Birthing Without Fear

Takeaways from Childbirth Without Fear by Grantly Dick-Read Melanie Ellison, August 2014 www.DevotedHandsDoula.com Personal note: Reading this book was one of the main factors that motivated me to become a doula. I found the old book falling apart in a friend’s bookcase and borrowed it, having no idea what a gem I held in my hands. As I read through it, I became very excited by the concepts that the author introduced—especially the fact that it is possible for some women to give birth painlessly. I thought, “if I can help women have better childbirth experiences through coaching them with the relaxation techniques found in this book, that will be an extremely meaningful career.” Thus my doula journey began. Childbirth Without Fear is a marvelous book that was first published in 1944. The author, Grantly Dick-Read, was a pioneer in returning women to trusting the intuition of their bodies during an age of totally medicalized birthing procedures. He writes in his preface about the use of pain meds and anesthesia in labor, “The consciousness of woman’s discomfort can now be dispelled, but only at a price, for with it goes the consciousness of birth and the sensations and emotions, not pains, which are the rock of experience upon which the stability and magnitude of motherliness have firm foundations.” He tells a story of one of his client’s choices, which opened his eyes to the possibility of natural childbirth. Towards the end of her labor, he offered her a whiff of gas, which was the standard fare in those days to relieve pain. To his surprise, she refused. After the birth, he asked her something like, “Didn’t it hurt without breathing the gas?” to which she replied, “No, doctor. Why should it?” and Childbirth Without Fear was born. He realized at that moment that “there was no law of nature that could justify the pain of childbirth.”1 Another title for this book could be Childbirth Without Pain. Verity Lovelock, a woman who had what she described as a pain-free birth, says of this book: “ ‘The crux of it is that your body is designed to give birth—it’s only your mind that holds you back ... So when I was in labour I didn’t let myself think of the experience as painful or scary, even for a minute.’ ”2 Dick-Read began watching women give birth around the world, and compared why for some it was a peaceful, relatively painless process, and for others it was agony. What he discovered was that utter relaxation of every bit of tension from the body was the key to having a smooth, and even sometimes painless birth. An understanding of the fear, tension, pain cycle helps make sense of why this is so. Sarah Ockwell-Smith, the author of BabyCalm: A Guide For Calmer Babies And Happier Parents, explains how fear impacts labour: “ ‘Oxytocin is the hormone that kick- starts your uterus to contract and your cervix to dilate, helping the baby to move down,’ she says. ‘It also makes you feel high, but it’s inhibited by adrenaline, which you produce when you’re afraid. Your body doesn’t want you to feel drugged if you’re in danger [which it thinks you are, if you are afraid], so it stops oxytocin production so that you can run away and be safe.’ ” Pain in labor is “ ‘a very real physical pain,’ she adds. ‘But it’s not a pain that needs to accompany labour. It’s a side-effect of adrenaline, which triggers a “fight or flight” response in your brain, diverting blood to your legs and respiratory system and away from less essential areas—such as your uterus. The drop in bloodflow leads to a build-up of lactic acid—as it would in any muscle—and a hideous cramp that lasts however many hours labour lasts. Which, without oxytocin, is even longer.’ Once adrenaline kicks in, she says the process is hard to reverse.”3 So, in simpler terms, fear (adrenalin) leads to tension, and prolonged tension creates pain. If we can reverse the process at the start by eliminating fear and tension, it is possible to birth with far less pain. So, how do we get rid of fear? To begin with, “the most common cause for anxiety today is the stress of time.” Healthcare providers often impose artificial time limits on labor. “Usually it would be better to throw the watch away... what the mother needs is peace, so that she may relax with perfect confidence not only in her own body, but also in her surroundings, and her labor proceed without worry.”4 Then, focusing on total relaxation should be the aim of the laboring woman. Dick- Read writes, “If the body is completely relaxed, it is impossible to entertain the emotion of fear.”5 It is far easier to focus on relaxing and to have fear evaporate as a result than to focus on dealing with fear directly. There are several key points to remember when relaxing. One is the connection of the sphincter muscles. What one does, they all do. So, if a mother’s jaw is relaxed and her mouth is open, her cervix will also be open and untensed. Dick-Read found that “any woman who is capable of relaxing her facial muscles at will can go through labor with the maximum ease that the absence of tension makes possible.”6 Another point to remember is that it is impossible to completely relax a straight limb. Each joint must be bent in order to relax. “The discomforts of labor vary inversely to the woman’s ability to relax.” -Grantly Dick-Read Let’s look at relaxation pointers from Childbirth Without Fear for each stage of labor: Early First Stage Mother is moving around, distracting herself as much as possible from micromanaging labor by continuing to go about daily life. “But as soon as there is a sign of a uterine contraction, she must at once apply herself and relax to the very best of her ability.”7 She may stop and lean on a countertop, or wrap her arms around her partner’s neck and let her weight sink down, totally letting go of tension. When the contraction ends, she can continue her cooking, cleaning, or board game, etc. Early labor is usually the longest stage, and it can be hard for a mother to wait for things to really kick into gear. “As rhythmical contractions of the uterus increase in intensity, gradually dilating the cervix, there is a demand for patience. If the training that has been given in deep, quiet breathing and complete relaxation is well and truly carried out during contractions, this period of waiting is much less taxing on a woman’s patience. The routine of becoming completely flaccid, especially in the abdominal and pelvic area during a contraction, will help her improve her skill as time goes on.”8 “There is no hurry—the door [of the uterus] will open, but you must not make the work harder for the uterus by tightening the door. If you are rigid and squeeze up your face, then the muscles of the outlet will squeeze up, too. The uterus is astoundingly strong and persistent; the result of your resistance will be pain. But the more completely limp your muscles become, so much the more elastic will be the mouth of the womb, and so much less discomfort will you experience.”9 Late First Stage (active labor) Now the mother should remain relaxed not only during contractions but also between them. She should remember to go to the bathroom about once an hour to keep her bladder empty and to avoid excess tension. “She must consciously ‘let go’ all muscular tension in the upper thigh, lower abdomen, and lower back, relaxing the pelvic area so completely that the outlet seems to be falling open of its own accord.”10 “Relaxation during the first-stage contractions has the most astonishing effect. ... she should have no difficulty whatever in avoiding all pain during the first stage of normal labor. It may be that it will not be easy for her, during the last part of the first stage, to avoid discomfort, but the calmer she is the more relaxed she will become.”11 Second Stage (pushing) There is no need to try to relax during this working stage. “One could not require, nor would it be possible to obtain, physical relaxation during expulsive contractions of the second stage. The idea of nature here is that, the door being widely opened and the birth canal ready for the baby to pass through, the mother can assist the muscles of the uterus by pushing down to the degree of the urge.” Third Stage (delivery of the placenta) During this stage, the family marvels at the miracle of an empowered birth, new life, and the amazing placenta. Dick-Read once told one of his patients after handling her placenta: “Madam, when man can make one of these, he will have reached the footstool of the Creator. As I hold this discarded mass in my hands, I am humbled by the limitations of science.”12 Conclusion While it may not be possible for every woman to have a completely painless childbirth, knowing the incredible efficacy of relaxation and getting out of the way of the body’s innate ability to birth can help every woman have as optimal a birth as possible. It is exciting to realize that we do not have to endure birth, but rather can experience it on an intense, yet exhilarating level. Footnotes: 1 Dick-Read, Grantly. Childbirth Without Fear: The Original Approach to Natural Childbirth. London: Pinter & Martin Ltd., 2005. P. 19. 2 www.dailymail.co.uk/femail/article-2333008/The-women-say-theyve-proved-giving-birth-doesnt-hurt-No-gas-air- epidurals--just-positive-thinking-Dont-mock-Theyre-deadly-serious.html#ixzz3BVnJ5OY6 3 Ibid. 4 Dick-Read, Grantly. Childbirth Without Fear: The Original Approach to Natural Childbirth. 5th ed. New York: Harper & Row, 1985. P. 199. 5 Ibid. P. 63 6 Ibid. P. 71 7 Ibid. P. 93 8 Ibid. P. 94-5 9 Ibid. P. 213 10 Ibid. P. 96 11 Ibid. P. 96-8 12 Ibid. P. 117