More on Pain

Babies are the biggest things that pass through any of our orifices. Ever.

- Ina May Gaskin

I wouldn't have a root canal done without novocaine. Why would any woman give birth without an epidural?

- Husband on A Baby Story

The most common thing I hear pregnant women say is, "I'm going to try and go natural, but we'll see. I don't know how bad it will get." Fear of pain - rather than the actual amount of pain experienced during labor - seems to be the foremost reason women opt for an epidural. It's rarely because the pain is intolerable; the women are almost always afraid that it will get worse and if they don't get an epidural now, they will have lost their chance and will suffer more than they want to.

I can only speak of my own experiences here, though I have seen and heard enough accounts from other women that I believe mine are at least typical if not representative. The pain I felt during labor progressed to a point, and then the only change was that the contractions came closer together. The pain itself was not the issue; the frequency of the contractions was what bothered me, and that only psychologically, especially in my second labor. I had a trapped feeling, a sense of loss of control over my circumstances, that was far worse than the physical pain.

There are two things I want to say about pain. First, there are different kinds of pain. I have said before that I think it's more painful to stub my toe than have a baby, and I mean it sincerely. There are so many varieties of pain. Sometimes it is intolerable when I bite my lip or crash my shin into a table, but I can function relatively well through a migraine headache or menstrual cramps. And occasionally a tiny paper cut produces all-consuming agony. Some pain is harder to bear than other kinds. I think that labor is entirely bearable.

I think that when women (and from time to time, men too) think about what happens during labor, they find it hard to imagine that pushing an entire baby out of their vaginas could be anything other than traumatically painful. They think it is like pushing a bowling ball through nonelastic tissue, not realizing how much we can stretch and open up during birth:

Even though I had been attending births and respecting women's bottoms for their amazing powers for twenty years, Judy showed me something new and exciting. A first-time mother, she came to our birth center because her baby was in breech position. Several people tried to scare her into having a cesarean by warning her that her baby's head could be caught inside at birth. I told her that in my experience, her baby's large bottom was actually going to prepare the way for his head. Holding my hands in a corcle to indicate the size to which her vagina would open gradually (about the size of a large grapefruit), I told her, "You're going to get huge."

One week later, her son's bottom was just coming into view after seventeen hours of labor. Before his butt pushed directly against her perineum, her vagina enlarged and opened to an extent that astounded me. I had seen this phenomenon in women who had already had seven or eight children, but never before in a first-time mother. Judy's vagina would easily have allowed the passage of a baby considerably bigger than her seven-pound eight-ounce son without a tear.

Some days later when Judy and I were talking about her birth, I told her how surprised I had been to see how open her vagina became without direct pressure on her perineum. (I was still amazed.) Judy said, "I used that mantra you gave me."

"Mantra?" I repeated, uncertain of what she meant.

"I kept thinking while I was pushing, I'm going to get huge. I'm going to get huge!"

(This is from Ina May's Guide to Childbirth, chapter 8.)

Giving birth is not like pushing a watermelon out of your butt or having a root canal without anesthesia (incidentally I don't recommend trying either of those). Women are powerful in birth when they work with their bodies, and women's bodies can do amazing things. Birth is not meant to cause injury or be unbearable.

When I hear women describe their labors as the worst pain they ever felt, I always assume that they either had painful complications or did not know how to relax during contractions. It is also interesting to find that American women rate their labors as more painful than do women of other cultures. Indeed, every media portrayal of labor is of the woman in unbearable agony, twisting about, yelling, maybe cursing at her husband; every discussion is about how much it hurrrts. And while I don't wish to downplay the intensity of childbirth, I want to emphasize that the intensity and the pain are not equal in labor.

The greatest collective obstacle before laboring women is to face their fear of pain. Both Ina May Gaskin and Dr. Grantly Dick-Read (author of Childbirth Without Fear) have excellent perspectives on the fear-tension-pain cycle, and both of their books are part of my must-read list for pregnant women. Basically fear produces tension, and tension increases pain, which then feeds our fear, and we are headed down a frightening path. The most practical advice I can give pregnant women is to find a way to be present, to stop thinking about "What ifs" (especially "what if it gets worse?" or "what if what I'm doing, doesn't work?" or "what if this goes on for (x) hours?"), and deal with labor as it's happening right now. Don't anticipate the next contraction; get through the current one and then be happy for the break. There are more breaks during labor than there are contractions. Your focus is needed on relaxing your body, so that it can do the hard work it's doing with as little resistance as possible. For that to happen, you need to not be afraid of the process. "Embrace the water", as joyful_mommy said (that's a great analogy, by the way! Read her comment here). Use your prenatal time to deal with your fears and learn effective relaxation techniques. I can't promise pain-free labors, but having those tools will significantly reduce the pain experienced.