Take a walk down the hall of a busy labor and delivery unit on any given day and you’ll most like hear an interesting mix of sounds.

These include the lusty cry of a newborn, cheering and coaching from staff and families, low moans and growls from laboring moms, and the inevitable yelling and screaming often associated with women in active labor.

Women handle labor and birth in different ways. Some work through the contractions quietly, need no pain medication and make it look very easy. On the opposite end of the spectrum are the women who scream and cry throughout labor and birth, even after effective epidural anesthesia.

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Most women fall somewhere in the between these two extremes, but I’ve found the strongest predictor of how a woman will handle labor is her level of fear.

In his controversial 1942 book Childbirth Without Fear British obstetrician and natural childbirth pioneer Dr. Grantly Dick-Read outlined the fear-tension-pain cycle theory. His theory suggests that fear creates tension, which in turn increases pain, which in turn causes more pain and the cycle continues.

Many modern childbirth preparation courses such as HypnoBirthing® use this theory as the basis of their education. The goal is to help parents, particularly expectant mothers, eliminate fears surrounding childbirth and parenting prior to giving birth.

Last year, BJOG: An International Journal of Obstetrics and Gynaecology published a study about the impact of fear on birth. The findings suggest that women who have a fear of birth experience longer labors and a higher incidence of cesarean delivery than women with no fear.  

I think that most seasoned labor nurses, midwives and obstetricians would agree that fear often plays a huge part in the course of labor. Often, simply getting a laboring mom to relax, either with a shower, slow breathing or epidural anesthesia can help labor progress more quickly and smoothly.

I will often inquire about my patient’s fears during prenatal visits in the third trimester. Encouraging women to explore and address fears can help them overcome their apprehensions before labor begins. 

Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.