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  • Sarah Landry

Part I: Negative cycle of fear-tension-pain in birth

Raise your hand if you’ve felt a fear and subsequent rush of adrenaline at some point in your life when faced with a stressful, unsafe, scary, or painful situation. IYKYK. That is fight-or-flight. The experience can illicit physical and physiological responses that impact us in a myriad of ways. It is intense and can leave you feeling rattled, even after the danger is gone. Fight-or-flight is a useful biological safety mechanism for survival—in dangerous, threatening situations. But birth? That’s (typically) a normal biological event in which fear is not helpful, and can in fact disrupt the process and progress. Some common fears we enter birth feeling might include:

· Health of the baby

· Fear of the unknown

· “Damage” during childbirth

· Exposure and embarrassment over bodily functions

· Being cared for by strangers

· Behaviour during labour

· Being vulnerable

· Wishes not being respected

· Fear of losing control

· Fear of pain

Unpacking those fears and working on them is something that we do in childbirth classes. I will say that fearing birth is not natural. Yes, it is normal and common due to our culture, but it is not innate—other mammals do not fear birth. Many other cultures do not fear birth. Historically, birth has been something to be valued, honoured, celebrated, experienced, and supported in while surrounded by community. It takes work to shake our culture of fear surrounding birth, but we’re going to try! Since the fear of pain is on many people’s lists in our corner of the world, that's our focus here.

Imagine an elastic band shared among 3 people to form a triangle, with each person holding one “point” in a neutral state. In this stasis, you can really only feel the slight tension of the elastic. Now what would happen if ONE person tugged outward on their point? The other two would feel increased tension on their fingers, right? This is basically how the “fear-tension-pain” cycle works. Coined by Childbirth Without Fear author and obstetrician Grantly Dick-Read, the F-T-P cycle can be a useful tool in childbirth. Confidence and fear are intimately linked. If you can build your confidence, you can reduce your fear (and change/control your response to it), thus breaking the negative cycle. More on that in part II. Let’s start by looking at the original F-T-P cycle in the context of birth.

Negative cycle:

Fuel for fear is lack of education and understanding about birth, negative birth stories and trauma, lack of trust in your body and birth. Fear increases tension, tension heighens pain, and pain spikes fear creating a negative cycle.

Examples of what might “fuel the fire” to trigger the F-T-P cycle:

· You enter your birth uninformed and unprepared (lack of education and understanding)

· Your view of birth is overall is muddied (negative birth stories, past trauma) · You do not know how birth will go (lack of trust/confidence in your body and birth)

How fear leads to tension:

In fight-or-flight mode, your body unleashes protective measures in your body. It pumps you full of adrenaline and stress hormones, increases your heartrate, gives you cold sweats, tenses and readies your extremities to run, slows your non-essential biological functions, etc. None of those responses are conducive to productive labour. They can slow or even stall labour progress, derailing the work of the good hormones (oxytocin and endorphins) in the physiologic birth process. Again, we want to do things to help labour along. So when you feel fear, you tense up physically. Your jaw, your muscles (including your pelvic floor) feeling tense is going to make you more sensitive to pain.

How tension leads to pain:

So, now you might be feeling both fearful and your body has responded with tension. When you are tense and being flooded with stress hormones, that leaves little space in your hormone-receptors for pain-relieving hormones like endorphins, which work in tandem with the oxytocin-fueled contractions that are supported by calmness. This is likely to reduce your body’s natural threshold to pain and its ability to cope (hormonally). We feel pain more acutely when we are tense and poised for it. Think of getting an immunization and you’ve hyped up the pain in your brain. It might actually hurt more, even if the procedure is no different. Those flexed muscles will make that injection hurt more than relaxed muscles. Taking some deep breaths to relax yourself can do wonders to coping with stress responses, relieving tension, and therefore pain. Once you feel that pain in response to tension and fear, it all comes full circle.

How pain spikes fear:

No revelations here. If you’re tense and/or in pain, your response to all that might be a state of distress which can circle back to those feelings of fear; again raising the risk of slowing or stalling labour progress. While the cycle often starts with fear, any point on that elastic band can actually trigger the negative cycle with the same effect. Perhaps you physically feel tense first? Or you feel pain first because of fast and furious contractions? Whatever the trigger, we can RESPOND to this negative/F-T-P cycle with mental and physical coping strategies. That antidote? A positive cycle, outlined in part II.


Reference: Dick-Read, Grantly, Linton Snaith, and Alan Coxon. Childbirth Without Fear: The Principles and Practice of Natural Childbirth. London: Heinemann, 1968. Print.

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