A couple of weeks ago, I had the opportunity to drink coffee with two ladies who run a small women’s group for women in their twenties and thirties. I am now preparing as they kindly invited me to address the rest of their group tomorrow on the subject of pregnancy and birth. None of the group currently have children and many are now trying to conceive or thinking about it.

One subject that cropped up during our chat was fear. The fear of childbirth (tokophobia), fear of pregnancy and even the fear of trying for a baby.

When you think about it, these fears are justified. Pregnancy and birth is a life changing and somewhat unpredictable process. Infertility is deeply upsetting. Miscarriage is surprisingly common. Many of us live far from our mother or sisters and are the first of our social group to have children. Our first real experience of pregnancy and babies comes with our own. Yet there is a counter-argument that it is all completely normal and that women have been giving birth since the human race began.

But pregnancy isn’t all that normal in our society. Most women in the UK and the US will only do it once or twice in their lifetime, compared to some countries where women have an average of 6 or even 7 babies. (Niger has a birth rate of 7.19 and Afghanistan has 7.07 compared to the US at 2.10 and the UK at 1.66). My ‘hometown’ of Guernsey ranks only a little above China’s birth rate at 1.40.

Neither is the process of childbirth seen as normal, instead the American norm requires intrusive tests throughout pregnancy and a highly medicalised labour and birth which is ‘managed’ in order to proceed along a tightly defined curve and frequently results in major surgery.

Of course we all want the best outcome possible during pregnancy and childbirth, but our quest for perfection leads down some very odd routes and the climate of fear begins at preconception. “What if I can’t get pregnant?” My rather flippant answer of course is, “You’ll never know if you don’t try!” but this is where it all starts.

The ‘rules’ are laid down at the start and most of them are sensible and easy to follow – taking folic acid for example prevents a number of birth defects. Avoiding unpasteurised cheese reduces the likelihood of contracting listeria, stopping smoking improves outcomes immensely. But it doesn’t stop there. Many of the ‘rules’ are not evidence based. In fact, many of the ‘better safe than sorry’ rules (such as avoiding all alcohol during pregnancy or avoiding eggs altogether) arise from absolutely no evidence – just a misguided extrapolation that ‘excess alcohol is bad, therefore ALL alcohol is bad’ or ‘raw eggs are bad therefore better to avoid even possibly undercooking an egg.’

I have seen some immense anxiety because a woman had a couple of drinks before realising she was pregnant. The drinks were unlikely to do any harm at all, yet the fear kicked in. Fear and anxiety certainly have a negative effect – on blood pressure, heart rate and mood, all of which can also effect the baby. Yet the media feed on this fear, day after day feeding out non-stories based on misinterpretations of data and on theories rather than studies. Similarly, the medical profession fuel this climate of fear, abetted by lawyers and insurance companies. Pregnancy as an illness is a lucrative concept.

Another source of fear is the weighty sense of responsibility that goes with having a child. There is a perfect balance of physical fitness, ideal weight, financial stability, a suitable home, a secure relationship and career security that many of us long to attain before trying for a baby. Achieving these factors together is very difficult for most of us. When you throw in the time limits of peak fertility ages, it starts to look impossible. Then you have the woeful stories which await any woman who dares to get pregnant in her forties.

Of course we want the best for our baby, but sometimes you just have to go with ‘good enough’ – many women feel healthier and fitter naturally during pregnancy – the body does wonderful things to prepare itself for birth. And money and housing can be stretched.

Tokophobia, the fear of childbirth is the biggest fear of all for some women. It is considered a valid reason for an elective caesarean section and it is a fairly reasonable fear – after all, childbirth hurts. The situation is not helped by the portrayal of birth on television or by often exaggerated horror stories of birth. However ’secondary’ tokophobia is increasingly common. This is a fear which occurs in second or third pregnancies (or even later) and is rooted in previous birth trauma.

Birth trauma rates are rising dramatically and contribute to postnatal depression and other mood disorders. Birth trauma also significantly affects breastfeeding and bonding and has similar symptoms to post-traumatic stress disorder. While the term a ‘negative’ birth experience is somewhat vague, the causes may be very specific to a woman experiencing it. A sense of aloneness during labour, a sense of not being listened to, an arrogant or dismissive medical professional. Many women report that birth trauma arises from a sense of violation – a procedure or intervention that was conducted without their consent. For example, several women I have spoken to have found the amniotomy – breaking the amniotic sac with a ‘crochet hook’ like instrument to encourage labour to have been particularly traumatising, both visually and physically, although this is a common hospital intervention, albeit with limited medical evidence supporting its usage.

It is amazing to me that mortality rates are relatively low, yet birth fear is rising. Yet it is totally understandable. A normal hospital birth carries a high risk of birth trauma. Home births, birth centre births and doula attended births are all showed to greatly increase the mother’s feeling of satisfaction with the birth experience and reduce rates of postnatal depression.

The only way to ease the fear is to normalise birth. To show that it can be a safe, family centred event. To stop marginalising natural childbirth as a hippy or bohemian concept. To educate women that birth is a normal life event.

And most importantly that when left to its own devices, the body can do wonderful things. All the pitocin and medication are poor substitutes for the body’s natural hormones which are inhibited by fear and an artificial environment. When we labour in safety, our own endorphins are released freely and are a natural painkiller, helping us through the process.

What is clear is that in any stage from preconception right through to parenting a teenager, fear, anxiety and guilt are destructive, psychologically and physically. Take up yoga, take a hot bath, have a beer. But do try to relax.

It’s good for you!