Introduction to my blog

Hi! my name is Brenda, a nurse and midwife of many year, welcome to my blog. Here I will share my interests, experiences and thoughts on various topics that I hope will be of help and interest to you. Please feel free to make a comment or request more information, clarification or to ask questions.

My Thoughts On Tocophobia

If You Are Anxious About Labour You Are Not Alone

As a midwife I have supported many women in their pregnancy and labour and during antenatal visits many of them express fear of labour. Even at the start of labour my patients tell me the don’t expect that they are capable of a normal vagina birth and that they are anxious about the pain they will experience.

For some women this is their first experience of pregnancy and labour, while others have had previous experience that left them feeling disappointed, like they failed or they feel traumatised.

What is Tocophobia?

For a small minority of women (about 14%) this fear is all consuming and more mentally challenging and they are affected adversely by pre-occupying thoughts and nightmares about the upcoming labour and birth. These women are usually seen by their obstetric consultant and a specialist midwife who discuss their options for labour and an elective delivery via caesarean section would normally be arranged.

Why I Was Anxious About My Labour

In my own experience of pregnancy and labour, which was before I became a midwife, I was scared mainly because of hearing about other women’s experience. At the time I didn’t know the details about how the female body works and adapts to pregnancy and labour. So looking back I realised that my midwives who provided antenatal care did not educate me so that I could feel positively prepared for my labour. This would have allayed much of my anxious thoughts.

But training as a midwife changed my perspectives. I now understand all the hormonal changes that allows much greater flexibility to make labour possible, as the pregnancy progresses. This is because coming up to and during the labour process the body makes and circulates much larger volumes of relaxin, oxytocin and prostaglandin. These all work on the connective tissues of the body making them very soft and stretchy to enable the uterus and vagina passage to open and transform itself in order to push the baby out into the world.

How The Hormones Prostaglandin, Oxytocin and Relaxin Make Labour and Birth Possible

They act on the ligaments and joints so that the pelvic bone including the coccyx are more mobile and flexible to yield as the baby moves down the birth canal. There is much more of these hormones during labour to soften the cervix to make it stretchy so it can open as the baby passes through it. When we midwives do an internal examination we are assessing more than just how open the cervix is, or the dilatation.

We are assessing the descent of the foetal head (or other presenting part in the case of a breech presentation) into the woman’s pelvis. We are also checking the length of the cervix and how soft it is and how well it is applied to the baby’s head.

Antenatal Care help to Monitor for a big baby

But even before we get to the labour room, growth scans and other assessments in the antenatal period would give us an idea of the fetopelvic ratio and an indication of the woman’s body shape (which does matter) and how the baby is growing. If the baby seems to be getting too big (macrosomnia which may occur in diabetes and for other reasons) this is usually picked up and discussed with the woman and her partner about the way forward.

Sometimes this may include an induction of labour, to start labour off by a certain cut off point to prevent further intrauterine growth that can increase the risk of trauma to mother and baby during delivery. So this highlights the importance of antenatal care, education and communication between the woman and her midwife.

Your Body was designed for labour and birth

So in summary, the phenomenon of tocophobia is a real experience for some women who have a real and heightened fear of labour pains or the contractions of labour and birth. Fear of pain is normal but when it is pathological the woman may need to discuss an elective delivery with her obstetrician.

For women who have questions about their body’s ability to birth a baby with out too much trauma, this should be addressed by the midwife at antenatal visits and antenatal classed to assure women and alleviate their fears. If the body was not so well designed to adapt to labour and birth the world would not be so well populated. And labour would really not be possible without the great surge in hormones that transform the female body to cope during this special process.