Birth anxiety: what to do when you’re expecting the worst

Mental Health

Birth anxiety is a common experience, but it doesn’t have to rule you

Birth anxiety is extremely common – thought to affect up to 80% of women, with a further 14% experiencing ‘tokophobia’, a severe fear of childbirth. And, if we take a minute to consider where this fear might come from, it doesn’t take long to come up with some hypotheses.

“When we think about the images and perceptions of birth which flood our subconscious from early childhood, it’s no wonder labour and birth are surrounded by feelings of fear and apprehension,” says Samantha Phillis, counsellor, midwife, and hypnobirthing teacher. “Women are usually portrayed as helpless, screaming in agony, relying on another person (usually a man, like a doctor or husband) to rescue them. Normal labour and childbirth are, quite frankly, not dramatic enough to make ‘good television’.”

Samantha goes on to explain how, even in supposedly ‘real’ portrayals of birth on mainstream television – One Born Every Minute being one example – what you see on the screen is likely to have been edited to ramp up the drama. “Women are usually in the ‘lithotomy’ position (on their backs with their legs in stirrups), lots of people in the room telling them to ‘PUSH’, with a lot of noise and seemingly a considerable amount of drama.”

But the consequences of this kind of culture are more sinister than simply making the whole thing look a bit unappealing.

All those stories, sometimes passed down through the generations – of births gone wrong, near-misses, emergencies, accidents, and trauma – stick with us. Those stories help to continue the cycle of fear, and that fear can become self-fulfilling.

“Physically, the effect of anxiety can actually increase how we experience pain,” Samantha explains. “When we are tense, we reduce the amount of oxygen flowing to our muscles (known as a state of hypoxia) which increases the experience of pain.”

She points to Grantly Dick-Read’s description of the ‘fear-pain-tension’ cycle in his 1921 book Childbirth Without Fear – which outlines how the more that we fear the pain of birth, the more tense we will feel and therefore the more we will experience pain. What’s more, fear can also prolong the labour, caused by the release of adrenaline when we’re frightened.

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“One of the most important hormones we require for labour to progress is oxytocin,” Samantha explains. “Oxytocin is a shy hormone that needs privacy, dim lights, and for you to feel safe in order to work effectively. When adrenaline is released, oxytocin is inhibited, therefore labour will slow down or even stop if women do not feel safe.”

When it comes to tackling birth anxiety, Samantha has plenty of practical tips – including avoiding negative stories, reworking your mindset, and building support systems – but she also highlights how the key to having a more empowered and positive experience is having trust in your body and your instincts.

“We kind of ‘overthink’ birth, which can interfere with the labour process,” she explains. “Just like with breathing, urinating, or opening our bowels, we can do these things without thinking about them, but we can also have conscious control over them. The same applies to birth.

“Think about other mammals and how they birth. Cats, dogs, horses etc., all go to a quiet place, make a nest, and birth. Sometimes they will need intervention, as will human births, but a lot of the time they are just able to birth. Human births are slightly more complex due to how we have evolved and the shape of our pelvis, hence why women have birthed with support throughout our herstory. However, the majority of women can birth their babies when provided with a safe, supportive, private environment, whether that be at home, on a midwife-led unit, or in a hospital with doctors.”

Samantha recommends looking up positive birth stories on YouTube and elsewhere on social media – as those can give you some insight into what this might look like, and what you can expect. But she also recommends finding your tribe IRL, too.

“If you attend antenatal classes, you are likely to be surrounded by like-minded people, so share stories and tips for coping in labour with each other. Hypnobirthing is a great method for ‘quietening’ our new brain (neocortex), and allowing our ancient brain to get on with the process of birth. Although the term ‘hypnobirthing’ may sound a little ‘out there’, it actually just refers to antenatal classes which educate about pregnancy, labour, birth, and postnatal support – and includes techniques to tune-in to processes your brain and body are naturally able to do.”

Ultimately, no two births will ever be the same, and interventions and C-sections can be life-saving and equally positive. Through it all, if you have knowledge, choice, and trust, you’re in the best position possible.

If you are finding your anxiety about birth is intruding into your thoughts on a daily basis, and you are struggling to function due to intrusive thoughts, you may find you need more specialised support. Speak to your midwife or GP, and explore how talking therapies can help.

If you’re supporting a pregnant person, Samantha suggests…

“If you are supporting somebody who is pregnant, help them to surround themselves with positive images and stories about labour and birth. Encourage friends and family members to only share positive stories, and ask people to not share scary ones.

“Be kind to your loved one. If they share their worries or concerns, listen to them and try not to minimise those fears. Remember that throughout a person’s life, they have likely only heard and seen images and stories of birth which are fear-inducing, so even if you have attended hypnobirthing classes and know all the facts around birth, women and birthing people are still likely to feel apprehensive with the impending birth – so validate these feelings while also gently reminding them of what you learnt together.

“When labour starts, remember the techniques you learned together in classes, and use these techniques, allowing your labouring partner to be however, and wherever, they need to be. Being supportive means trusting your partner and your partner’s body, but also advocating for them if they do not feel able to advocate for themselves. Labour and childbirth can be an incredibly vulnerable, as well as empowering, time – and knowing your partner and having been on the journey together, you are the best person to be the voice for your partner if they are unable to be.”


If you are struggling with anxious thoughts about your birth, visit counselling directory for more information or to speak to a qualified counsellor.

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