Consider Psychological Roadblocks That Might Keep You From Laboring Normally
Women rarely consider that their minds can prevent their bodies from performing as they are able. But psychological roadblocks are as much of a problem as a big baby or a smaller pelvis. A woman may never relax enough to let the instinctual part of her brain take over the labor. A woman should take some time to examine her feelings and concerns about childbirth as soon as possible when considering pregnancy. Many of these barriers to normal labor require some time to overcome. Understanding that these things are obstacles can help a woman’s provider give her better care. So be sure to have discussions in prenatal care and to write in a birth plan exactly how the provider can be sensitive to her needs is very helpful.
Awareness of The Following Impediments May Help a Woman Avoid Them for The Purpose of Getting Her Baby Delivered.
Family History of Cesarean Section
If a woman’s mom or many women in her family have had cesarean sections, the woman may harbor doubts about her ability to have a vaginal birth. Women must keep in mind that the section rate in America has been high for many years. Our mothers, aunt, sisters and cousins may have just fallen victim to the same good odds of ending up with a surgical birth that many women have today. It is likely not a defect in our genetics; it is more likely a problem with modern medicine intervening in a normal process. That being said, there are situations where family members bearing similar genetics might encounter similar problems in pregnancy and birth. A woman should be sure to talk to her family and gain a good understanding of the circumstances of the cesarean births and then discuss with her provider. It might be possible to improve a woman’s odds for vaginal birth by better managing her hereditary obesity, gestational diabetes or Polycystic Ovarian Syndrome better from the start of pregnancy or even before conception.
History of Sexual Abuse and/or Rape
Women who have suffered from sexual abuse or trauma in the past may have a very difficult time coping with the sensations of labor and birth. They might benefit from an epidural to mask the sensations. If these women desire a medication-free childbirth, they should try to get some counseling hopefully before pregnancy but during pregnancy can help as well. It goes without saying that a compassionate provider, and one that the woman trusts, is key. Limiting vaginal exams is important. Laboring and birthing in a tub of water can help because immersion in water definitely decreases the pelvic pressure and overall pain from labor. Sometimes a woman finds it helpful to watch the birth so that she can see that the baby’s head is the cause of the pelvic sensations she is feeling.
Phobias About Labor or Medical Procedures
If a woman has a fear of labor and birth that would make her decide to not have a child at all, or the thought of labor creates a state of panic, she should certainly be given the option to choose a cesarean section. Cesarean birth is possibly a good way to afford this particular woman an opportunity to have her own child. She should seek a supportive provider and discuss the option of entering labor and using pain management, like epidural, to help her achieve a vaginal birth so that she can reduce her risks of abdominal surgery and also discuss the option of elective cesarean too without fear of judgment.
Fear of medical procedures is a common fear. This can be a huge barrier to the progress of labor. Plans can be made with the woman ahead of the birth to make sure that all procedures are necessary and when they are, as quick and comfortable as possible. Things that help are combining blood draws, limiting pelvic exams and even planning a homebirth because there are fewer mandatory medical procedures. When the woman requires a hospital birth, the hospital can be informed of her particular needs ahead of time. If the woman knows what the hospital requires, she can prepare ahead of time and then the fear should be greatly diminished.
Women who are terrified of medical procedures are usually terrified of needles. I like to care for these women because they have natural childbirth all the time! The Midwives try to make things like blood draws as easy as possible for these clients; we plan to have the best phlebotomist available, to minimize their embarrassment, we need to draw their blood on days when there are no other patients or as far away from other patients as possible because these terrified women often scream or cry while their significant other holds them down. We need to allow plenty of time for pelvic exams. It can take 10 minutes or more to insert fingers or the speculum. Obviously, women often seek out Midwives to provide the special considerations that they require and we welcome them!
Subtle (and not so subtle) Messages from Her Provider
Patient Is Not Likely to Deliver Vaginally
This seed of doubt is sometimes planted as early as the very first prenatal visit. This happens the most often for women who are overweight, short in stature, first-time moms, moms expecting twins or women who have a history of cesarean section or difficult first delivery. Women have a hard time pushing past the tough parts of labor if they have already been told that they are likely to go to the OR anyway.
Patient Has a Foolish Birth Plan
Many Obstetric providers see no value in unmedicated childbirth. They seem insulted and even angry when a woman questions the routine care given by the OB and the hospital. A power struggle may then ensue within the patient/provider relationship, especially during labor if it is not conducive to the normal progress of labor. This lack of cooperation is very stressful to the laboring woman. She may find it impossible to relax and labor well which can then result in the interventions she never wanted but her provider did. A pregnant woman needs a provider who values her birth plan and supports the woman’s autonomy even if the care provider does not agree.
I have known of women who were scheduled for a cesarean before the end of the 2nd trimester because the provider believed that baby was already too big. When I was still teaching breastfeeding classes for all of Hackettstown Hospital Patients, Amanda came up to me during the break to ask for information specific to breastfeeding after a Cesarean section. I asked her how she already knew that she would be having a cesarean. She had been told that based on her recent ultrasound at 28 weeks, her baby would be too big to deliver vaginally. Amanda was 5’2, overweight pre-pregnancy and had already gained 30 pounds in the pregnancy. Her husband was at least a foot taller than her. This woman had been told that her diet would have no bearing on the size of her baby. We talked after the class about strategies to avoid a big baby and a scheduled surgical birth. Ultimately, she transferred into our practice, changed her diet and started to exercise. I attended her first birth and she did work hard but she delivered a 9# baby boy vaginally without incident. She has since had 2 more vaginal deliveries.
Look at your Personality
Labor is harder for women who are generally anxious. They have a hard time seeing ANYTHING as normal and find many parts of their daily life anxiety-producing. So labor, which is a much bigger event, really elicits panic. In labor, the provider or nurse can tell her that the amount of bloody show that she has is normal but her basic personality cannot get past the fear she originally felt when she saw the show. Labor does not progress well when the birthing mom keeps herself in a “Fight or Flight” mode throughout labor.
If a woman’s personality would classify her as “type-A”, her planning, perfectionistic tendencies might seem like an asset to the progress of normal labor. Follow all the rules for childbirth and it will happen, right? Well, no. Because there are so many variables and obstacles to normal labor progress, childbirth is not a place to make a rigid plan. A woman who tends plan her own baby shower because no one else can do it right, may very well have some mental hurdles to contend with once in labor.
A very modest person can have a hard time relaxing enough to let her baby out. Many parts of labor strip away the physical and emotional protections that a woman might need to be able to progress in labor. Birth workers forget that routine procedures like vaginal exams could be mortifying to the laboring patient. They might forget to do things like keep the door shut and the lights dim. Providers and staff can the modest woman trust that her environment is safe and private. If a woman believes that her need for modesty could hinder her ability to labor well, she should write specific instructions on her birth plan and speak with her provider about it. She could ask for things like: allowing her to be covered during pelvic exams, to use the bathroom alone and keeping the number of people around her to a minimum.
Spend some time doing a self-evaluation of anything that might impede labor progress. Knowing yourself can make a big difference in the mental part of your birth.
Read the next post in the Avoiding Cesarean series on Alternative Medicine Benefits for Vaginal Birth.