Recently, I saw a meme going around on facebook, a quote about childbirth from one of my all-time heroes, Ina May Gaskin: “Don’t think of it as pain, think of it as an interesting sensation that requires all of your attention.” Did I mention how much respect and awe I have for Ina May Gaskin? I have studied her, read her books, and watched videos of her speaking. Her wisdom inspires me to no end, which is why it’s a little awkward for me to say that I think this quote is an oversimplification, misleading even. I think it’s safe to say it’s not her complete philosophy about pain in childbirth.
I’m about to say something controversial: birth hurts. I imagine there are many women out there who have given birth who don’t find that controversial at all- they already know that. So why is it provocative to say so? Because I am a midwife, an advocate for natural birth, someone who helps women prepare for childbirth. I am not in the business of bringing more fear to the realm of birth. It is not my intent to add another agonizing or horrifying labor tale to our cultural memory and experience. But I think it’s time we, the voices of the natural childbirth movement, be more real. Pain doesn’t have to be a dirty word in birth stories. No, pain doesn’t have to be the focus, either. But giving women the idea that pain is not a normal part of birth is a disservice to childbirth preparation. I’m calling our bluff.
In the last decade, I have witnessed the popular messaging of the natural childbirth movement promote ideals about natural childbirth being orgasmic, painless, or ecstatic. Don’t get me wrong, I don’t seek to insult the wonderful tools and preparation methods that have helped many women cope with childbirth. Nor do I intend to invalidate the women out there who have experienced pain-free or orgasmic births- I know they happen. In fact, validating orgasmic birth is arguably as important as validating traumatic birth. Birth has infinite possibilities, and it’s a positive thing to explore the spectrum of experience. I am just wary of the pain-free birther being the poster child for the natural birth movement. It’s exclusive, it’s uncommon, and for many, it’s unobtainable.
Idealizing painless childbirth is a backlash, I surmise. For so long in this culture, women have been fed misogynist ideas about childbirth pain: pain is a punishment, it’s deserved, we won’t be able to handle it, we need to be saved from the pain by medical intervention, birth is inherently dangerous. So it makes sense that, over time, when women began to take back the story of what birth is and can be, that we swung way out to the extreme. Thanks to many important voices in the natural childbirth movement, we know a lot more about the relationship between fear and pain in childbirth. Fear and lack of relaxation can increase pain and interfere with physiologic labor. We know that preparation for childbirth is valuable. Women have internalized a lot of scary or sabotaging concepts about what birth is that can inhibit the safety and satisfaction of birth, and childbirth preparation can help dis-arm these ideas. We know that the experience of natural birth is so much more than pain. But let’s not swing so far that frank discussions of pain are being avoided for fear of promoting fear while false-ideals are being romanticized.
For the vast majority of women, pain is a common, normal part of childbirth which does not prevent the experience from being positive and empowering. As birth advocates, I would like to see more encompassing ideas promoted about childbirth pain. I want women, especially first-time mothers, to be told that pain is a likely possibility, and that they are strong, they can cope and they will be supported. I want women to get the message that if they experience pain during birth, they are not alone, they are not inferior or unenlightened, and they have not failed.
Pain in childbirth has purpose. Pain triggers a release of beta-endorphins, analgesic hormones with euphoric effects, which contribute to the altered state of consciousness of natural labor. The experience of pain in this altered state is shifted. In fact, the altered state of consciousness typical of undisturbed labors is a great example of how women’s bodies support them in the birth process. The release of beta-endorphins because of pain during labor stimulates the release of prolactin, which in turn, helps put the finishing touches on infant lung maturity and primes breast tissue for breastfeeding. Looking at it from that perspective, rather than viewing pain as a betrayal, pain can be seen as a catalyst for a healthy birth.
Pain in childbirth comes in waves. In-between contractions, there is rest. The cyclical nature of a normal labor pattern is yet another inherent coping mechanism that makes pain during birth tolerable. We often think of pain as unrelenting and constant because that’s how we experience pain in other circumstances, such as with injury. But that is not what pain in childbirth is like. The breaks between contractions give women a chance to communicate a need, shift positions, or relax deeper. It also provides an emotional opportunity to integrate the experience, and to stay present with the birth experience. Take contractions one at a time.
There are many things mothers can do to cope with pain. Birthing in a setting and with a provider who encourages women to act on their instincts is a good place to start. Women know how to breathe, they know when they want to change positions, they will say so if they are hungry or thirsty. If they want to be in a dark quiet space, that’s because low lights and minimal use of language helps them maintain the hormonal and neurological balance that keeps labor flowing.
Pain gets women moaning. Vocalizing is a powerful tool for coping with pain. It’s Ina May Gaskin who has educated us so well about the value of a low moan during contractions, which she terms the” law of sphincters.” Making low moaning sounds opens up a birthing mother’s throat and relaxes her jaw, which in turn, helps open up the cervix.
An important piece of a soon-to-be-mother’s preparation for natural childbirth is cultivating trust in her support system. In other words, she needs to be able to know that, because she is likely to experience pain, the environment and the people surrounding her will be encouraging of her process. She doesn’t want to be rescued, she wants to be supported. The environment she births in needs to allow for freedom of movement, a decent amount of privacy, and should be equipped with basic equipment that can provide access to desired pain management tools, such as a birth tub, a shower, a hot water bottle, a place to squat, a bed to rest in, and food to keep her energy up. The people around her should be aware of her desires for her birth, reasonably able to read her cues, and comfortable with (rather than personally triggered by) her experience of pain. She may want massage, counter-pressure, simple words of encouragement, a cold rag on her head, companionship, supportive suggestions, or music. When her needs for support are met, she will be in less pain. When she can anticipate good support, she can let go of some anxiety or fear around the pain of childbirth before she goes into labor.
Birth, however it happens, is a rite of passage. Authentic rites of passage often include some sort of physical challenge, and a psychological stretching of what we believe our limits to be. My message to women preparing for birth is this: birth hurts, but you can do it. You are strong enough. You are supported. You will step up to receive what your birth experience asks of you. I believe in you.
 such as Dr. Grantley Dick-Reid, Dr. Robert Bradley, Ina May Gaskin, Elena Tonetti-Vladimirova, and Marie Mongan.