Dear Doctor,

I am pregnant with my first child and almost due. The pregnancy has been pretty smooth but I can’t shake off the fear of child birth. I have been so worried lately that my appetite went down and I lost some weight. Any tips on how I can prepare myself mentally for what is to come?

Sandra

Accept my heartiest congratulations on your first pregnancy. Anticipating motherhood is indeed a very unique and exciting experience in any woman’s life. It also creates a lot of anxiety, regarding how the delivery will go, the child’s health, childcare, and etcetera. But major anxiety is prompted by the pain during childbirth.

Pain while giving birth to a child occurs due to uterine contractions and can indeed be severe. How long it will last is unpredictable. The duration can be from one hour to several hours, particularly during the first delivery. The tight muscles of the lower part of the uterus and vagina have to be slackened, birth canal is also broadened to facilitate the passage of the child. These add to pain and discomfort. Sometimes during the first delivery, if the vaginal tissues and muscles are very tight, they are cut open surgically (episiotomy) to ease moving out of the baby. This adds to the pain for a few minutes.

However, the pain perceived varies from one woman to another, depending on mental makeup and, tolerance to pain. Before the actual delivery, an expectant mother gets to listen to many horrifying tales of pain during delivery by other experienced women. Fearing it, many women demand a Caesarean section to avoid pain. However C-section is a major surgery and carries all risks of any surgery during and after the procedure. The recovery is also delayed as compared to a normal delivery, hence C-section is best avoided, unless there is a strong need.

There are certain ways which can help in reducing the pain and or fear of pain during delivery. Taking a balanced diet, which would meet the increased demand for nutrients during pregnancy keeps the body healthy. Regular physical exercise, such as brisk walking, yoga, keeps the joints supple and flexible.  This helps in easing the labour pains as stiff joints cause more pain when in labour. There are specific exercises in yoga to help reduce the labour pain. Deep breathing done regularly helps to keep the mind calm and prepare to face the forthcoming pain.

Attending regular antenatal clinics is useful. There, a pregnant woman gets to see several others in her predicament. Listening to their anxieties, fears and anticipation of joy, can take off the stress from one’s mind regarding pain during childbirth. Professional counsellors can also help in reducing the anxiety.

Women with much anxiety regarding the pain can opt for epidural anaesthesia during labour. However, it carries the risk of giddiness, backache, weakness and numbness of legs after delivery.

Dr. Rachna   Pande is a specialist in internal medicine.