Pain in Labor

May 3, 2010 at 3:18 pm (Comfort Measures, Doula, Education) (, , )

Lots of mamas ask me “What does labor feel like?”  “How much does it hurt?”  “Can I prepare for labor pain?”  Pain in labor, the big P word, can be a touchy subject to discuss prenatally.  Some doulas I know don’t use the word at all, instead mentioning “intensity”, “rushes,” and “waves.”  While I will definitely use the words “pain,” and “birth” in the same sentence, I also find myself qualifying it with many adjectives, to help modify the tenor of that charged word.  I do that for two reasons. 

First, not all women experience labor as pain.  In fact, some people even claim that any well-prepared woman will not feel the work of labor as pain, as long as she is sufficiently relaxed and not fearful.  Although I won’t go so far as to say that pain is not a part of labor for the majority of women, I am aware that expectations help to shape reality.  If, prenatally, a woman is not deluged with the expectation that her labor will be painful, then she might have a clearer mental and emotional path toward a pain-free labor.  So I, as  a birth professional, don’t want to shape a woman’s experience based on my own experiences- I want her to use her own words and feel things in her own way.

But what about the women who do experience labor as pain?  Are they done a disservice if the P word is never mentioned by well-meaning birth advocates before they enter into Labor Land?  I suspect that the vast majority of women I’ll encounter as a doula have already heard about many painful labors, and have a well-rooted idea of birth as painful.  So how can I help those mamas prepare prenatally for their coming birth?

Here’s what I tell mamas: For most women, birth is painful.  At the beginning, it is manageable.  At some point, it will reach a level of intensity that you may not have felt at any other time in your life.  But that pain is not the “something wrong” pain of an injury or illness.  It’s pain with a purpose- it teaches you how to move your body to best birth your baby, and it teaches you what an incredibly powerful, capable woman you are.  And there are things that can make the pain worse, and things that can make it more manageable.

The three most important things that have helped my birthing clients experience the sensations of birth with relative ease are: a quiet, safe environment, an attitude of acceptance, and the freedom to move.   And much of this can be cultivated and practiced before the actual birth.

A quiet environment helps a mama sink out of her neocortex, her thinking brain, and into her more instinctual mind.  She becomes less thought and more experience, less brain and more body.  If people don’t try to engage her by asking questions or chattering with each other, then the path to mental stillness is easier.  And this internal and external quietness has a big reward: endorphins.  Endorphins are the body’s natural pain relief, the internally produced morphine.  They are naturally produced when we go through painful or high intensity experiences.  They don’t always take away the pain of labor, but they soften the experience of it.  Endorphins can be counteracted by catecholamines, including adrenaline.  Adrenaline is produced when we start thinking a lot and becoming anxious, or when we feel that we need to defend ourselves.  So if a mama is made to talk and think, or if she is scared, nervous, or stressed out, she will not have as many benefits from her endorphins.  Prenatally, to encourage an endorphin-producing state, mama can do progressive relaxation exercises, prayer, or meditation.

The attitude of acceptance goes hand in hand with the quiet mental state, but it is a distinct thing.  Basically, it means allowing the birth process to happen, physically, mentally and emotionally.  It is an open state, non-resistant.  When a mama has this kind of attitude, then her labor energy can flow through her body without blockages.  And when she doesn’t resist the energy of labor, and yes, the pain as well, then she will feel less fear.  To cultivate this attitude of acceptance beforehand, a mama can practice saying some positive words or phrases in the shower, on the toilet (strange, I know, but it helps to associate the energy of opening on the toilet with the opening that will happen during birth), and in bed at night.  She could say things like, “I am open.” “I welcome this experience.” “I am joyful.” “Iam relaxed,” or any other positive statement that feels good.

Finally, position changes can do a lot to help mama navigate the pain and other sensations of labor.  Sometimes, one position (such as lying on the back) might feel intolerable, while another (such as standing and swaying) might feel doable.  This difference in sensation is teaching mama what positions are most helpful in opening her up and allowing labor to progress.  As labor goes further, it may get to a point where no position feels really good.  This is a great sign that labor is nearing the end, and it’s also time to listen to the body in a different way.   Sometimes, during transition and pushing, the positions that feel the most intense are the ones that are doing the most work.  So, at this point, a mama could choose a resting position, and allow her body to do all the work (a great choice at the end of a labor!), or she could choose an upright position where there is a lot more energy, and therefore more ability for mama to add extra power to the work her body is doing.  I remember this moment in my first birth, where I had been pushing though the first 2/3 of each contraction, and then resting as they eased off.  I finally got to the point where I realized that, if I wanted to see my baby any time soon, I’d have to find the strength to push beyond what I thought I could manage, to push all the way through the contraction and the pain.  And once I started doing that, I found more power and energy than I thought I possessed.  And I found that, even though the pain became more intense, there was also a great delight in feeling my baby finally move under my pubic bone, and very soon after that, into the world.  Once I stopped fearing the pain and trying to lessen it, and instead I stepped into the center of it and surrendered myself to it, I found that I could do more than I ever thought I could.  In this way, pain taught me not just how to labor, but also that I was capable of doing anything that I needed to do, and that I had more than enough strength and courage for the task of parenting my beautiful new baby.

So yes, for many women, there is pain during labor.  But it’s pain that you can work with, and it’s pain that will teach you a great deal about yourself, your body, and your potential.  As Pam England says in Birthing From Within, “Labor is hard.  It hurts.  And you can do it.”

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