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Friday
Mar142008

Do NBA Downplay Pain in Childbirth?

According to researchers in England, natural birth advocates such as childbirth educators and others who educate women during the pregnancy do just that.

The journal Bio-Med Central looked at 346 published papers in a variety of journals, abstracts and databases to cull their information.

Four key themes were found in the literature:

- the level of pain
- pain relief
- involvement in decision-making
- control

They then further broke down each theme into these categories:

- expectations
- experience
- the gap between expectation and experience

The Cochrane review found that women greatly underestimated the pain they felt and many felt like failures if they accepted or requested medication.

One point I found interesting was the aspect of decision-making when choosing whether or not to have medication.

The study says, "... it is multiparous women (women with more than one child) who place emphasis on being fully informed rather than primiparous (first time moms) who are concentrating on controlling emotions rather than being involved in decision making." Besides this, women who'd had more than one baby thought it was even more important to be treated with respect and be seen as an individual.

Would this be because women who've been through labor before (I would say, specifically in the hospital) felt they'd been on a production line last time? I'm glad they pointed these thoughts out; perhaps it can illuminate gaps in the care of women in the hospital.

When looking at control issues, they focused on a study in America and found that women who birthed at home wanted more control of their labor and also wanted more control in the decision-making process. Women in the hospital wanted the safety of the medical model and thought more about safe outcomes than wanting control or even a quality birth experience. I suspect primips were more likely to feel this way than multips... it seems the studies say the same thing.

When they looked at pain issues, they didn't look at things like positioning, but they did see that women who had the most support wanted or needed more medication. One press article called it "hand holding." While they didn't specifically mention doulas, they did mention midwives and family members. I don't know if doulas are as prominent in the United Kingdom as they are here in the United States, so that might have made a difference in their not mentioning them.

I wish they'd have looked at things like a woman's positioning in labor because I suspect that had a lot to do with a woman's experience of pain. Those of us who work in birth see, over and over, that a woman's pain level is dramatically different when she is "allowed" to move around... in the hospital and at home. And if they'd have looked at natural pain relief such as aqua-therapy (birth tubs, pools and showers), I'm willing to bet women felt more in control and more relief than women in beds on monitors.

I also wonder if they took into account women who had posterior babies or women who were going along delightfully until complications arose and they were looking at possible cesareans. I know that in my own experience with women that once the idea of surgery presents itself, many women jump into the wanting an epidural camp - the pain suddenly becomes unbearable.

I wonder if they looked at the length of a woman's labor, seeing that the longer it went on, the more often she chose medication... perhaps the baby was in a funky position that wasn't aided by movement because of the monitors.

I wonder if they looked at women who had pitocin or other means of induction. How does a care provider or childbirth educator prepare a woman for the pain of pit, cytotec or even prostaglandins? Some women have very little pain with induction or augmentation, whereas other women have excruciating pain. How do we teach about the different types without scaring the bejeebers out of women?

Wonderings we probably won't get answers to.

A look at how the press reported the information can be read in the following locations:

The Independent's "Women 'are misled into thinking childbirth can be pain-free'"

The EurekAlert - "Pain free childbirth? Get real!"

The BBC News says, "Women 'unprepared for childbirth'"

The journal article can be read here.

Reader Comments (31)

"unprepared for childbirth?"
Um, I am pretty sure that our bodies have been "preparing" for childbirth since puberty. lol.

NBAs don't tell women that childbirth is painfree. They tell women that they can manage the pain and come out on the other side. Hard to argue with, imho...

It's just weird to me that despite all of the evidence, "experts" still claim, and women still believe, that hospital births are always safer.

*sigh*

March 14, 2008 | Unregistered Commenterradical mama

My experience has taught me that "Pain hurts more than you think it's going to." (Also that "Death is sadder than you think it's going to be.")

March 14, 2008 | Unregistered CommenterAlison Cummins

I felt mislead by NBA's before my birth experience. I was told that contractions were "surges" and that I could manage them by using simple breathing techniques. If you call screaming a "breathing technique" then maybe they were right :-)

I did end up taking drugs (because they denied me a tub, which was my pain management plan), and I did feel a sense of failure because of it.

I currently I feel that it is almost impossible to have a drug free birth in a hospital, and though I plan on a natural home birth next time, I am considering putting it in my birth plan that if I transfer I want an epidural immediately. Does that make me a bad birth advocate?

I think that NBA's want women to choose drug free birth, so they downplay the pain aspect. However, if I was realistic about the pain I experienced, nobody would choose a natural birth after talking to me, so I can see why the pain is downplayed. Also, I don't think NBA's are realistic in thinking that it is even possible to have a drug free birth in a hospital with absolutely everything working against the woman. To imply that it is, is almost irresponsible and sets women up for trauma.

March 14, 2008 | Unregistered CommenterJennifer

My theory is that the pain of childbirth (if everyone were allowed to move freely) would fall on a bell curve from pain free to overwhelming.

Pain in childbirth seems to be a pain-for-24-hours versus pain-for-weeks-or-months choice. I don't tell women to pick NCB because it's pain free. They can either work through pain for 24 hours during labor or for months when their c-section/episiotomy scars are recovering; when they suffer from painful intercourse; when they have flashbacks and force themselves into future c-sections by electing for the first; and on and on.

There is no such thing as a free lunch.

March 14, 2008 | Unregistered CommenterAnonymous

I just came back from an appointment with my midwife. In reference to this, she said "Childbirth is the hardest thing that you will ever do. No matter what you do, the pain will be there. What matters is your perspective about that pain. It's a lot of hard work, but it's work that makes sense."

I thought that was both honest and easily digested.

March 14, 2008 | Unregistered Commenterkh

I for one think that our expectations of pain have more to do with wishful thinking and less with a dearth of information on the subject. Childbirth education is not our only source. You'd have to live on Mars not to have heard something along the lines of squeezing a watermelon out your nostril! Sure, as a primip I did not want to hear about how painful birth is; so of course it turned out to be more painful that I'd imagined. (For one, it was *real* pain, not imaginary, just like Alison above said) I also wouldn't believe when people told me that as a mother, I'd be more exhausted than I could ever possibly imagine. I didn't want to hear that either and I was duly shocked when reality set in, LOL!

Joking aside, why not prepare by learning to frame the experience positively. I am sure that a slight overdose of optimism is a good mental safety mechanism that does serve mothers-to-be reasonably well. Imagine the nervous wrecks we would be while realistically anticipating all that pain! If women feel like failures for eventually using pain medication, that can and should be addressed separately, and definitely NOT by scaring the bejeebers out of everyone beforehand. Perhaps natural birth advocates ought to focus more on the other, desirable aspects of physiological birth that a mother should know she is giving up if she commits to getting her early epidural.

I'm curious to hear a personal experience of literally feeling like 'a failure' (as opposed to relieved though disappointed) for getting the epidural? Jennifer, it sounds like it was your PLAN that failed, as the hospital failed to support it, not you--I understand you regret that, but I hope you didn't really feel like a failure as a person? I hope no one implied you were!!

March 14, 2008 | Unregistered CommenterJudit

Anonymous,

With this statement;

"They can either work through pain for 24 hours during labor or for months when their c-section/episiotomy scars are recovering; when they suffer from painful intercourse; when they have flashbacks and force themselves into future c-sections by electing for the first; and on and on."

You seem to be implying that 1) every woman has a natural labor course that spreads out over 24 hours, and 2) if every woman had a drug free labor and birth then she is protected from a c-section and episiotomy. Your first presumption is simply not true, there is great variation in the lengths of labor for women, just as there is variation in pain experienced. Your second point does hold some truth, but of course having a drug free labor and birth does not protect a woman from having a c-section or episiotomy. Those things are also affected by complications that arise during labor and birth, the chosen birth setting and the chosen provider. If you tell this to women and then they do end up with a c-section or episiotomy, how do you think they feel afterward?

March 14, 2008 | Unregistered CommenterJennifer

Your wonderings are valid questions, as all of that can affect the level of pain or perception of pain a woman feels. I know that I feel pain more intensely when I cannot move to try and alleviate the pain.

The problem with NBA's descriptions of pain is that there is no good way to prepare a woman. Everyone's experiences are wildly different, precisely because the pain is not quantifiable and because perception of pain level is individual.

No should imply that birth will be pain free, but there are plenty of women who claim they do not feel pain, only intensity. You cannot promise a woman that she will be among them, however. Nor is it fair to tell people that childbirth will be the most painful thing they ever experience, and it is so traumatic! because, as you know, that isn't true for many women.

Nor can it be said, as a previous commenter said, that labor is a concentrated pain and that the other options will create long term pain. There is no free pass on painful intercourse because of a drug free birth, nor do all c-sections or episiotomies result in weeks or months of pain.

There isn't a comfortable scale, you know?

I think the best way to prepare women is to be honest and say that there is no way of knowing in advance, but that these things can help you cope with the pain (visualization, relaxation, deep and varied breathing, water, movement, light touch massage, position changes).

I think enough is known about the fear/tension/pain syndrome to say that trying to over-prepare women (by gory stories of agony)generally results is more fear and anxiety centered around birth.

I find it interesting that when birth is discussed there are the really gory stories and they are met with one of two responses: "I'm sorry you had such a rough time, but really, it's not like that for everyone." and "Oh, thank GOD someone is being real about it." And I find that stories that say there is little pain involved are nearly universally treated as revised history or a fairy tale by the mainstream.

No good answers. Because some woman are overprepared and wonder what the hell the big deal is, some freak out in advance of labor, and some (like a friend of mine) feel utterly betrayed by the pain they felt. As she put it - she did every bloody thing the NBAs said to do, and it was the most miserable, horrifying, painful experience of her life and the only thing that she can be grateful for (besides her child) is that she'll never do it again.

March 14, 2008 | Unregistered CommenterEliza

Another aspect I forgot to mention is how often postpartum women will say, "I didn't think that would happen to me, so I didn't even listen to that part of the class."

How many women don't hear the discussions about pain simply because they believed they wouldn't have it as much as all the other women in the room!?

I believe a significant amount.

March 14, 2008 | Unregistered CommenterNavelgazing Midwife

The thing is, I've never pulled a watermelon out my nose, so those analogies are useless to me. I can't even begin to imagine what it's like to have a watermelon pulled from my nostril--besides which, those analogies really make it sound like all the pain is from vaginal stretching, which just isn't true. All I get from the "ohhh it's gonna hurt, like a watermelon! in your nose!" is that it's going to hurt. It says nothing about the nature of the pain, or the psychological aspects (which for me were some of the worst.)

Most women preparing for a natural birth read stuff like Ina Mae, anyhow, where all the birth stories talk about "rushes" and "feeling empowered" and walking for 6 miles in transition just because it felt good. The birth stories also usually emphasize how the first part of labor hurt, but then pushing was a "relief." What a surprise I got when pushing felt like I was being disembowled.

I think the most frightening part wasn't the pain but the feeling of being overpowered. It almost felt violent in a way. That's something few women talk about outside the context of a traumatic birth caused by medical mismanagement. In my case I was at home, with competent midwives who didn't do anything wrong. But it was still a little traumatic, just because it was so frightening to be overpowered like that. It was like the worst case of food poisoning I had ever had, times ten. You know, if you've ever had salmonella and could not stop vomiting, then shaking, then vomiting. Complete overpowered misery, shaking uncontrollably, unable to move or sit still or think, frantic.

I guess I was just a stupid "primip" who didn't listen? Maybe. I remember reading about people feeling pain, though, and not a word about the rest of the experience being anything like what I felt.

March 14, 2008 | Unregistered CommenterThea

I've been musing about pain and birth for the last month or so and was very interested to read your post and the associated links. I'm a childbirth educator and it is a constant struggle for me to acknowledge pain without also contributing to a "climate of fear and doubt" for the pregnant women. I posted last week in my birth blog about needing more words for pain/to describe pain.

Molly

March 14, 2008 | Unregistered CommenterMolly

I am the same "anonymous" as above. I don't think labor lasts only 24 hours; my first lasted 30+. But it was only overwhelmingly painful for 2-3 hours. The rest was what I'd call moderate pain.

Do I think you're guaranteed a normal birth if you don't use pain medication? No. But do I think using an epidural increases the total pain experience including recovery because of suboptimal maternal and fetal positioning; epidural headaches; increased risk of c-sections; tearing/episiotomy; etc? Yes.

Why don't we talk about other forms of pain management in this country beside epidural? Why is it all or nothing? Why can't we use other local forms of anesthesia if a woman wants drugs? Why does she have to lie flat on her back where labor is bound to hurt more and take longer?

March 15, 2008 | Unregistered CommenterAnonymous

Absolutely they do.

I'm extremely disillusioned with the whole childbirth advocacy movement because of them of lying about the pain. I was woefully underprepared to deal with the worst agony I can ever imagine feeling, because I totally bought the lies, hook line and sinker.

Once I knew how much it hurt and was prepared for it I was able to go through my second labour without any drugs.

My personal favourite is "it doesn't hurt when any other muscle works, why would your uterus?". Except muscles do hurt when you run a marathon, plus it's also your cervix and your pelvis coming apart.

You could say I was naive to believe the lies, but when every person who is honest about the pain says you'll definitely need drugs and c-sections are fine, etc etc, and every person who says it doesn't hurt that much is telling you your body can do it, who would YOU beleive?

I blame the NBA for my epidural the first time. And I tell everyone who'll listen that birth is excruciating, but you can do it, and it's worthwhile.

March 15, 2008 | Unregistered CommenterAnonymous

I don't think you can normally have a doula here. We give birth on the ward, not in LDRs.

I have seen some British midwives be incredibly dismissive of pain and pain relief. Someone I know gave birth in a hospital (no other local hospital) where epidurals were simply not allowed unless you had a CS. When she asked the midwife "what happens if you can't take it?" she got told "you suck it up and get over it". She had a hellish birth. After 48 hours with nothing more than gas and air, she was still only 5cm dilated and needed a section.

The Royal College of Midwives also proposed charging women £500 for an epidural (impossible in practice as it violates NHS principles).

(The other issue with epidurals is that if you have one, you need one to one midwife coverage. In many hospitals they don't have enough midwives for that--one midwife is looking after 2 or 3 women--so there's an incentive to discourage them.)

March 15, 2008 | Unregistered CommenterAlexis

Funny that I just put my hypnobabies bumper sticker up at long last! I feel that my childbirth class instructor was very clear about the pain, and the books I read were as well. They gave us the chance to prepare for it, so we weren't just going in saying "we'll try for natural" but had techniques that because second nature. I also did hypnosis for months and birthing was the hardest thing I've done but it really wasn't that bad. I know it varies among women, but I slept through most of transition. Everyone was saying I was going to feel a lot of pressure as I pushed/my baby crowned but I really didn't. It was darn hard and intense and I wanted to get through it and was glad when it was over, but I think my techniques saw me through well. I also agree, I was more concerned about long term pain interventions can cause. I can OWN birthing pain-- it's ME doing it, you know? But to have headaches, backaches, etc stemming from a spinal? That's scarier to me. I also agree; it wasn't painful like vaginal stretching, it was the sick intensity of the waves that were the hardest for me.

Just my very limited personal experience.

March 15, 2008 | Unregistered CommenterLeanne

I had my third child two weeks ago, and this was my first natural birth. I have to say that, at first, I thought it was a horrible experience. I was laughing at 8 cm, but after being there for more than 5 hours, I had my midwife break my water and promptly fell off the cliff.

I was in transition for a total of TWO contractions, and pushed for less than 30 minutes (a water birth, no less). I cannot imagine what it would be like to be someone who pushes for any length of time; the pushing was the worst part.

HOWEVER, 12 hours later, when I was essentially back to normal and could go to the bathroom by myself and didn't feel like I'd been hit by a train, I was totally hooked. Yes, it really did kind of suck for the 30 minutes, plus a couple of hours later when I couldn't stop shaking and everything down there hurt like hell, but then it was over. With my other two births, it took me at least a week to even feel like walking up the stairs.

March 16, 2008 | Unregistered Commenterheather

I think it's important to remember that everyone's experience can be different. Childbirth was not terribly painful for me - in 4 unmedicated births I'd say I had maybe 4 hours total of what I'd call "pain" and the rest was hard work, intense, and exhausting but very tolerable. That's not a lie, it just is how is was for me.
I've attended enough births to know that that's not how it is for everybody though! I think women definitely feel things differently, and also that some labors are more painful due to factors other than a woman's perception of pain, including baby position, length of labor, physical factos like pelvic separation, etc.
I try to to tell my own clients that I don't know what childbirth will be like for them. I don't want to say it is universally the worst pain ever, because it's not for everybody, but I also don't want to downplay and have women be unprepared. I tell women that most women experience childbirth as painful, and most need to have some kind of plan in place for coping with the pain (whether that is all the great non-drug things we have available, or knowing about the various medications we have available and their potential downsides.) I remind my clients a lot at the end that there is no way I can promise that they won't feel any pain, even if they are planning an epidural - even if you head for the hospital at the first contraction it is still going to take some time to get things going.
I think it's important to avoid telling women anything "always" or "never" happens. I think it is vitally important, too, that what I do as a birth attendant/care provider not ADD to a woman's pain if at all possible.

March 16, 2008 | Unregistered Commenterdoctorjen

Judit said:

"I'm curious to hear a personal experience of literally feeling like 'a failure' (as opposed to relieved though disappointed) for getting the epidural? Jennifer, it sounds like it was your PLAN that failed, as the hospital failed to support it, not you--I understand you regret that, but I hope you didn't really feel like a failure as a person? I hope no one implied you were!!"

No one implied that I was a failure. I did feel like I failed at having a natural birth, because I did fail to have one. I did not have an epidural, I had nubain, and it was not a "relief", it simply brought the pain back inside my body again, if that makes any sense.

I was actually much more disappointed by other aspects of the birth then choosing to get drugs (which I felt was my *only* option for pain management at the time), and that sense of failure I felt came into play much more with those other things. The drugs are much further down the list, and the way that I see it now, drugs are pretty much the only way I could ever set foot in a L&D ward again. You'd have to give me narcotics just to get me through the door. But, I also have PTSD from the birth, so this isn't a simple case of "I regret that I took drugs".

I do feel that NBA's downplay the pain though. I've found myself doing it, because I want people to have a natural birth because I know it is safer and better on so many levels. But it is also very traumatic for some women, especially women who lose all control over their birth experience in other ways, and you don't want women suffering, and being so traumatized that they can't properly care for their babies afterward either. So I try to keep it in mind to be realistic when talking about pain, and emphasizing that pain management isn't just about knowing certain techniques, but also about choosing a care provider, birth setting, and support people very carefully.

March 16, 2008 | Unregistered CommenterJennifer

My midwife told me that when she was in labor she felt someone was stabbing her in her tailbone with a knife... I don't think that's a rosy picture. Praise God my labor included no such pains... in fact, I would not describe my labor as pain free but certainly less painful than I expected... what I wasn't prepared for was the pain of recovery from the stitches (more stitches than would have been necessary due to a less than stellar performance by an NP).

Incidently, my friend who recently gave birth in Scotland tells me that Doula's are scarce at best where she lives.

As usual very interesting article.

blessings, Cindy

March 16, 2008 | Unregistered CommenterQuantmlife

Postscript to my last comment:

When I said that my birth experience was less painful than I thought it would be let me clarify that my midwife was not the only one who'd told me a "horror story" about the pain of childbirth, and that she did say that even though the contractions felt that way to her that she was able to get through it with the techniques she gave me the opportunity to learn as well the fact that not everyone had the type of pain that she had experienced in her birthes.

I did have natural childbirth without even an IV, in a hospital... in fact, when the MD came to do the stitches that the NP could not do she told the nurse to give me "whatever she had during labor" to relax and several people (myself included) said "She/I didn't have anything during labor." Then she said, "well, just push xmg of Stadol." The nurse said, "she doesn't have an IV." So she finally had them push it straight into my vein.

I will also say that I agree with the whole "freedom of movement" for the pain management during labor because that was one of the biggest factors in my pain level during labor... I slept, ate, moved and did whatever I wanted while I was in labor... I didn't go to the hospital until I knew it was time (I was 9cm the first time they checked me). In many respects I feel very blessed to have had as little pain as I did (the part I found painful during labor was crowning -- no surprise there).

Forgive me my rambling run on sentences all... I just came off a 12 hour shift. Hope all this makes sense.

blessings, Cindy

March 16, 2008 | Unregistered CommenterQuantmlife

During the induced labor of my 3rd baby my CNM and I were talking about the pain of labor. She told me that during HER labor she managed to find an absolutely pain-free position. I sat up, eagerly awaiting what I thought was going to be a monumental secret. Then she looked at me over the top of her glasses and said "20 minutes later I was rushed in for an emergency C-section.".

March 17, 2008 | Unregistered CommenterAnonymous

(A client asked me in email to publish this. Here you go, Amy!)

There is so much here, it's a little hard to digest...It is also obvious from the many comments that there are as many birth experiences as there are children in the world. I, for one, had two radically different birthing experiences between my own two children - and both were natural, non-medicated births.

Of all the things I would say if we were all sitting in a room together and having this conversation in person (wouldn't that be awesome??), the thing I most want to say is I believe all of life's experiences are affected by the expectations you have going into them.

With childbirth, there is really no way to appropriately set someone else's expectations; nor should you ask someone else to set yours. So when I was pregnant the first time, I chose to mentally prepare myself as best I could, and get totally psyched and excited about what MY experience had the potential to be.

I have found (at least in the U.S.) that women only like to share the "horror" of childbirth. Like it's some sort of competition to have the most grueling tale of pain, or number of hours, or mean-spirited nurse. No one (outside of the home-birth advocacy community) tells tales of peace, control, choosing the people who will be around you during labor, etc.

So I took it upon myself (with the help of the navelgazer) to immerse myself in as much positive birth information as possible.

I had already read the scary books like, "What to Expect When You're Expecting" (and now I tell every pregnant woman I meet to NOT read that one), and so I set out to find something better. I found books like the ones written by Ina May Gaskin. And, yes, her books can be perceived as all sweetness and light, but if you really read the stories, I believe you’ll see a spectrum of experiences that do, in fact, speak to pain and discomfort, but mostly speak to the ability of a woman to make the best choices for her, in order to get the outcome she desires. (This, of course, in no way takes into account the very real fact that medical intervention is sometimes necessary.)

For me, the bottom line is this – the fear of something is often far greater than the actual thing. And if you fill your mind with the possible pain and anguish of childbirth, then that is likely what you’ll get. If you fill your mind with the possibility of peaceful, graceful, empowering birth, then your chance of getting that is much, much greater.

On a personal note – and the thing that makes this such a volatile topic – I think the reason the “pain” of childbirth is so difficult to convey is that many of us wouldn’t describe it as “pain” at all. At least not in the usual sense – it’s not a broken bone, scraped knee, or bruise. It’s something entirely unlike anything else. Was birth “painful”? I suppose it was. But it was also the thing that makes me stronger, more powerful, and better able to cope with all the other curve balls life throws my way.

We’ve all heard that some experiences “separate the men from the boys.” I hope that no matter the “experience” of a woman’s birth, at the end of it she realizes that birth is what separates the women from the men.

We are women, hear us roar!

Thank you, Navelgazer, for giving us some very healthy food for thought.

--Amy

March 17, 2008 | Unregistered CommenterNavelgazing Midwife

With six births and no pain medications, this is how I describe the pain I experienced in most of my births...like a brain freeze in my abdomen and pelvic area. When I had an OP baby, I did have pain also in the lower back, but I never thought of it as back pain until later. I believed I could get through the pain, and with my first births trained myself by thinking of the pain as a hill. I knew it would hurt and crest, and then fade, and that's exactly what happened. A contraction would begin with me being aware it was coming before it really felt painful, and then it would increase in pain sharply. I found that I would at first pray in my head, and then with later labor pray out loud. This last time I kept saying, "I can do it, I can do it" and the nurse must of thought I was saying "I can't do it" because she kept telling me "you can do it, you've done this five times before, you can do it." Only when I was very close to delivery or when I felt out of control (the nurse was controlling me) did I feel the pain was unmanageable. I know each birth had a moment of "oh my, this really hurts" but I believed I could make it. Sometimes the nurses were a big help, and they would calm me down. If they were calm, I felt better and had less pain. If I had been allowed to move freely, I know my pain seemed less intense. I believe I have had OP labors at least three times, two I was told were OP at the very end, and one I think was based on the back pain. I coped much better in the ones I was allowed to move around and felt I had control over. This last one was bad for me, and I had nurse hyper who loved the monitor. Even when I didn't look at the monitor she told me about it. Also, I felt my baby was in danger because the nurse kept putting me on my back. This made the pain seem like I was just steps away from a c-section to me. The fear made it worse. The fight made it worse. I can say that my first birth was so much easier than my 6th, because my support nurse was so calm and beautiful with me. She helped me relax and guided me through the pain. In fact, my 1st, 3rd, and 5th births were good as the nurses were excellent. My 4th wasn't as bad because the nurse left me be. My 2nd was good until pushing, whirlpool bath! Yes! So, really, what I learned is best for a woman in labor is kind, caring, and knowledgable support. If you cannot give that support, then back off and don't give bad advice. Give the woman space in that case. Of course, I also had babies under 8 lbs, so I believe that had everything to do with the lower pain compared to others with those 9-10 lb babies. Child birth is not pain free, but for me it was a purposeful pain that I knew would end. I coped with each contraction, and used all the positive help I could get from those around me. Really, love and care goes a long way.

Dawn

March 18, 2008 | Unregistered CommenterAnonymous

There are some things (related to both birth and motherhood) that I feel I've been lied to about, but pain isn't one of them. I expected birth to hurt. A lot. Nearly everyone I know (among them many supporters of unmedicated birth) had said it would be extremely painful. I wasn't buying this "rushes" or "orgasmic" stuff that I'd read and heard; I didn't expect birth to be easy. I did expect to be tough and calm and fantastic and able to handle the pain better than I did -- but that was about me, not anything anyone told me. I didn't underestimate the pain; I overestimated myself. But I made it through anyway.

In my own advocacy for unmedicated birth I have said to women that "pain rarely kills anyone" and I guess that's basically what I believe about the pain of birth. It won't kill you . . . but beyond that, I don't have a clue what it'll be like for you.

March 18, 2008 | Unregistered CommenterLynette

What I've ended up saying to primip friends who ask what to expect is that it is different for everyone, but for me, I would describe the pain as the same kind one gets when doing serious weightlifting. When you push yourself farther than you think you can, and you think you can't do even one more rep, but you find a way to eke it out, and your muscles are burning, and your whole body is hyper aware, and your mind is wholly focused, and the focus muscles are burning so deep- and then, just like when you finally max out on weights and feel almost a sense of euphoria- the sense of euphoria with birth is even greater.
Unfortunately, not many people have had the experience of pushing themselves to the limit athletically to be able to understand that comparison, but those besides me who have experienced both (natural birth and athletic maxing out) have agreed with me that it is the closest analogy they could think of also.

March 20, 2008 | Unregistered CommenterPegaeae

I have a question about the baby-size/pain connection, since it was mentioned a few comments up.

Why would contractions hurt more with a bigger baby than a small one? I have had two very large babies 10 lb and 10.5 lb. The first was pain free, the second hurt like crazy, and 8 oz isn't enough to make that much of a difference. People always act like my big babies must have been torture to birth, but even the painful labor wasn't unmanageable. Apparently it was better than a vast majority of births because it didn't scare away from having more babies.

March 20, 2008 | Unregistered CommenterCappuccinoLife

After 4 babaies, I have gotten to the point where I am totally ok telling anyone who asks that the pain of the contractions was like a truck parking on me for 60 seconds, and then dissappearing. I did not "relax" in between, I was absolutely horrified because that truck was coming back, to slowly drive onto my back and park there for another minute.

It sucked and it was the furthest thing from sexual ecstacy ever. But when it was over, it was over, and not only is that truck gone, but your baby is here and the endorphins are gushing and you want to kiss everyone and just cry and be so happy, nothing can touch you, you are victorious!

Contast to c sections, just some disembodied wierds surgery where you feel upside down and you throw up and choke on it and then they tell you "its a boy" and then you are hurt and semi crippled for close to a year.

Call me evil, call me negative, but this was my experience.

March 20, 2008 | Unregistered CommenterJoy

Interesting discussion. I've long felt the "natural" birth advocates underplay the potential trauma and difficulty of birth.

I went into my first birth having taken Bradley classes and done lots of reading. I wanted it to be an empowering experience. I knew it would hurt, and I told myself I would cope with that well. I was proud of being a woman and of bringing life into the world. I opted to have a midwife birth with no interventions and no drugs.

And that's exactly what I had. No drugs. No IV. No episiotomy. And it was the worst experience of my life.

I spent 8.5 hours -- not a long period of time -- in the most unspeakable agony I have every experienced. I started out with strong contractions and that's how my labor remained. I puked my guts out, vomiting even during hard contractions. In the end, I felt like my body was tearing itself apart to get this whatever-it-was out. I couldn't even focus on the fact that it was a baby. (The midwife told me I had an abnormal "labor profile," with my uterus remaining contracted between contractions. My cervix eventually tore rather than fully dilating.)

For a couple of months afterwards, I had nightmares. I swore I'd never have another child. I couldn't imagine anything could hurt worse, and, no, it didn't feel "worth it" to me, because I couldn't accept that anything should hurt that much.

Then, out of love for my son, I decided to have another child, but I would only do it provided I could have an epidural with no flack from anyone the moment I hit 4 cm.

I couldn't find an OBGYN who would agree to those conditions (and I was uncompromising -- no stupid stadol, no "we'll see" -- I wanted an epidural PERIOD.) It was a CNM who finally agreed.

It was great. 7.5 hours of virtually pain-free labor with no complications. I had an IV and the epi, and that was it. It wore off as I was pushing, so I had about 15 minutes of bad pain, but it was nothing in comparison to what I'd endured the first time.

And guess what? My second birth felt much more empowering and beautiful than the "all natural" birth of my first son.

What I dislike is the notion in some quarters that there's only one "right" way to have a baby and that if a woman chooses to skip the drama of screaming and hurting, she's somehow letting her baby down or not fulfilling her potential as a woman. Baloney!

CHOICE is the key. Education, choice, and good support. If a woman's not into the pain and understands the risks involved with anesthesia, that's her business and no one else's. I've never regretted having that epidural and heartily recommend making informed choices to my pregnant friends.

April 5, 2008 | Unregistered CommenterAnonymous

What a beautiful and wonderful story. Thank you so much for sharing it. It's very important to hear.

April 6, 2008 | Unregistered CommenterNavelgazing Midwife

This quote really struck me in the article, because it addresses exactly how I feel.

The study says, "... it is multiparous women (women with more than one child) who place emphasis on being fully informed rather than primiparous (first time moms) who are concentrating on controlling emotions rather than being involved in decision making." Besides this, women who'd had more than one baby thought it was even more important to be treated with respect and be seen as an individual.


I don't think anyone downplayed the pain issue to me, though I didn't really talk to any NBAs specifically. I was induced with my first child and I didn't think it was really intolerable at all. It hurt, but I don't consider that kind of pain to be comparable to the pain I had after the c-section I ended up with.

I do have to say that in comparison to friends who ended up with tearing or episiotomies, my healing from the c-section was MUCH quicker than I expected it to be. I don't know if that's because I took the doctor's advice and didn't try anything stupid, or I just heal quickly. I had to take the pain meds for about 10 days, gradually weaning myself off of them, and the pain, when it came unexpectedly, was unbearable--much worse than any contraction that I had had.

I have no fear of natural childbirth, because I know it's what my body is *meant* to do. I know that's not a 100% guarantee that it will work out exactly as I plan.

I do feel that everyone's experience is different, and that pain is individual, but I look at it as going through a trial to get a really great prize at the end, and if I have to endure some pain in the process, it will be worth it. That's my perspective!

April 9, 2008 | Unregistered Commenterbetweenbabies

Pain is a four letter word! once you tell a woman it will hurt, yep it will hurt! The more she focuses on the pain, the worse it will be. FEAR of the pain will cause more pain. Some women do report low-pain/no-pain births - some of this may be luck, genetics.... some of it may be preparation, environment, mental attitude.... On the other hand, sometimes it just plain HURTS right from the beginning.... I suppose for the same reason some women have horrible menstrual cramps while others don't feel a thing! Position of the baby can also have an effect. And to go in completely unprepared for the pain can't be a good thing either.

I look at it this way: Pain - particularly not agonising pain - is not a given for every women, or every birth. There is a great deal you can do to minimise it. There is a great deal you can do to cope with it. It is also helpful to remember that it is not a "bad" pain (where there is something "wrong" in your body, or where something is being damaged). It's constructive, positive and normal. It's feedback from your body - it might be telling you to change positions or to walk around, to push or pant or groan or arch your back. It's not something to escape from, but surrender to, and LISTEN to, to ultimately make the process easier and more comfortable.

Maybe it is more helpful to focus on the fact that there is a very fine line between pleasure and pain, and that while birth CAN be painful, it can also be intensely pleasurable too.

May 19, 2010 | Unregistered CommenterSam

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