Issue 156 – September/October 2009
It’s safe to say that the No. 1 worry for most pregnant women is pain during labor. Secretly, you ask yourself, “Will I be able to handle it?” But it’s hard to know if you’ll be able to handle something you’ve never experienced before, especially when the cultural messages about birth in the US do not inspire confidence.
It’s understandable that you might be afraid of the unknown, but your experience of pain in labor may be more within your control than you realize. The amount of pain you feel during labor is affected by your perceptions of pain in general, and your beliefs about pregnancy and birth in particular. A supportive environment during pregnancy can help you to change these perceptions so that you feel more ready for a natural birth, which is, by definition, drug-free.
But what is labor pain like, anyway? Its nature is so couched in mystery and overdramatized by the media that you’re probably terrified of it. Pain in labor is the result of the dilation of the lower, narrow portion of the uterus, called the cervix, which must open to a diameter of 10 centimeters in order to allow the baby to pass through. In labor, the job of the cervix is to stretch from an opening the size of the tip of your nose to an opening the size of a circle drawn on the palm of your hand. No wonder you feel a stinging sensation as this is happening.
This dilation of the cervix happens gradually and rhythmically. During a natural childbirth, the contractions that stretch the cervix last for only 45 to 90 seconds, and peak in intensity at about 30 seconds. There are breaks between contractions during which there is no pain at all. The reason you can have confidence in your ability to handle these contractions is because of their very rhythmic nature. You have to handle only one at a time!
Pain in labor is not like the pain from an injury—persistent, constant pain that requires attention. Tooth pain, for example, is throbbing and relentless. You have to get to the dentist. Unlike tooth pain, pain in labor lets up. It is not aching but stretching. A toothache hurts; labor stings.
If you’ve ever had a massage, particularly a Rolfing session, you may have experienced what it feels like when a knot in a tight muscle is smoothed out by the strong pressure of someone’s fingers. There is a distinct stinging sensation, depending on the degree of pressure. You squirm from the stinging, but you can handle it. You can handle it because the practitioner tells you to breathe with it, and because it’s over quickly. It’s the same during labor: The pain is manageable because it doesn’t suddenly begin as a gripping pain at full intensity. It generally starts as a mild tightening that slowly builds, in strength and intensity, to a burning sensation. The contractions come in waves.
Although I can give you a general description of labor pains, no two women experience it in exactly the same way. In fact, the perception of pain in labor is uniquely subjective. In one study, a group of pregnant American women were compared with a similar group of women from the Netherlands. Each woman was given the same information beforehand about the risks of pain medication during labor. Only about 33 percent of the Dutch women asked for pain medication during labor, while 83 percent of the US women did. Forty-eight hours after birth, the American women noted that they had generally anticipated a painful birth and the need for drugs, whereas the Dutch women had anticipated less pain, and thus less likelihood of the need for drugs.
This study tells us a lot about how our expectations can affect our experience of labor. We are affected not only by our expectations about what birth will be like, but also by the perceptions and beliefs about birth we have inherited from family and culture. You can examine your own perceptions and beliefs about pregnancy and birth by asking yourself the questions in the box on this page.
Perhaps the most important factor in reducing your perception of pain in labor is to reduce your experience of stress. One important way to reduce your stress is to have the companionship of another woman during labor. A number of well-designed studies show that continuous labor support is one of the most effective methods for reducing pain in labor. One study reported a 30 percent reduction in requests for pain medication among women who used a doula for labor support. Clearly, you’ll be less likely to want drugs if you don’t feel alone.
Women who take childbirth-education classes also tend to request less pain medication. Most such classes teach breathing techniques, the purpose of which is to give you something other than the pain to focus on during the contractions and to help you stay in the moment. Practicing meditation is another way to learn to be in the moment, and can help prepare you to take labor contractions one at a time.
During labor, there are many things you can do to soothe the discomfort of the dilation of the cervix. You may enjoy a shower or bath in early labor, or a birthing tub as labor progresses. You can ask your partner to use the tips of the fingers to lightly and rhythmically stroke the bare skin of your abdomen, back, or thighs. This will help you to relax and focus. Massaging the inner thighs, buttocks, or lower back can also help to relieve pressure during labor.
Scent is another natural labor soother. Some essential oils are relaxing, and reduce sensations of pain by increasing the production of endorphins, the body’s natural pain relievers. Examples are lavender, chamomile, sweet geranium, jasmine, neroli, rosewood, lemon balm, mandarin, and cedarwood. Try them during pregnancy and choose ones that appeal to you.
One of the most important ways to relieve discomfort during labor is to change positions. Get off your back. Birthing upright can make labor shorter and less painful. Alternate among sitting, standing, and squatting; squatting can widen the pelvic outlet by 25 percent. Walk around during early labor. Get up on your hands and knees during contractions.
A number of acupressure points can also afford pain relief. In China, acupuncture is used instead of epidural anesthesia in 98 percent of births. The homeopathic remedy arnica, indicated for sore muscles, can be used effectively during labor. The herbs skullcap and catnip relieve pain, and calm and relax the body. Chamomile tea helps to control pain by relieving tension. Nutritional supplements such as calcium, vitamin E, essential fatty acids, and magnesium can ease labor discomfort. Ask your birth attendant for herbal, homeopathic, and nutritional recommendations specifically for you.
If it isn’t obvious by now, pain in labor is intensified by fear and tension. Tension can be the result of poor expectations regarding birth, and you can become fearful when you feel disturbed during childbirth. Childbirth is an involuntary process, and no one can help an involuntary process. The point is not to disturb it.
If you feel disturbed during your labor you will produce adrenaline, which slows the production of the hormones of labor: Your body, assuming you are in trouble, prepares to stop labor, and start again at a more opportune time. The uterus is the only muscle in the body that contains two opposing muscle groups: one to contract and open the cervix during labor, and another to close and tighten the cervix to stop labor. If your body produces adrenaline at the same time that your uterus is contracting, you will feel more pain.
If, on the other hand, you are undisturbed during birth, your body will release a cocktail of chemicals that will alleviate pain, give you an ecstatic rush after childbirth, make your baby irresistible to you, and help your breastmilk to let down. This cocktail is one of the many benefits of drug-free birth.
Drugs in labor unequivocally disturb the labor process. The cocktail of local anesthetics used for epidural blocks can cause varying degrees of maternal, fetal, and neonatal toxicity, according to the Physicians’ Desk Reference. While the efficiency of pain-relief methods during labor has been studied more than any other medical aspect of pregnancy, the adverse effects of these drugs on mother and baby have hardly been studied at all. We do know, however, that while the placenta reduces the effects on the baby of drugs given the mother, about 70 percent of any medication given the mother does reach the baby.
Narcotic analgesics such as Demerol, Nubain, and Stadol slow the baby’s heart rate and affect her respiratory system while she’s still in the womb, and, if given too close to birth, can also affect her breathing after birth. Babies of mothers who receive such narcotics show general sluggishness and sometimes have trouble in the early days. Remnants of the narcotics stay in the baby’s bloodstream for weeks. Long-term consequences of narcotics on the baby’s health are unknown, although a well-designed case-control study in Stockholm showed an increased risk of drug addiction among children exposed to pain-relieving drugs during labor.
I know you’re afraid of the pain of childbirth. I was too. We all are. Even after I’d had my first child, I always dreaded it. But the pain was never bad enough to make me want to stop having babies. I handled it.
It’s something you, too, can handle. Don’t let others underestimate you, and don’t underestimate yourself. You can’t expect yourself to know everything, especially if this pregnancy is your first. Find another woman in your area who has experienced drug-free birth and ask her to be your guide. Allow yourself to be supported and nurtured during your pregnancy. Model your pregnancy after the pregnancies of those who have had successful natural births. Find a practitioner who has lots of experience with drug-free birth and who believes in you. Believe in yourself. Your baby does.
Pregnancy and Birth
A look at your own perceptions and beliefs
- What do you believe about your own birth?
- What does your mother believe about your birth?
- How would the women in your family complete this statement: “The women in our family are _______.”?
- How would the women in your family complete this statement: “Childbirth is _______.”?
- What do you believe about sex?
- What do you believe about pregnancy?
- What have friends told you about pregnancy and birth?
- What three words do you associate with pain?
- What are your three most secret thoughts about childbirth?
- What do you fear most?
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