As the doula, it is your job to make sure that a laboring woman is adapting well to the stressors that are placed on her during labor. Anxiety and stress can be beneficial, as noted above. It moves the woman to action when needed, it produces endorphins to help her cope, it can give her strength and determination when she is tired or fatigued. Anxiety becomes maladaptive when it interferes with the birthing process. This can happen when it causes muscle tension that slows down labor, uses up the woman’s energy stores, or interferes with the transfer of oxygen to the baby. Thus, it is the signs of maladaption that you need to focus on rather than whether or not she is actually experiencing stress or anxiety.
Physical signs of maladaption include a high heart rate or blood pressure that may become harmful, the babies heart rate begins to decrease during or after contractions, a slowing down of labor when it has been progressing steadily, and fatigue that makes it difficult for the woman to cope with labor.
If a woman has been determined not to use pain medication, the desire for pain medication may also be a sign that anxiety is no longer working with the woman’s body, but against it. In this case, it may be necessary to try both medical and non medical means to help her adapt successfully to labor and birth.
It is important to assess what their fears and anxieties are and how they usually deal with them before labor even starts. This will give you an idea of what works best for that particular woman.
In general, anxiety should not be viewed as a good or bad thing, but as a normal human response that can sometimes hurt and sometimes help a laboring woman. As doula’s, we should make sure that we are looking for specific signs of maladaptive to help guide us in how we help our clients.