Fear Factor

If you dread delivery, here's what you can do to overcome your anxiety and have a better birth experience.

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Do you lie awake imagining a painful, protracted labor? Are you afraid something bad will happen to your baby or you? Does the whole prospect make you want to sign up for a quick Cesarean section? Nearly every pregnant woman feels some anxiety about labor and delivery, especially if it's her first time, but some women are so nervous that it interferes with their pregnancy.

"When a woman is anxious, it gets in the way of her enjoying the pregnancy," says Shari I. Lusskin, M.D., a reproductive psychiatrist at New York University School of Medicine. "It also can interfere with her adherence to prenatal care and her relationships with her partner and other children, as well as increase the risk of postpartum depression."

Substantial anxiety during pregnancy also can contribute to insomnia, eating too much or too little, headaches, high blood pressure and lowered immunity. Women who experience very high levels of anxiety or stress are more likely to experience labor and delivery complications and, perhaps, to schedule medically unnecessary C-sections. They are also at an increased risk of premature delivery and having a low-birthweight baby.

What Makes Women Afraid?

The number of women in the U.S. who suffer from a substantial fear of childbirth—called "tokophobia"—is unknown. In Sweden, however, studies show that it affects some 10 percent of pregnant women there.

There are many possible causes. "Some women have increased fear because of what they've heard or read or seen on television," says OB-GYN Elizabeth Eden, M.D., a clinical assistant professor at New York University School of Medicine. Horror stories from friends, television and the Internet can be particularly anxiety-provoking because they dramatize and overemphasize the pain and risk of childbirth.

Fear of childbirth is also more common among certain groups of women, according to a 2008 Danish study published in BJOG, an international OB-GYN journal. It found that women who were young, unemployed, less educated and less connected to other people were more likely to fear childbirth, as were women who smoked or had poor overall health. Also at risk are women with a past history of anxiety, depression or sexual abuse, marital problems and low self-esteem, Lusskin says.

Dealing With Your Concerns

The first step in overcoming fear of childbirth is to figure out what you dread. You can do this by keeping a journal or talking about your fears with a trusted friend or therapist. Then you can take action to restructure, or turn around, your anxious thoughts. Here's some advice on overcoming the most common childbirth fears:

Pain

Solution: Breathing exercises and other relaxation techniques can help you cope with pain, so sign up for a Lamaze, Bradley Method or HypnoBirthing class. But there's no shame in taking pain-relief medication. If pain scares you, "Look to deliver in a facility with 24-hour, in-house obstetric anesthesia staffing," Eden suggests. "That way, there will be no delay in receiving pain relief."

Having a C-section

Solution: Talk with your doctor about your desire to avoid a C-section unless it's medically necessary. Factors known to reduce C-section risk include having a doula and/or a midwife and choosing a doctor and hospital with a low C-section rate. Plan for a vaginal delivery, but work on accepting that a C-section may be the safer delivery method if complications occur.

Losing Control

Solution: "If you tend to be a very controlling person, childbirth is one of those ultimate out-of-control situations," Lusskin says. Remind yourself that doctors and nurses have seen and heard just about everything, and nothing you say or do—including screaming or emptying your bowels during labor—will surprise or disgust them.

Tearing

Solution: Learn about perineal massage, which can gently stretch the tissue between the vagina and rectum and reduce your risk of tearing. (To view the American College of Nurse Midwives' perineal massage guide, go to midwife.org.) Tearing can sometimes also be avoided with controlled pushing and frequent position changes at the end of the second stage of labor.

Fetal Distress/Birth Defects

Solution: Remind yourself that although some babies have problems during delivery, the majority does not. Also remember that birth defects are rare—more than 97 percent of babies are born healthy (for perspective, see "Flawless," pg. 74). If a baby is in distress, an experienced doctor can take appropriate measures to deliver her quickly and safely.

5 Ways To Fight The Fear

1. Avoid horror stories. Don't watch overdramatized childbirth shows on TV, and ask people not to share their negative experiences.

2. Find the facts. Learn about normal labor and delivery, as well as the actual vs. imaginary risks.

3. Address emotional issues. If you have a history of depression, anxiety or abuse, especially sexual abuse, seek professional help early.

4. Learn to relax. Meditation, deep breathing, yoga and guided imagery can help, as can long baths and peaceful walks.

5. Ask for support. Tell others how you feel, and spend time with supportive people who make you feel strong and confident.

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