Episode 31: Disrupting the Fear-Tension-Pain Cycle

You might have heard of the Fear - Tension - Pain Cycle -- it's one of many different ways to conceptualize methods for making labor more manageable and keeping labor progressing. In this framework, fear, tension, and pain contribute to each other, with fear making you tense, tension causing more pain, and more pain causing more fear, etc. So we have to disrupt the cycle!

To disrupt the cycle, we do the following:

• Intercept fear with education
• Disrupt and release tension with relaxation
• Reduce pain with labor coping strategies & partner support

Next week we'll discuss some coping strategies and specific relaxation tips for labor. I put together a cheat sheet for birth partners to remind them of what to remind you during labor! I'll share that with next week's video.

See you next week!

Full Transcript:

Hello, and welcome to your next episode of the free weekly, brave journey, birth preparation videos, where I pick a topic related to birth and postpartum and I talk about it. Today we are talking about disrupting the fear, tension pain cycle. So. Now, this has been used as an explanation for why our relaxation techniques and coping techniques, strategies, tend to work during labor.

And it's just one additional way to think about labor and coping strategies in labor. Next week, I'll be providing some tips for labor and they include some specific strategies. But in this, we're going to talk generally about this concept, how fear contributes to tension, tension contributes to pain, pain contributes to fear and how we cut through this cycle to make labor more manageable and progress. I'm Cara Lee I'm a birth doula and a childbirth educator. Let's get started.

So first off, have you ever seen this diagram, the fear tension pain diagram. I'm going to pull it up right here and show it to you. As you can see in this diagram, you've got fear. It's like a triangle. Fear is on one corner. Tension is in another corner and pain is in the last third corner.

And as you can see the concept here is that as you become more afraid, you become more tense. Or as you become more tense, you feel more pain. And as you feel more pain, you feel more fear. And as you feel more fear, you feel more tension and that this con this, the cycle, it makes things harder and harder and labor.

And so the goal is when thinking about labor within this concept, There's so many different ways to think about labor and labor coping. I like to offer them all. So the way to think about disrupting this one is just cut through it. And the way you cut through it and you stop this cycle is with, I'm going to give you some four main methods and means of doing so.

The four are education, relaxation, coping strategies, and labor support. So we'll go through them one by one.

Education. The more you know about labor, the less fearful you will be. The more that, you know, you can decrease your fear. You can decrease your fear of the unknown. So we'll learn about how labor tends to progress.

Learn about some of the interventions in our modern medical world that you may be grappling with or navigating as you birth your baby in our modern medical context. And just learn about how labor sensations had to work and learn coping strategies that tend to help reduce the sensations of tension and pain in labor.

Doing that ahead of time will help you so that you're not walking into something completely blind. So you're not walking into your labor expense. Thinking with your contractions 20 minutes apart that it's time to race to the hospital. So you're not in the hospital with, um, with transition style, contractions thinking that something's totally wrong because your contractions are back to back when the fact is that when your contractions are back-to-back, something is usually really right. That means your baby is close to it. And of course, these are all I'm giving you more norms and "usually"s and how things tend to go. And everybody's experiences a little bit different. You never know how your experience is going to go, but I'm giving you examples of where having a little bit of education will help you hugely in your mind state and how you interact and navigate with your modern medical system, wherever your birth of your baby hospital, birth center, doctor, midwife, home midwife.

But how you navigate will be changed by having some knowledge ahead of time. No, you're not going to be an obstetrician by the time you finished your pregnancy and have learned all the details, but you'll have learned enough. So seek out a birth education class.

I offer the Brave Journey Birth Preparation Program. Seek out a class in your community. And find read books. If books are your thing, for some people, books, aren't their thing. So just however you like to build your knowledge, listen to podcasts, watch all my videos, all these free videos, whatever you like to do to build knowledge, do it.

Next relaxation. So relaxation, what we're going to talk about next week are some specific strategies, but it's if your hands are clenched, unclench them. If your jaw is tight tight on unclench your jaw. If you're standing up on your tippy toes, lower your heels, release your pelvic floors, sway your hips.

We'll talk about these next time in detail. I give a tips like a cheat sheet for partners to, to help remind you. But these are things you can do to relax your body. And by relaxing your body, you're going to decrease tension. Decreasing tension is going to decrease some of your pain. So, this is how we cut through the cycle.

We cut through the fear with education. We cut through the tension with relaxation and coping strategies and specifically coping strategies. That's our next one.

Coping strategies include a whole gamut of things that you can do to help work through your labor. They're positions, there's breath work.

There are visualizations. There's hypnosis. I'm of the opinion that it all works. If it works for you. And if it doesn't work for you, then it doesn't work. So if you really are drawn to hypnosis, by all means, go seek out a professional hypnosis course. If you're really drawn to positions, take a P take a class from somebody who's going to teach you different labor positions.

That's more where my background comes from as a yoga instructor, I'm more drawn to talking through positions and body movements. So there's lots of different ways that you can cope through your labor. There's also hydrotherapy, which is just fantastic for everybody. Showers and baths in labor feel fantastic. There's so many different coping strategies and pain medication is a coping strategy. Now, in the traditional way that people like to talk about the fear tension pain, they're talking about unmedicated birth. But what I want to see is that somebody is getting through their labor feeling that they are managing it, however they want to manage it. So coping strategies include pharmacological pain relief, and there's no shame in that. There's there's benefits and there's risks to pharmacological pain relief. And you just navigate that with some education. Back to our first point.

Next or last is labor support. So labor support is huge. I'm biased. I'm a birth doula, and I think birth doulas are hugely essential. There is some fantastic data though, that doulas both are statistically proven. There is solid data. It's good research that doulas will decrease your labor time, decrease your use of pharmacological pain relief, if that's your goal, and generally improve your experience and your perception of your experience after the fact. So they doulas have a huge effect, a positive effect. Now doulas are professional labor support. You also have your, amateur sounds rude, but I don't, I don't know. There's gotta be a better word than amateur, but you have your nonprofessional labor support, which is also important. This would be your birth partner, or any people that you want in the room to support you.

Now, I'm going to be real about the context we're in, we're still in a COVID context, I'm recording this in 2021. And there are hospitals that are still limiting the number of people who can be there as your labor support people. So you might have to pick carefully, but your co-parent could be your, your, your birth support person, your birth partner, your, uh, your romantic partner, the person who's also going to parent the baby, or it could be somebody else in your life, a best friend or a family member who is there to support you, who knows enough about birth, that it's not going to scare them, and they're not going to contribute to the fear in the room.

But can be there to support you and help you navigate this process and really make you feel like you're in a cocoon of support and safety. That's what your doula and your labor support person do. Your birth partner do together. Create this cocoon of safety for you to just move through your labor. Use your coping strategies, relax into your contractions. Use the knowledge as it's available to you. But also you got to turn your brain off sometimes at some point in labor and just really work with it. But those are those strategies.

So this is how we disrupt the tension, fear and pain cycle. So instead of each contributing to the other, we disrupt fear with knowledge, education. So educate yourself prenatally.

We disrupt tension with relaxation.

We disrupt tension and pain with coping strategies, with the, some of the coping strategies. We'll talk about next week with, when we talk about tips for labor and others are more complex. And so you can dive into that.

And we disrupt the fear tension pain cycle with our labor support, whether it's a professional labor support person a birth doula, or with your lay, that's the better word than amateur then your lay birth support person, the non-professional, but still, hopefully someone, who's important to you and who can help you feel that sense of safety and support.

Okay. That's it for this week, I will see you next week.