Lucy Atkins, Junior, Pregnancy and Baby. September 2004
You’re looking forward to holding your baby, but there’s a small matter of the birth to contend with. So, what is it really like?
Say ‘labour’ to any pregnant woman and probably one of her first thoughts will be ‘pain’ .You know you have to experience it – in some form – but what will it feel like? How long will it last? How will you cope? Nobody can tell you, because every labour is different. My friend Fiona, a mother of two (both born without drugs) describes the pain of unmedicated labour best when she says it’s “outrageous and manageable”. But just how outrageous your pain is, and how well you manage it, depends on three major factors: your mind, body and baby.
The first thing all of us should be taught about labour is that it does, indeed, hurt. You will cope far better with labour pain if you’re expecting (but not fearing) it, and have an arsenal of techniques to hand for coping with it. The pain part may seem obvious: you will, after all, be squeezing a fully-formed baby out of your vagina. But you’d think that these days, with medicated births becoming almost the norm (33 per cent of us now have epidurals), we’d fear pain less, but we don’t. Studies have shown that women today are more anxious about pain than ever before. In 1987 and 2000 two large British studies (Great Expectations and Greater Expectations) looked, among other things, at women’s anxiety at the prospect of labour pain: in 1987 nine per cent of women reported feeling ‘very worried’ about the thought of pain in labour; by 2000, 26 per cent did.
Understanding where the pain comes from and what it does might help you if you find the prospect of childbirth scary. The pain of an uncomplicated labour is a productive, healthy pain. “Your uterus is one big muscle that intermittently squeezes during labour. These are your contractions,” explains Jenny Smith, Head Midwife of
Private Midwifery at Queen Charlotte’s & Chelsea Hospital, London, who is putting together a clinical trial looking at how alternative therapies can help women giving birth. “With each contraction, the baby’s head pushes down on your cervix (the neck of your womb), pushing open the entrance to your birth canal. Your baby then has to stretch open the tissues of the vagina and perineum before entering the world.” During this contracting, stretching and opening, your nerves transmit pain signals to your brain. This is not some horrible genetic misfire: pain can actually help your labour to progress. “The cervical nerves, pelvic floor muscles and vagina transmit a stretching signal with the pain,” explains Kim Kelly; a Seattle midwife. “That then tells the pituitary to produce more oxytocin, intensifying labour, helping your cervix to dilate and giving that urge to push.”
Your mind has its own part to play in all this. If you are panicky and afraid, feeling unsafe or exposed (as many of us are in labour) you’re likely to tense up and produce stress hormones called catecholamines. These trigger your instinctive ‘fight or flight’ response. Studies have shown this can in turn inhibit labour and slow contractions.
If, however, you feel relatively relaxed, your body will produce fewer catecholamines and more hormones called endorphins. Endorphins (often called the body’s natural painkillers) are thought to be as potent as morphine, if not more so. They are also mood elevators and hang around for a bit after the birth, giving you a natural high. Furthermore, they have amnesiac qualities (which is why many women say they don’t remember the pain of birth once it’s over). You’ll only avoid this ‘tension-fear-pain’ cycle if you expect pain, but don’t fear it.
This, of course, is easier said than done. Most of us are not used to pain and expecting to feel it can make the best of us a little tense. We think of pain as ‘bad’, ‘scary’ or ‘dangerous’. But unlike the pain of a broken leg, for example, labour pain is intermittent and varied.
Most women experience pain-free breaks between their contractions and few of us are hurled into hard labour the minute our waters break. Most labours actually start quite slowly, giving your hormones chance to kick in properly (this is usually called ‘pre-labour’). When labour does get going (during the ‘first stage’ where your cervix is actively dilating), the pain can certainly feel overpowering – women talk of ‘sledgehammer’ contractions, ‘fierce’ ones, feeling pain around their middle, their back and sometimes up and down their thighs. This usually peaks during ‘transition’ – the phase when your cervix is finishing its dilation and preparing to push the baby out. This is a time when many of us panic, yell or demand drugs. But fortunately, as Sarah, 35, mother of 18-month-old Margaret, and four-week-old Thomas (both unmedicated births) puts it, “When you’re feeling this level of pain, it’s nearly over.”
Many women describe the pain of pushing as ‘controlled’ or ‘productive’, more of a ‘marathon’. The moment your baby’s head crowns is known as the ‘ring of fire’ for a reason, but this moment is usually fleeting, and then you have your baby. Which is another helpful thing about labour pain: it is finite, and there’s quite a considerable reward at the end of it. You do have another 20-30 minutes of lighter contractions while you deliver the placenta (known as the third stage). Once the baby is out, you will probably experience a different pain -the pain of stitches or bruising – which can usually be managed simply by taking regular doses of paracetamol or ibuprofen.
The best approach to labour pain is preparation: exploring ways to cope with it in advance. Much is made, these days, of celebrities who supposedly schedule Caesareans to avoid the pain of vaginal delivery. But what about those who go the other way? London-based obstetrician Dr Gowri Motha has helped celebrity clients such as Elle Macpherson and Kate Moss to prepare for the pain of childbirth using her ‘Jeyarani Method’. You are, Motha believes, likely to have severe pain in labour if your uterus is not detoxed, your cervix and paravaginal muscles are too tight, your joints too stiff, and your vaginal opening too rigid.
“I believe that pain comes from these sources,” she says. ‘And I deal with each using a combination of diet, exercises and mental suggestion”. Motha’s Caesarean rate is significantly below the national average, and her clients have far fewer epidurals, episiotomies, instrumental deliveries and inductions than the rest of us. “There is no need for mothers to worry about pain,” says Motha (whose whole philosophy is to keep labour short), “if they have a few tricks up their sleeves.”
Carolyn Cowan, a yoga teacher specialising in pain relief, teaches her pregnant clients lots of ‘tricks’ for coping with pain, including meditation, yoga, breathing, visualisation, water, positions, hypnotherapy, acupuncture, acupressure and massage: “However much you fear pain there is a lot you can do to deal with it,” she says. “We are designed to handle amazing amounts of pain. Our female glandular system can cope.” And judging by the rise in popularity of techniques such as self-hypnosis, relaxation and yoga, more and more women are looking for alternative ways of managing the pain of labour.
But why not just have an epidural? After all, you wouldn’t have a tooth pulled without pain relief, so why put yourself through childbirth without drugs? Well, for a start, your body isn’t designed to handle unmedicated dental work. It is, however, designed to withstand the pain of a straightforward labour. If your labour becomes complicated you may well need drugs. Some babies, for instance, are simply not lying in the right position, and this can cause unreasonable pain, a prolonged labour and medical intervention such as a forceps or ventouse (suction) delivery. In those circumstances you may well need an anaesthetist. But if your labour isn’t complicated, epidurals aren’t necessarily your best starting point: studies show that if you have an epidural you’re more likely to need a syntocinon drip to strengthen contractions, a ventouse or forceps delivery or an episiotomy (a surgical cut to the perineum).
Still, many of us believe we are not the kind of people who can cope with pain, although this may not be true when it comes to childbirth. “Personality can influence how you handle pain,” says clinical psychologist Dr Frances Goodhart. “We know that messages from peripheral nerves to the brain are influenced by activity in other sensory areas, such as touch (this explains why massage helps relieve labour pain), and also by the activity within the brain itself. Many psychological factors – distraction, mood or your own expectations -can also playa central part in how you personally experience pain.”
So, whether you go to pieces when you stub your toe or not, you can still influence how you handle labour pain. “A key part of coping with pain,” says Jenny Smith,
“is to have trust in your carers and to feel that your environment is right (i.e. safe, comfortable, and reassuring). Most women, with confidence and support, can cope with labour pain, or at least, can cope most of the way.”
If your labour is complicated or prolonged you should never be expected (or expect yourself) to suffer unmanageable agony. We are lucky that we live in an era of anaesthetists and surgeons: if we are not coping, we can – and should – call on them.
But don’t underestimate your body during childbirth: if you prepare properly for the pain, your ability to cope with it may surprise you on the day.
Junior. Pregnancy and Baby, September 2004