Being really scared during labor can impact how things progress (or don’t).
If you’ve ever given birth, you might think the word “stressful” in relation to pregnancy, labor, and delivery doesn’t quite describe the experience. When I asked folks if they had felt anxious during birth, many of them told me they could not have pictured feeling any other way. K said that while delivering her second child, she felt nauseous and had to be given oxygen, and she was “wigging out. Like, I don’t think I can do it this time! But I was delivering a human being out of my vagina without even an aspirin for the second time in my life!” Later, she learned that what she was feeling was due to a hormone surge, borne out of fear, pain, and exhaustion. She was, she said, still totally responsive to those around her and her labor progressed normally.
When labor doesn’t progress because of extreme emotional or psychological stress, that’s a condition known as emotional dystocia. Extreme stress causes catecholamines, hormones produced by the adrenal glands, to rise, which reduces circulation to both the placenta and the uterus, and can render contractions ineffective, increasing the need for a c-section. Indications of emotional dystocia include fear and anxiety during labor (a reminder here that being afraid of pregnancy and birth is normal), being unresponsive, screaming, throwing things, and feeling unsafe. A 2012 study published in the BJOG: An International Journal of Obstetrics and Gynaecology revealed that there’s a link between a fear of childbirth and the length of one’s labor – specifically that if you’re afraid, you’re more likely to have a either an emergency c-section or an instrumental vaginal delivery (that’s a birth with assistance via either forceps or a vacuum device).
Ruth is a Labor and Delivery RN. She’s worked for 13 years in hospitals from California to Virginia, and has seen many cases of emotional dystocia. “Labor is a physical process,” she says, “but like all things physical it is definitely linked to a woman’s emotional and mental state.” There’s absolutely a connection between past trauma and the experience of giving birth. “I have sat outside a room and discussed with nurses, doctors, and midwives many times what is holding a woman’s labor up. Many times we do discuss possible trauma whether it is something the woman has shared with us, or is suspected.”
Trauma most likely will present itself well before labor, says Ruth. If a person is resistant and/or anxious at a vaginal exam, or another common procedure, that can be a hint that something is up, and it’s a reason to believe emotional dystocia might take hold in the future. Trauma can also manifest in conditions like vaginismus and vulvodynia.
The term “emotional dystocia” wasn’t familiar to the folks I talked to for this piece. It’s possible that it just wasn’t an issue for them while they were in labor or before, but according to Ruth, it’s not something providers discuss with patients.
“The medical view is that birth is a physical process fraught with dangers that need a doctor’s skill to intervene and ‘actively manage.'” Many physicians still operate according to how they were trained 5, 10, 30 years ago. So much depends on the culture of a hospital and its physician’s values and nurse’s values. So much also depends on the awareness of a patient population.” Because how physicians and nurses behave is so closely related to culture, many simply aren’t trained to pick up the signs of emotional dystocia, which also include being intolerant of even minor interventions during labor.
Addressing emotional dystocia, and preventing it, looks a lot like how a doctor might help a patient who’s anxious in general about medical procedures, taking into consideration that the person may have a history of trauma. “Waiting for consent, asking permission to touch, always,” says Ruth. “Minimal invasive procedures and exams, and when something is necessary, taking the time to explain why it’s happening, what it will involve, what it will feel like, instead of just informing someone that this thing is going to happen, and then putting a woman in position of feeling like she is resisting or being ‘bad’ if she says no.”
A 2003 study in the Journal of Perinatal Education recommends that childbirth educators and doulas employ techniques to address stress during labor with pregnant people, including meditation and yoga, encouraging pregnant people to talk to one another about their fears around birth, and recognizing when a person should be referred to a mental health professional.
An epidural can be useful for someone experiencing emotional dystocia during labor, but Ruth points out that just because you can’t feel pain, doesn’t mean you can’t still remain tense and continue to impede labor. It’s super important, she says, to know when to talk a person through their feelings, and when to give them space, so that even when things get overwhelming, the patient is still able to feel seen as a human with needs. “What is beautiful to see is a woman who can rest into the process and heal from past traumas through holistic care in labor, whether from sensitive midwives, doctors, or nurses.”