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Fear Tension Pain Cycle

Updated: Dec 30, 2021

We go on and on about how doulas help reduce pain during childbirth.

It has to do with a lot of intuition, a little bit of magic, and a deep understanding of the Fear Tension Pain Cycle.

So...What is it?

The Fear Tension Pain Cycle is just a title for the connection between Fear, Tension, and Pain. They are connected in such a way that if one goes up, they all go up. Likewise, if one goes down, then they all go down.

This idea isn't just related to birth, however. It's an innate law that applies to any pain you may be experiencing. Anything from getting your annual flu shot, all the way up to delivering your baby.

So let's make this work for you.


Let's look at fear. When your brain receives a signal from your body that something is happening (for example, contractions), your brain has to decipher that signal, using only the memories and knowledge available in your "long term storage" center. Let's look at what happens when your brain decides that this is "bad":

  • Fight or Flight Response is triggered

  • Increased Stress Hormones - These stress hormones "block" your natural "feel good" hormones that occur during labor, which increases your pain levels.

  • Your body increases it's tension to prepare to "fight" or "flight"

So as a doula, it is so important that I address your fear as it comes up. However, the best time to do this is during your pregnancy. In my Gentlebirth Course, I go into great detail about the ways to reduce fear, including knowledge about your body, birth, and your brain. I'll also equip you with several "brain hacks" to help keep fear out of your birth.


When I refer to tension, it is regarding the tension in your body. Tension can be caused by a multitude of things, from emotional causes (stress, fear, anger, etc) to physical causes (injury, overuse, fatigue). When you have excess tension in your body, your brain receives signals saying "my body is tense, something scary must be happening". The loop works both ways, fear can increase your tension, and tension can increase your fear. Both of which increase your pain. As your doula, I am extra mindful of the tension in your body, how it impacts your pain, and ultimately, your birth experience. Tension is addressed before, and during your birth. Here are a few of my favorite ways:

  • Stay loose! Go for lots of walks, and keep your hips and back moving.

  • Heat - using a heating pad or warm bath can be very helpful for achy muscles

  • Spinning Babies! This is a favorite resource amongst doulas. There is a stretch or a move for every ailment.

  • Massage - using a variety of firm, and gentle touch, getting a release in the right spot can be just the thing needed to let baby move through the pelvis with less pain.

  • Reminders - Sometimes, just a gentle reminder can be helpful. You'll hear me tell you, soften your shoulders, nice soft forehead, or I'll use a gentle touch on your legs to help you relax the muscles.

When your body is relaxed, your brain receives the message that all is well. When the brain feels safe, your pain is eased.


When the fear and the tension have been addressed, all that remains is pain. There are several instances when it can be best for the birthing person to address the pain directly, especially when the fear and the tension have already been addressed. This is when my favorite buzzword "informed consent" comes into play. Nobody gets to make the decision for you in regards to treating your pain. This goes both ways. Nobody is allowed to force you to treat it, but also, nobody can prevent you from treating it. There are certain pain management tools that work best for certain times, but that's a decision between you and your medical provider, but I'm happy to help with the education piece as well. What can also be missed here is that there are a variety of ways that pain can be treated directly, on a scale of least to most invasive. Knowing your options, the benefits, risks, and alternatives to each, is an important part of the equation when it comes to having a safe and empowered birth. Here are few to keep in mind:

  • Tens Machine

  • Sterile Water Papules

  • Nitrous

  • Narcotics

  • Epidural


So where do doulas fit into this equation? Well...everywhere! When you have a doula at your birth, you have a trained and intuitive eye. We have a deep understanding of this cycle, and how to interrupt it. We have a variety of techniques, tools, and ideas that we can use that align with your birth goals, whatever they may be. Really, a doula is a key ingredient to a safe and empowering birth experience. Reduced pain is the cherry on top!

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