Mental Fitness for Labor and Delivery

For most of us the impending prospect of labor and delivery is both exciting and frightening. It is easy to get caught up in a cycle of worry about every aspect of the process, including fears about the baby. There is a monster on Sesame Street named Telly Monster who frequently acts out this cycle of anxiety. This "Telly Monster anxiety syndrome", when applied to labor and delivery might sound like this, "oh no...what if my water breaks and my doctor wants to induce me? Oh no...what if I can't handle the contractions? Oh no! What if I need a Cesarean? Oh no! What if there's a problem with the baby? Oh no........" Does this sound familiar?  Unfortunately, this cycle only creates more anxiety. One of the ways we create and magnify worry is by inaccurate perceptions about the likelihood of a bad thing happening. In other words, we spend a lot of time worrying about things that are unlikely to occur. On the other hand, each of the concerns mentioned above are real, valid, and could happen. My intent is to help you plan for all the possibilities that worry you as your due date approaches. Another significant factor that increases anxiety is that we often minimize our strengths, such as coping skills, access to resources, and support systems. This increases our sense of vulnerability. Not only do we fear that something bad will happen, but we feel when it does, we couldn't cope or handle it. Creating a coping plan will help you see and be prepared to utilize a variety of coping tools. Many couples go into labor with a birth plan. While this plan is helpful in advising your medical and nursing staff of your preferences it is important to remember, as one OB/GYN told me, that "babies don't read the plan". Mental flexibility is a crucial part of mental fitness. One of the scary parts of the labor and delivery process is a sense of loss of control. Things don't always go as "planned". Having a trusting relationship with your medical practitioner and your partner, having a flexible attitude, and having a plan for all the contingencies you fear, will help lower the stress level.

Some wonderful research by Dr. Kathleen Mooney at the Center for Cognitive Therapy in Newport Beach can be very helpful in breaking this cycle of worry. She developed the "PR Plan" (c. 1992) for managing anxiety. The first step in the PR Plan is to PREDICT the feared events. Your list might include having an induced or very long or difficult labor, or concerns about needing a Cesarean Section or problems nursing. The second step is to PREPARE. Instead of the jumping into the "what if" cycle, say to yourself, "If X happens, I can....." For each prediction, make a list of all the positive things you could do; things you could say to yourself, support people and resources you could utilize to help you deal with the situation. The third step is to frequently PRACTICE in your mind each of these situations. See yourself using your plan to cope with and manage each situation.

Here are some frequent labor and delivery concerns I hear in my practice, used as examples of the PR Plan.

Prediction: Labor is more uncomfortable than I imagined, the breathing isn't helping, and I can't take it anymore. I planned to do a drug free delivery, but I am scared.

Plan: I will talk to my doctor in advance about my options for pain management. These options could include non-medication choices such as hypnosis, Lamaze, Bradley, or other childbirth preparation courses, and pain medications. I will include my partner/support people in this process so they will be able to support me in my choices. After the birth I will feel good about my choices, knowing I made the best decision for me at the given time of distress.

Prediction: What if I need a C-section? I will feel like a failure. I will feel like I missed out on a beautiful natural experience. I will feel cheated.

Plan: I will talk with my doctor in advance about the likelihood of my needing a c-section. I will ask my doctor about what kinds of things could come up during the course of labor that might indicate a c-section is necessary. I will discuss how a decision to have a c-section will be made, both on a non-emergency and emergency basis. I will ask about the role of my partner if I need a c-section, and when I will be able to see the baby. I will tell my doctor my wishes; I want my partner with me if I need a c-section, and I want to nurse as soon as possible. I will keep first and foremost in my mind that my most important goal is to have a healthy baby; the outcome is way more important that the process. I will remind myself that growing a healthy baby; eating right and exercising were in my control and that I did that very well.

Prediction: What if there is a problem with the baby? (Remember, it is important to plan for even your worst fear in order to be prepared, and reduce anxiety).

Plan: First I need to remember that the likelihood of a serious problem is quite small. But if there is a problem, it's OK to cry. I can ask my pediatrician for the best specialist in the area. I can find a support group to join and talk to other parents who have faced a similar problem. I can look on the Internet and go to the medical library and find out everything I can about the problem. I will call on my family and friends for emotional support and help. I will be able to be there for my baby. I will remind myself frequently that I did everything I could to have a healthy pregnancy and baby.

Instead of getting caught up in a tidal wave of fear, this approach will help you evaluate each concern and then create a coping plan in preparation. By having a plan you will stop the anxious spiral that keeps you stuck in your fears. It is my hope that after doing this exercise you will be able to think about labor and delivery with an attitude of increased confidence and flexibility.

References:

PEC INDMAN Ed.D, LMFCC, has a Doctorate in Counseling and a Master's Degree in Health Psychology. She is a Licensed Marriage and Family Counselor and formerly a Physician Assistant. Specializing in issues related to reproductive health, pregnancy and postpartum, Pec is a member of Depression After Delivery, Postpartum Support International, The Marce Society, and Postpartum Health Alliance. She is the mother of two girls.