Uncertainty in Labor

**EDIT** Original post in 2012

Certainty. Why do we seek it? Is it possible to have any sense of certainty going into labor and birth? Isn't that uncertainty some of the beauty and mystery of the sacred event? A hands-on lesson in spontaneity? Join me as I dive into the issue, fueled by my own frustrations in working with moms who crave the elusive predictability.

After 5 weeks of 2 hour classes with a large group of expectant couples at the birth center, I opened the discussion up for further questions. We had spent our 10 hours together by learning a handful of pain coping practices including Breath Awareness, working with our senses and embracing distractions, vocalization during labor…covering countless tips on navigating the culture of birth today, ways to connect with our endurance, a birth art process to move beyond some of our birth worries…Giving book recommendations and local resources… One soon to be mom asks, “Well, do you have and tips on how we can actually prepare for labor?”

Really?....Where are the dots not connecting? Where is the disconnect between preparing for the past 5 weeks and practicing what we’ve learned, and accepting the uncertainties which accompany labor and birth?

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At the end of a birth class individualized for a couple I’ll be doulaing for in the fall, after hours of teaching and mentoring pain coping practices, psychological preparation tools, and tips on fetal positioning during pregnancy, the father asks, “You’ve taught us how to mentally prepare for the pain…but what about actually dealing with the pain?”

Really? Where are the dots not connecting? Where is the disconnect between the psychological mindset required of natural birth and the physiological preparation for the event? Is it me? Do I need to spell out that labor can in no way be predicted?

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During a prenatal doula appointment with a soon to be mom we took some time to talk about pain coping practices after we had gone over some of her birth preferences, namely for a natural birth without medical support including pain medication. After teaching Breath Awareness using “ice contractions”, and Non Focused Awareness, which allows us to use our senses and our breath to embrace distractions and our environment, she seemed to become frustrated. “So far all I’ve learned is that I need to breath. What about the Pain??”

Again I picture a connect-the-dot puzzle and wonder where the disconnect is between inward focus and mental stillness and coping with labor’s uncertainty. The father, bless his heart, asked if labor could be reduced to a certain number of contractions, i.e. if there was a study done on the average number of contractions in an average labor, could he not keep track of the number his wife had so he would be able to predict when she was halfway done. Wow, if only! That would certainly lead us to some certainty. Uh uh. Nothing nice and neat and predictable about labor!

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I sat with these experiences, frustrated at my role as a Birth Mentor, in gently leading couples toward their own knowing. How could I really offer them help in preparing for their labor, when I could offer no certainty at all? As typical in my existence within the Universe, that very week I was invited to participate in a Birthing From Within monthly phone conference titled “Working With Uncertainty in Labor and Birth”. We were discussing a book called “Uncertainty: Turning Fear and Doubt into Fuel for Brilliance” by Jonathan Fields. In his book, he says that when we are uncertain of an outcome, we are living in creativity. Uncertainty causes anxiety and fear. Why? One reason is that our brains are hardwired to avoid this fear and anxiety. Adrenaline is released, we’re ready for fight or flight, and in a nutshell, generally feels bad.

But the other reason is purely our fear of judgment. This judgment comes from ourselves and from others. We fear judgment and so we choose the more certain decision, the less risky choice. If we bridge this to birth, we have a culture of women making choices to avoid judgment, to choose certainty. Scheduled Cesarean? Predictable. However in teaching about natural birth, it is impossible and foolish to make any promise of certainty. I cannot be certain about the intensity of your labor, how you will judge the pain, or how long your labor will last. As Pam England wisely said, and I’m paraphrasing here, birth is a series of hurdles and decisions that we cannot predict. Should we stay on this course? Change course? It’s quite complex. So I sit with numerous couples desiring a natural birth, without the mental or emotional tolerance for uncertainty.

So the question remains, how can we prepare for uncertainty in labor? And why do we seek this certainty anyway? A lot of this is covered in the Birthing From Within model. In preparation, you can develop rituals, routines to ground yourself and to quiet your mind. In Fields’ book, he notes that those with routines are actually the most creative, as routines decrease anxiety. So, take those pain coping practices and Practice! Develop connections in your mind, rituals around your practice, until it’s second nature and your mind knows instinctually how to cope. Train your brain to be still. Meditate. Paint. Play music. Learn to concentrate intensely but without effort. This is natural birth preparation.

Well that sounds pretty hippy-dippy, even to me.

So I opened up the question to the new mamas at the monthly Birth Circle Gathering. How can we prepare for the uncertainty in labor? What would you tell expecting moms? What helped you most, in preparing for your labor?

There was a shift, perhaps intense concentration on the question. Answers and ideas were not immediate. Here’s what was shared:

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“Read personal stories to help you feel connected. I remember reading the craziest birth stories, things that I never imagined would happen to me, and would imagine that.”

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“To be in yourself…very mindful. And prepare so that whatever happens doesn’t mean you’ve done anything wrong.”

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“We have all these classes for pregnancy and birth and then we have the baby…We should spend more time preparing for the baby!”

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Intrigued, I asked her how to prepare for the uncertainties that go along with caring for a newborn. “Ummm…well…As a new mom, we learn day by day, on the fly…and I don’t even remember how ignorant I was, as I sit here today….”

I love that. I really do. Isn’t that similar to birth? I just love that. During labor and birth, we learn on the fly. We can prepare, and that preparation is important, especially in preparing for our own psychological and emotional process. We prepare ourselves for an enormous transformation. “Dealing” with the pain is mostly an inner process, one that is difficult to describe and difficult to name, one that requires endurance and mental clarity, strength and stillness. How to prepare for labor’s uncertainty? Accept that there are some things that are unknown and inherently uncertain. Everyone's answers above were some form of "Accept Uncertainty."

One final note. The mom-to-be from the beginning, whom I truly have come to love like a sister, the one who I met with at a prenatal doula appointment, had her sweet baby last week. I attended her labor and as she was in active labor, with intensity exclaims, “There is No Way to prepare for this!!” Yeah. You got it.

What about you? What do you think? How do you prepare for uncertainty in labor and why do you seek this certainty in the first place?