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We all know that labour is painful, that birth hurts and that we all scream all the way through it in a terrified daze.  Don’t we?

This seems to be the given wisdom at the moment.  Where does that wisdom come from?

Current view of birth.

Well, lets step back a little bit.  Traditionally, by the time a woman had reached child-bearing age she would have assisted at many other labours and births.  She would consider birth a normal part of life and there would be no great mystery surrounding it.  Most women would have been present during births and known that for most women it is manageable, normal and everything turns out well.  They would also have seen that sometimes it doesn’t turn out well, and that would also be considered as a normal variation.

Now, the typical western woman reaches child-bearing age having never attended, assisted or even seen another woman give birth.  Many woman have rarely even held a newborn baby, and babies and children tend to be at the peripheral of their life.  Bearing this in mind, is it any wonder that the average woman in the UK approaches her first birth unsure of what is going to happen, what the experience is like or how she will cope?  Birth is no longer a normal part of life for women, it is shrouded in mystery.

So, the experience of birth is no longer present.  What has replaced this?  Sadly, it is probably media depictions of birth.  We all know how these look.  A screaming woman, a hapless partner, a general air of panic.  Don’t worry though, they are normally saved by the hero health professional on his/her white charger.  Birth is now an agony that women need saving from.  This view of birth is all that most little girls ever know, and this continues through puberty into adulthood.  By the time that most women are pregnant the only thing they think they know about birth is that it will be really painful.  It must be, look how strong the pain relief is!

Of course, this is not helped by the fact that the second the little blue line pops up a whole plethora of women suddenly appear with their ‘horror’ stories.  And boy, do they make sure the newly pregnant woman get’s the ‘no holds barred’ version of the story!  I wish women would consider a little more carefully about this, and that women with positive and fantastic stories told them more.

Why is birth painful?

Why would something as necessary to human survival as birth be so painful that we couldn’t cope with it?  Does that make any sense at all?  Just ponder that question for a second.  It just doesn’t make sense.  So, why do so many women experience birth as too difficult to cope with?  Let’s look at the factors that impact on labour and birth.

Hormones

How do birth hormones work?  There are three main hormones at play during a labour.  They work together to make the birth as efficient as possible.  They are:

  1. Oxytocin.  The ‘hormone of love’.  This is the real driving force behind labour.  The more oxytocin that is produced the more effective the contractions are, the more efficient the uterus is.  Oxytocin is inhibited when Adrenalin is produced.
  2. Adrenalin.  If the womans body produces adrenalin during the first stage of labour it will stop or reduce the production of oxytocin which will mean she will have a ‘stop and start’ labour and labour may be slow and long.  It’s vital during second stage though.
  3. Endorphines.  These are the body’s own natural pain relief.  Endorphines build up and up through labour so that at the point of birth the woman has huge levels in her body.  This, combined with huge levels of oxytocin, ensure the mother is ready to meet and fall in love with her baby.  They also act as a memory suppressant postnatally.

Oxytocin is produced in large quantities when love-making.  The same environment that will allow a woman to orgasm during sex is the same environment that will be conducive to an efficient birth.  There are not too many women who could orgasm in a brightly lit, sterile room with a number of people watching and monitoring progress and a whole ward able to hear her.

Adrenalin is produced when a woman feels observed, when people talk to her, when she meets someone new, when she is in an unfamiliar environment, when she can hear other labouring women and knows they can hear her.  Adrenalin is normally produced at the start of 2nd stage to give the mother the energy she needs to push the baby out.  Before that, it cripples the progress of labour.

Endorphines build up gradually so that at each point in labour the mothers body is ‘just about’ coping with labour.  If the mum starts to worry about coping and becomes stuck in the pain-tension-fear cycle (see below) then this can inhibit the production and effectiveness of the endorphines.  A woman is more likely to worry about future coping ability if the labour seems long and the contractions are ineffective which is why the interplay between oxytocin and adrenalin is so important.

Unfortunately, as you can see, the environment the majority of women are placed in to give birth is not going to assist the delicate hormonal balance necessary for a quick and ‘copeable’ labour.  In fact, I would go so far as to say the environment actively hampers the possibility of a normal and easy to cope with labour.

Why can’t we afford the same respect and birthing environment to a human labouring woman as we recognise as vital for any other mammal?

Pain – Fear – Tension Cycle

If something feels painful this is often followed by fear.  The natural reaction to fear is to tense up, which unfortunately heightens the experience of pain.  This can then become cyclical, and develop into a downward spiral where the fear and tension actually make the pain worse and inhibits the endorphines which can lead to the pain being too difficult to manage.

If a mother is tense because she has just had a 20 minute bumpy car drive through traffic to go to a large birth unit where she doesn’t know anybody then she is likely to be tense.  This will mean that any contractions she has will feel more painful and difficult to cope with.  Combined with the effect of adrenalin on the oxytocin production, this can mean that a mother arrives at the birth unit already overwhelmed with pain and asking for pain relief before she is even through the door.

Already she is in the cycle, and her hormonal balance has been disrupted.  Often this continues right through to the birth, where the hormones haven’t been able to work as normal and the mother then needs further assistance to birth her baby.  No wonder we all think birth is so difficult!

Make a positive change: allow yourself the optimal birth experience.

Thinking about all of the above, I hope it becomes clear that birth is not too painful to cope with unless we make it too painful to cope with.

So, how can you turn things around and allow yourself to birth normally without intervention or the necessity of pain relief?

Firstly, try to find women who have birthed normally and found birth easy to cope with.  Maybe attend home birth groups or just find friends who have found birth manageable, exhilarating and awesome.  Wallow in their stories.  Read positive birth stories online.  Go to pregnancy yoga, aquanatal, antenatal relaxation classes.  Download positive pregnancy relaxations and visualisations and make it your business to listen to them every single day.  Ignore the negative and allow the positive, coping, strong woman to come to the fore.  Indulge her.  Over the 9 months allow yourself to believe to your very core that your body is capable – more than capable! – of birthing your baby.

Secondly, take action.  The biggest intervention you will make into your birth is choosing where you give birth and who will be your birth attendant.  These two choices will make the biggest difference to your birth than anything else put together.  Ask yourself why you are considering going into hospital.  Find out about home birth.  Home birth is normal and is safer than a hospital birth for every ‘low-risk’ pregnancy, and most ‘high risk’ women.  Talk to women who have given birth at home, read up on it and allow it to become normal in your mind.

If you are unable to birth at home, consider a birth centre instead.  Birthing in a stand alone birth centre is going to create the nearest chances of a normal birth to home, a birth centre in a hospital is the next best choice.  The option that is least likely to produce a normal, manageable birth is one that takes place in a consultant unit.  This should be the last choice, only to be used when medically necessary.

I have to go to a consultant unit!  How can I have a normal birth?

If you weigh up all the information and decide to go to a consultant unit, or have medical reasons for choosing a this option then don’t despair.  You can still maximise your chances of a normal and healthy birth.  You can do everything you can to ensure you are part of the minority of women who give birth normally in this environment.

How?  There are lots of ideas.  Keep in your mind the ideal environment for birth (or sex if that’s easier to envisage!) and create that environment in your birth room.  Your birth room is yours.  You can move furniture around, put on music, bring any equipment or special items and food and clothing or whatever you need to help to create the ideal birth environment for you.

Ask for your midwife to keep her voice low, and keep at a discreet distance.  Write a good birth plan that outlines what you need to birth well, get your birth partner on board and up to speed so that they can be your advocate which will leave you freed up to birth.

Some women have even put a blanket over their head to keep the ‘outside world’ out, or used headphones with relaxations or music to ‘zone out’.  Close your eyes and you can be in your own little world.

Perhaps most important, be aware of the impact that the journey to your birth unit and settling in will have on the birth.  It may start to feel difficult to cope with, the labour could stop or contractions get less frequent.  Set up your birth room, settle down and allow yourself to relax and feel at home.  It could take a couple of hours before your body feels safe and ready to start birthing effectively again.  Don’t worry about this.  It’s a normal physiological response to moving into a strange place during birth.

Visualisations and relaxations are perhaps even more important when you are birthing away from a familiar environment.  If you know you are going to a birth centre or hospital then practise doing your relaxations and visualisations all the way through the pregnancy so that when you arrive you are able to immediately counter the pain-fear-tension cycle and allow yourself to start labouring again more quickly.

Pain and Labour

I am hoping that this will provide you with a new perspective on pain and labour.  A new understanding of how the labouring body works, and why we have to help rather than hinder.

If we can understand how everything works and respect the environment that any labouring mammal needs to feel safe and birth easily then we can maybe banish the myth that human labour and birth is too painful for us to cope with.

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