by Haley Macklin
Culturally, pain in labour appears to vary subjectively between different groups of people. Ina May noted a significant difference between the expectations of Dutch and American women, where the Dutch women believed, “the woman’s body knows best and that, given enough time, nature knows best and that, given enough time, nature will take its course”, whereas the American women, “expected labour to be painful…and they expected to be given medication for [the] pain” (Gaskin, 2003). In Japan, birthing mothers stated that, “Birth is natural…I would be afraid of an earthquake, but not of having a baby without anaesthesia…If you take the anaesthesia, you miss the ecstasy. You miss the euphoria” (Gaskin, 2003). The Japanese mothers actually indicated it was the medication that was preferable to avoid, not the pain. It’s not only cultural differences where contrasting beliefs around pain and birth are evident; studies suggest mothers who birth in hospitals vs mothers who birth at home have very different expectations of pain during labour, with the mothers birthing in a hospital environment rating childbirth pain as significantly higher than those who birthed at home (Gaskin, 2003).
The occurrence of labour sensations can happen leading up to labour (what is known as early, latent or pre-labour), during active labour, birth and even the last stage of labour, which is when the placenta is born (at this point, the sensations result from the contractions of the uterine wall squeezing to release the placenta). Speaking from experience, there can even be some rather uncomfortable sensations that are experienced in the fourth trimester, the period of time after birth, from uterine contractions when the uterus is reducing back to its pre-pregnant size (called involution). This can take up to six weeks to occur and is often perceived more during breastfeeding when oxytocin is released from the brain into the bloodstream.
Labour sensations themselves are triggered by a concoction of hormones, causing strong uterine contractions. Pressure from the baby on the cervix and the position of the baby (back labour is a perfect example of this) are other causes of pain during labour. The sensations can be mild, or they can be forceful, and very importantly, the emotional state of the mother will affect how she perceives them. Mothers who feel relaxed, calm, peaceful, safe and undisturbed will often note that the ‘pain’ sensations of birth are easier to manage then those who feel stressed, uncomfortable, anxious, fearful or ‘on show’ (Buckley, 2009). This is very important to recognize, because it can result in the difference between a woman experiencing birth as unbearable and unmanageable to a woman experiencing birth as challenging but achievable. When women are encouraged to shift their perception of the sensations they are experiencing, through their psychology (thoughts and beliefs), very often the sensations can subtly change (Beigi et al, 2010). Even changing a thought from, “this contraction is so strong and painful” to, “this sensation requires all of my attention to relax and breath through it” can manifest in a change of experience. Van der Gucht & Lewis (2015) have demonstrated that women who experience continued care throughout their labour and encouragement to surrender to the sensations rather than resist, actually feel an acceptance of the pain and discomfort, rather than a need to avoid it.
Michel Odent has suggested that it is the fear of pain that most commonly causes difficult labours, and this fear can lead directly to the experience of an actual painful and unbearable labour. Experiencing a resistance and desire to inhibit pain can lead to an increase in stress hormones, resulting in a decreased frequency of contractions and their intensity (Alehagen et al, 2005). This has the potential to reduce uterine blood flow, which can cause harm to the unborn foetus, and slow the progress of labour (Coad & Dunstall, 2001). The introduction of artificial hormones also interrupts the body’s natural pain relief, which is produced by various hormones released by the mother’s body. The wonderful chemical cocktail the mother’s body creates under natural birth circumstances has an opiate effect on her body, making it easier to manage the intensity of labour. Even if labour is long and arduous, the hormones at play (namely endorphins and oxytocin) will help the mother on her journey into the unknown, taking her ‘out of body’ to the realm only those of us who have birthed children know of.
Ironically, it is in the avoidance of pain that pain itself becomes prevalent after birth for many mothers. Interventions used during labour to reduce pain can lead to other more serious interventions (which are, in and of themselves, very painful, and unlike labour, enduring!). The frequent administration of epidural anaesthesia, for example, is directly associated with an increased rate of caesarean born babies, as well as the rates of births requiring vacuum extraction and forceps (Gaskin, 2003). Other painful risks include the use of epidurals causing long term back pain in about one in five women, the discomfort experienced after an intravenous line is removed (which can last for days) and various injuries to mother and baby from the use of forceps and vacuum extractors (Jansen et al, 2013). It can take weeks, months and sometimes even years for women to heal both physically and emotionally from these interventions, and the financial cost for a mother to heal fully can be counted in the thousands.
(Part II in August Enews)