This post originally appeared on the Voices blog at Down Under School of Yoga: https://www.downunderyoga.com/blog-voices/the-only-thing-we-have-to-fear-is

The only thing we have to fear is fear itself- Franklin Delano Roosevelt

What if I told you your mental state could have an impact on what you feel during labor? For some this conjures up images of the new agey idea of mind over matter, or the magical thinking concept that if you only focus on good thoughts you will inspire your body to birth without any pain. While we could debate the merits of mental stamina, and the Law of attraction as they relate to labor, I’m actually talking about something far more basic and physiological. The Fear-Tension-Pain cycle and how it can affect the labor process.

What physically happens in your body when you are afraid? Your muscles tense. If you hold tension in a muscle group for an extended period of time, what do you start to feel? Pain. There could be other descriptors here: burning, heaviness, etc- but the overall sensation is painful. And what would a normal, and even understandable emotional response be to feeling strong, painful sensations within your body? Fear. Thus we have a cycle within the body where Fear, leads to tension, which leads to pain, which leads to more fear, and so on and so on. Pain is our body’s way of alerting us to something being wrong, and it understandably triggers a heightened alertness as we asses our current situation.

This cycle is built into our bodies at the level of our central nervous system. The autonomic nervous system is subdivided into two halves. We have the parasympathetic side, which controls the down regulation of the body systems, and the relaxation response. More commonly referred to as “Rest and Digest,” this is the system responsible for lowering our blood pressure, heart rate, and even creating that slight mental foggy state after a large meal (think post Thanksgiving haze). On the other side from the parasympathetic we have our sympathetic nervous system. This one get far more attention, partly because it is more immediately palpable when triggered. This one is more commonly known as the “Fight or Flight” response and is responsible for activating life saving systems in moments of stress. The body quickly assesses whether the stressor we have encountered is one we can fight and win, or one where we would be better served to run away at top speed, and then activates the body to allow for this fight or flight.

Picture of Uterine Muscle layers- courtesy of HypnoBirthing: The Mongan Method 4th edition

To see how these two systems intersect with the labor process- and where Fear-Tension-Pain comes into play- it might be helpful to understand the muscles involved in labor. The uterus is not a single muscle, but is actually made of 3 sets of interweaving muscle fibers. Each of these layers fires in synchronized rhythm with the others during the labor process. The most outer fibers run from the top to the base of the uterus. The middle fibers run in diagonal loops, encircling the blood vessels with run through to feed the placenta. The most inner layer is comprised of concentric circles. These circles are wider at the top (fundus) of the uterus and get closer together as we move towards the base. In fact, it is this inner layer which forms the cervix at the bottom of the uterus. When someone speaks of the cervix opening or closing during labor they are talking about the deepest and lowest set of muscle fibers within the uterine wall. The outer muscle fibers are connected to the cervical fibers which is how the muscles are able to affect one another during the labor and birth process.

What is happening in labor? Well muscles can only contract in the direction the fibers are running, so the outer fibers can either lift up or release down, but not go side to side. Likewise the inner concentric circles can either squeeze shut, or can relax open, but they cannot push up or down. During the first stage of labor the outer muscle fibers contract and draw upwards against the cervix. Because of a built in reflex known as reciprocal inhibition (muscles opposing one another release when the other fires), as the outer fibers contract, the inner fibers of the cervix release. The circular muscle fibers are gradually drawn upwards and outwards by the outer uterine fibers, becoming thinner and eventually opening outwards as the baby’s head presses down. After a period of time, the lip of the cervix widens more than the dimensions of the baby’s head and there is no barrier into the lower pelvis. Like drawing a turtleneck over your head (but upside down), the outer fiber continue to contract, but with no cervix below the head, the baby slides down out of the uterus, spirals through the bones of the pelvis and emerges out into the world. Once the baby is out, the middle layer (remember there were 3?) contracts squeezing its fibers around the blood vessels to the placenta. This tourniquets the blood vessels, and separates the placenta from the inner wall of the uterus. As it separates the placenta drops down and triggers the same expulsive reflex the baby triggered, and the outer fibers to move the placenta down and out of the body.

That’s the whole process of labor. Outer fibers contract, the cervix releases and opens, the baby descends and is born, and the placenta follows. But now let’s look at how the nervous system plays into this rhythm. The above description assumes the muscles are working harmoniously together, but what if that pesky sympathetic nervous system is triggered during labor. If we activate the fight or flight system during labor, the body sends out all its usual stress hormones like cortisol and adrenaline. These divert blood from the internal organs out to the limbs, heart, and lungs in preparation for a life saving action. Additionally all muscle tension in the body increases as we get ready to either fight or flee. Physiologically what this means is the uterus becomes oxygen deprived (since it is not part of your defense systems), so the muscles don’t fire as strongly due to a lack of good oxygen, and instead of releasing the fibers of the cervix contract at the same time as the outer fibers. This is like trying to both bend and straighten your arm at the same time, and it leads to a baby’s head being forced into a cervix which is refusing to open. This is a recipe for very real pain! And remember, the emotional response to pain is to increase the fear response. Fear lead to tension, tension to more pain, and we move into the downward spiral or Fear-Tension-Pain and so on. The activation of the sympathetic nervous system during labor actually triggers the third option in the fight/flight response: Freeze. Faced with a situation where we cannot fight labor, nor can we flee in, the body reverts to the “deer in the headlights” response, and decides that it will not open any further until whatever threat it perceived has resolved itself.

Ok so now we get back to where we started and your mental state. Why on earth would the body have this mechanism built in to effectively shut the whole labor process down? Well if there were a genuine threat to your safety, your labor should shut down! In my HypnoBirthing classes I point out to students that if a genuine bear walked into your labor room your labor should stop (I don’t know how it got up the hospital elevator- but ignore that for a moment). But the nervous system activates on perceived threats as much as genuine ones. Horror stories about labor, disempowering comments, even the cultural assumptions that labor is going to be complicated and dangerous, create a state where our minds are primed to activate the “fight, flght or freeze” response rather than staying in the “rest and digest” side of things. We expect a negative experience. We emotionally brace for things being uncomfortable, and assume there is nothing we can do about it. And when we then are “forced” to move into the environment we fear (seriously how many of us feel super relaxed and rejuvenated when in a hospital setting?), we wind up creating the very sensations we thought were inevitable. The mind does not differentiate between a real bear, and a person who is acting like a “bear”, or thoughts about how a “bear” might come into the room.

Now before someone starts thinking I’m claiming women cause their own labor pain, or that I’m claiming labor doesn’t have moments of discomfort, let me clarify. I’m not saying we don’t feel something during labor, or that there might be moments where those sensations become uncomfortable. Labor is, after all, a series of very strong muscle contractions of which we are not completely in control. But when we encounter fear, many of us do not stop to investigate whether this fear is justified or not; we simply shut down. If we have spent our pregnancy assuming that any and all pain during labor is inevitable, and simply to be endured (or worse, focused on what challenging, or even life threatening, situations we have heard others encountered) we set our minds up to panic when strong sensations occur, rather remaining curious about how we might be able to move or shift to better work with our own labor circumstances. Instead of using the pain as information, our mind shuts down and simply endures. It is quite possible that there will be some pain during labor, not the pain of strong muscles working, but genuine pain. But if there is I would suggest that pain is doing exactly what it would do in any other circumstances. It is seeking to alert us that something is off, and that we need to do something to help. And the only way we can figure out how to assist and relieve the discomfort is to slow down and bring some mindful exploration into the situation. To down regulate our fear response so we can look more fully and without judgment at what we are feeling, and maybe try something new. This could be changing a position- even when we don’t know for sure it will feel beter, breathing more deeply- which calms the sympathetic nervous system, swaying and moving rather than freezing in place, or going deeper into our thoughts to see if we might need to release preconceived ideas about labor, so we can be present and work with the sensations we are actually having.

The short version? Curate the information your take in during pregnancy. Put down stories/blogs/videos that show labor as something traumatic or overly dramatized. In my yoga and childbirth classes I focus on how the female body was designed to go through the birth process, and to start recruiting our inner resources of mindfulness, breath, and body to gain confidence and strength as we prepare. I also encourage students to explore what would make them feel the most supported during the labor process. For some this means hiring more support people, for some it means changing environments, and for some it means finding the success stories they can lean on when fearful thoughts begin to surface, to reassure themselves that at the end of the day, women have been birthing babies for thousands of years, and given the human race is still here, the birth process works.

TL:DR

· Your body’s nervous system has a strong impact on how the muscles of your uterus work together

· Activating the fight or flight response during labor leads to greater discomfort and possibly a slower labor due to the cervix refusing to open

· Being able to remain curious and open to all sensations creates more optimal conditions for working with the twists and turns of labor

· Be mindful of how stories and information of labor and birth affect your nervous system. If they are triggering anxiety and fear, or reinforcing unpleasant ideas about the birth process, consider working with those feelings, and putting aside those fearful images and assumptions.