“The Confidence Method" - How to lessen fear and stress during birth
        
Background
The foundation of the book “Confident Birth” is that the knowledge of how to give birth already exists in the female body. On the other hand, feelings of fear and stress too often block this inherent ability, due to the fact that these feelings trigger powerful survival mechanisms. The fact that more and more women today are experiencing fear and stress before and during childbirth is a well-known phenomenon within the maternity care sector. The problem has been how we can support and help birthing women to change these negative spirals that are created by stress and fear.
 
Aim
The process of Confident Birth will not only deepen the understanding of how fear often has a negative effect on the delivery, but will also provide a solution, that is based on physiology and modern science. The method is unique and has already been taught at several midwifery schools in Sweden, at conferences in Sweden and abroad, and to staff at maternity wards in Sweden.
 
Method
The method and book offers knowledge and practical training in how to detect, change, and disrupt or break stress patterns. The method used is based on physiological knowledge about the role of the autonomic nervous system in birth and the existing evidence about the importance of support during birth.
 
The method “Confident Birth”

Is a well-known phenomenon within the maternity care sector, that increasingly more women today are experiencing fear and stress before and during childbirth. The problem has been how we can help women to change these negative spirals that are created by stress and fear. Confident Birth will not only deepen understanding of how fear often has a negative effect on the delivery, but also provides a solution, based on physiology and modern science. The Confident Birth method is a modern approach to birth, that is built upon a knowledge of the female physiology and so the knowledge of the importance of support. The method is unique and has already been taught at several midwifery schools and to staff at maternity wards in Sweden.

The starting position of the method is the notion that women already know how to give birth and that everything is completely set in stone for the last 30,000 years. However, there are emotions that may block this inherent ability. One such very powerful block is the combination of fear and stress that have their evolutionary task of warning us of danger. However, just as there is a stress system that is linked to the feeling of fear, there is also a system of peace and calm that is connected to the sense of security. So just as stress and fear may impact on this natural ability and stop it from initiating. Other emotions, such as confidence, peace and calm can help the body to nurture and open up this inherent ability.We can see the stress reaction as a physiological directive of “no” from the body (i.e., it is not safe to give birth) and the system of peace and calm as a physiological directive of “yes” from the body (i.e., it is safe to give birth). This connection is shown by the choice of the most important hormone, oxytocin that is linked to the feeling of “security” during labour.
Knowledge of both of these normal conditions is the core of the method, along with the knowledge of how to change and influence these conditions so that the body can get access the inherent ability. The method and book offers a unique understanding and training in how to detect and break stress patterns with the help of four practical tools. Each of these tools is designed to activate confidence and safety in opening up the inherent capacity to give birth within the woman. 

Instead of learning a technique needs to be put into practice, the method uses the physiology that already exists in the body and the knowledge of how it can be activated. The method is, therefore, simple to use while being extremely powerful and effective, since the physiology is the same in all-human bodies. For example, nobody can hyperventilate and feel safe at the same time.

The stress response - Fight or Flight
An important cornerstone of Confident Birth is that it is not the pain in childbirth that is the problem, but the reactions linked to the pain, and above all the fear and stress. Why is it like that? Well, that fear triggers a stress response that sends out signals in the body that there is the potential for a threat, or that there actually is a threat. Stress hormone rushes throughout the body and the body prepares for escape. This is the so-called fight-or-flight reaction. It is an ancient reaction that was once necessary for our survival, and this is still true in some countries. The idea is that we should act and move, and put ourselves into a mode or place of safety. Once this is done, the new signals will be sent out with the message that it is safe to give birth and that everything is as it should be within a safe situation. Thus, one can see the stress reaction as a physiological “no” from the body - that it simply is not safe to give birth at that time. The body does its job, and is trying to hold back until we are in a mode and place of safety and security again.
 
A negative spiral
Today, in our modern countries even if there is no external threat remaining, we still have these powerful survival mechanisms in our bodies. Many women still feel normal emotions such as fear before and during birth. Many times this fear is connected to the fact that we are not used to handling pain in the modern world. But, the body does not understand that this fear is not related to any external threat, and the body simple responds to the messages of fear and then activates the fight-or-flight response. Hence, even if there is no “real” threat to the body, the body still responds to fear and cannot separate the real threat from the threat that now lives within itself. The body simply carries out its job of protecting us from danger. This creates a negative spiral of stress that is continually in a state of increasing acceleration. Since survival is the most powerful mechanism that we have in all situations, this reaction is expressed throughout the body. Breathing increases, the body goes tense, lifting from the ground, the voice becomes light and mind is set to be worried. The thinking processes go into a mode of tunnel vision. The feeling of security, which is the signal that everything is fine, and that it is safe to give birth, becomes absent. When the state of natural liberation from whatever is triggering the fear response never happens, then the individual gets stuck in this downward spiral. The pain leads to fear, which leads to stress, which leads to more pain that constantly circulates in a repetitive cycle of events. Moreover, many individuals believe that the sense of chaos and fear is naturally related to the act of giving birth, when in fact it is due to a normal stress reaction.
 
The opposite of stress is security
But just as there is a stress system that is linked to the feeling of fear, there is also a peace and calm system linked to the feeling of security and confidence. This powerful system is the body's physiological  “yes”. Therefore, after 30,000 years of human evolution, the body has chosen the hormone that is linked to everything that makes us feel confident that our childbirth is going well. The hormone Oxytocin that controls the entire contractions is the hormone, which is also the hormone that is connected to a feeling of security within the body. But, we do not always, and sometimes never, link childbirth with any feelings of security and confidence. Yet Oxytocin is the hormone that the body has chosen, simply because we are supposed to give birth when we are feeling safe and confident. So the reason for this is linked to the basis of evolution, that these feelings tell the body that it is the best chance for survival for both the mother and the child; we can activate the inherent ability we have to give birth. But, this hormone is not just taking care of the birth. The body is, of course, meant it to work at an even deeper level. It is the strong Oxytocin that activates bonding, breast feeding, emotional ties, wound healing, sleep, recovery, and so much more.
 
The Confident Birth tools
The aim if the method is to focus on leading the body towards the feeling of confidence in each contraction, because that feeling tells the body that it is safe to give birth and that everything is as it should. By understanding how this is connected, women can avoid falling into chaos, stress, fear and panic during labour. The tools in the methodology use the connection between our emotions and our bodies to create an empowering and positive birth experience. In order not to fall into the negative spiral that stress and fear can cause, the Confident Birth tools simply use the opposite of stress and fear, which are the system of peace and quiet, and the feeling of confidence. This is unique to the method and it is based on the human physiology. The tools use the relationship between emotions and their bodily expression. Each emotion has a bodily expression, which is an underlying feeling. By using the body language for security, the feeling is realised, which in turn opens up the inherent ability and the body allows the birth to take place. All of the physiology is now working to maximise the ability to give birth.
Simply put, it is all about daring to act in the opposite manner, instead of following in the automatic and normal reaction that can occur in the face of pain, when it is easy to tense up, breathe in a forced manner and to feel chaos. This opposite manner is to work with the contraction instead, breathing softly, being heavy in body getting and instead handling the pain and any degrees of its intensity. The function the tools have, thereby, is to lead the body away from fear, and towards security and confidence. The support is all around and holds together the whole process, protecting the experience of giving birth and is an important tool to keep the course of the birthing process on the path towards security and confidence.
 
The four tools of Confident Birth are: 1) Breathing; 2) Relaxation; 3) Voice; and 4) The power of the mind, around where there is support.
 
The Breathing Tool
Instead of focusing on the way in which we breathe, as some older methods do, the method focuses on breathing quietly and calmly during contractions, so as to stimulate the sense of security and to avoid the risk of falling into a state of hyperventilation. By breathing slowly during contractions as we breathe during our sense of security, peace and confidence, we are creating as much distance as possible from stress and fear. To avoid stimulating stress and fear, we two authors have, over the years that we have worked with birth, seen that it fills a very important function of learning to deal with the pain and using a breathing pattern that is as far away as possible from how we breathe when we are stressed and frightened. The confident birth methods have a soft and soundless breathing pattern, which aims to encourage an internal system of peace and quiet together with the important hormone Oxytocin. By breathing during contractions, as we breathe when we have feelings our security, peace and tranquillity, creating for the woman as much distance as possible from any stress and fear, and consequently, the risk of “falling” into a state of hyperventilation decreases.
 
Respiratory Physiology
Breathing is controlled by an incredibly sensitive physiological mechanism and it is handled automatically, based on how much or little oxygen needed we need for whatever we are doing. For this reason, we do not breathe loudly and in a rushed manner when we are relaxed home in the living room, but we breathe faster when we run to the bus, for example. It is not something that we constantly think about. Breathing is also strongly linked to our feelings and we breathe differently when we are feeling safe, compared to when we are feeling scared or stressed. Many believe that it is good to breathe a lot in order to oxygenate properly. But, if this is outside of the framework of supply and demand, it has the opposite effect instead. It is not the intake of oxygen, which is negative in a rapid and forced breathing, but it is the exhalation of carbon dioxide. This creates a respiratory alkalosis, known as hypocapnia. Contrary to popular belief, one can no longer carry oxygen optimally, either in the body or through the placenta to the baby. This in turn can lead to numbness, tremor and a sense of anxiety and panic. Hyperventilation may also lead to negative changes in the cardiotocography (CTG) curve.
 
Partners and support
Support has been researched and is proven to be the single most important factor influencing birth positively, both in the medical outcome and the experience. The support person is, therefore, extremely important and has a huge opportunity to contribute to the birthing experience. If you look at the physiology, it is not so difficult to understand why this hugely powerful effect occurs. The support stimulates the peace and calm system. Hence, if the body is in its physiological “yes” state of relaxation, there are clearly less complications than if the medical interventions are trying to solve the problems that arise in a body that is struggling to do its job and that body is keeping the baby inside, in order that we do not birth when it is dangerous. It can be difficult to know how to give the best support during childbirth. Our unique techniques and basic principles provide some simple and clear guidelines for developing and adapting support to the labouring woman and what the physical work of a birth means.