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Tuesday
May272008

Pain

I went to get my lily (Meghann’s birth flower) colored in. My leg looks like a coloring book now… two flowers and Tinker Bell filled with beautiful color and the rest of the flowers and leaves outlined, waiting to be decorated.

The first time, I got pretty darned drunk because of the pain. This time, I anticipated the pain so took 1.5 Vicodin in advance of going, plus brought a bottle of amaretto in case I needed more “pain relief.” (My Tattoo Doula, Donna, called it an “Alco-Dural.”) Donna wasn’t able to come with me this time, but Sarah said she’d be my Tattoo Doula. Let’s just say… she wasn’t Donna. Love her, but her sensitivity to someone in pain isn’t the highest.

When Craig started painting with those needles, the pain was unbelievable. How I ever had babies naturally is beyond me! I swear this tattoo hurts gobs more than any of the three births.

However, interestingly, during this tattoo, I whined, “It hurrrrrrts,” almost the whole time. The next day, I remembered that during Meghann’s labor, I’d mantra’d that exact phrase for hours on end. I remember my attendants saying, “If we heard ‘it hurrrrrrts’ one more time, we were going to scream!” Sarah counted how many times I said it; it was too many times.

I remember everything about this tattoo despite drinking copious amounts of amaretto on top of the Vicodin (do not follow my example!); I wish I hadn’t. I am so embarrassed by my writhing, crying, whining… all in front of a client. As my wonderful Hypnobirthing educator said, my client has a free pass to all the writhing, crying and whining she wants to do in labor for as many hours as she can do it. laughing

If I could have had an epidural for this tattoo, I would have been right there, paying whatever, to have it done. As it stands now, my leg just might have to stay half-colored. (I know I won’t do that, but it’s a distinct thought.)

Why do I do tattoos if they hurt so much?

For me, they are a rite of passage. I get one when I have accomplished something powerful in my life. I got one when I completed many years of therapy for sexual abuse. I got another when I came out as a lesbian. I have one that reminds me of my own rebirth every single day (a woman on hands and knees, leaning over, with the words: I am a woman giving birth to myself). This one is the joy of my children, my relationship, my future and my past, rolled into one mural – just as my life is a conglomeration of all my experiences.

When I had my kids, an epidural wasn’t an option for labor. If it were, I would easily have had one when Tristan was born (25 years ago). I had Demerol twice, but if I could have numbed the pain, I would have in a second. I never imagined the option of complete pain relief.

Women without the option – or the knowledge of the option – don’t ask for something to numb them from the waist down. They deal with the pain.

In Germany, in the late 80’s, an epidural wasn’t an option for the women in labor. Women had their babies with nothing or with Stadol or Nubain, sometimes Demerol or Morphine, but my doula clients usually chose nothing.

When I was a doula for migrant women in the early 90’s here in San Diego, epidurals weren’t an option for women on Medi-Cal (California's Medicaid). If the women wanted an epidural, they had to come up with $1000 cash, pre-labor, in order to get one. Of course, that became illegal with time and all women, regardless of their financial status, are able to get an epidural. But, back then, those women never whined about not getting one. I never heard any woman cry and ask me for the money to get an epidural. They labored and birthed, no matter how much it hurt.

I wonder how many of those women chose an epidural for their next child.

The topic of pain in childbirth finds many foes. Some childbirth methods try to change the anticipated perception of pain by calling contractions “surges” or saying they are “tightenings.”

For me and many women, they flippin’ hurt!!

In natural birth, we have ideas about how to minimize pain: movement, water, vocalization, visualization, distraction, music, eye contact, hand-squeezing and more. If birth didn’t hurt, women wouldn’t attend childbirth classes, read books or worry about what’s to come. It’s the rare woman who doesn’t describe at least part of her birth experience as painful.

In From Water to Water, a postpartum mom says, "The minute I stepped in (the birth pool), it was instant relief."

We’ve all heard the multitude of stories of women scheduling cesareans to avoid the pain of labor, the “embarrassment” of vaginal changes and the desire to have a baby by appointment.

No longer is this desire just in the United States. This article from Jamaica, Birth By Design, states:

“Dr. McDonald admits to having some patients who have opted to have this procedure (a cesarean) for fear of pain during natural childbirth. ‘Actual pain is one concern, but there are also those patients who fear because of the pain they will display abnormal behaviour during labour which is out of sync with their personality.’”

Hmm… kind of like the embarrassment I have by “losing control” in front of a client – except add spreading my legs, too?

Plenty of women apologize for their “behavior” in labor. So many think they screamed or whined or they pooped on us or their amniotic fluid got our clothes “dirty.” I have never judged anyone in labor but myself. Yet, I know how that feels to worry about one’s actions in times of dependence. When I was really sick with the coccidiomycosis, I couldn’t have cared less about the burden I was putting on others (except the midwives that worked with me – they were a different breed altogether).

But, when I began healing, I was mortified by the difficulties I’d caused others, family, friends and peers. It is rare in one’s life that those feelings materialize – and it makes me sad that so many women conjure it after their births. I wish I could say, “Stop it!” and the worries evaporate, but I know they won’t.

So, women talk to each other and for some women, it must be really scary to think of being that open, that vulnerable in front of others.

One of my clients hasn’t pooped in front of her husband of nearly 20 years. They don’t talk about it. It’s a topic of much embarrassment for her. She’s had several kids, most at home and when she started pooping as she was pushing one of them out, she was horrified to hear her midwife say, to no one in particular, “I guess she should have had that enema after all.” Still pushing, the midwife commanded someone to “open that window,” insinuating the stench was annoying her. She changed midwives for the next baby because of these incredibly insensitive comments.

How can a midwife even think birth isn’t going to be filled with sights, sounds, smells and feelings?

But, I’ve also known family members and partners to say things that stick in the mom’s head for the rest of her life – words inexorably connected to the baby’s birth story. While they meant no harm, women are so raw in labor and during birth, perhaps some prenatal counseling of the sensory aspects of the experience should be discussed. The question is, however, if we do talk about it beforehand, will that soothe or agitate women? Hard to tell until after the fact.

Pain comes in many guises.

In Natural Childbirth: Whose Birth Plan is it Anyway? comes this observation from a woman who had an epidural with her first baby:

“‘A couple of hours later (after the epidural was in place) Hancock's daughter Ines was born.’ The birth was brilliant. Thanks to the epidural I actually enjoyed it because for the last bit I was in no pain’”

With her second labor:

“'I knew I wanted an epidural but the midwife ignored me, saying, "Why do you want pain relief? You're doing really well." I was crying, saying, "I don't want to do well!"' Hancock begged her to find the anaesthetist. 'But she just stood outside the door not going anywhere.'”

“In the end Hancock gave birth to her daughter using just gas and air. 'It didn't help at all. I was panicking so much at the prospect of no pain relief I couldn't relax and tore really badly. I couldn't understand this patronising attitude. You'd have pain relief for a tooth extraction so why not for a baby? It really coloured my view of the birth. When Ines was laid in my arms it was a special, dreamy moment. The second time I was in such shock, I'd been in so much pain without anybody helping, I could barely look at the baby.'”

I’ve encouraged many a woman to “hang in there” as she considered pain relief in labor. How many women, near the end of their labors, say, “I can’t do this anymore!” or “Just make it stop.” Isn’t this a hallmark moment in labor? One of the major signs that labor is almost over and the baby will soon be born?

Was I wrong to do this? From now on, when a woman says she wants the pain to go away, should I transfer her to the hospital for an epidural? (Of course, if I were to consider that, how many babies would we have in the car on the way there?)

Or is one of the great things about being in a homebirth setting knowing you don’t have easy access to an epidural? I know when I had Meghann at home… when I whined and whined and begged for drugs, it was safe for me… I could beg for drugs but knew I wouldn’t get any unless I moved my laboring ass into the hospital… the place I was even more afraid of than the pain I was experiencing.

The article makes this fantastic, polarizing comparison:

“On one side sit the medics, portrayed by their detractors as men in white coats intent on cutting women open so they can avoid litigation and clock off on the dot of six. On the other sit the midwives, scoffed at as strident feminists denying women modern analgesia in favour of whale-music CDs and back rubs. In the middle of these competing philosophies is a labouring mother, her wishes drowned out in the clamour of debate.”

If one were looking at the two sides in an unbiased manner, it really is rather hilarious. And if there weren’t real women and babies involved.

I’ve written many times about birth abuse, birth rape and birth trauma. Maureen Treadwell has created the Birth Trauma Association which is based in the UK. In the same article she says:

“…that far too often ideology takes precedence over individuals' needs. 'The consequences can be unbelievably cruel. The truth is that what suits some women can be distressing and wholly unacceptable to others. Some women are obsessed with a natural birth and are distraught if this doesn't happen. But for others - say, a 40-year-old woman who has had three miscarriages - the priority may be having the safest birth possible with naturalness very low on the list.'”

I think that many of us say we support women’s choices, but when it comes down to it, do we really?

When we’re at a baby shower, do we listen to another woman’s birth story, picking it apart in our heads (hopefully, only there!), tsk tsk tsking her choices and wishing for her the “empowering” birth we had?

When someone tells us they are having a scheduled cesarean, are we careful in how we want to make sure they know about the VBAC option without judging her choice as it stands today?

Do we keep second-guessing our own birth experiences, using the knowledge we have today and beating ourselves up because we “didn’t know better” back then? Do we mourn the experience we didn’t have because of then-wise and astute decisions?

Isn’t there a way to embrace both the horrible-ness and the awe-filled-ness of birth at the same time?

This beautiful (and religious) post – Labor is Like Dying – poetically describes her labor and birth as a metaphor for our singular experiences as we also die… that no one can describe it to us exactly, that what happens afterwards is our own individual knowing, that those around us can merely love and support us through the process. She also says:

“Josie’s birth was extremely good. It is probably the greatest good that has ever come upon me. BUT, the process and the experience was NOT pleasant or enjoyable. It is not an experience that I find desirable. It IS a 'good' that should cause me to tremble before our Lord. It IS a 'good' that is totally beyond me and my capabilities — it is a work of God that requires my total surrender.”

I love that she was able to grasp the dichotomy that is birth (and death)… that even as one can be sometimes overwhelmed with the experience, in the end, it can be – should be – of a magnitude so amazing, the only word that can describe it is “awe.”

When women have cesareans, no matter how they walked there, to me, it is such an enormous gesture of love towards the child… it is the demonstration of just how far a mother will go to save her child, that she will be cut open to allow him or her to come to life. I wish the women themselves could somehow set aside the horrible emotional pain, just for a moment, and see how amazing they were/are.

Isn’t there a way to experience the joy and excruciating sadness all at the same time?

Shouldn’t healing also include love for oneself and one’s choices made at the moment? If we are so quick to forgive others, shouldn’t we also forgive ourselves?

I know comparing getting a tattoo to childbirth is a stretch for some people, but when I am asked if it hurts, I say, "It's worse than childbirth!" To me, it is worse than childbirth, but really, it's different. It's a different kind of pain, not one my own body makes, but one "inflicted" on me. Voluntarily, sure, but put upon me nevertheless. It's painting with needles, for crying in a bucket!

Just like trying to describe the memory of the pain of childbirth, describing this type of pain is vague and inadequate. If I hadn't acted like I did in birth, I probably never would have thought about comparing the two. If it doesn't resonate with you, then it doesn't. And, of course, that is fine. It does with me and many others I have spoken with. So... I write about it!

I still have to get the rest of my tattoo colored. It’s scary now! I spent four days nursing my leg this last time, fearing an infection because every step I took made the “wound” weep and bleed. I cleansed it continually with Epsom Salt water and Bactine (which was recommended by the artist) and it eventually calmed down and, a week later, is finally on its shedding-healing path.

I don’t want to lose control this next time like I did last time. It was the same when I was pregnant with Aimee after the loss of control at Meghann’s birth. Instead of surrounding myself with people, I labored this third time completely alone until I began pushing. It was only then that I left the confines of the quiet bedroom to announce it was time to go to the hospital.

Pushing on the way, I was exhorted to blow through the contractions.

Once at the hospital and left alone while my former husband went to get help, I felt Aimee slip from uterus to vagina – I can feel the feeling even now 22 years later! It was a glorious feeling after the work of labor; I knew she was very close.

Even though I pushed her into the world in front of a doctor, midwife, nurse, my husband, a stranger on the balcony watching and a room full of women inside the hospital (Aimee was born in the car), surprisingly, I felt connected to only Aimee at that moment. The pain hadn’t been so bad that time; going deep inside was how I needed to labor. It's kind of sad I figured that out with my last child.

The next time I lay on the table to get a flower colored in, I will only bring music and Donna to guide me to the place where I know I can relax and allow the artist at my heels to work unencumbered and without hearing the suffering I shared the last two times. I should have known better because in other very painful procedures in my life, I always insisted on staying sober, without the relaxing Valium that was offered so I could keep myself in a mental and physical position that wouldn’t make things worse… that wouldn’t allow me to embarrass myself… that allowed me to stay in the moment and experience it… all of it… even the parts that I wished I could sleep through.

I now know, though, that not everyone wants the same experiences as I do. For some, medicating is their choice for working through those painful times, for not feeling as if they embarrassed themselves. I feel that as long as they aren’t medicating their entire lives, maybe it isn’t so bad to allow others to get through isolated incidents numbed… in the psyche or in the body. If it brings them through to a place of joy in the end, who am I to say one way is better than another?

I’m not ready yet for the next tattoo session – and if (through some miracle) I were to have another baby, I know I would have to dig deep again to birth in awareness and completely sober. It will be the same with the next tattoo.

But, I can do it. It’s what I choose to do. Not better, nor worse… just my own way.

Reader Comments (7)

having had several tattoos myself now and also having birthed two kids at home, I can relate to your comparison. In birth, in order to cope, I needed few distractions, not much (if any ) conversation going on and I found this to be true in coping with the pain of being tattooed. By happenstance and not by conscious planning, my tattoo sessions have been spaced about two years apart. I just had a full back outline done and it will probably be at least a year or more until I get the thing colored in. I don't mind, the outline is very cool and I get to recuperate and integrate the changes on my body in the meantime. Maybe this is why most women wait to have subsequent babies?! Your leg looks gorgeous by the way!

Jewel

May 27, 2008 | Unregistered CommenterJewel

When women have cesareans, no matter how they walked there, to me, it is such an enormous gesture of love towards the child… it is the demonstration of just how far a mother will go to save her child, that she will be cut open to allow him or her to come to life. I wish the women themselves could somehow set aside the horrible emotional pain, just for a moment, and see how amazing they were/are.

Very moving words. I've never seen someone acknowledge the love that I had for my baby which led me, willingly, to the Cesarean section table to have a 34 week tiny baby. I could have waited, and she would have died. I could have demanded to labor, but with what we learned about the placenta from the pathology exam, she likely would not have survived that either.

Instead I chose the safest choice for her, but the one with the most risks for me, a scheduled section. Not the birth I wanted, but a life changing experience none the less. I became a mother in that room. I do not mourn how I birth. I do mourn that from what was previously known about my malformed uterus, and what was learned during the surgery, vaginal birth is not an option for me.

I've been bashed for having a section. When I told my mom at 24 weeks I would likely have a section, I was accused of surrendering my birth. Crushing words to hear. "Hi mom, my pregnancy is so messed up we are talking about c-sections at 24 weeks." "Why are you surrendering your birth?!" from the woman with 5 healthy pain relief free births.

I see so much "bashing" of Cesarean births. But that's how I became a mother. I have a healthy, but still tiny, two year old peacefully sleeping, and she is my world. I willingly laid there so she could have the best chance of being born.

And yeah, I am amazing. It was empowering, even though to many it was the very opposite of empowering. I was not forced or coerced. It was a decision made jointly by myself, my husband, guidance from the Lord, and by the medical team assembled.

I wish those in the "natural" birth community as a whole could realize this. Thank you for writing it.

May 27, 2008 | Unregistered CommenterWendyLou

I really enjoyed your post. I know nothing of birthing babies, but tattoos...I am familiar with. Try going without the booze for the next tattoo session. It really helps with the bleeding. I would also suggest some Advil to help with the swelling. Lots of water, and apply lotion 2-3x a day for a week. All of my tats have shed within a day or two, and healed within a week. I never did the soaks. My artist recommended keeping it as dry as possible. Try to get really comfortable with your artist. After six hours total, I felt like I had known my artist for ever. It really helps the time pass. And don't be embarassed about the pain. We all know it hurts. I passed out within the first ten minutes of my first tattoo.

I think it comes down to communication and support for each mothers choices. With each of my clients, - I'm a doula- I ask them to read Penny Simkin's Pain Management Preference Scale and I let her decide where she is on that scale and to let me know so I can support her best. Some women also choose to use a 'code word' that they tell their birth team, so they know when she's serious.
Thank you so much for your post. Absolutely, cesarean births are the ultimate sacrifice for moms. I hope someday soon a balance will be set so women get the best maternity care possible without sacrificing.

May 28, 2008 | Unregistered CommenterLiz

Just as a side note, cause I've been there and studied both methods...
HUGE difference between changing the words of contractions to "surges" and using imagery......
to ACTUALLY using *medical* hypnosis. The kind that those who are allergic to any anesthetic but HAVE to have life saving surgery use. Like I said. I studied both, and prefer the latter compared to the first that only uses simple imagery.
Some say that I had a rare "comfortable" birth, but Hypnobabies boasts a 70% success rate for a fully comfortable and easy birth, with 15% for discomfort at the end, and 15% only during pushing.
Then again it's all determined by if you practiced or not.

May 28, 2008 | Unregistered Commentermommymichael

I had an unmedicated birth with my second. It doesn't seem like such a big deal later, but I remember saying, "You do whatever you have to do to get through that! Epidural, c-section, whatever, I cannot judge anyone anymore!" Of course, now that I don't remember I still do. Working on that.

May 29, 2008 | Unregistered Commenterreeciebird

this is great! i think the biggest thing we need to do is let your body fully heal between sits so you are 100% ready next time.
and i agree that you should try some calm music and have a quiet environment, everyone works different but i think that would help, you dont seem like the distraction kinda gal.

and i may be taking you up on that offer to whine and bitch my whole labor! that could be fun!

May 30, 2008 | Unregistered CommenterJackieD

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