Exploring pain in childbirth

In this blog I will explore how helpful it is to focus on pain in childbirth. Today is a very special day for me, as my lovely daughter Rosa Lia, my first born, was born 24 years ago today: 14 June 1990 in Bristol. I enjoyed my journey of birthing her, like my mum enjoyed birthing me, at home.

There is an Italian version of this post

I recently read a neurologist warn how people are poisoning themselves by taking headache pills and often making their headaches worse. Consultant neurologist Russell Lane warned that repeated use of codeine-based drugs, such as Co-codamol or Panadol, was likely to result in a “medication-overuse headache” — a headache all day, every day. London Evening Standard 23 May 2014. This indicates how much pain is perceived as a “bad” thing which should be got rid of. However pain is simply our body letting us know something. Headaches may be telling us that we are tired, stressed, have poor posture, don’t exercise enough, have an underlying physical condition, or an expression of something going on emotionally.

This obsession with “getting rid of pain” has come to be a major factor in childbirth. Often when women start discussing childbirth, uppermost in their thoughts are questions such as

I hope I’ll be able to have a natural childbirth. Will I be able to cope with the pain?

Or

Why should I suffer? Give me any drugs to help ease the pain

Or

Pain is a myth and if I am relaxed enough I will feel no pain

Of course it is natural to be concerned about how birth will be. It is a life-changing experience, and one which most women only experience a few times. A first birth is a journey into the unknown: your body has never opened up in this way before. If the first birth was traumatic then there will be worries about how the next birth will be.

But how have we got to this place where the uppermost idea is more about the avoidance of pain and trauma, rather than excitement about welcoming a new baby into the world? Or wonderment at the amazing power of our female body to birth a new being?  In most ancient cultures birth was a sacred, even ecstatic, event, often celebrated with dance and song and the woman was honoured as a powerful being.

By contrast, today, for most women, birth is a medical event. Rather than taking place outside in nature or at home, it happens for most women in hospital. Only 2.3% of women in the UK gave birth at home in 2012.  It is unusual for women to have no form of medical intervention if you include all forms of medical pain relief , induction of labour, forceps.  In the UK the C section rate alone is 25-30 %   while in Latin America in some areas it is up to 80% and the national average 40%. According to a 1995 study by Dr. William Emerson, 95 percent of all births in the United States can be classified as traumatic. Fifty percent were rated as “moderate” trauma, and 45 percent as “severe.”

The effects of all these interventions introduced over such a short period of time , largely from the 1950’s onward, is unknown. Indeed we could argue that we are conducting a huge experiment with birth and affecting mothers and babies in ways which we don’t really understand. A new film, Microbirth,  currently being made is exploring this: I gave this some funding and will be helping host the world premier in Bristol on September 20th.

How can birth have changed so much? Why is there so much fear and lack of trust in our body and capacity to give birth?

On one level it is linked in to living in a culture where pain is seen as something to be avoided rather than a cue to listen to our body. On another fundamental level, we have absorbed the biblical story of birth being difficult and painful and that women are somehow being punished. This attitude is part of a culture which devalues the power of women: especially around birth, which can be scary for men as well as women.

So is pain in birth a myth or a reality? And should we be trying to avoid it?

The reality is that pain may or may not be part of birth. Each woman, each baby, each birth is  different.

Our expectations of birth: the emotional aspects

It is certainly true that our fundamental beliefs about birth have a powerful influence on how we experience it. If we expect it to be joyous and are excited or intrigued by it, then we meet it as an adventure, a journey, rather than focusing on pain. With this approach, like with any journey, we prepare for it in some way, emotionally as well as physically. Emotionally, in a way, we have been preparing for this as women, for much of our life. From the onset of puberty, each month is a mini birth, a letting go and opening up: and indeed in older cultures, menstrual blood, like birth, was seen as sacred. However, many women resist or are even ashamed of this aspect of their energy, and rather than listen to their body each month, and tuned into their emotions and physical sensations, have suppressed them through pain killers. The nine months of pregnancy, also offer a chance to prepare for birth: the emotions associated with becoming a mother, changes in our relationship dynamics, fears, and joy. However again, many women are not particularly in tune with their changing body, and may resent the changes which prevent them from getting on with the rest of their lives.

During birth, strong emotions surface: sometimes these may include fear of dying or of the baby dying. While actual death is rare these days in healthy women (although, sadly, many women and babies living in poor countries, mostly sub Sarahan Africa do die from largely preventable causes)  emotionally death is part of the process: an aspect of the self dies, the single person, the old family relationships, and it is the ending of pregnancy. Perhaps a woman’s own experience of being born was difficult and so they are carrying the memories of this in their body. Maybe the story in their family is of birth being difficult.

Or maybe it is more about the baby’s journey: they get stuck, they panic. Being born is about how we move from one phase of our life to the next. For some of us this is easier than for others.

For a woman who is used to listening to her emotions, she is not afraid of them and has learnt ways in which she can work with them.  If this is the first time the woman has really listened then it is scary.

Fear is a powerful emotion: and it has been shown that it can physically block the process of birth. It can make it more painful. Indeed one of the most effective strategies in labour is to be as relaxed as possible.

The Physical nature of birth

Birth is a physical event: a complex dance between the bodies of the mother and baby. Pregnancy goes some way to helping us prepare for this dance. As we get heavier, we can learn which positions ease pain or discomfort, how to move around and support ourselves and our baby. Some of the pain experienced in birth may be due to being in the wrong position: lying or sitting back on hard surfaces puts pressure on areas which need to move and may cause pain. Pain then indicates that we need to shift position and perhaps lean forwards. Pain may be indicating that we are tired and need to rest. In a medical setting the resting aspect of labour tends not to be emphasised enough, with the focus on the need to progress. Pain could indicate we need to eat.

Pain might also indicate that the baby is needing to change position. In most cases changing position or working with emotions can shift this. Occasionally the baby is so stuck that medical intervention is necessary, but in fact this is quite rare in a healthy mother and baby, because our bodies and our babies are designed to give birth.

Of course, extreme pain, may also indicate other complications but again, these are usually rare.

Meeting contractions and knowing how to be with the powerful energy of birth

If we understand that our uterus is contracting to dilate we can learn how to work it. I find it a little odd that some people don’t like using the word “contractions”: it’s more about how we view them which is important. It is what the uterus is doing and they are a powerful energy. Contractions help open up our womb and birth our baby. They can be freeing and liberating: if we can open up to them. They are a form of massage for our baby. They are like waves or rushes.

The specific way of meeting and experiencing contractions is different for different women. Each woman has different levels of sensitivity. Some of us have shorter labours. Others longer labours. Some women experience ecstasy during birth. Some women experience pain, regardless of how much they prepare. I often get women to consider what they normally do to help them navigate stressful situations or times of great change and uncertainty. A key aspect is to understand what helps us to relax, focus and be present with what is going on. This could be simply breathing out. It could be physically focusing on areas of the body and relaxing them. It could be having images or sounds. It could be through touch, often pressure, although it could be stroking. It can include shiatsu points. I don’t usually find it is so effective to use avoidance techniques, since birth is so physical, but if they work , then I would encourage women to use them. As we relax, our body produces an interesting mix of hormones including oxytocin, which Michel Odent calls the “love hormone”,  and endorphins  which act as natural pain killers. These help us to go more deeply into a connection with our body, often into a trance like state. Then we experience the power and even the ecstasy of birth.

If we block and tense and resist the contractions, afraid of their intensity and power, then our body actually physiologically finds it more difficult. This is because tension tends to lead to a stress response, in which more adrenalin is produced. This then interferes with our body’s ability to produce the “Love” hormones which help us to relax. Furthermore, if our body is tense, for example our shoulders, neck or jaw, then it will tend to tense our uterus and pelvic floor, making it hard for it to open up. Try it.

Using the energy of contractions positively

One image which can help women connect with the energy of contractions can be imagining them like powerful waves moving through our body. I have written this image on p 23 of my book “Beautiful Birth”

If we can learn to listen to our bodies in labour, which is such a powerful time, we learn something deeper about our body, our baby and our emotions. If there is pain which we can’t manage or we are faced with a real life or death situation, then modern obstetrics can offer support. However, most women find that if they listen to their body, they can work with the pain, which is an expression of the life in their body, and it is not necessary to introduce something from outside. Working with the body in this way can be immensely freeing and liberating and we find something out about ourselves that we didn’t know.

There is not a formula for an “ideal” birth: it is how we experience the journey. We are all unique. Birth is as rich and complex as life is rich and complex. It is time for women and men to reclaim the power of birth and for us all to start listen to our bodies every day.