Lets Talk About Pain
by: Kimberly Ambrose
of Open To Birth
The word ‘pain’ is defined by Dictionary.com as:
- physical suffering or distress as due to injury, illness, etc
- a distressing sensation in a particular part of the body
- mental or emotional suffering or torment
The pain of childbirth can relate to all of these definitions, however, birth pain is in a category all its own because it’s not caused by an injury or illness. The distressing sensations of birth are a part of the normal functioning of the birth process, but why does birth have to be painful?
I mean, it’s supposed to be, right? We see it in movies, we hear horror stories and jokes about it. Mothers like to remind misbehaving children of the burning agony and hard work that brought them to the world. Feeling pain is a natural occurrence in life. Health24.com reports, “pain stimulates pain receptors, and this stimulus is transferred via specialized nerves to the spinal cord and from there to the brain. The pain stimulus is processed in the brain, which then sends an impulse down the spinal cord and via appropriate nerves which command the body to react, for instance by withdrawing the hand from a very hot object.” The feeling of pain is not only a part of life, it helps us understand how to take care of ourselves, from pulling your finger off of a hot stove to relaxing when we’re tense. Really though, why is childbirth pain a part of the process? I have a 2 part answer to that question:
Part 1 is that when the uterus contracts, it hurts, as any woman who’s experienced menstrual cramps knows. At the time labor, the uterus is the largest it’s ever been and all of its muscle fibers are squeezing both laterally and longitudinally. The cramping and squeezing, combined with the baby’s head pressing on the hip bones and stretching the vagina, creates some intense sensations, to say the very least. Not to mention that the sensations get stronger as labor progresses. In Early Labor, uterine contractions last anywhere from 10 seconds to 45 seconds, and occur anywhere from 5 to 20 minutes apart, on average. As things progress, contractions become longer, they get stronger, and they occur closer together. In Active Labor, contractions are about 40 – 60 seconds long and come on about every 3 – 6 minutes. When the cervix is fully dilated (opened) and effaced (thinned), also known as Transition, contractions last about a minute to a minute and a half and occur about 2 – 3 minutes apart. There’s no arguing that giving birth is an overwhelming experience that does involve pain. However, the second part of my answer is the good news: the overall experience is not entirely painful. In fact, most of an average length birth (about 14 – 24 hours) is not spent in pain. I don’t remember where, but I do remember reading about a man who timed and recorded all of his wife’s contractions throughout a 24-hour labor and then added them up. His data revealed that his wife’s total time spent contracting was less than 4 hours. When you hear “24-hour labor” that sounds very daunting, and it is true that longer labors are a great deal of work, but if less than 4 hours were spent contracting, what was happening the rest of the time?
When I was becoming a Doula, I remember hearing that the time in between contractions is called the “rest and be thankful time”. That’s a cute way of putting it, but the focus really is on resting for both the Mother and the Baby. When Mama’s not coping with contractions, she can regroup, take a breath, and communicate her needs before the next one comes, while the Baby gets a break from being pushed on by the uterus. Most importantly, the amount of oxygen going to the uterus, the placenta, and the Baby all decreases during each contraction. As the uterus is squeezing, blood vessels are also squeezed, which affects how much blood-carrying oxygen can get through. Relaxing and using your breathing in between contractions allows more oxygen to get delivered to both Mom and Baby, and helps to relax the muscles so the baby can pass through. Rest-time and focusing on relaxation is not only crucial for labor pain management, but it’s also how most of labor is spent.
When you think of it in that way, childbirth is actually rather anti-climactic. Forget the screaming and running around they do in the movies, in real life Mom is either drinking fluids, readjusting her position, focusing on relaxing her pelvic muscles, going to the bathroom, communicating with her support team, keeping count, or just being present in between contractions. So most of birth, depending on the length of labor, is not spent in pain or terrible discomfort. That doesn’t mean it’s not hard work, it just means that the full labor time is not spent in agony, like on a TV show. Remember that contractions are timed in seconds, while the “rest and be thankful time” is timed in minutes.
Okay, so birth is painful, and now we know why, but is that all there is to it? Of course not! Yes, the process of bringing a baby earth-side does create some intense sensations, but here’s the thing, pain is not pain without the brain. It’s the brain that registers whether or not a sensation is painful or pleasurable. When your toe is stubbed on a piece of furniture, it’s not the toe that decides that pain is happening. The impact of the toe sends messages through the nerves to the brain and the brain takes that information from the nerves to decide, “is this a good sensation or a bad sensation? Does this help us or harm us?” The brain then decides that a stubbed toe is indeed painful and it sends out signals that illicit us to not only respond (yyyouch!) but also to mend and help heal (ice, bandages). That’s what makes birth pain so different. The pain of birth is not because the brain sees something is wrong, but quite the opposite. Birth pain is Pain With A Purpose. Contractions become longer, strong, and closer together as your baby is getting closer to being born. The pressure of the baby being pushed against the cervix and the vaginal floor increases the hormones that increase labor progress. The sensations that come with contractions are a sign that things are good and moving along well.
Additionally, a woman’s body knows how to give birth, and it’s been prepared for it since before she was born. Three naturally occurring hormones are the star players of childbirth. Oxytocin increases contractions as needed, more oxytocin is delivered into Mom’s bloodstream as labor progresses. As oxytocin increases, so does adrenaline, giving her the power and energy to maintain coping and give her that umph! she needs to push the baby out in the final stage. Here’s the best part: as oxytocin and adrenaline levels increase, Mom’s body floods with pleasure-providing endorphins. Endorphins encourage the brain and the body to enjoy a sense of calm and natural labor pain management. This natural hormone exchange is a part of trusting your body to do what it was made to do. Your body doesn’t leave you hanging like an un-returned high-five but instead gives you support by increasing the naturally occurring “feel-good” chemicals as labor intensifies. By practicing relaxation through meditation and breathing techniques, these endorphins are increased at the same time that oxygen is brought into the body, down to the uterus, the placenta, and the Baby. With increased endorphins and increased oxygen through patterned breathing, coping through contractions becomes a matter of focus, support, positivity, and strength rather than a fight and a struggle.
Finally, I’d like to address pain as a matter of one’s perception. What does that mean? Well, we know that contractions decrease the supply of oxygen. When oxygen levels are decreased, pain levels are known to increase, which means that, by tensing your body during a contraction, you are causing yourself more pain. When your muscles are relaxed and you are breathing full, patterned breaths, you are bringing in oxygen and allowing the brain to register both pain and pleasure sensations. LiveScience.com reports, “two regions of the brain that become active during orgasm, the Anterior Cingulate Cortex and the Insula, are also active during painful experiences”. It may be hard to believe that labor could produce feelings of pleasure, but it is true. Not only do the same areas of the brain become activated when experiencing pain as well as pleasure, but the same areas of the body are stimulated during birth as during sex. Ina May Gaskin, a midwife and published author, is famously quoted as saying, “The way the baby goes in is the way the baby comes out”, and she means more than the physical aspect. When a woman feels safe and relaxed, she is able to open up and let herself be vulnerable to her partner. It’s the same with labor: when a woman feels safe and supported; when her birthing space is protected and she is confident in herself and her body, she is able to roll with the sensations of labor rather than fighting against them. Hypnobirthing, a childbirth education program that uses hypnosis-style relaxation to cope through contractions, does not call them contractions, but rather refers to them as “pressure waves”. This takes away some of the negativity and fear that we’ve all learned to associate with the word ‘contractions’. By changing the way we view contractions, as progress instead of punishment; the way we see childbirth, as an intimate and personal reproductive experience in a woman’s life instead of a hellish and dramatic ordeal; and the way we see women’s natural ability to give birth we can begin to see the possibility of childbirth being a positive experience, and maybe even a pleasurable one.
A documentary called Orgasmic Birth is changing the way women and men perceive the possibilities of childbirth. Women are now stepping forward and publicly acknowledging that, yes their births did include pain, but they also included sensations of ecstasy and pleasure. This doesn’t mean that now all women are expected to not be in pain during their births, it simply paints a different portrait of childbirth and welcomes the idea that if you are in an environment you feel safe in, if you are surrounded by a support and medical care team that you trust, and if you have faith in yourself that you can get through the process as your body has been designed, you will be okay and you do not have to suffer. By doing what you can to encourage relaxation, both physically and mentally; by preparing for a safe and supported birth; by having trust in your body’s natural processes you are setting yourself up to have a positive and empowering childbirth experience, and you will have to worry less about pain management during labor.