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Entries in pain in childbirth (2)

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.

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.