facilitates the body’s process. Prostaglandins and oxytocin are the MVPs here for the most part, working to contract the uterus. This not only moves the baby down into the pelvis, but also helps the cervix soften, move forward, thin out, and open. The body also produces endorphins, which are our natural pain management system. When our bodies are stressed, they produce cortisol and adrenaline. These hormones inhibit prostaglandins and oxytocin, which are working hard to contract the uterus, and also endorphins, which are managing our pain.

So, remaining calm is the key to labour. Problem solved? Easy peasy? Well, actually, it turns out that staying calm is not so easy when you are a) experiencing pain, b) in an unfamiliar environment, c) doing something completely new to you, and d) in the company of people who are unfamiliar to you.

In the1950s, a doctor named Dr. Grantly Dick-Reid hypothesized the “Gate Control Theory” of pain. His idea was that pain signals can be prevented (or gated) from travelling along neural pathways and reaching the brain if we are able to release fear and tension from the body (i.e., if we are able to keep stress hormone levels low). Dick-Reid elaborated on his hypothesis with the concept of the “Fear Tension Pain Cycle” which introduced the idea that fear plays a critical role in opening this “pain gate” because fear leads to tension in the body, therefore increasing pain perception. This pain level then increases fear levels, and so the cycle continues. Evidence of this cycle has been documented in studies of anxiety and pain.

The Fear-Tension-Pain Cycle is not beneficial to a labouring person. It increases stress-hormone production and slows or stops labour in its tracks. Not the goal! It is a negative cycle, and we need to stay away from it. During labour, we want to try and maintain relaxation in the entire body–every muscle from head to toe–allowing only the uterus to become tense during contractions, and to release between them. Further, when we tense a muscle, oxygen is sent to the cells of that muscle. The labouring body is far more efficient when we allow the body to send that oxygen to the cells in the uterine muscles, rather than using up oxygen by sending it elsewhere.

So, the question is HOW? How do we prevent the labouring body from going into a cycle of Fear, Tension, and Pain? What is the alternative? How do we cultivate an external environment and internal state that maintains calm, reduces stress hormones, and boosts the hormones that will aid a smooth labour?

Grantly Dick-Ried offers:

The Confidence-Calm-Comfort Cycle. A positive cycle for birth. THIS is the cycle I help my clients float into. This is what I cultivate during pregnancy with my clients, so you can take it into your birth, which will otherwise be unfamiliar (even if at home rather than the hospital, there are a lot of new and unfamiliar sensations for a birthing person). With my clients, we prepare beforehand for your birth by making sure you feel informed, reassured, heard, and respected. 

I ensure you can be open and vulnerable with at least one person who is supporting you throughout pregnancy and at least one person who will be present at your birth. I make sure it’s known that your body has power and phenomenal capability (I believe this, and I make sure you learn to believe it too). I remind you to surround yourself with people who you trust, and who fuel your confidence with positive birth stories. I remind you to seek out people who create comfort and serenity in your mind and body in the lead up to your birth.

Now imagine you’re giving a presentation. You’re nervous. And then someone you know and trust walks into the room with an air of tranquility, exuding confidence, and giving you a little reassuring squeeze on the shoulder, or an affirmation in your ear. Now how do you feel?

My midwife was this person for me. Once she arrived at the hospital, my labouring body resumed its process.

I can be this person for you, as my client. The familiar, the trustworthy, the tranquil, the cleansing breath.