Please note, this blog post is a portion taken directly from chapter three of Birthing From Within, an excellent book on childbirth preparation written by Pam England.
Worry is the Work of Pregnancy
Our study group in Albuquerque resisted when Dr. Lewis Mehl, a psychologist who specializes in childbirth-related issues said, “worry is the work of pregnancy.” We were all holding onto the notion that women who appear relaxed, confident and together, birth normally.
We were intrigued by his story about a childbirth class in Georgia. There were six couples in that class. One of the couples was particularly concerned about how to avoid a Cesarean birth. Every week, they stretched the patience of their childbirth teacher with questions. Later, at the group’s postpartum reunion, every one was amazed that the couple who had worried so much about a Cesarean birthed normally, while the five couples who had sat quietly all had Cesareans!
In the years to follow, my midwifery practice taught me that for some women, worry is the work of pregnancy. In fact, an over-confident first-time mom who thinks she has it all figured out, worries me. I worry she will not be truly prepared for what awaits her.
Women all over the world worry about pain, the health of their baby and dying in labor. Western mothers have additional worries: whether their own doctor or midwife will be on call when they’re in labor, avoiding unnecessary interventions, separation from their newborn and the cost of medical care.
Worrying Effectively
Hannah, a second-time mom, wanted to have a simple, natural birth experience after having had a highly medicalized birth. Her worry that this birth would be another painful disappointment clouded her pregnancy. She remained immobilized and ambivalent into her eighth month.
She longed to hear me say that everything would be all right. Even though her problems were not likely to recur, I resisted the socially expected, “don’t worry” response. Empty reassurance might have supported her avoidance of the hard, painful work she still needed to do.
Hannah wanted to believe that positive thinking would make this birth work out, yet intuitively, we both knew that more was needed. Instead, I encouraged her to face what she feared. In trying to control her fears, Hannah hadn’t been worrying enough!
The first task I gave her was to write down all her secret worries. “Some of your worries may be genuinely trivial,” I suggested, “but look closely at the ones you are trying to minimize or ignore. Pay particular attention to worries that creat a physical tension in your body.”
When Hannah brought her worry-list to our next session we explored each worry using the following questions:
- What would you do if this worry/fear actually happened?
- What do you imagine your partner (or birth attendant) would do or say?
- What would it mean about you (as a mother) if this happened?
- How have you faced crises in the past?
- What, if anything, can you do to prepare for, or even prevent, what you are worrying about? What’s keeping you from doing it?
- If there’s nothing you can do to prevent it, how would you like to handle the situation?
Some people believe that exploring fears or worries make them more likely to happen, in fact , worrying effectively helped Hannah shift from frozen, fearful images of not being able to cope, to more fluid images containing a variety of coping responses. Weeks later, Hannah gave birth simply and normally to her daughter, Laura, in a hospital birth room.
Ten Common Worries
- Not being able to stand the pain
- Not being able to relax
- Feeling rushed, or fear of taking too long
- My pelvis not big enough
- My cervix won’t open
- Lack of privacy
- Being judged for making noise
- Being separated from the baby
- Having to fight for my wishes to be respected
- Having intervention and not knowing if it is necessary or what else to do.
- Fear of dying in labor
The Joy of This 
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