We prepare the baby’s room. We pack our bags for the hospital. We spend time thinking about being home with our babies. We go to our weekly OB appointments to make sure our bodies are ready to give birth and growing our babies well. But how much time do we spend preparing mentally and emotionally for the process of labor and birth? Or for those first weeks or months being home with our newborn?

Birth is both a physical and an emotional process. It’s called labor because it’s work to bring your baby into the world, and a lot of that work goes on in your head. Women who are not prepared for this are more likely to feel scared or out of control during the process. Your thoughts, feelings, and expectations about labor and delivery can make the difference between a traumatic birth and a beautiful and empowered birth. So how do we prepare psychologically and emotionally for labor and birth?

Knowledge+support=empowered birth

1. Know what to expect.

Knowledge is power in that it keeps you from being surprised. It gives you the chance to consider decisions you may encounter and weigh your options, identify your preferences ahead of time. I have worked with many women who have come to me and said “I never thought that much about the actual birth. I just thought I would go to the hospital and have my baby. ” Feeling surprised, unheard, and that you have no control over decisions involving your body and your baby are two major contributors to postpartum PTSD.
So what information do you need to know? Think of this in three categories: labor, birth, postpartum. Find out what the policies are in the place that you will give birth that will affect you for each segment of this journey.

Labor– For example, when should you go to the hospital? Can you eat while you are there? Will you have an IV? Will it need to be connected the whole time you labor or just at intermittent intervals? Will you have constant monitoring of your baby where you will be hooked up to a monitor or can they do intermittent monitoring so that you will be free to move around when you need to during labor. (Intermittent monitoring leads it I better outcomes, btw). Will you be allowed to eat during labor? What are the risks and benefits of the different pain management options? Under what conditions will your doctor induce labor with stripping of membranes or pitocin? What are the risks and benefits of each intervention or procedure offered? Who will be with you?

Birth– Who do you want in the delivery room? When will the MD be there? Episiotomy or no? Under what conditions will a c-section be recommended? If you have a C-section who can be with you? Do you want the baby to be laid on your chest skin to skin or cleaned up and wrapped before being handed to you?

Postpartum- Who will be with the baby after the baby is delivered? How long will it be before your baby can be with you after you give birth? Will your doctor or midwife be there to deliver your baby or will it be someone else in the practice? Will you want someone to stay in the hospital with you overnight?

Our bodies are designed to give birth in safety. If we don’t feel safe our bodies find ways to stall labor. The more ways we can find to feel safe the smoother labor and delivery tends to go. Evidenced-based birth is a good resource for finding policies and procedures that have research evidence behind them to support healthy birth.

2. Know your options.

Assert them or find someone who can do that for you during labor (doula!). Women who have a labor support person have shorter average labors and request less pain medication. Make as many decisions as you can ahead of time, but hold them loosely. Birth rarely goes exactly as planned. Even with unexpected turns of events or interventions, knowing that they were possibilities, understanding why they are happening, believing that your birth can still go well, and trusting your caregiver can help you feel empowered through this transformation. Make sure you trust your birth professional. Don’t hesitate to change if you don’t feel comfortable.

3. Plan for support during labor and at home.

We need many different types of support to help us through this powerful experience. While you are bringing a baby into the world, your supports help you bring your motherself into the world. Partners often provide emotional support during labor, while doulas can provide practical and physical support.

4. Rehearse.

Whether you plan to have an epidural IV medication or go for a natural childbirth it’s important to prepare for the possibility of laboring without medical pain management. Thinking “I’m going to have an epidural so I don’t have to worry about it” is not adequate preparation. If you take any non-hospital-based birth preparation classes, such as the Bradley method, hypnobirthing, hypnobabies, or Lamaze they almost all use some form of focused concentration and relaxation. These only work when they are practiced on a regular basis. And lest you think that practicing the skills will be only for labor and birth, know that they are very helpful postpartum for coping with postpartum uterine contractions,the anxieties of being a new mother and for soothing your new baby.
Pain is very cognitively mediated. This means that if we expect pain our bodies tense up we are more likely to feel pain and the pain we feel is more likely to hurt worse because of both the expectation and the physical extension. Our thoughts about the pain also make a huge difference in our experience of it. For example if we think “I can’t take the pain!” Then this pain will be more scary and more painful then if we think “I can get through this pain. It will be over in a minute. I can breathe through it.”

5. Know your triggers.

What freaks you out, makes your nervous or uncomfortable? One in four women have experienced a sexual assault by the time they reach their twenties. If this has happened to you, is there anything that might be triggering for you in this process? If so, consider what you will need to feel safe and cared for in the labor and birth process. Consider whether you might benefit from a one-time consultation with a mental health professional to find ways to think about what is going to happen that help you feel safer or to cope with triggers if they arise.

6. Plan for a postpartum adjustment period.

Now is the time to take stock of all of your support and arrange for them as much as possible to help you during this time. Our culture is one of the few in the world that expects women to just “get back to normal” after having a baby. Often people will offer to help by saying “just let me know if you need anything after the baby comes. ” Take time to actually arrange with your supports for concrete ways they can help you after the baby arrives. This may mean planning for people to bring you meals every few days or arranging for someone to come and clean or do the laundry or even sit with the baby so you can nap. If you are short on supports in our community and have the financial means there are people you can hire (postpartum doulas) to help you with some of these things in the first weeks after you bring your baby home. It is also important to have reasonable and accurate expectations for what you’ll be able to do postpartum. If you underestimate what you can do you can always end up doing more. But if you overestimate what you will be capable of emotionally and physically it can lead to guilt, shame, disappointment and resentment. Nothing can really prepare you for the effects of severe sleep deprivation that is par for the course in the first few weeks after bringing baby home. For this reason alone the lower you can set your expectations for yourself the better.

7. Know the signs of a postpartum mood disorder.

Pregnancy, birth and the postpartum period can be wonderful, but there are many women who suffer, often in silence, during this time. While it is normal to have some anticipatory anxiety about labor and birth it is not normal to be consumed with worries, to be irritated all the time, to feel constantly overwhelmed. Many women ignore the signs that they are struggling emotionally during pregnancy assuming that it will go away once the baby is born. I hear often from clients “I did not want to hurt my baby so I figured I couldn’t be experiencing depression.” Many mamas with postpartum mood disorders feel very attached to their little ones. What we know is that women who have had depression, anxiety, or other mental health issues prior to or during pregnancy have an 80% higher chance of developing a postpartum mood disorder some time within the first year after their baby is born. If you and the people around you know the signs of distress you can get help sooner than later. I hear all the time from women in my office “I wish I had known that this was what was happening. I wish I had gotten help sooner. ”

Knowledge helps us make good decisions. For example most of us know that if we have a stuffy nose and a little cough it is probably just a run-of-the-mill cold that will get better on its own. But if we have a raging fever or intense pain we know that something else is likely going on and we probably need to seek medical attention. Mental health is a little less cut and dry. There is no thermometer that can tell you that you’re depressed or more anxious than you should be. This is why it’s often difficult for people to identify when they need to seek medical attention. For mental health it’s usually an issue of symptom severity, duration, and the impact of the symptom on your ability to do the things you need to do every day.

8. Remember that this a major life transition with the power to change your identity.

Having a baby, especially if it is your first, is not just giving birth. It is a transformative life experience. What’s the difference? Transition involves an adjustment from one thing to another. After the adjustment you are the same person – you have just made some adaptations to meet the new situation. Transformation involves change at your core. You are not the same in a fundamental cannot-be-reversed kind of way. Think of caterpillar to butterfly. We can’t see what goes on in the chrysalis. Everything looks the same on the outside, quiet…still. Then one day it becomes evident outwardly that a major change has taken place. Becoming a mother is like that. It takes time. Our bodies change – hips, breasts, bellies- but also our sense of self in the world once we have given birth to a new person. It is beautiful, it is hard work, and it is life altering in ways that words can’t fully describe. Recognize the depth of change happening, and give yourself grace for ways the process happens differently than you would have liked or hoped. That is the beauty in the birth. You come out the other side with a Motherself that did not exist before. Give her time to emerge. She will be beautiful.