Pain to be avoided or encouraged? - Page 2

[pageta]

I had a very similar labor - back labor, lots of contractions but no progress, ended up getting an epidural because I was so exhausted (I chose the epidural so I wouldn't have to use precious energy dealing with the pain). I went to the hospital at 10 pm at 3cm and my dr said I could go home but he would prefer that I stay and have some morphine so I could rest. Then they checked me again at 8am and I was still 3 cm. I was completely exhausted and could hardly walk around when we tried that in order to get things moving. Around 10 am I asked for the epidural after going over the risks and benefits with my doula (I listed them to her, not her listing them for me) - I was so exhausted, I simply couldn't deal with the pain anymore. They also started a very low dose of pit when they started the epidural. At noon, my dr. broke my waters. I believe I was 5 cm at that point. At 5pm I reached 10 cm. Occasionally, they told me to push but I was so exhausted I didn't even open my eyes. They were also giving me oxygen at that point due to the lowered heartrate of the baby. DS was born at 10pm, 24 hours after we arrived at the hospital. My OB used vacuum to pull him out. He also gave me an episiotomy. HERE IS WHY IAM AM TELLING YOU MY STORY - I was the 7th episiotomy he had given in 7 years. Obviously my OB does not give episiotomies unless they're necessary. I will be eternally grateful to him for giving me an episiotomy rather than a c-section. After reading about your labor, I am thinking that perhaps the manner in which the OB gave you the episiotomy was wrong (he shouldn't have laughed - he should have explained why at least), but I don't fault him for giving it to you. Your baby was obviously in distress (with all the meconium) and that got your baby out quicker. The doulas in my area all say my OB is a "midwife with a penis" because he has a very natural approach to childbirth. He's the only guy who gets in odd positions in order to delivery babies in a birthing pool - all the other OBs make the moms get out of the water to deliver. Like I said, I'd rather have an episiotomy than a c-section. That's just how I choose to look at it.

[cottonwood]

What I am really confused about is the role of pain in childbirth. A lot of what I read said that pain is the body's messenger...guiding you to do the right thing. And that was what I tried to do. I tried to listen to my body. BUT my labor wasn't normal and so I think that whole idea went out the window because I think there was a point where there wasn't anything my midwife or I could do. I think it was beyond our control. I felt like my body was being ripped apart over and over again for about 6 hours. I don't think that was normal.

No, there is no reason to think that it was normal. So what I think I hear you saying is that you'll buy that listening to your body is the right thing to do in a normal labor, but that it might not apply in an abnormal labor. Well, sure. The body can certainly be prevented from accessing its instincts or from communicating them to the mother. And even if it is able to manage both of those, the mother may be prevented from hearing it.

[doctorjen]

I have a slightly different take on the issue of whether women are too scared/in pain/hung up to get their babies born. In the setting where I attend births, I do see a lot of women "holding back" so to speak. But how can I think that's unusual, when they aer in hospital gowns, hooked up to mulitple things, with strangers staring at their crotch? And many (most?) of the women I attend bring with them cultural and social ideas about childbirth that include it being the most painful event of your life, and something to grit your teeth and get through, and I often have family members standing around reinforcing that.
And, I fully believe that labor is experienced differently by different people - I've been to enough 24 hour marathons, and 2 hour easy as pie births to see that women labor differently. I never had unbearable pain in any of my births, and birthed all my children fairly easily, but I know that doesn't happen for everyone, and I'm not arrogant enough to believe that it happened for me because somehow I just mentally prepared better, or had a different attitude. I was frankly scared to death the first time I had a baby, and then pleasantly surprised that it wasn't so bad.
Many women I attend are frightened, and then add to that the unfamiliar environment and the expectations a woman brings with her and certainly some women seem to be trying to get away, rather than get a baby.
I have found that I can often temper that by encouraging the women I attend to listen to their bodies. If you don't feel like pushing, then don't. If you don't feel comfortable with us looking at you, then get out of bed, put more clothes on, cover up with a blanket, send people out of the room. If you are only comfortable on the toilet, or in the tub, then I sit in there with my doppler to comply with hospital monitoring policy. If it hurts to sit, kneel, lie down, whatever, than don't do those things - or if we can't get the pain down to a reasonable level for some reason, at least we as attendants can help a woman know that pain sometimes happens that way, and that it isn't anything she's doing but just how it's going. Often, having such support helps women to find the strength to give birth in their own way. And I work for my clients - if I have to wait around a couple hours until a completely dilated woman decides to push, or the baby emerges on its own - well, I'm smart enough, I could have gotten an MBA and be doing something else. Nobody forced me into this career, so I can't really complain when things take a while.
But I recognize that I can't completely overcome the limitations of my setting or the expectations and plans a woman brings with her. I don't think everyone who births with an attendant has a worse experience, but I also don't think everyone who goes unassisted has a painless birth either, so while I recognize that the environment plays a huge role, it isn't the only factor.
In general, to address the OP, I think pain is a sign that we need to do something different, and if there are ways to relieve that pain we should definitely do them. But there isn't always a sure fire way to make pain go away or even better, so sometimes we just have to find ways to cope. Sometimes that's with position changes and non-medical support, and sometimes there is a role for pain meds.
There is never a role for disregarding a birthing woman's wishes and beliefs. Never. If an episiotomy is necessary (and I use the word necessary loosely, because I don't do them and don't see a need, even with a vacuum assist) than explaining to the birthing woman's satisfaction why and getting permission is also necessary. To do otherwise is unethical and bordering on criminal.
And don't forget that every birth is different. I've seen so many people who had second births that were so different from their first. all you can do is prepare, work through the issues with the first birth, and pick your support team well and insist they be on the same page as you.

[doctorjen]

Originally Posted by fourlittlebirds

The body can certainly be prevented from accessing its instincts or from communicating them to the mother. And even if it is able to manage both of those, the mother may be prevented from hearing it.

:

I was trying to say that, too, in part, but she said it better!

[natashaccat]

I think that for the most part women can guide themselves to through the pain of labor and will instinctively use movement accordingly but I also think that once exaustion kicks in the instinct to curl up and simply surrender to the pain can be counter productive.

I think that a good doula or MW will be attentive to the signs of "surrender" (where the woman is no loner using the pain to productively encourage progress) and will intervene with suggestions of alternate positions.

At least this was my experience, I reached several points during my labor where my MW gently insisted that I briefly experiment with a position different from the one that I had instinctively assumed and in both cases she was right on. It hurt like heck to get out of my prefered (least painful) curl up ball position but also gave me sort of a second (and third) wind KWIM?

[pageta]

Originally Posted by natashaccat

I think that a good doula or MW will be attentive to the signs of "surrender" (where the woman is no loner using the pain to productively encourage progress) and will intervene with suggestions of alternate positions.

My doula certainly tried to do that. She had me walk down the hall and try different positions, but I was so exhausted and in so much pain. When I asked for the epidural, I told her, "Either I need a really good pep talk or I need an epidural." She didn't really try, IMO, on the pep talk (perhaps giving pep talks isn't her strength), and so I ended up with the epidural.

If I had known why walking was so important and decided to do it myself, I am sure things would have come out differently. But the fact that my doula had to sell me on the idea of walking when I was completely exhausted and had practially lost the will to try...I think that was a lot more to ask of her.

I knew why I didn't want an epidural, I knew why I didn't want drugs, I knew why I didn't want a c-section. But I didn't know what to do if various issues came up. The Bradley book I have is "Husband-Coached Childbirth" and I think it does a pretty good job of describing what to do in many of those situations. I read it before my last birth, but subconsciously I just didn't get past him talking to the husbands as though the wives aren't smart enough to learn that information and use it themselves. I left it up to my team to tell me what to do, and I just told them I wanted a natural birth. Next time I will coach myself, and I will have my team there to support me.

So really, I blame myself, not my support team. Next time I am preparing for an unassisted birth even though I am planning a hospital birth. I want to learn myself what the potential problems are and what to do about them. That way my support team may see what is going on and know what to do, but if I tell them what is going on and confirm their observations and tell them what I want to do about it (based on listening to my body), they can help me do that - that will make it easier for both them and me because they won't have to worry about convincing me to try something else when my reserves are low. I can use those reserves to do what I need to do rather than using them to convince myself to try something I don't understand already.

BTW, my OB does vacuum assists all the time without an episiotomy. I don't know what all the monitors said. I think the baby's heart rate was dropping really bad during contractions, but I was so out of it I really don't know for sure. But from what all the doulas say about my OB, he does not do episiotomies unless he really has a good reason. Could I have done it without? Probably. But it may have required a bit more effort on my part, and as tired as I remember being, I really don't hold it against him.

[pageta]

Originally Posted by CuriousLion

But my point is...I've been really confused about that whole idea of what to do about labor pains. Books I read and the childbirth instructor at the birth center made me think that I should change positions to help with the pain. But my midwife told me differently and that just totally messed me up with how I dealt with the labor. I no longer had a plan I could hold on to when things were bad. And things were bad. I lost my mind. And now I'm scared to ever have another child because now I feel like I don't understand birth or how to deal with it. I'm not saying that caused the labor to be bad, I'm saying that the change in what I was supposed to do took away my ability to mentally deal with what was going on.

So back to the OP...(I'm trying to lend my experience in order to relate, not hijack the thread...), I think that change in gears really does make it more difficult. It's back to the idea of not just trying something else but selling you on the idea that it's going to make it better so you do what you have to do to muster up the strength to do it. That's difficult. I know I don't change course mid-stream very well at all.

That's why I say my strategy for next time is to read so many birth stories that I gain an incredible amount of secondhand experience so I know what happens and what I might possibly do about it.

I think the first time, you don't have that confidence that comes with experience. Even though every birth is different, it's hard to say, "I know you're telling me to do this, but it just doesn't feel right - can we try something else?" I mean, all you know is that it hurts a whole lot worse when you do that. I think its easier to trust yourself the second time around and to be more assertive in giving your caregivers feedback on what is and what isn't working. Perhaps I'm deluded, but that's what I choose to believe. One must not give up hope.

[Jilian]

I agree with most of what the others have said, next time listen to your body. I believe that WE are the ones ultimately in charge of our own care. That is why I don't have a problem telling a doctor "No, I'd rather not do that". It's hard when you are in an unfamiliar situation, like giving birth for the first time. Next time just stick with your instincts, they are usually right.

[natashaccat]

I think the first time, you don't have that confidence that comes with experience. Even though every birth is different, it's hard to say, "I know you're telling me to do this, but it just doesn't feel right - can we try something else?" I mean, all you know is that it hurts a whole lot worse when you do that. I think its easier to trust yourself the second time around and to be more assertive in giving your caregivers feedback on what is and what isn't working. Perhaps I'm deluded, but that's what I choose to believe. One must not give up hope.

Well said, I've had one horrible birth and a subsequent perfect birth and I 100% agree with the pp about experience making all the difference.

That is why I don't have a problem telling a doctor "No, I'd rather not do that".

I think that it's unusual for most women to have that sort of confidence and strength in a fear/exaustion/pain state. I think in our culture, this generation of women get bombarded with mixed mesages about assertiveness and cooperation. As children most of us were raised to value cooperation teemworking skils and then suddenly as adults society's expectations shift and we are suddenly supposed to be strong assertive superwomen who can always find the answer's within.

This conflict makes it very difficult to emotionally recover from a difficult birth especially in a situation where the provider makes a poor judgement call or is disrespectful of the woman's physical or emotional needs. During birth you are in a state where you need the people around you to step up to the plate and assist you in making good descisions because you are too far in a fear/exaustion/pain state to make these descisions for yourself. If this sort of support doesn't happen and the birth goes bad we get bombarded guilt producing msg's like (self inflicted or otherwise) "you should have been more assetive" or "you should listened to your instincts."

So to the OP...as a parent you have to forgive yourself for mistakes that occur during birth. That's not to say that you should forgive bad descisions by you caregiver but that you have to trust someone during birth and you can't blame yourself if they misuse that trust or make bad descisions. You did your best with the strength, information, and resources that you had at hand.

[AnditheBee]

Originally Posted by love_homebirthing

Here's my take on the whole pain in labor thing. I do believe that it's an indicator to change positions, but it's also a tool that you use to work with your body rather than against. Personally I believe (and perhaps this isn't a popular view here) that plenty of women try to flee from the pain - essentially they fight it (this probably happens most often in women who aren't educated in pain coping techniques outside of medication, like the woman who expected an epidural at the first sign of labor but had to wait or it didn't take, kwim?). I don't think that's what happened in your case, but I think it does happen. For labor to procede as smooth as it can I think you have to surrender to the process and go with the flow. So that might mean lots of pain (it always has for me) but that would be pain with purpose as long as you followed your body's lead (i.e. this position hurts, but that one hurt WAY more). Hope that made some sense.

: That's what I was trying to say, but apparently not being as coherent about it!

And on a side note about pain in labor, I don't think that every woman has to experience it at all. Unless this information is untrue, in my Hypnobabies manual it talks about how the women who work in the rice patties of China (I might be off on geography, but I think you'll understand my point) were surprised to learn that childbirth hurt to people like us Westerners. The point was that no one ever told them that birth hurt, therefore it didn't. So I hate to say to someone, "it WILL hurt - except it" because I don't believe that it has to. But in our culture I'm sure that it will more often than not, despite a great attitude and good intentions. So it's good to be prepared and know that you can use the pain to guide you. I don't think you were off at all on that assumption.

Again, well-said. My first post was probably awkward because I was torn between trying to explain my view of "good pain/bad pain" and wondering how to even address the issue, without trying to tell CuriousLion whether or not she would even have pain at all. Some people don't, and it's not an unrealistic thought to imagine your labor might be fairly painless. On the other hand, I didn't want to say, "Yes, if you're in pain, switch positions" outright because I worried that it might suggest that every woman can "turn off" the pain simply by moving around more. I had pain, but most of it felt like "good pain," productive pain, very much endurable pain. The pain of, for example, laying on my back, was the "bad" kind, and I avoided it.

Wow, this discussion has gotten very complex...who knew labor pain could have so many layers? Hope we're not just confusing you further, CuriousLion!