The Psychology of Labor

Most of what I have written about labor involves the physiological progression and can be found in any book on pregnancy. I think it is important to know what is happening and what it might feel like to be in those phases. But there is more to labor than phases. What I'm going to write about here is mostly based on my experience, and I hope it will give insight and alleviate any fears and feelings of being overwhelmed that all the information of the previous entries may have caused.

The first thing I want to say is going to sound strange. I want to tell pregnant women to not be afraid of the pain. Women in labor are not being injured. The only thing that is happening - the only thing - is that the uterus is contracting to open up the cervix. This does not cause injury; barring malposition, the only pain felt is due to the hard work of the uterus, that it is working up to and sometimes past the point of muscle fatigue that we feel when we lift weights. It feels like menstrual cramps at first because it is the same mechanism: during menstruation, our uterus contracts to get rid of the blood-rich uterine lining, so much so that the muscle rapidly uses up a lot of oxygen, causing cramps. The same thing is happening during labor.

This is why it is so important to find ways to relax during contractions. If we can relax our bodies, we are not using up oxygen anywhere extra to maintain tense muscles, and we are also not fighting against the hard work our bodies are doing. When we tense up during a contraction, we are counteracting the uterine contraction, as if we are trying to stop it from happening, and this results in serious pain.

Let me use an example from my first labor. With the help of a doula, I was doing great, not feeling the need for anything else. I had a difficult time progressing from 4 to 7 centimeters. Around the end of this time, I was getting weary of dealing with contractions, of having to stay so focused, and I decided I didn't want to do it anymore. Unfortunately I made that decision in the middle of a contraction. I panicked and tensed up, fighting against the contraction. Suddenly the manageable amount of pain I was experiencing, increased by about 100 or more, and it instantly became more than I could handle. I learned my lesson and tried hard to stay relaxed during the rest of the labor; it went back to being well within what I could take.

From that I learned that relaxation is tied to how much pain we feel during labor. With the help of my doula and several family members, I had enough support that I never even considered asking for drugs. (I remember in the few minutes after my baby was born, I had the thought, I wonder if I'll need pain medication? It took me a moment to realize, Oh my goodness, I did it already!)

Do not be afraid of the pain. The pain is temporary, it comes and goes, and you just need to get from one contraction to the next. It is well within your ability to manage, especially if you have a support person who is dedicated to making you comfortable during labor. The bodies of laboring women are doing the work all by themselves, and all the women need to do is let it happen. If you get to the point where you don't feel like you want to do this anymore, try hard to regain your composure. If you're exhausted but your contractions are still going strong, try to let it keep going; if you're overworked, have had a long labor, have been restricted from eating and drinking for a long time, or your contractions are weakening instead of progressing, you may need something like an epidural just so you can get some rest. This is not failure; this is dealing with the labor as it has happened. Labor is not intended to be a path into the depths of hell, and I hope that women never experience it as this.

I was never sure I could have a drug-free natural birth, not until it happened. I was worried during the last parts of both of my pregnancies about needing medication, mostly because I didn't know what to expect. I didn't know how much I could handle, and I didn't know what labor would be like. It was different from how I imagined. It was a much more psychological, introspective experience. Hours flew by without me being aware of how much time had passed (my first labor was 20+ hours but felt like 3-4 hours to me).

In the fantastic book Birth Reborn, Dr. Michel Odent talks about the need for laboring women to be able to get in touch with their natural instincts, that they already know what to do during labor and birth. He says that birth is in the primal realm, not the cerebral, intellectual world we usually live in, and to get in touch with that part of ourselves, we should ideally be in an environment with little or no interruption, low light, a place where we feel comfortable being uninhibited.

I want to say two things about this. First, a word about our intellects. This part of our minds, makes lists and organizes calendars, plans and arranges, and works logically and rationally through decisions. This is not the part of our minds we want to listen to during labor. Here is one example of why: It might take us fourteen hours to dilate to a 7, and our minds will tell us that we cannot endure another (quick math: one centimeter every 2 hours, means 6 more hours of labor) 6 hours of labor before the baby is born! While that is mathematically reasonable, labor does not follow that pattern. After 6 or 7 centimeters, the woman enters transition, labor speeds up, and by 7 centimeters she might have less than one hour before she is holding her baby. It should be clear that if we listen to this voice, we will be misled, feel discouraged, and might make decisions we will regret. A better gauge is something like, How am I doing? Is this bearable right now?

The second thing I wanted to address is the need for the laboring woman to feel comfortable using her coping techniques. My favorite during my first labor was low moaning - the low tone keeps the body relaxed, while making noise helped me to feel like I was doing something other than just sitting there. I could moan as loudly as I needed to, so long as I kept the tone low. Sometimes I roared and yelled, lowly of course. I can't imagine what I would have done if I hadn't been allowed to make noise or if I had been worried about disturbing other people. I believe that women should feel free to do whatever it is that helps them during labor, whether that's walking around, being completely naked, on all fours, moaning, chanting, wiggling, making horse noises, or anything else. There are so many techniques that have helped laboring women, and while pregnant women might look into those things and be familiar with them, there is a chance that they will not know what the most effective one(s) will be until they are in labor.
To read about some of those, and for lots of knowledge and confidence in the power of women in childbirth, read Ina May's Guide to Childbirth by Ina May Gaskin. This is a great book, and essential reading for pregnant women.