by Kristen Hands BSN, RN, ICCE

I was recently asked how childbirth educators can help reduce fear in expecting families during these stressful times. Pregnancy is often anxiety-filled, even in the best of seasons. With rising sociopolitical instability and a global pandemic in full swing, pregnant women are experiencing unusually high levels of fear and anxiety (Saccone et al., 2020). In addition to birth fears, families are now dealing with added stressors such as isolation, financial insecurity, and fear of the coronavirus. Fear not only influences psychological well-being, it activates a hormonal stress response that can produce unfavorable birth and long-term health outcomes (King et al., 2012; Kramer et al., 2009). It can lead to longer labors and increased risk for cesarean section, preterm births, and lower infant birth weights (Adams et al., 2012; Loomans et al., 2013; Lima et al., 2018). Childbirth educators are in a unique position to help families reduce and manage fear because we are experts in the three E’s: Education, Empowerment, and Encouragement.

Education

Childbirth educators know firsthand how education can reduce fear. We teach comfort measures and effective coping skills. We know that these skills can be used not just in labor, but also in life. We teach how stress blocks oxytocin, and oxytocin feels good! We teach how breathing techniques, mindfulness, massage, hydrotherapy, aromatherapy, distraction, and optimism influence physical response. We can refer families to quality information sources and community support services. We can help promote exercise and other behaviors that positively influence mental health. A recent study showed that pregnant women who engaged in 150 minutes of moderate exercise per week had significantly lower anxiety and depression scores than those who did not (Davenport et al., 2020). This can be as simple as a brisk walk every evening after dinner. Other strategies include spending time outdoors, feeling the sunshine, connecting with friends and family (perhaps virtually!), journaling, prayer/meditation, yoga, and talking about our feelings with a trusted support person.

Empowerment

In labor and in life, childbirth educators acutely know there are things we can control and things we cannot. We know that acknowledging our fears and disappointments can be the first step toward healing. We can encourage families to verbalize their feelings, and focus on what they can control. Choices and preparedness are empowering. When families know their options, and their rights, it empowers them through knowledge of alternatives. It is so easy to fixate on all the things that could go wrong. One strategy to mitigate this is to purposefully reframe our thinking to consider what could go right.

Encouragement

Childbirth educators are champion encouragers. We routinely reinforce how we are all capable of doing hard and amazing things. Of all professions/callings, we understand how travail can bring meaningful reward, and struggle can bring strength. We can use our unique skills to ease the burden of fear and anxiety in the families we encounter. As sociologist Barbara Katz Rothman said, “Birth is not only about making babies. Birth is about making mothers- strong, competent, capable mothers who trust themselves and know their inner strength.”

References

Adams, S. S., Eberhard‐Gran, M., & Eskild, A. (2012). Fear of childbirth and duration of labour: a study of 2206 women with intended vaginal delivery. BJOG: An International Journal of Obstetrics & Gynaecology, 119(10), 1238-1246. Davenport, M. H., Meyer, S., Meah, V. L., Strynadka, M. C., & Khurana, R. (2020). Moms are not ok: COVID-19 and maternal mental health. Frontiers in Global Women’s Health, 1, 1. King, S., Dancause, K., Turcotte‐Tremblay, A. M., Veru, F., & Laplante, D. P. (2012). Using natural disasters to study the effects of prenatal maternal stress on child health and development. Birth Defects Research Part C: Embryo Today: Reviews, 96(4), 273-288. Kramer, M. S., Lydon, J., Séguin, L., Goulet, L., Kahn, S. R., McNamara, H., … & Meaney, M. J. (2009). Stress pathways to spontaneous preterm birth: the role of stressors, psychological distress, and stress hormones. American journal of epidemiology, 169(11), 1319-1326. Lima, S. A. M., El Dib, R. P., Rodrigues, M. R. K., Ferraz, G. A. R., Molina, A. C., Neto, C. A. P., … & Rudge, M. V. C. (2018). Is the risk of low birth weight or preterm labor greater when maternal stress is experienced during pregnancy? A systematic review and meta-analysis of cohort studies. PloS one, 13(7), e0200594. Loomans, E. M., Van Dijk, A. E., Vrijkotte, T. G., Van Eijsden, M., Stronks, K., Gemke, R. J., & Van den Bergh, B. R. (2013). Psychosocial stress during pregnancy is related to adverse birth outcomes: results from a large multi-ethnic community-based birth cohort. The European Journal of Public Health, 23(3), 485-491. Saccone, G., Florio, A., Aiello, F., Venturella, R., De Angelis, M. C., Locci, M., … & Sardo, A. D. S. (2020). Psychological impact of coronavirus disease 2019 in pregnant women. American Journal of Obstetrics & Gynecology.