By Beverley Turner
Think of one word that you associate with giving birth… OK, done? Great. Now, if you are yet to become a mum, the chances are you thought of ‘pain,’ ‘agony’ or ‘uncontrollable’; and if you have already experienced birth, maybe ‘diffcult,’ ‘dehumanised’ or – hopefully – ‘amazing’ spring to mind.
Interestingly, women who have tricky or even traumatic births, rarely talk of the ‘pain’ involved – they describe not being listened to or being treated with a lack of respect. And yet, physical agony and labour are so inextricably linked in our culture and our minds, that it’s a subject worthy of close examination.
A recent newspaper headline announced that women who have epidurals and therefore feel less ‘pain’ during labour are less likely to experience post-natal depression. With an estimated 140,000 women per year in the UK enduring this debilitating mental illness, it’s the sort of study that we should take notice of. However, it was announced at the American Society of Anesthesiologists annual meeting – an audience who depend on such statements to keep them in jobs. In the US, women are not even offered the cheap drug Entonox (gas and air) as it can prevent them needing an epidural – which is extremely annoying for drug companies who make a fortune from selling expensive epidurals.
Experts discredited the study, including Professor Stuart Derbyshire, of the National University of Singapore, who said that it was too small to be meaningful: “The risk of causal relationship cannot be established. It’s just as possible that a predisposition to depression causes increased labour pain as it is that increased labour pain causes subsequent depression.”
So why does labour actually ‘hurt’ and is it ‘good’ pain? You may notice my prolific use of inverted commas on this topic. This is because pain and discomfort are entirely relative and individual – one person’s agony is another’s mere tickle. Like so much of birth, there are no hard and fast rules. Plus, the language available doesn’t quite do the job: the searing ache of breaking an arm is nothing like the all-encompassing, time-stands-still whoosh of breathing your baby into the world. And language is powerful, it affects our subconscious, laying down deep-rooted beliefs and fears. This is why hypnobirthing modifies words: ‘contractions’ become ‘surges’ and ‘pain’ is replaced with ‘sensation’.
Plus, in the west, in 2016, pain is almost always bad. We have been conditioned to quickly medicate discomfort (those drug companies again…) and it is easy to forget that some pain is ‘good’ (without even factoring in Fifty Shades of Grey): teething pain brings about teeth that are handy to have; growing pains elongate limbs; lactic acid makes our muscles scream at the gym but means we fit into our jeans. Crossing a marathon line may be agonising but can feel like the greatest high imaginable. Pain can be your best friend!
Labour pain should be firmly positioned in this category. Each contraction is a step towards the finish line of holding your baby in your arms. Mother Nature made labour ‘uncomfortable’ to incentivise women to focus, gather up their immense internal power and bear down with all their might. If it didn’t hurt, we’d have no reason to make it end and that would be bad for babies needing to be born. Nobody describes the process of labour like illustrator and writer Kate Evans, whose book, Bump, should be on every pregnant woman’s reading list. Evans talks of “great waves of passion”, and “flames” that “leap up” as the mother “shifts position, helping to shape the baby’s head within her with the precision of a sculptor.” Evans – a mother of two – is frank in her assessment. “This pain is a mountain to climb… an ocean to cross…So labour hurts. So what? This is labour, girl! This is where you work! This is where your body goes to places you’ve never been before and you will be all you can be. It can push you past what you thought you can endure. But in the extremes of the experience, a new person is forged. A mother. Bring it on!”
This tone is so different from the typical disempowering fear-mongering and drug-pushing that leads so many women into the labour ward convinced that an epidural is inevitable because they won’t cope. Epidurals are an incredible invention and the second best way of ending labour pain – the very best way is to get the baby out.
But epidurals do have potential side-effects: without labour sensations the body stops making oxytocin; the pelvic floor goes lax so the baby can’t rotate against it in the birth canal, making an assisted delivery with forceps or ventouse more likely; labour slows down and although the woman doesn’t feel the ‘lows’ of pain, she also doesn’t feel the epic ‘highs’ of birth. Being tethered to the bed means she stops being as active in the process.
Nevertheless, for many women, a good birth is one where they can moderate or manage pain whilst working with it. A one-to-one known midwife has been proved time and again to be the best medication for alleviating a woman’s stress hormones (adrenalin), thereby allowing her to release the positive ones that create contractions (endorphins and oxytocin) and manage pain. A TENS machine provides side-effect-free pulses to block the pathway between the brain and the uterus; hypnobirthing skills allow you to harness the power of your own mind and birthing pools offer a weightlessness that can feel blissful. Gas and air is also a godsend at ‘taking the edge off’ (a bit like that glass of wine at the end of a bad day). They all allow women to ‘stay in control’, but won’t entirely remove ‘pain’ – although we now know that’s no bad thing.
Kate Evans urges us not to learn “to cope with the pain” but “distract yourself from the sensations. If you try to hold it down, to minimise the feelings, your labour will be longer. There are places you can go that make it more intense. Go there. Kick away from the shore.” And when you reach the other side, it will be well worth the effort.