Emotional Safety in Birth

Emotional safety in birth is just as important as physical safety, yet it is something that is not given nearly as much consideration in maternity care systems (yet - I believe we will get there!).

Birth - no matter how we give birth - is raw, emotional, and very vulnerable. We have to open ourselves up to let the process of physiological birth to unfold. Even when we have a surgical birth, it is very intimate having so many people in your personal space. Emotional safety is created by having people with you whom you trust and feel safe being vulnerable with, who support you.

For physiological birth to unfold, we need three things: we need to feel safe, private, and unobserved. These things will allow that oxytocin to flow, to allow the process of birth to unfold. Unobserved doesn’t mean that we don’t have people with us - it means that the people we have with us are people that we trust and who we feel safe enough to be vulnerable with. These people who can hold that space for us, and witness us in the flames of birth, without trying to rescue us or project their own fears or beliefs into the birth space. These people need to be rock-solid in their belief of us, who know us and trust us, who know our wishes, and tools and who can offer them when required (not ask - asking a question will pull you out of the primal parts of our brain where birth needs to flow into the thinking part of our brain to answer the question, which can interrupt the flow of birth).

Being witnessed in birth is really important because it is such a deeply transformative event, and many describe it as a rite of passage. Being witnessed through birth can be important for so many women as an acknowledgement of what they have been through and their strength (no matter how you give birth, it takes incredible strength and resilience, which should be acknowledged). Being witnessed by a trusted support person is different to being observed by an unknown care provider where there is no trust present.

This beautiful photo (by Cat Fancote) is a beautiful image of emotional safety. This beautiful woman is in it right there. She's feeling those physical sensations, and her emotions are flowing through her with them. And now look at the man holding her. He has her. He's not running away from her emotions and vulnerability. He's right there next to her while she's in the fire. She is completely vulnerable and open, and he's holding her in it. He's not trying to save or rescue her, he's just there with her.

That is emotional safety.

Birth is intimate. There's a saying that how baby got in is how baby got out. Intimacy, trust and vulnerability is the optimal way we would want to conceive a baby, and it is definitely the optimal way to give birth.

So ideally, you would want to feel that level of safety with every single person with you in the birth space. Obviously your partner, but any support person that you have with you, be it a friend, sister, mother or doula.

If we could have that level of trust and safety with a midwife as well, that would be considered the gold standard of maternity care, which is what consistently demonstrates the best outcomes for women and their babies, both physically and emotionally. This is not always possible when we have systems set up with fragmented care, where you see a different midwife and doctor at every appointment, during your birth and after baby arrives.

However, this can be mitigated by having support people around you who can act as a buffer of safety, as long as they are an emotionally safe person for you. You might even be able to develop a trusting relationship with the midwife assigned to you on the day, particularly if you feel like they are on board with your birth plan or map, and go out of their way to help you feel comfortable.

If at any point you have a person who you do not know or trust come into your birth space, this is when we might start to feel observed - maybe their body language is off, the tone of their voice doesn’t vibe with you (too cold or too gentle etc) or you feel judged, this can interrupt the flow of your oxytocin. Maybe they can even feel threatening, which can cause your body to release adrenaline, which will slow or stop the flow of oxytocin, which can slow or stop your labour. Having tools or strategies in place if this happens (for example if your midwife goes on break and you get a relief midwife) can help to mitigate this feeling. Going into the bathroom and sitting on the toilet can be helpful (the toilet is often called the ‘dilation station’ because of the way we instinctually relax on the toilet can help things along really well) - even if you don’t need to go, no-one will think you weird if you decide to sit on the toilet for 15 minutes because of this, and you might find it really helps! Turning out the lights doing this can help boost oxytocin and be really helpful as well. Getting in the shower or bath can be really helpful as well for both pain relief, as well as to help give yourself some space because no-one wants to get wet.

Having a sign on the door to knock and wait for the midwife can also be really helpful as sometimes staff forget this as they are so comfortable in their workplace, to make sure they don’t just walk in. If you are in the midst of labour and a healthcare professional wants to have a conversation about how things are going and you are struggling to hold the conversation, have you partner ask them to step out of the room to have to conversation for you. They can then advocate for you using you birth map and what your preferences are, or summarise if the clinical picture has changed to get the message across in a gentler way that is easier to digest when you are in it.

Emotional safety also means feeling safe within yourself - trusting your body to carry you through it, trusting the birthing process, and having belief in yourself and your ability to hold it all. For some this might come naturally, for others, some deep excavation through any fears and beliefs might be necessary. Birthing classes - hypnobirthing or active birth, can help to develop trust and understanding in the birthing process, can also be really helpful.

Addressing fears and beliefs head on is really important, because they will come up during the birthing process to challenge you. If you would like some support in this, please feel free to reach out in how I can support you here.

Image by Cat Fancote | Capturing Birth https://birthphotographyperth.com.au/