By Kristine Arinos

When a mother sits down to write about the story of her child’s birth, it often starts with the first contraction. Delivering a child is unquestionably an emotional experience worth recording; however there is an emotional process that occurs before labour that is often overlooked.   What is the emotional process that leads up to the dramatic conclusion of holding a baby in your arms?  Many books that are read by women before labour emphasize the importance of emotional preparation, but what does that involve and how can it help?  By taking a look at the experience of women who have gone through, or who are about to go through, labour, I will discuss the importance of emotional preparation in order to help achieve the desired birth experience for the mother and to potentially start the labour process.  I will also take a look at ways that a doula can help her client to prepare emotionally for labour and the birth of her child.

            Many women at the end of their pregnancy are heard to repeat the same line – I just feel ready: “My mother was staying at my place and looking after my daughter, so I decided to work over time that night and get a few things done.  Then when I got home, my mother painted my toes.  I just felt ready, you know?  I went into labour that night” (Janice Cohen, 31, 2011).  This feeling can be the result of many factors, some of which are physical rather than emotional.  For example, it is easy to become tired of carrying around so much extra weight and the desire to give birth comes from the desire to return to one’s pre-pregnancy shape.  Other physical problems include difficulty sleeping, leg cramps, general discomfort and back pain.  But the beginning of pregnancy is also associated with physical problems, such as nausea, fatigue and mood swings.  Yet there are probably few women in their first trimester who would admit to be being emotionally prepared to go through the process of labour in order to return the body to its pre-pregnancy condition.  The thought of delivering a child is often the cause of anxiety at the beginning of pregnancy and many women look upon the upcoming event with trepidation: “I'm only around 5 weeks, but last night I suddenly felt really scared that I was going to have to give birth […] I keep thinking about how much pain I will be in and I keep thinking I bet it will happen in the middle of the night” (Baby2000, BabyandBump).  Therefore, women who “just feel ready” must have gone through some sort of emotional process during the span of their pregnancy in order to reach this level of self confidence. 

Let us take a look at what can help the individual woman achieve the level of self confidence in their body that they can tell you that they feel ready to give birth.  What is emotional preparation for labour?  The manual I purchased to read while I was pregnant was rich in scientific information; however, the side note offered on emotional preparation was brief and unhelpful: “[e]motional readiness is a component of labor that is rarely discussed.  Women who are emotionally unprepared may subconsciously forestall birth.  If you have any concerns about the effect your new baby will have on your life, discuss them with your partner or healthcare provider” (Stone and Eddleman, 208).  It mentions that emotional preparation for being a parent is important and that it can even have an effect on the initiation of labour, but it does not give any advice as to what one can do in order to feel prepared.   The text does not mention anything about emotional preparation for labour itself. 

On the other hand, perhaps the overly scientific textbook I read before my labour was just what I needed to help me feel prepared.  When I began to research what made women feel emotionally prepared before giving birth, knowledge of the physical process of labour appears to be a major factor in what allowed them to “just feel ready”: “I honestly recommend those [prenatal] classes. I learned a lot about the process of giving birth. It was my first child so I had no clue at all […] if I didn't attend those classes I would have been going nuts when I was in labor” (isha, Yahoo Answers).  But does knowledge of the mechanical process of labour bring confidence?  I found that women who wanted to feel emotionally prepared for natural labour, with as little medical intervention as possible, only found comfort in prenatal classes or textbooks that praise the female form and the perfection of a natural, physiological labour: “[f]ear is dispelled with information. To dispel fear about birth, I learned about physiologically normal birth. Not birth with interventions (as normally depicted on shows like A Baby Story or Born Every Minute), but unimpeded birth that proceeds with cues from the mother (not the provider)” (MamaEve).  Not every prenatal class or manual on pregnancy is designed to make a woman feel confident in the ability of her body to give birth.  Many classes, especially those offered by hospitals, focus on the birthing mother as a patient who is in need of medical intervention in order to have her child.  As a doula, if you do not offer prenatal classes yourself, you can encourage the mother to take a prenatal class that you know is directed toward the type of birth she wants to have.  Always speak of labour with the mother in positive terms and find hospitals, clinics or private classes in the mother’s area that offer a prenatal course that focuses mainly on natural, physiological birth.

The textbook I read when pregnant with my first child mentioned that emotional preparation before labour should be explored in order for the mother to feel ready to become a parent.  That mentally preparing for parenthood can help a woman to not only feel ready but can prevent unwanted delays in the beginning of labour due to emotional stress.  The most common form of emotional preparation for parenthood that I found came in the form of nesting.  The term “nesting instinct” is often discussed as a sign for pregnant women that labour is imminent: “For two days prior to going into labor I cleaned my house inside and out.  I went and made sure that any outstanding banking, bills, etc. were taken care of.  When I woke up on the third day my water broke and my daughter was born the following afternoon” (“niffer”; Yahoo Answers).  “Nesting” is the term used to describe the intense desire that many pregnant women feel to clean and prepare the house right before the baby is due to be born.  A new mother will often describe the days before her labour as an intense period in which she felt the need to scrub the house from top to bottom.  Or perhaps the days before labour were a time when it became urgent for her to finish any last minute preparations on the baby’s room or to take care of any loose ends at work or at home: “nesting instinct was already in full force since 8 months […] hubby and I bought our house and frantically remodeled the upstairs part […] finished it just in time before [our] daughter decided to arrive” (elizsono, Baby Gaga).  This instinct is directly connected to a mother’s need for emotional preparation before labour.  She is physically preparing the space where the baby will soon live so that she can have the capacity to create emotional space for the child within her: “[c]reates emergency behaviours, pushes the mother to make a physical space for the child, inducing what is sometimes defined as the “nestling instinct”.  This helps the mother to conclude all unfinished matters and to focus the attention on the real baby and the imminent birth” (Schmid, 9).  Once there is physical space in the house for the child about to be born, the mother can think about the baby inside her in a more concrete form.  Preparing a space makes the baby you have never met feel real and the idea of labour becomes an inevitable reality.

Another form of emotional preparation for labour and for parenthood can be to consciously take a look at any issues that are bothering the mother-to-be.  HypnoBirthing by Marie F. Mongan extols the importance of ridding oneself of any unnecessary fears and baggage that could hold one back from having the ideal birth experience: “[t]horoughly search your inner feelings to discover the areas that you feel very confident about and those that you need to work through so that you can resolve any fears or misgivings that you are holding […] these concerns can easily surface as fears when you are in labor, and they can affect the course of your labor” (Mongan, 59).  The book provides a list of problem areas that should be discussed with the mother in order to help her discover where her problem areas could be located.  Some of the problem areas highlighted in HypnoBirthing include: stories the mother may have heard about her own birth, previous labours she has experienced, parenting concerns she may have or fears in relation to her marriage, career and/or finances.  As a doula, besides suggesting the mother read HypnoBirthing and talking through any concerns with her and her partner, I could suggest that she start journaling her feelings and dreams.  We could also take time to free write any immediate thoughts or emotions that come into her mind when she hears the words labour, motherhood, contractions, pain.  Free writing and journaling can help to pinpoint any areas that are causing the mother to subconsciously stress over her impending labour and birth of her child.  After the problem is written down, it may make it easier for the mother-to-be to talk through any issues, either with you or with her partner or a friend.  Once the problem has been highlighted and discussed, it makes it easier to leave behind this unnecessary baggage that could potentially have caused difficulties in the upcoming labour. 

Unfortunately, we live in a culture where negative stories about birth are the pervasive narrative.   Although it may feel like all of the stories that you hear of birth and labour are negative and scary, positive stories do exist and must be focused on if one is to trust the ability of the female form to birth safely and without complications: “[t]he association of pain with childbirth is an example of a universally held conditioning, and it has become the source of needless suffering because of the myths that have grown up around it.  By the same token, if you listen to affirmations of positive, gentle birth on a daily basis, it will contribute to positive conditioning” (Mongan, 69).  It is therefore the role of the doula to support and encourage the mother to look for positive stories.   Provide her with examples, such as Ina May Gaskins Guide to Childbirth, and suggest that she search the internet for stories of women who voluntarily went through a natural, physiological birth with few complications: “I am due in about a week, first pregnancy and have been preparing for a drug-free birth! Now that I am at the end, I'm becoming a little nervous! I know I can do it but encouragement and positive birthing stories always seem to help” (Amanda M, Yahoo Answers).  Regrettably, we cannot be with the mother on a constant basis and there are undoubtedly many people in her life who will want to “inform” a woman who wants a natural birth that labour is too painful to be experienced without medication.  These people will want to recall horror stories of birth from their own past or that they have heard second hand. Recommend to the mother that she surround herself with only positive influences and try to block out any negativity in her life: “you do not need to assume the experiences of the people who are relating these stories.  There is no reason to believe that you will birth as they did” (Mongan, 60).  The energy that one wastes on negative stories of birth is unproductive and unnecessary and does not help the mother to feel emotionally prepared for the inevitability of labour.  

With my research I found that many women I spoke to thought that rest and reflection before one’s due date can also be a form of mental and emotional preparation.  One woman I interviewed had the following story:

In order to collect one’s thoughts before birth, it is important to find time for oneself outside of work and daily stress.  This does not necessarily mean that one has to quit working before one’s due date, but some quiet time to listen to one’s body and the movement of the baby at the end of the day should definitely be recommended.  It is the hormones that cause stress that can prevent the release of oxytocin, the hormone that causes contractions and is thought to start the process of labour:  “[a]t around nine o’clock in the morning, stress hormone levels are normally higher; they usually start decreasing around five o’clock in the evening, reaching minimal levels during the night.  This is the reason why spontaneous labour rarely starts between 09:00am and 5:00pm.  Labour, in fact, cannot start when high levels of catecolamines [stress hormones] are present” (Schmid, 23).  Earlier in this paper I mentioned that in my scientific textbook it states that lack of emotional preparation could potentially stall labour as well.  Therefore, if one is fully immersed in the stress that comes with everyday life at the end of her pregnancy, it is difficult to find time to emotionally prepare for the upcoming labour and listen to the body and what it needs in order to start the labour process.  Consequently, feeling emotionally prepared for parenthood and labour at the end of one’s pregnancy can potentially help lead toward starting the process of labour: “[w]hen the mother’s organism is ready and in harmony with the child’s, it usually gathers the message within 24 hours (Nathanielsz 1992, Rockenschaub 1998).  This is when the actual labour starts” (Schmid, 11-12). 

Exercise, such as yoga, swimming or prenatal exercise classes, can also help the mother to let go of any unnecessary stress that could cause her to feel emotionally unprepared for labour.  As a doula, recommend a regular exercise pattern or class to the mother so that she can free herself of any tension through physical activity.  By releasing stress through exercise, one can feel more relaxed and therefore more emotionally prepared: “let go of fear and tensions that can inhibit the involuntary birth process.  You will know how to centre yourself and accept both the pain and the change of consciousness which occur as your body opens up to give birth [through yoga]” (Balaskas, 31).  And as we all know, physical activity helps the body to be in shape for birth, making the process of labour easier through physical strength.  Physical preparation in conjunction with emotional preparation can help the mother to achieve the type of birth experience she desires: “[g]ood preparation of body and mind during pregnancy helps you to approach birth with confidence.  Practicing yoga [or another exercise for pregnant women] during pregnancy will ensure that you are at your physical best for birth and enables you to make friends with your pain and to shed some of it before the day of the birth” (Balaskas, 93).  Through exercise, the mother can become familiar with her body and therefore more confident in its ability to birth her baby.  She gains physical strength and, as a result, confidence in her body’s capabilities.  This confidence can significantly affect and improve one’s emotional state.

            Consequently, I believe that emotional preparation before labour should receive as much emphasis as physical activity during pregnancy.  Through knowledge of the process of a natural, physiological labour, working through any emotional issues that the mother might have about the pain of labour or subsequent parenthood, and familiarizing herself with positive birth stories, the mother can feel confident that she may have a positive birth experience: “[t]he attitude of the mother cannot be overestimated as a determining factor in the course of labor.  A relaxed mother can have her baby much quicker and easier than one who is uptight” (Gaskin, 333).  Furthermore, physical exercise is still important and should be practiced on a regular basis, as it is means to releasing stress and tension in the mother.  Emotional preparation or the lack thereof can also impact the initiation of labour itself.  Therefore, it is paramount that a doula helps the mother-to-be with all the tools available in order to achieve that “I just feel ready” confidence at the end of her pregnancy and on into labour and motherhood.

            Baby Gaga Forum:

“elizsono”: http://forum.baby-gaga.com/about56338.html

            Balaskas, Janet.  New Active Birth.  London: Thorsons, 1989.

            MamaEve Blog:

www.mamaeve.com/index.php/natural-childbirth/birth-without-fear-doesnt-mean-you-cant-be-scared/

            Gaskin, Ina May.  Spiritual Midwifery: Fourth Edition.  Summertown, TN: Book Publishing Company, 2002.

Schmid, Verena.  About Physiology in Pregnancy and Childbirth.  Florence: Litografia I.P., 2007.

Stone, Joanne and Keith Eddleman, eds.  The Pregnancy Bible: Your Complete Guide to Pregnancy and Early Parenthood Second Edition.  London: 2008.

            Yahoo Answers Forum:

“niffer”: http://answers.yahoo.com/question/index?qid=20080324051436AAZETqA

“isha”:  http://answers.yahoo.com/question/index;_ylt=Ak52lhn9QCXd.0TqefK5lmUjzKIX;_ylv=3?qid=20070824214436AA5EbJT

“Amanda M”:

http://answers.yahoo.com/question/index;_ylt=AuU.EIupgPJXh6_kQBWtGFEjzKIX;_ylv=3?qid=20070512065026AAe6RFp