Fear-Based Practice: When Birth Is Treated Like a Crisis Waiting to Happen

In the birth space, language matters. One of the most telling—and troubling—phrases I hear is “failure to progress.” It implies dysfunction in the birthing body, a failure to meet some arbitrary standard. But more often than not, it’s not the birthing person who is failing—it’s the system. It’s our collective failure to wait.

In our maternity culture, there’s an undercurrent of fear that shapes the way care is delivered. Fear of litigation. Fear of deviation from protocol. Fear of “getting it wrong.” So we intervene early. We act “just in case.” And we frame any variation from the expected timeline as pathology rather than physiology.

Recently, I supported a woman planning to birth in a midwife-led birth centre. Her labour began gently and steadily. She was coping beautifully, working with her body through a slow but meaningful early labour. But as time wore on and she didn’t dilate “fast enough,” the midwives shifted. Their suggestions moved away from reassurance and presence, and toward action—encouraging frequent changes in position, leaning into bodywork aimed at facilitating optimal foetal positioning.

These were well-intentioned efforts, but they overlooked what the birthing woman clearly needed: rest. Her body wasn’t stuck. She was simply moving through labour in her own time, with her own rhythm. Yet every passing hour seemed to diminish the trust in her process.

With time came more offers of vaginal examinations, as if more data might give permission to let her keep going. As if her word, her instinct, her coping wasn’t enough.

Eventually, she transferred to the labour ward—exhausted, in pain, and asking clearly and calmly for an epidural. Yet in this critical moment, no anaesthetist appeared. Despite her consent, her clarity, and her distress, she was left waiting. It was as though the earlier urgency to do something evaporated the moment she asked for support on her own terms.

This is fear-based practice in action. Not always loud. Not always dramatic. But persistent. Quietly shaping decision-making around imagined risks rather than the real person in front of us. It shows up when rest is discouraged in favour of “doing more.” When hands reach for gloves instead of offering reassurance. When words like “just in case” are used to justify escalation instead of holding space for trust.

Birth does not follow a factory setting. It doesn’t conform to shift schedules or cervical charts. It requires attunement, patience, and humility from those who care for birthing people.

But fear erodes that. It replaces curiosity with control. It turns natural pauses in labour into problems to solve. And too often, it robs birthing people of the calm, supported experience they deserve—not because of clinical need, but because of institutional fear.

We need to change the conversation. Birth is not inherently risky—it is inherently powerful. And when we respond to that power with trust instead of fear, we open the door for outcomes that are not only safe, but empowering.

Let’s move away from fear-based care. Let’s honour the body’s wisdom. And let’s remember: waiting is not passive. It’s an act of radical trust.