Investment

Investment

by Carol Lynn Pearson

How enviously
I watched
The rose bush
Bear her bud --
Such an easy
Lovely birth.
And
At that moment
I wished
The sweet myth
Were true -
That I could
Pluck you
My child
From some
green vine.

But now
As you breathe
Through flesh
That was mine,
Gently in the small circle
Of my arms,
I see
The wisdom
Of investment

The easy gift
Is easy to forget.
But what is bought
With coin of pain
Is dearly kept.

Carol Lynn Pearson is a Mormon author and playwright. Read more about her here.

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Afterthoughts on Epidurals

Thanks to everyone who posted about their epidural experiences! If you haven't already shared yours, please do. I've really enjoyed reading all of your diverse perspectives. I'll probably have several posts discussing various issues raised in the comments sections.

Today, I wanted to talk about the not-so-empowering epidural experiences and what we can do (if anything) to prevent those from happening as often. Some women really wanted to give birth without an epidural but felt cornered, forced, or coerced into one. Or they had inadequate support from the nurses or their spouse and there were really no other options but the epidural for dealing with labor. Some were induced and--quite understandably--found the pain of Pitocin-induced contractions totally overwhelming. Some had epidurals that supplied inadequate pain relief or that left them with long-term side effects such as back pain or nerve damage. Some felt abandoned after their epidural, like they didn't matter anymore now that they were quietly contained by their medications. Some felt like they had caved in/given up too soon. And so on...

My question for you is: what are some practical things we can do, both individually and institutionally, to make these kinds of experiences less common? I'd like to hear from all of you: "lay" women, birth attendants, doulas, and childbirth educators. I know that we can't prevent every case of disappointment, dissatisfaction, or dis-empowerment. But surely there are things we could do to help. (And I feel that it will be a LOT more complex than simply telling women to adjust their expectations, or telling them that wanting a natural birth is a silly, selfish goal, etc.)

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Epidurals

When I was a PhD student, I was chatting with an acquaintance about pregnancy and birth. She had four children. She said something that was really hard for me to wrap my mind around. "I just love it when I go into labor and get an epidural," she said. "I feel so empowered!"

Epidural + empowerment are two words that don't always get put together in the same sentence, even among women who gladly choose epidurals for pain relief. For me--huge caveat that I'm speaking about my own thought processes here, not generalizing myself onto all women--an epidural is the opposite of empowerment. Not just emotionally or psychologically, but in the literal sense, too, because an epidural causes full or partial paralysis from the waist down. The thought of losing sensation, of literally being unable to walk or move, isn't something I would look forward to in labor. To me, labor = movement. I cannot imagine having a contraction without moving in response to it.

I imagine that many people have reacted the same way to my choices (giving birth at home, having an unassisted birth, foregoing pharmacological pain relief) as I did when I was talking with my acquaintance. A sense of curiosity, a bit of the exotic other that feels genuinely foreign, the push-pull of one's own values and preferences at odds with another's.

I wonder why it is so surprising that women have such different reactions to certain choices or life experiences. We certainly don't expect everyone to feel the same about, say, their time in high school. Some people spend their whole lives reliving their high school glory days. They loved high school so much that they can't wait to go back and coach football or teach English at their old school. Some people would happily erase those years from their memory and are just glad that they made it through alive and relatively unscathed. (Or maybe they were like me: mostly oblivious to what was going on around me and happy in my own little world. It helps that I had a good set of friends, too.)

So what is it about birth experiences that's so divisive? Why are we so quick to take offense, or to react defensively, when people make different choices from ours? Perhaps we allow these significant life experiences to partially define ourselves--so that the choice to have, or to not have, an epidural isn't just about the epidural any more...it's about how we define ourselves as mothers and as women.

This meandering train of thought brings me to another set of questions. I want to hear about your epidural experiences. Tell me everything and anything (and you don't necessarily have to answer these specific questions in order--think of them more as prompts):

• did you plan on having an epidural during labor? why or why not?
• at what point in labor did you have one? 
• how did you feel about it at the time? later on? 
• did you feel at all pressured into choosing an epidural (from nursing staff, midwives, physicians, or even your own partner or friends)? 
• did you have adequate labor support? In other words, were you able or encouraged to use other forms of pain relief (shower, jacuzzi, birth ball, massage, hypnosis, movement, TENS, gas and air, etc) before the epidural?
• did you experience any short- or long-term side effects from the epidural?
• do you feel that the epidural positively or negatively affected the course of your labor (or had no effect at all)?
• what did your epidural feel like? did you have complete loss of sensation? pressure but no pain? etc...
• would you have an epidural again? would it depend on the particular circumstances of your next labor? (for example, maybe you'd have an epidural if you had another posterior presentation, but not for a normal anterior presentation)
• what about emotional/psychological effect of the epidural? did you feel empowered? disappointed? strong? weak?

Let's hear from you!

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Sour grapes?

Another article about Gisele Bundchen's birth gives a few more details. From Supermodel Gisele Bundchen claims son Benjamin's birth 'didn't hurt in the slightest':

Four months after giving birth to son Benjamin, she has opened up about the eight-hour birth - saying it 'didn't hurt in the slightest'. Gisele gave birth in her bathtub at home in Boston with no pain relief with her mother, sports star husband Tom Brady and a midwife by her side.

"My delivery was in a bath tub, in water," said the 29-year-old. "I wanted to have a home birth. I wanted to be very aware and present during the birth...I didn't want to be drugged up. So I did a lot of preparation, I did yoga and meditation, so I managed to have a very tranquil birth at home."

Speaking to Brazilian TV channel Fantastico, she said: "It didn't hurt in the slightest. The whole time my mind was focused in each contraction on the thought 'my baby is closer to coming out.' It wasn’t like 'this is so painful.' So I transformed that intense feeling into a hope of seeing him."

Bundchen says her son didn't cry after being born and rested in her lap for a long time. "It's wonderful," she said. "Never in my life I thought I could love like this. You hear people talking about it, but you don't know until it happens to you. I couldn't be happier."

Poor Gisele. She had a lovely birth, one that she planned and prepared carefully for--and she gets ripped apart for talking about it. Commenters to this article call her a liar, an android, a robot. They call her brainless and dumb, or deceitful, or selfish and shallow, or overly competitive. All because giving birth was not a painful experience for her. Sour grapes, anyone?

Now I love my birth experiences. Pain was definitely a part of the experience, although not the dominant or defining aspect. I've written earlier about how I view pain and what giving birth feels like (great stuff in the comments sections, too!). I don't at all begrudge Gisele her painless birth, nor do I doubt that she is telling the truth. I know several women who have had births where pain really wasn't present at all (I'm not talking about painless births due to early epidurals--but unmedicated or "natural" births). Often they were using some form of hypnosis, such as Hypnobirthing or Hypnobabies. Several gave birth in out-of-hospital settings, but not all. The fact that I experienced moments of pain as part of giving birth doesn't make me doubt that Gisele didn't, nor does her experience evoke feelings of hostility, defensiveness, or anger in me.

Gisele's description of focusing the power and intensity of birth--"I transformed that intense feeling into a hope of seeing him," she remarked--reminds me of the video Birth Day. Naoli Vinaver Lopez, herself a midwife and mother of three, transformed the sensation of pain into one of "love bursting out of my womb" by focusing on her husband as she labored. I also recall an essay by Ingrid Bauer about "Birth as sheer pleasure" (from Midwifery Today Issue 68). Some excerpts:

With this second birth, I went into active labour very suddenly and without warning just after 3:00 a.m. I was taken aback by the intensity of the contractions. For some bizarre reason (fear!), I decided to time the contractions even though I hadn’t planned that and had no idea what the timing actually meant! They were five minutes, five minutes, then three minutes, three minutes, then two minutes, two minutes, progressing rapidly.

I didn’t realise how fast things were going and sank into fear mode. If these first six contractions were already this intense, how would I ever stand 10 more hours? After all I was an older mom, hadn’t had a baby in 12 years, and this was going to be hard! Immediately, my abdomen was gripped with incredible pain. I couldn’t stand straight. I bent over, grasped the sink and rolled and rocked and moaned with every contraction. Despite the intense pain, I was “coping” well.

But all of a sudden, I remembered. I realised that even as I was rocking and moaning with the contractions, part of me was actively resisting and holding back against the powerful life energy that was coursing through me. I was still split, hadn’t fully embraced or committed to that energy, and was being painfully pulled between the two choices. It became crystal clear to me in that moment that the only thing that was causing pain was not the strength of the birthing energy, but my fear and resistance to it. The more I resisted, the more it hurt.

I decided to completely move into that energy, as part of it, rather than against it or bravely alongside it. I had a good look at the next contraction. The words, “This is only sensation” came very clearly, out of nowhere, into my awareness. I decided I wanted to feel this sensation, not resist it, no matter what it was, no matter what it felt like. I wanted to be and feel alive, no matter what that might mean! I consciously opened my arms, heart, sex and body to it. I was willing to experience the very centre of it, now, in this very moment. And wow!

Forget about pain-free! In that moment, literally within seconds, the overwhelming pain was transformed into the most intense orgasmic pleasure. And I mean intense. Those contractions were powerful. Contractions came one upon the other with rarely more than 5-10 seconds between, and often less (not like my first birth where I slept between contractions!). I felt sometimes close to the edge of being overwhelmed and falling back into fear (have you ever been so happy that you’re afraid you can’t take any more and it’s going to end? It’s a bit like being at that edge).

But then I opened my mouth to sing and didn’t stop. I just melted right into that life force, flowing like an open channel through my body, out my mouth, out my sex, out my heart. I wish I had a tape recording because apparently I sang some incredibly beautiful melodies (“not like any birthing sounds I’ve ever heard,” said my good friend, who caught the last bit and has been to several home/unassisted births). I don’t remember what it sounded like (except one note); I just remember the feeling of the energy.

I felt everything within my body: the cervix opening, the baby moving down, the bones cracking apart slightly, his head emerging. No pain, no burning, just oh-so luscious, sexy, sensual, wet, alive, moving fullness. There was absolutely no pushing at all. I just kept breathing and singing and wasn’t aware of any contracting or bearing down in my uterus, just smooth movement. Just before he emerged, I instinctively arched way up and then lay forward again (I was on hands and knees), as it felt almost like he was moving “around a corner.”

Exactly two hours and 10 minutes after the very first twinge, he came out to the waist into his papa’s and my hands and paused there between contractions, opened his eyes, looked around and sang “Oh” on the exact same note I was toning. Then he whooshed out on the next contraction and I took him in my arms.

That birth changed so many things in me, showed me the true beauty and pleasure of Nature and birth, cracked my heart wide open. I can hardly read a single book on birth now — even the most progressive, alternative natural birth kind — and not think that somehow, something utterly vital is missing. Something nobody ever told me about. So much emphasis is on how to handle the physical pain. Nobody ever prepared me to simply fully embrace the sheer sensual pleasure of birth.

My parting thoughts? "It is an unfortunate part of human nature to envy those who climb above us and to pull them down literally or verbally or at least within our own critical and judgmental minds," Richard and Linda Eyre commented in an essay about motivating children through praise and positive reinforcement. Let's move beyond our impulse to deny other women's experiences when they are different from our own. Let's stop tearing each other down and instead celebrate those moments of intense joy and fulfillment.

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Burn the male midwife!

A British midwife and PhD recently submitted an article to Evidence Based Midwifery, a publication of the Royal College of Midwives. Some of his viewpoints were featured in an article in The Observer. Its headline proclaimed: It's good for women to suffer the pain of a natural birth, says medical chief. The midwife argued that epidurals are overused and that having an unmedicated birth can be beneficial to women by helping them bond with their baby, preparing them for the demands of motherhood, and serving as a significant rite of passage. Instead of routinely offering epidurals, the midwife wrote, hospitals should encourage non-pharmaceutical forms of pain relief, such as yoga, hypnosis, and birthing pools. Any article discussing pain relief--whether epidurals are over- or under-utilized--is bound to be controversial. But this midwife's perspective has elicited an outpouring of what can only be described as mass hysteria.

Why? Because the midwife, Dr. Denis Walsh, is a man.

The outcry has been fierce and swift. Newspapers (mostly in the UK, Australia, and New Zealand) and bloggers quickly joined in the debate. Most simply repeated what The Observer reported, but with increasing levels of embellishment, outrage, and indignation. A sampling of headlines from various media reports about Dr. Walsh's paper:

The Mail Online's headline announced: Why mothers should put up with pain of childbirth - by a male expert in midwifery. A companion article in the same publication began with these words: "Obviously, it was a man who said it. A man who will never know the intense fury of a contraction, the hours of desperation or the waves of fear as a baby makes its painful way into the world," wrote Laura Kemp in I dare you to say that to a woman in labour.

Momlogic's headline asserted that "Midwife Says Childbirth SHOULD Be Painful." The first line of the article shouted (emphasis theirs): "When he pushes a baby out of HIS body, maybe we'll give a damn what he has to say!...Of course, this would be A GUY who says this ... a guy who has never had to go through the pain of childbirth himself!"

British midwife calls for end to pain relief during childbirth, says Australia's 3News. `

From the UK's Marie Claire: Male Midwife: Women Should Endure Labor Pains.

Medical News Today announced that More Women Should Endure Labour Pains Says Leading UK Midwife.

This is a classic case of telephone--each article reporting what another article said, each step away from the source becoming more extreme and distorted. For example, you'd think that Dr. Walsh were saying that no one should ever have the option of any pain relief and that all women should just suffer in agonizing pain. However, he did not say that at all. In fact, he strongly advocated the use of other techniques that reduce the pain of labor, including hypnosis, yoga, and water immersion. (Hydrotherapy in labor is the second-most effective form of pain relief, eclipsed only by the epidural, and was rated as the safest form of pain relief by Britain's National Institute for Health and Clinical Excellence.)

Even the original article in The Observer probably distorted Dr. Walsh's intended message. I have been interviewed multiple times for magazines, newspapers, and television. Most of the direct quotes attributed to me were, in fact, inaccurate. I never actually said those things verbatim. Instead, the people interviewing me made up quotations approximating what I said. In addition, the process of writing an article necessitates emphasizing some points and omitting others--further changing the interviewee's original message.

I doubt that any of the authors actually read Dr. Walsh's original article about "Epidural Culture." Why? Because it does not yet exist! If the authors and readers submitting comments had actually taken a moment to do some research, they would have discovered that his paper has not even been published yet! (It is currently undergoing peer review.) Nevertheless, many of the articles assume the article has been published, and that Dr. Walsh's quotes are taken from the article, because of the wording in The Observer:

He has set out his controversial views in an article for the journal Evidence Based Midwifery, which is published by the Royal College of Midwives (RCM). In a sharply worded critique of the rising popularity of pain-free labour, Walsh warns that normal birth is in danger of being "effectively anaesthetised by the epidural epidemic" in the NHS. A widespread "antipathy to childbirth pain" has emerged in the past 20 years and combined with increased patient rights and risk-averse doctors to create a situation where almost all hospitals now offer epidurals on demand, even if that is not in the mother's or baby's interests.

It sure sounds like those quotes are coming from the article, right? But they aren't, and the article doesn't yet exist.

On top of playing telephone, most of the commentary about Dr. Walsh's views suffers from a classic case of killing the messenger. Notice how quickly so many of the authors and bloggers and comments are quick to discredit his viewpoints, simply because he is a man and has therefore not given birth. Because if we can dismiss anything a male midwife says, simply because of his gender, then we surely must also discount any viewpoints on pain relief from male OBs. And we must also dismiss anything from any female midwives or OBs who have not had children. And, for that matter, any female birth attendants who have had a baby by cesarean--since they would not know what giving birth feels like, right? What we have is a reductio ad absurdum argument: if you have not given birth and experienced exactly what I felt, you have no right to have an opinion, research-based or not, about the value of labor pain.

There is a serious case of gender bias going on here. Not only is he male, he is a male midwife. Almost as weird as a male nurse. Note how many of the articles mentioned his gender. However, if the author had been a female midwife, they would not have emphasized her gender and mentioned it alongside her profession. I wonder if the response would have been as dismissive if it had been a male OB, rather than a male midwife, voicing the same ideas.

I also sense a lot of defensiveness about the use of pain relief, as if people feel threatened or personally attacked because this particular midwife feels epidurals are used too commonly and that there is value to feeling the sensations of labor. If having an epidural was the right choice for a woman, why the need to be defensive about it? (Besides the obvious reasons--1) he is a man and 2) most authors and readers were reacting to someone else's perception and interpretation of Dr. Walsh's message.)

More posts about Dr. Denis Walsh, Male Midwife:

• Village Midwife of Australia remarks that labor IS a rite of passage
• Lisa Barrett, another Australian midwife, writes about Denis Walsh and Andrew Lavender at Homebirth: Midwifery Mutiny.
• Bellies and Babies writes about Pain in Labor
• MedGuru reports that It’s good for women to undergo labour pain: Professor Denis Walsh
• The Times says: Pain in Childbirth. Professor says endure it!
• 'Embrace the pain' of birth, mums told, reports Northern Territory News of Australia

If you only have time to read one link, be sure to visit the commentary at Feminist Philosophers: A Brief Defense of My Current Hero, Denis Walsh. Here is an excerpt:

SO, big dumb MALE midwife versus women just trying to do the best they can to cope with horrible pain, right? No. Not at all. Denis Walsh has made it his mission to write about and try to put into practice good, well-designed midwifery and obstetric research, with a particular emphasis on respect for the woman as a dignified person in a highly vulnerable and difficult circumstance. I know this because–in preparation for a second delivery, of which I was formerly shitless on account of a *terrible* first–I happen to have recently read Walsh’s midwifery text Evidence-Based Care for Normal Labour and Birth. Here is a brief run-down of what I took from his text wrt epidurals:

* epidurals interfere with, slow, and generally throw off the body’s efforts at expelling the fetus, thus greatly increasing the instance of assisted delivery. (For those not in the know, “assisted delivery” means they slice into your genitals with a sharp knife and then shove heavy metal tongs up your vagina to yank the baby out. It is not fun, and even if it’s “simple” (as you’ll hear in the interview linked below), it is certainly not nice–nor are the lasting pain and disfigurement caused by it. And charmingly, in many instances of use (take my experience, for example) it doesn’t even seem to be medically indicated.)
* Midwives (a) have in some delivery ward contexts become so accustomed to routine intervention and pain relief that they’ve simply lost the ability to accurately judge ‘how it’s going’: they see a woman screaming in labour pain and think something’s gone wrong, when in fact she’s simply in labour. Because of this, midwives are quite often quick to try to “fix” the situation by offering epidural; (b) are sometimes simply not willing to take part in helping women to manage pain; in a nutshell, they simply don’t like putting up with screaming patients; and so they like for their patients to receive epidural as quickly as possible.
* Childbirth is a frightening experience, especially for women who aren’t well-educated about it, and as such, midwives tend to influence very heavily what decisions women make for themselves in childbirth.

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What does giving birth feel like?

I remember reading a book by Sheila Kitzinger back in my early graduate school years called Giving Birth: How It Really Feels. I can't remember too many specifics from the book at this point, but it reminded me to write a post about what labor & birth feels like. This event is hard to describe, because there's really no other physical experience quite like it. Most of us resort to metaphor or analogy, usually in reference to some bodily function: menstruation, elimination, & sex are the most common.

The closest I can come to describing what a contraction feels like is: a sharp, knifelike menstrual cramp that I feel right above my pubic bone, from hipbone to hipbone. It's funny that I use menstrual cramps as my analogy, because for me cramps are a dull, constant ache, whereas contractions are strong, sharp, and intermittent. But that's the closest sensation I can compare it to. Many women describe their contractions as coming in waves or peaks. I would do the same. The prevalence of electronic fetal monitoring has probably cemented that imagery, since the contractions are traced on paper as oscillating peaks. If I think of peaks (as in mountain peaks or steep hills), I think of something that requires effort, that becomes harder and harder, and then goes downward and becomes easier.

When my body began pushing, I experienced three distinct sensations. During Zari's labor, I had about an hour of "throwing down": abdominal pushiness/heaving that felt just like throwing up, only it was in a downward direction. No rectal pressure, very mild. I skipped this stage with Dio's labor. Next, I felt intense rectal pressure as the baby moved down, like my butt was going to split in two. I really didn't like this sensation. And finally, the rectal pressure subsided as the baby began crowning. In its place I felt intense stretching and stinging as the baby's head emerged more and more.

I was thinking about something one of my sisters-in-law told me about her experiences of labor. Her first three births (with obstetricians) were either augmented or induced with Pitocin and, not too surprisingly, followed by epidurals. She had told me that labor felt like your skin was being turned inside out--basically that it was pretty awful. Then with her fourth and fifth babies, she had unmedicated hospital births (with CNMs) and no Pitocin during labor. She realized that the awfulness that she had assumed was inherent in labor itself was due to the Pitocin.

We know that a majority of women in the U.S. receive Pitocin during labor. It's not entirely clear how big of a majority it is, but the Listening to Mothers II survey found that 50% of the mothers surveyed received Pitocin to either induce or augment labor. Others have estimated that the number is much higher. Of the women Robbie Davis-Floyd interviewed for her 1992 book Birth as an American Rite of Passage, 81% received Pitocin during labor. In any case, at least half and quite likely three-quarters or more of women experience a Pitocin-enhanced labor.

I wonder if this is responsible for a large part of our culture's fear of labor pain. It's no wonder that so many women talk about labor as being excruciating if more than half of them have had Pitocin! Almost all women who have labored both with and without Pitocin report that Pitocin makes labor much more painful. Pitocin contractions are usually longer, stronger, and closer together than those of a spontaneous labor. I haven't ever had Pitocin during labor, so I can't comment personally on this.

So I would love to hear from you:

• What did labor and birth feel like for you?
  
• What made labor more or less painful for you?
  
• If you have experienced labors with and without Pitocin, how would you describe the difference between the two?

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Let's talk about pain

With some of the buzz around this recent article Epidurals: Time to stop labouring over 'natural' childbirth, I thought I would add a few thoughts and mention some older blog posts worth revisiting.

Okay, first thing: the obstetric anesthesiologist quoted in the article discusses the "lucrative natural childbirth industry" and claims that "Natural childbirth has become a multimillion-dollar industry." First, we have to put this into perspective. He gave no sources for those figures, but I suspect he is referring to childbirth educators who work for organizations such as Bradley or Lamaze. Thing is, childbirth educators make no more or no less money if women take drugs during labor; their work occurs prenatally. If a woman declines pain medications during labor, no one profits. But if she accepts an epidural, a lot of people do: in particular, the hospital, the pharmaceutical company, and the anesthesiologist. I sense some anxiety from the author of Enjoy Your Labor over the viability of his profession if women choose natural childbirth. He has a very vested interest in encouraging as many women as possible to accept epidurals, because that, after all, is what pays his mortgage.

Second, he claims that "much of the information that women receive is incomplete or inaccurate." This phrase implies that natural childbirth advocates--whoever they might be--are the ones doing the withholding. I would argue that the opposite is more often the case; those with a vested interest (monetary or otherwise) in promoting or administering epidurals have an obligation to share all of the possible risks and side-effects of epidural anesthesia. (By the way, Dr. Sarah J. Buckley has written an excellent article reviewing the risks in Epidurals: Real Risks For Mother and Baby.) How often do women receive full informed consent about this procedure, meaning a thorough discussion of all risks, benefits, and alternatives? I do not know, and I would appreciate input on this.

Third, there's all this talk about the "natural childbirth industry" as if it is one unified conglomerate. Who exactly makes up this "industry?" Childbirth educators? Certainly childbirth educators discuss the risks and benefits of pain medications, as well as non-pharmaceutical alternatives, but that is only a small part of their job. Doulas? Not really, since doulas attend births in all settings and encourage the mother to make her own decisions. I really don't know who else might be part of this "lucrative industry" that he claims is profiting heavily from women's non-use of epidurals.

Last, the article itself was poorly written and poorly organized. The sections do not flow well together, and the transitions from one point of view to another were totally lacking. The article relied almost entirely on quotes or paraphrases from other authors, with little explanation or discussion of the ideas. The university rhetoric teacher in me gives it a thumbs-down.

Now, on to some of my old blog posts:

In a different approach to pain relief, I linked to Britain's National Institute for Health and Clinical Excellence, which recommended that "all expectant mothers should be offered a water birth for the safest form of pain relief." NICE found that birthing pools were the most effective non-pharmacological form of pain relief and second-most effective overall (with epidural anesthesia being the most effective but having more risks than water immersion).

In my Comments on To The Contrary, I briefly mentioned some of my own experiences of pain during labor. I wrote a long post about pain two weeks after Zari's birth called Some thoughts about a four-letter word.

In my review of Jennifer Block's Pushed, I ended with two quotes about the role that hospital policies play in creating pain. On the same topic, it's worth reading this recent blog post on NYC Moms about how epidurals are for tolerating the hospital; labor is the easy part.

Food for thought had some discussion about pain medications and whether or not they were pushed/encouraged by hospital staff. Several comments from blog readers on this topic.

In Labor and marathons, I examined the similarities between the two events and how attitude and beliefs greatly influence the way we experience and interpret them.

Speaking of marathons, I want to end with a plug for Elemental Mom's post Only One Word. She argued that we just don't have language adequate to describe the sensations of labor, so we use the word "pain" as a distant runner-up. I love how Laureen described labor pain as purchasing an endorphin rush! A quote from her post:

What we’re lacking is the linguistic differentiation, in two syllables or less, to say "pain that is the sign of pathology and illness and needs to be obliterated by any means possible" and "pain that is your body’s way of kicking in an endorphin payoff down the road."

Got that? I’m not enduring labor pain. I’m purchasing my endorphin rush, one sensation at a time.

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A different approach to pain relief

Britain's National Institute for Health and Clinical Excellence has just recommended that "all expectant mothers should be offered a water birth for the safest form of pain relief." Birthing pools are the most effective non-pharmacological form of pain relief and second-most effective overall. NICE has published clinical guidelines on intrapartum care. You can also read a summary of its findings here.

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Food for Thought

I just came across this interesting article, "Drugs, Knives, and Midwives" about the state of childbirth in the US.

Marsden Wagner is a favorite author of mine. He is a neonatologist and worked for the WHO for 15 years as director of Women's and Children's Health. Some of his articles of interest include:

• Technology in Birth: First Do No Harm
• Collection of articles about Cytotec for induction of labor, many by Dr. Wagner
  
• Fish Can't See Water: The Need to Humanize Birth
  

As a side note about the first article, I found the claims at the end of the article a bit exaggerated. The author makes it sound as if women are frequently denied pain medications. I would argue that the opposite is true; it's very easy to obtain drugs while in labor, and many women in fact find themselves pressured by their nurses or doctors to take medications.

For example, a CNM practice at a large university hospital where I used to live had an epidural rate of over 50% (and a C-section rate between 20-25%; they didn't know their actual statistics, but guessed it fell somewhere in that range). I interviewed one of the midwives for a paper I was writing as a doctoral student, and she told me that "the drugs that we use today are very safe for the mom; they're very safe for the baby" (direct quote).

Women who choose to birth in hospital alternative birth centers often do so because they DON'T want the option of immediately available pain medications.

For those of you who birthed in hospitals, what were your experiences of pain medications? Did the staff pressure you into having narcotics or epidurals? Did they try to talk you out of them? Did they suggest other non-pharmaceutical comfort measures, such as showering, hot tubs, birth balls, massage, etc?

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Some thoughts about a four-letter word

PAIN.

I hesitate to even write this post, because it gives pain a privileged position in childbirth. We all know how pain and birth are talked about: birth as the most excruciating pain a woman will ever endure, pain management in labor (a euphemism for drugs), getting a pain-free labor with hypnosis...

But now that I have been there done that, I feel the need to share my experience of pain. Not because it was awful or excruciating, but because it was one of many, many sensations that made up the entirety of labor.

Before my labor began, even before I became pregnant, I knew that I wanted to experience labor in its fullness. I wanted to feel every sensation, pleasant or not. I firmly believed—and still do—that by numbing myself to the painful parts of labor, I would also miss out on the bliss and the ecstasy as well. I wouldn’t be pain-free by taking drugs or having anesthesia; I would be sensation-free. I didn’t like that idea.

I wasn’t wedded to the idea that labor had to feel a certain way. I didn’t expect pain, but I also didn’t expect its absence. Honestly, I expected to feel a great many sensations as I labored, and I knew that pain might be one of them. I loved reading stories of painless births, ones that take a woman by surprise because she doesn’t realize she is in labor, or the ones where a woman experiences bliss and waves of pleasure. I listened to Marie Mongan’s Hypnobirthing CD and read her book. The CD was incredibly useful for relaxation during pregnancy and helping me sleep when nothing else could, but I resisted her assertion that if you relax the right way, you will not feel pain. I think that often is the case, but I didn’t want to be so dogmatic about my own labor and feel that I somehow failed if I experienced a sensation as painful.

My contractions felt like sharp, intense menstrual cramps, all entirely in the front of my abdomen close to my pubic bone. I can only say they were “like” menstrual cramps because cramps for me don’t come and go like contractions—they are a slow, dull, relentless ache, almost in my pelvic bones. The contractions became more intense and more painful as labor progressed. Pushing brought on a different kind of pain. I think the ferocity of the contractions and the uncontrollable urge to push made the sensations a bit more difficult to integrate. All I had to do during the labor contractions was relax and let everything happen, keeping my body totally loose. During pushing, however, I HAD to actively participate even though I sometimes didn’t want to, because it was so intense.

The funny thing about pain is that it fills any given space. It’s like a gas—no matter how small the amount, it will completely fill the volume it occupies. That’s why I hesitate to say something like “it was the worst pain I have ever felt.” Heck, even a paper cut, at the moment it happens, can be the worst pain ever!

The pain I felt in labor was clean and finite: as soon as it was over, it was over. Completely gone. I calculate that I spent far more time feeling pleasure during the rest periods, than I did feeling pain during the contractions. Except for a few short moments when I became discouraged during pushing, I never felt like I was suffering or in distress. Just very focused on the task ahead of me.

A few times during my labor, I was able to alter the sensations from being painful to pleasurable. During the early morning hours while I was leaning over the kitchen countertop and breathing deeply, I started smiling and making my face look blissful. Another time, soon before I started pushing, I said to myself mentally, “breathe in comfort, breathe in relaxation” (a phrase from the Hypnobirthing CDs). Both times, the pain altered itself instantly into a rushing kind of pleasure, kind of like the dizzy tingly feeling you get before you faint.

One of the best ways I have found to approach labor pain is with this acronym:

Progress
Anticipated
Intermittent
Normal

Labor pain indicates that your body is working. You know it will come and then it will disappear completely (unless you are having back labor because of a posterior presentation, but that is another story). It is not a signal that anything is injured; instead, it comes from muscles working incredibly hard and from tissues stretching and expanding—as they are meant to do.

Pain was one of many sensations I felt during labor. It was strong when it was present, but it did not dominate the experience. Almost all of the time I was able to integrate it without judgment. Instead of thinking oh no this hurts, I am suffering, make it stop, I was able to think this way: another contraction, the pain is building, inhale, exhale, sway my hips, the pain is ending, now I can rest. I had awareness of pain without labeling it as good or bad. It just was.

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