We’re meant to avoid pain in today’s society. Every ache, every muscle cramp, every bout of soreness can be soothed away by one pharmeceutical or another, and if the over the counter medications don’t touch it, there’s always a prescription to try, presumably.
Laws against direct marketing to consumers were relaxed in 1997, and since we’ve seen an unprecedented marketing strategy, combined with an unprecedented upswing in the number of prescriptions. A popular reply to questions about natural childbirth is a comment about giving birth without an epidural being similar to having a root canal without pain medication.
I don’t think they’re even comparable.
A root canal is a treatment for a pathology. Gallbladder surgery, which necessitates pain relief, is a treatment for a pathology. When I was having gallbladder attacks and accepted pain medication, I was accepting pain medication for a pathology.
Birth is not a pathology.
Again, birth is not a pathology. Birth is a normal, natural process in the course of life, not dissimilar to sex, death, breathing, eating, or using the restroom.
When something hurts beyond reasonable expectations during sex, it’s considered a pathology. Yet it’s accepted that there will be a moderate amount of pain experienced in relationship to sex a moderate amount of the time. It’s when it crosses some threshold point that it’s seen as a pathology.
There are reports of painless childbirth, and while I believe it can happen, that’s not my concern. My concern is a normal childbirth, a biological childbirth. There will, in many cases, be some pain. The muscle tissue of the uterus is contracting massively in order to draw back the cervix and then push the baby out into the world. If a mother did not push at all, her baby would still be born, forced into the world by uterine contractions. That’s what contractions in childbirth are – contractions of the uterine muscle, similar to any other muscle contraction. There’s another parallel in that other muscles will usually hurt when contracting if they are doing an unprecedented or nearly unprecedented amount of work in a short period of time. Additionally, there will typically be pain associated with the perineum when the head is crowning, as these blood-rich tissues stretch and then stretch more around the baby’s head.
This pain associated with labor and birth, however, is pain with a purpose. The body is actively working, of its own accord, to birth the baby, at the appropriate time for that baby and that mother.
Pain that cannot, in fact, be managed adequately is a signal of something wrong. I know someone who experienced an enormous amount of pain as her daughter made her way down through the vagina, which is actually atypical. Once the baby girl’s head was born, the reason was clear – atypical presentation, where one hand was alongside her head. Another atypical presentation that causes back labor and atypical pain is a posterior presentation. Babies can be birthed in these presentations, yes, but the fact of the atypical pain is a clear sign that something is different than expected.
O’Mara states that pain is experienced the same, physiologically, by everyone (116). The unaccounted factor is the psychological response; that is, how each person has decided to respond to the painful stimulus, both consciously and unconsciously (O’Mara, 116). Other factors, not necessarily under the mother’s control, include the environment during labor, baby’s position, mother’s position, who is with the mother, the mother’s energy level, and whether or not the mother has previously given birth (O’Mara, 116).
The crux of the issue is that there is a very large difference between feeling pain, and suffering. The pain that a woman experiences is purposeful. England brings this together when she states, “The sensations [experienced] are part of an ingenious feedback mechanism which is essential to normal labor and birth. The pain and sensation of labor tell [the mother] what position is best… and how to move in labor to get [the] baby out. With an epidural, this feedback is wiped out” (240).
To a large extent, childbirth proceeds best when the mother is unmedicated, because abnormal pain can guide the mother. “Commonly, the positions and activities she chooses for comfort are also those that promote good labor progress or help shift the baby into the right position for birth. Remove the pain, and you kill that feedback mechanism” (Goer, 252) While I don’t know what labor and birth would have been like for me had I not heeded my body’s warning, I certainly experienced ‘abnormal pain’ during the pushing phase, as I attempted to squat. There was a searing, rubbing pain in my pelvis that was decidedly not normal. I stood, and then later, leaned forward, an approximation of a hands and knees type position (though I was not on my knees). That hands and knees position is commonly accepted as a way to resolve shoulder dystocia. Is that why I felt compelled to get into that position? I won’t ever know.
What else can pain, or the nerve stimulation interpreted as pain, provide? The nerves in the cervix, pelvic floor, and vagina transmit signals that tell the pituitary gland to produce more oxytocin. More oxytocin moves labor forward, thereby causing more cervical dilation and later telling the uterus to direct its efforts towards pushing the baby out. If the nerves are numbed – such as with an epidural – this feedback mechanism is completely wiped out.
Now, there are various ways of dealing with pain. Previously, I discussed the use of epidurals. However, there are a multitude of non-pharmological means of pain relief which are not commonly considered and may even be ridiculed. First, if a woman is in a situation where she is able to follow her body’s guidance, the amount of pain to be relieved is going to be less, as mentioned above. Another method of “pain prevention” would be paying attention to fetal positioning. The website Spinning Babies has information on this subject, as well as the now out of print books Sit Up and Take Notice! and Optimal Foetal Positioning.
During labor, many women find that their pain is lessened through movement. This movement may be walking, or may be a form of ‘dancing’ that involves moving the hips, rotating the body, and swaying. Bellydancing was originally a form of preparation for childbirth, and moves reminiscent of bellydancing often arise spontaneously in the unmedicated woman. Other women find some relief in the form of sitting on or leaning on a birth ball, which is really another name for an exercise ball. Massage and other forms of touch therapy can provide pain relief, while other mothers swear by acupuncture, acupressure, or reflexology. A number of women swear by hydrotherapy, whether in the form of a shower or immersion. Relaxation and visualization are often mentioned as tools to employ in the service of pain relief. Hypnosis for childbirth, espoused by programs such as Hypnobirthing, Hypbirth, and Hypnobabies, is in some respect an “extreme relaxation” brought on through conditioning.
All of these methods of pain relief are worth using. All of these methods have had considerable success, though some may not work for some people, while others do not work for other people. All of them are valuable to have in a “toolbox” for relief and coping.
Finally, I would be remiss not to mention the idea of painless childbirth. Grantly Dick-Read first brought this idea to the attention of the modernized Western world with the publication of his work commonly known as Childbirth Without Fear. Throughout the sixty years since he first brought the idea to the attention of large numbers of people, other writers have discussed painless childbirth, while others have decried it as an impossibility, or suggesting that to imply it is possible is to set women up for failure. While I agree that the majority of women in North American society are not going to experience painless birth, it does not mean that we should deny that the possibility does exist. Similarly, the possibility of orgasmic birth also exists, and is potentially more common than painless birth, since the orgasmic portion does not necessitate painlessness. Pain and pleasure are both experienced by the same nerves, just different signals are sent to the brain.
Pain is the major thing discussed in American birthing today. How to avoid pain, what causes the pain, and ways to get rid of the pain are all major concerns of the majority of pregnant women in today’s society. The idea of not avoiding pain and instead embracing it is both strange and revolutionary.
originally written 10 January 2007
