Pain in Childbirth

Here is HypnoBirthing mom Sarah, laboring in water and in her husband’s arms. Notice how relaxed her face and hand are!

I’ve written about the fear of childbirth, which I believe has two main causes:  we question the safety of childbirth and we believe it’s going to hurt.  I’ve written about the safety of birth, and now I’d like to address the issue of pain.  Pain is real, but it can be avoided or at least diminished through simple, natural means.  Avoiding pain, rather than treating it symptomatically, not only leads to a more comfortable labor.  It also makes labor progress more quickly.

I do believe women who tell me that childbirth hurt.  I also know that mine, for the most part, did not.  I attribute my relatively comfortable labor partially to luck, but mostly to HypnoBirthing.  The foundation of HypnoBirthing is the replacement of fear with trust in the body’s ability to birth safely and comfortably.   Upon this foundation techniques for working with the body are taught, the most important being profound relaxation and deep breathing.  The result is a more comfortable labor – i.e. less pain, even no pain.

I have two children.  In both my labors I had a direct experience of how fear caused pain and an experience of how relaxation made the pain go away.  With my first child, labor began very gently in the early morning hours.  Mid-morning, I was crossing the dining room on my way to the kitchen when I felt a more powerful surge coming on.  The intensity frightened me and I braced myself for it against the wall and held my breath.  It crashed over me like a wave, painful and disorienting!  I panicked, sure I could not do it.  Then I remembered that I had learned HypnoBirthing.  It was time to put it into practice!  So I put on my HypnoBirthing relaxation CD, got comfortable on the sofa, called my husband to sit by me, and when I felt the next surge come on, instead of bracing myself for it, I relaxed into it.  I breathed.  It made all the difference!  Instead of a wave crashing over me, I felt myself riding a swell.  It was then that I knew I could do it, then that I recognized that fighting labor only made it hurt.

With my second child, an easy day-long labor kicked into high gear after I woke from an afternoon nap.  As we drove through 5 pm traffic my surges kept coming quickly and powerfully.  When we found ourselves stopped completely as three lanes of traffic merged into two to cross a bridge, it occurred to me that we might not make it to the birth center.  I did not want to have my baby on the side of the road!  While having that fearful thought, I had a very painful surge.  They’d been powerful, but not painful until then.  I quickly made the connection that my fearful thought had created tension within me that caused the pain.  I smiled and decided that, if my son wanted to be born at the side of the road, it would be okay.  When the next surge came, it was just as powerful as the previous one but there was no pain.  (We did make it to the birth center, incidentally, and my son was born soon after).

Why did relaxing and breathing make my pain go away?  Because breathing and relaxing are the antidote to fear – more specifically to the body’s response to fear, the well-known “fight or flight” response, has two specific effects on labor.

First, fear causes muscular tension in the body, and tension causes pain.  To understand this, recall that the uterus is a muscle system like others in the body, composed of two opposing muscles.  The inner layer of muscle runs in a circle, parallel to the floor, like latitude lines.  The outer layer of muscle runs longitudinally, perpendicular to the floor.  When you’re in labor, the longitudinal muscles pull up on the base of the uterus to thin and open the cervix and uterus so that baby can be born.  In order for this action to be accomplished, the latitudinal muscles of the uterus must relax.  If there is tension in the body, the latitudinal muscles will not relax and allow the longitudinal muscles to do their job.

To experience this for yourself, try this exercise.  Extend your right arm to the side so it is parallel to the floor.  Now flex your arm at the elbow.  Easy right?  As your bicep contracted, your tricep relaxed, and the movement was almost effortless.  Now extend your arm again.  This time please try to flex your arm at the elbow while keeping your tricep tense.  Much harder, isn’t it?  If the movement can be accomplished at all, it will be exhausting and painful.  The surging of the uterus – the flexing of the longitudinal muscles – is involuntary, so it will keep trying, even if the latitudinal muscles resist.  The result is exhaustion and pain.

The second effect fear has on labor is a hormonal one.  If the action of the uterus is involuntary, that means it is controlled not by intention but by hormones, namely the hormone oxytocin.  Oxytocin causes the uterine surges that result in birth.  But fear releases stress hormones called catecholamines, which slow down or stop altogether the release of the hormone oxytocin.

To understand this, it will help to remember that oxytocin is called the hormone of love and bonding.  It is responsible for sexual arousal and orgasm.  It is one of the hormones involved in the let-down reflex of breastfeeding.  It promotes bonding with your partner, with your children, with anyone you love.  It causes a feeling of connection, even oneness that feels heady and blissful.  It is now easy to see how much the release of oxytocin is influenced by the environment:  you cannot make love if you’re scared, or breastfeed your baby, or experience that sense of oneness with loved ones.  Catecholamines suppress the release of oxytocin, because they are released by a body that believes itself to be threatened.  In nature and human evolution, safety trumps reproduction.  Oxytocin will not release if you don’t feel safe, and no oxytocin means a slowed or stalled labor.

Free from fear, the muscles of the body relax and do not resist uterine surges. Oxytocin flows freely, not only achieving the birth of the baby but also preparing the mother to bond profoundly with her newborn.  In Nature’s perfect economy the hormone that got you pregnant, oxytocin, will birth your baby and facilitate your bonding.

But there’s more!  Equally good news is the body’s own natural response to physical exertion: endorphins.  “Endorphins” means “endogenous morphine”; i.e. morphine made by the body.  Endorphins are the most powerful pain reliever known to us, and they are Nature’s plan for the exertions of birth.  Furthermore, release of endorphins can be enhanced through meditation and relaxation.

This understanding is profound.  It suggests that by managing fear, relaxing, and entering a meditative mental space — in my case, this was facilitated by HypnoBirthing breathing and visualization techniques — during labor, mothers can have easier, faster and more comfortable birth without drugs.  That doesn’t necessarily mean that there will be no discomfort or circumstances that require medical intervention when giving birth.  No one can predict what course a mother’s birth will take.  However, how encouraging to know that Nature’s design is for efficiency and comfort during labor!

Please share your experience!  What helped you during labor?  Did you notice ways that stress and relaxation influenced the course or your labor or your level of comfort?

The Farm: Why You Can Trust Nature’s Design for Birth

 

Ina May on the Farm

Quick:  How many women out of one hundred do you believe could give birth safely at home?  What’s the first number that pops into your head?  Your answer to this question reflects how much you believe in the body’s natural ability to birth.

Before I was pregnant myself, I made the simple calculation that the national c-section rate accurately represented the dangers inherent to birth.  In other words, if our national c-section rate was 30%, only 70% of mothers could give birth safely without medicine.

When I became pregnant, this question of safety became an urgent one for me.  I figured educating myself would improve my chances for a safe birth, so I took a HypnoBirthing class.  It worked.  I gave birth safely, calmly and with a minimum of discomfort.  I knew I was physically no different from other healthy mothers, so I reasoned that HypnoBirthing had made the difference.  I became a HypnoBirthing Certified Educator to help other mothers have safe, satisfying births.

I have been studying birth ever since.  My reading has always sought to answer the first, fundamental question:  how safe is birth, really?  This the biggest source of fear about birth, which I wrote about in a recent blog post (http://www.wisdomchildbirth.com/why-we-dont-talk-about-birth-as-a-womens-issue/).   Can Nature’s design really be trusted?  How often does it need medical back up?

Attempts to answer this question coalesce around the topic of homebirth, because there is no medical intervention in a homebirth; if intervention is needed, the mother is transferred to hospital.  Unfortunately, there is not a clear answer in the scientific research to the question of the safety of homebirth.  The best we can say with confidence is that home birth has not been proven to be any less safe than hospital birth.  Feel better?  I didn’t think so!

Enter the book Spiritual Midwifery, by Ina May Gaskin.  Gaskin is a self-trained midwife who practices on the Farm, the commune in Tennessee she started with her husband, Stephen, in 1970.  (Read more about Ina May in the New York Times magazine’s recent article, http://www.nytimes.com/2012/05/27/magazine/ina-may-gaskin-and-the-battle-for-at-home-births.html?emc=tnt&tntemail1=y).  I read Spiritual Midwifery with passing interest, believing it a quaint relic of an age gone by:  there were black and white photos of long-haired hippies in 70s clothes (or none at all) and they talked about auras and said things like, “It was psychedelic!”  But one day I happened upon Appendix A in the back of the book, “Outcomes of 2,028 Pregnancies: 1970 – 2000.”  I snapped to attention.  Their groovy birth culture and midwifery model of care was nice, but did it actually make birth safer?

It seems so, but you be the judge.  Here are a few numbers from her most recent book, Birth Matters, in which 2,844 pregnancies, 1970-2010, are reviewed:

Births completed at home:     94.7%

Transports:     5.2%

Emergency transports:     1.7%

Cesarians:     1.4%

VBAC:     108 attempted; 106 completed.

Maternal mortality:     0

Neonatal mortality:      1.7 per thousand

Ninety-five percent of women gave birth safely at home! Only one percent of births were c-sections!  Only five percent of moms needed to be transferred, and only 1 percent was considered an “emergency.”  (This begs the question, should 92% of women, the national average, really be giving birth in hospital when only 1% are actually going to experience an emergency?)

These numbers are striking, but what makes them utterly compelling are the low death rates.  They lost no mothers – it should be said that in the US maternal death is so rare that it’s counted in the 100,000’s – so that is good but not unexpected in such a small population.   However, neonatal mortality is much more common, with numbers expressed in the 1000’s.  Neonatal deaths on the Farm were well below the national average of 8 per 1000 (as of 2005).  This tells me that the standard of care was a very high one: they did not sacrifice mothers and babies in the service of a principle.

Furthermore, births that are increasingly considered “automatic” c-sections were accomplished on the Farm.  3.5 percent of births were of breech presenting babies, 90% of whom were born at home.  All 17 sets of twins were born vaginally.  And to those women who have been pressured into an artificial induction, would you be surprised to learn that only 5% of mothers on the Farm were induced – and with castor oil instead of with drugs?

These numbers give me great confidence in the body’s ability to birth naturally. The only fault I can find with them is that there are so few!  That is the only rationale I can imagine for their relative obscurity in the conversation over the safety of homebirth.  The numbers may be few, but they are consistent over forty years.  At the very least this is proof of the viability of the midwifery model of care for low-risk mothers.

If you are now persuaded that birth is mostly quite safe but still feel a great deal of fear, I think I know why:  pain!  It’s the subject of my next blog post.

Are you persuaded?  Persuaded enough to consider birth at home?  Have you heard of Ina May and The Farm before?