Pain to be avoided or encouraged?

[CuriousLion]

I just remembered a question I've wanted to ask ever since DS's birth. When I was pg I read Dr Sear's Birth book and many articles about natural birth. And one of the things I took away from my reading was that during labor when you're in pain it is your body's way of telling you to change something. And my childbirth instructor said the same thing. So...that was my understanding of what to do and I felt like I understood birth and was prepared. I had a plan...if it hurt too bad...I would change positions.

But then when I was in labor my midwife and others told me to stay in positions that really hurt because it would bring the baby. It totally messed me up mentally. I no longer had my plan to go by.

My labor ended up being a horrific 36 hour nightmare. I was in transition for 6 hours! I cannot even put into words how bad it was. My midwife said the problems were because DS had the cord around his neck and couldn't descend. She had me transferred to the hospital (after I'd been in active labor for like 20 hours) for an epidural because she said that was the only way i could still hope to have a vaginal birth. And I did.

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.

Any thoughts?

[2+twins]

I would tend to agree with the idea that pain in labor guides you - like into a different position. So I think it was unfortunate that your mw discouraged that. I think a laboring woman should always feel free to move as she feels is best. Perhaps you need ideas and your mw can offer them, but ultimately *you're* giving birth so who would know better than you what your body needs? I'm really sorry you had such a difficult experience. If you do have another baby in the future, be sure your support person is on the same page as you. Oh, and don't expect your next experience to be anything like your first. It probably won't be.

[doula and mom]

Wow. I'm really sorry your first experience was so difficult but it sounds like you got through it like a champ.

As far as your questions: my doula said that pain is inevitable during labor, but suffering is a choice. However, she has looooooong labors that involve slowly increasing contractions and dialation, whereas I go from 3cm to pushing in about 2 excrutiating hours. So I'm not sure I entirely agree with that.

I do not think you can completely avoid pain during labor. However, I do think you should find the position in which you are the MOST comfortable. If you are in pain and uncomfortable, your body will not respond well, in my opinion.

The only caveat to this is if your baby is breech or posterior during labor, in which case you have to be on all 4s for a while to encourage the baby to move into the birth canal in a more optimal position. But it doesn't sound like those were the positions you are talking about?

Before you get pregnant with #2, I might interview some other midwives and see what they say about your last experience. Also, consider having a doula to support you.

Hope that helps.

[fourlittlebirds]

Sometimes no matter what you do, it hurts. But if your body is telling you to move or get into a certain position (even if just because it feels better) that is what you need to do.

Your midwife was wrong. And her directing you instead of letting you listen to your instincts may very well have prolonged the labor and made it harder.

Out of curiosity, what positions did she want you to be in and why did she think they were right?

This is weird: "My midwife said the problems were because DS had the cord around his neck and couldn't descend." Um, obviously he *could* descend, as he did. :scratch

[fourlittlebirds]

"my doula said that pain is inevitable during labor, but suffering is a choice."

Oh, WHATever. I'd like to see her go through my back labors and still be able to look me in the eye and tell me that suffering is a choice. How incredibly arrogant and ignorant. Sorry, but this one just gets my goat like nothing else. She simply doesn't know what she's talking about.

And how about people who have painless or pleasurable labors? Does she think they're lying?

[davidah]

This is an excellent question! I would highly, highly recommend purchasing and using The Pink Kit (a childbirth home-study preparation course from New Zealand) for your next birth. And if you are feeling sufficiently traumatized, you could purchase it now and see if if helps you figure things out from your last birth. The Pink Kit really explains why certain kinds of "stuck" pain happen, and the very specific position changes that can help relieve certain kinds of pain. They make the point, for example, that back labor where the baby is pressing on the sacrum often FEELS better with counter-pressure on the sacrum, but this can be counter-productive for progress because what you really need to do is take action to help free up the sacrum and create more room for the baby there. So this might mean more short-term pain (because you're not using counter-pressure), but less long-term pain because you will help the baby descend.

So I am definitely a believer in listening to your body during labor and using that information to help resolve problems in descent, positioning, etc.

BUT -- I also think there are times when women are trying to "escape" the pain of productive contractions, and this can also make things more difficult, slow things down, etc. For example, getting into a tub at a very early stage of labor might decrease the contractions and "stall out" labor for a while. This can be fine if Mom has lots of stamina, but probably isn't optimal. Or a Mom might be too scared to really push. Sometimes "the only way out is through." And you need to summon up the courage to just make it through a difficult part, instead of trying to avoid what is happening.

So on the one hand -- you're right that changing positions can be very helpful for helping to resolve positioning and other problems that are causing pain. And on the other hand -- your Midwife might have had a good reason (in her mind) for either encouraging you to stay in a position that she thought was beneficial (like hands and knees to encourage rotation of the baby), or she might have thought that you were trying to avoid ctx instead of working through them. Birthing from Within has a great description of an exercise to do during labor if Mom is "stuck", to help her welcome and bring on stronger contractions.

But I think the real issue is that your Midwife did not communicate with you well or respect your own wisdom about your body. She didn't respect your autonomy. She could have given you information "I think position X is beneficial for Y reasons; I would recommend trying it for 15 minutes"; without *forcing* you to do anything.

(((hugs))))

Davidah

[rootzdawta]

:hug to you . . .

When I was giving birth, my midwife encouraged me to move: get into the tub, try to sit on the toilet, do this, do that. I was in so much pain I wanted to be left alone in the position I was in to deal with it. I don't know if pain is avoidable but I do know that in our culture, we have learned to try to distance ourselves as much as we can from pain. We are not really raised learning how to cope with pain. We get a headache, we pop an Advil and so on and so forth. I think more than anything in your situation, the pain was really so bad because the midwife screwed with your mental plan--you two weren't on the same page. I don't know if pain should be encouraged but I don't think it should be avoided. Pain tells your body something's going on, something must change or else.

[Thmom]

I agree with fourlittlebirds on all accounts.
I think it's really sad your mw didn't encourage you to listen to your body and do what you felt you needed to.
I also don't get how an epidural ensures you have a vaginal birth?

I would encourage you to interview other mw's prior to your next pregnancy and find out just exactly what thier philosophy is.

[stafl]

But then when I was in labor my midwife and others told me to stay in positions that really hurt because it would bring the baby. It totally messed me up mentally. I no longer had my plan to go by.

My labor ended up being a horrific 36 hour nightmare.
:crying :hopmad :bang :soapbox

oh, dear. I am so sorry your midwife did not trust your instincts and intuition, and had to be so in control of YOUR birthing process. That sucks big time.
:hug I have no doubt that must have been quite traumatizing for you. It takes time to heal from that sort of trauma. Talking about it helps most women, writing down your birth story, with commentary, helps many of us too. Don't be afraid of having more children, though. There is no reason in the world to expect a repeat of that experience! Now you know what you need in a midwife, someone who has enough faith in you that you can trust and follow what your body is directing you to do. It might take a good bit of searching to find her, but she's out there somewhere, just waiting to be present (quietly present) at your next birth. Or maybe you'll even go unassisted! Wouldn't that be so cool? Read Ina May's Guide to Childbirth, that book, more than anything else, helped me regain faith in myself and my body's ability to give birth after the very traumatic experience of my first child's entry into this world.

[CuriousLion]

I agree that suffering is not a choice! But after reading this I feel that my midwife did the right thing. Let me go a little more in depth into what happened:

DS was posterior. We knew that going into the labor. Even though I practiced fetal positioning he turned posterior a few weeks before the birth and wouldn't budge. I went into labor very early in the morning on the 30th. A contaction woke me up and I thought I might be in labor so decided to get as much sleep as possible. So, went back to sleep and slept until noon. When I got up I was still having light contactions and luckily I had an appt with my midwife at 3. So, I went to that and she said that I was in labor and would probably have DS by midnight. She told me to go home, eat, rest, pack the car, and come with the contractions were 5 minutes apart. Around 5 pm things picked up, but my contractions were clustering...I'd have like 5 one on top of the other then nothing for 10 minutes or so. Finally, I decided to go in around 11 pm.

When I got there my midwife checked me and said I'd have DS before sunrise. And she pretty much left me to myself. I walked and rocked and just moved around. But I really wasn't in much pain at all. When it started getting closer to sunrise and nothing much was happening my midwife started getting more actively involved. She encouraged me to walk because my water hadn't broken. But nothing happened. She then told me to lay on my left side to encourage DS to turn. And that's when things changed horribly. When I layed on my left side I suddenly felt like my hips were being ripped apart by a monster. I started screaming and pretty much didn't stop until I got the epidural 6 hours later. She encouraged me to stay on my side so he'd turn. Then she had me get on my hands and knees. I realize now that she was trying to get him to turn and releave my back pain...but those positions actually hurt the worst. And that's what I was talking about when I said she encouraged me to stay in positions that hurt. She was telling me that those positions would bring the baby. so, that switch in gears from "move if it hurts" to "stay in positions that hurt to make the labor progress" really messed me up with mentally dealing with it. Then she decided to break my water. I didn't know it, but there was meconium in it.

For the next like 5 hours she tried everything to get him to turn and descend. I was on the toilet, ended up in the tub even though I hadn't planned for or payed for a waterbirth. She tried all kinds of herbs, etc, to help me with the pain. But nothing helped. I had horrendous back pain and I was delerious. I was a freakin' mad woman. Somewhere close to noon she checked me and I hadn't made any progress since the bad pain started like 5 hours before. I had stalled at like 8 cm. And there was fresh meconium. So, she said I had to go to the hospital. She said she wasn't sure what the problem was but something was really wrong.

So, at the hospital they gave me an epidural. The purpose for that I guess was to get me to relax so DS could descend. (I guess I said that wrong before...DS couldn't turn because of the cord, but couldn't descend because I guess I'd tensed up a lot from the pain) They let me rest for a bit until I started feeling like I wanted to push and DS was born at 2:47 pm on the 1st. He had the cord wrapped around his neck twice and it was very tight so they had to cut it immediately. So, that's what caused all the problems.

So, I think under the circumstances my midwife did right...she was trying to get DS to turn and she didn't know that he couldn't turn. And I think if it had been a normal labor things would have been much different. She and I probably didn't have the best communication, but I actually didn't know her very well. My origional midwife got pregnant right after I did and I didn't know that until I'd been seeing her for many months (I thought she was just getting fat :lol ) So, I was seeing both her and her replacement for just the last few weeks. The replacement midwife was who I ended up with and we just didn't know each other very well. But heck...she was much better than the idiot doctor I ended up with at the hospital. That man said he was going to give me an episiotomy, I said, "No!", he laughed at me and sliced. :angry

After the birth my midwives told me that I had done really well under the circumstances. I didn't give up mentally until they told me I had to go to the hospital. Then I wanted to give up because I felt like I'd failed. They told me that what happened wasn't my fault it was all because of the cord being wrapped around his neck.

So, I guess I have a better understanding of what happened in DS's birth. But now I wonder what a normal birth would be like. And if my origional ideas about changing positions to relieve pain would be correct in a normal birth. It seems like some people say you should work to relieve pain and others say that pain is productive. I really want to have a better understanding of the reason for pain and what to do about it in a normal birth before I could ever have another one.

Thanks for all the replies, mamas!

[stafl]

keep writing and talking about what happened. That will help you more than anything else possibly can. You don't have to justify the choices your midwife made to anyone, not even to yourself. Sure, she most certainly did what she thought was right at the time, but she did not trust you to trust your instincts, and that, I think, is the whole point we are all trying to make. The usual baby-turning positions hurt - that was your body's way of telling you it wasn't working and you needed to try something else. What was your gut instinct at the time? Did you know, deep down inside, that you should stay in those positions, or were you having to force your body to do what your midwife was telling you to do? That makes all the difference in the world. Women who feel supported and respected by their care providers, and who are relaxed and comfortable with the birth process tend to have much easier labors than those who do not. :hug

[AnditheBee]

I guess the key point here is that there is pain, and there is pain...and then there's PAIN. I had a drug-free labor for 14 hours, and I found that the pain of, for example, lying on my back (which they made me do for the cervical checks), was different than the pain I felt when I was upright and having contractions. Yes, my normal contractions caused pain, but it still felt "okay," if you know what I mean. I understand your need to go into the process with a "mental plan," because I'm the same way, but when you don't know what the contractions will feel like, it's really difficult to know for sure how you should/will handle them, you know? So I guess what I'm trying to say is that even though you may feel pain if/when you have another baby, you may be able to listen to your body to know whether or not it's a "good pain," or pain that is unproductive and unnecessary. I hope this makes sense! The important thing, IMO, is to trust your instincts in the moment rather than relying solely on another person's opinion, or even solely on your own pre-made plan. Going with the flow seems really important in a natural birth, from what I can see.

I'm so sorry that your first experience was so difficult! You sound like you are approaching the event with a clear head, though--it's always good to figure out the why's and wherefore's before making decisions about the future.

[Thmom]

keep writing and talking about what happened. That will help you more than anything else possibly can. You don't have to justify the choices your midwife made to anyone, not even to yourself. Sure, she most certainly did what she thought was right at the time, but she did not trust you to trust your instincts, and that, I think, is the whole point we are all trying to make. The usual baby-turning positions hurt - that was your body's way of telling you it wasn't working and you needed to try something else. What was your gut instinct at the time? Did you know, deep down inside, that you should stay in those positions, or were you having to force your body to do what your midwife was telling you to do? That makes all the difference in the world. Women who feel supported and respected by their care providers, and who are relaxed and comfortable with the birth process tend to have much easier labors than those who do not. :hug
I completely agree... yes the midwife was attempting to help but in the process circumvented your own instincts
and I hope you at least wrote to the hospital about the doctor performing an unnecessary, unwanted medical act. Personally, I would take it up with his licensing board.

[fourlittlebirds]

BUT -- I also think there are times when women are trying to "escape" the pain of productive contractions, and this can also make things more difficult, slow things down, etc.

On what do you base this belief? What do women do that makes you think they are trying to escape?

I ask because after my own experience with a midwife who felt I was doing that, I am very skeptical about how often it's really true, and how often it's just the midwife assuming it because the way the woman is dealing with the pain is different from the way the midwife was taught was "right". Or, the woman is displaying escapist-type coping mechanisms, but that it is impossible to separate out how much of this is her fighting her body, and how much is a response to pressures from her attendants.

Perhaps for midwives to say "she was too scared/uptight/unwilling to accept the pain or do the work" is more often than not just a convenient way to blame the laboring woman for a difficult birth.

For example, getting into a tub at a very early stage of labor might decrease the contractions and "stall out" labor for a while. This can be fine if Mom has lots of stamina, but probably isn't optimal.

I disagree. If a labor slows or stalls for non-stress reasons, there's no reason to assume that it isn't exactly right for the mother's body and birth process. We focus too much on the notion that the mother will get tired out with a long labor. If her labor is going slow, or is stalled, and she isn't being made to do a bunch of stuff to try to get it going, she is going to be able to use that time to rest. The mother may psychologically lose energy if she has expectations of a normal labor process being no more than half a day long. But I have to question whether she would if quick labors weren't regarded in our culture as more normal than long labors (a myth begun and perpetuated by obstetrics.)

Or a Mom might be too scared to really push. Sometimes "the only way out is through." And you need to summon up the courage to just make it through a difficult part, instead of trying to avoid what is happening.

Or (probably more likely given the widespread notion that the mother needs to start pushing when "complete",) maybe her body simply is not ready.

[Thmom]

:truedat: :clap :twothumbs :nod

[fourlittlebirds]

CuriousLion, I know you're just trying to give your midwife the benefit of the doubt, and I certainly believe she thought she was doing what she thought best. She was still wrong, though, and I don't mean just that she was mistaken in her assumption that the baby could turn. I mean that it was wrong of her to assume that the pain you were experiencing wasn't a message from your body that those positions were wrong in your situation.

[CuriousLion]

yeah...the point of this post is not about my midwife, and I certainly do not want to speak negatively about her. She is a very sweet woman and I know she tried to do what she thought was best. I know that any time a labor doesn't progress normally it's a tough situation. She tried to help me and even when I had to go to the hospital she went with me and stayed right by my side. I am really thankful to her for the support she gave me.

My basic question was whether or not I was right about pain being an indicator to change positions. From what I read that seemed to be true, but then other people talk about not avoiding the pain. 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.

Looking back now...I don't think I could've relaxed enough for DS to descend no matter what I did. I was completely delerious because of the pain. As much as I hated it...I think getting the epidural saved DS's life and maybe even my own. DS was in distress and was not well when he was born. I think if I hadn't gotten the epidural he would have died. I found out just recently that my grandmother had kept a secret her whole life about a first marriage and pregnancy that I never knew about. And the same exact thing happened...except she didn't get any pain relief or other procedures and her daughter was stillborn. And she had severe hemoraging (sp?) and almost died. I also started to hemorage after the birth but they controlled it. I think if I hadn't gotten the epidural DS would've died and if I weren't at the hospital I would've been a lot worse off too because of the bleeding. So, as much as I really hate to say it I think what they did at the hospital saved our lives.

So, what I'm really wondering about is the idea of pain being an indicator to change postitions in a normal labor. I want to understand the role of pain in a normal labor. I want to know if the ideas of pain being a guide to you to change positions would be correct in a normal labor. Someone here said something about a mother maybe being scared to push. I don't see how that could happen. In my experience I couldn't not push. I'd let the epidural wear off after I'd relaxed and DS descended. So, when I pushed I had pain...but my body told me to push...I couldn't not do it. I don't see how someone could avoid that. I don't think I tried to avoid pain...I tried to work with my body. I wanted DS out of me! :lol But my labor went wrong and I know it wasn't my fault. I just wonder what a normal labor would have been like and if I have the right ideas about the role of pain.

[2+twins]

My basic question was whether or not I was right about pain being an indicator to change positions. From what I read that seemed to be true, but then other people talk about not avoiding the pain.

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.

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.

[Thmom]

Posterior is a variation of normal... it's actually pretty common for women to have posterior babies, sometimes you can get them to turn sometimes not.

I think pain is relative... my idea of the kind of pain that means to change positions is probably different than yours. It's all about listening to your insticts, doing what feels right to you. If it felt wrong to be on your side then it probably (and in this case obviously)was wrong, had you listened to your body and found a position that was more comfortable to you, you most likely would have been able to relax without the aid of drugs.

I have alot more to say, but I doubt it would prove productive. I'm sorry you feel the way you do about your birth, hopefully your next experience will be better.

[fourlittlebirds]

My basic question was whether or not I was right about pain being an indicator to change positions.

All right then, I'll put it that way. :) You were right. But I 'd better qualify that. It's not that pain necessarily means you to change positions, it's that pain is one way in which the body can impel you into the right position. That doesn't mean that the pain will go away, because there may be other reasons for the pain too. But if you are in a situation where your instinct is to move in order to deal with the pain, that is your body telling you that. That's not going to be wrong.

From what I read that seemed to be true, but then other people talk about not avoiding the pain.

They're wrong. Pain is not necessarily normal; it is in non-birth situations an indicator that something is wrong, and it often is in birth as well -- some would say that it is always an indicator that something isn't right (and I agree, even though I had extremely painful births with good outcomes) although not necessarily to a life-threatening degree. In any case, sometimes it just is going to hurt no matter what you do, so sometimes you just have to accept that and work through it. But pain doesn't make a birth more normal. It's not as if the more painful you make it, the more normal it's going to be. That's absurd, right? It's also absurd to assume it's normal and measures shouldn't be taken to reduce it.

[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.

[fourlittlebirds]

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]

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.
:yeah:

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]

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]

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]

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

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!