Pain & Beliefs

IS CHILDBIRTH PAINFUL? A MATTER OF BELIEFS

By Heather Beaudoin

previously published in Birth Issues Fall 2011

Helga Himer Photography

Helga Himer Photography

I intended to write an article about pain in childbirth. I wanted to research all the hormonal and physiologic changes that occur in a woman’s body when she experiences sexual arousal and orgasm. Then I wanted to compare that with the hormonal and physiologic changes that occur during natural vaginal birth. As well, I hoped to compare a woman’s childbirth experience to a man’s experience of arousal, erection, intercourse and ejaculation.

I had a strong suspicion that we would see a great deal of parallel between these three scenarios and I hoped that demonstrating those parallels would provide a convincing argument that pain in childbirth has no physiologic basis—that given its physiologic similarity to sexual arousal, childbirth could, or even should, feel enjoyable and is not necessarily painful as the large majority of us have come to expect.

My research, however, kept leading me elsewhere. The mechanics of childbirth, like sex, are relatively constant for all of us. So it seemed that maybe it doesn’t really matter if anatomically childbirth should feel like sex. Instead, I realized that what mattered is the experience—the experience of pain or the lack of pain. A significant number of women experience childbirth as orgasmic while a large majority of people in our culture (even those who have never given birth) describe childbirth as painful.

From where does this difference originate? I keep coming back to the stories that formed my beliefs about how childbirth would feel. Could the differences between women’s experience of childbirth be not only dependent on physiology but also on our belief system?

Dr. Michael Klein, who is a family physician and a professor at the University of British Columbia in the Faculty of Medicine, argues that this is true indeed. In one of his studies he explored the beliefs of caregivers and the effect these beliefs have on maternal and newborn outcomes.He discovered that pregnant women, midwives and doulas all believe that a woman’s belief system and attitude on childbirth has an impact on the outcome of birth.1

So let’s explore that idea: The reason that women describe their childbirth experience as painful and others will not, has to do with their beliefs—especially, the belief about whether or not to expect the experience to be painful.

As of today Dr. Michael Klein’s research has not expanded to the second phase of testing out his research conclusions, thus, I will use myself as the first test subject. Here are the stories that formulated my beliefs and then my actual experience that normal natural vaginal birth would not be painful.

My mother had three children. I was her second baby. I knew that in the early 1970’s when she had given birth to my older brother, natural childbirth was not the norm. My mom, however, attended Lamaze classes, dutifully applied the breathing patterns she had rehearsed and with the analgesic effects of laughing gas delivered her first baby with the assistance of forceps. To her mind, she had successfully experienced a natural childbirth as she had intended. Throughout my childhood, she repeatedly told me, both prompted and not, that the only time my brother’s labour and birth had ever hurt was when the doctor used the forceps to assist the delivery.

Nearly four years later Mom and Dad dropped my brother off at his Nana’s and went into the hospital apologizing for being there so early in labour. Mom had been unsure of how quickly labour might progress with a second baby. Always one to err on the side of being too early rather than late they had decided it was best to get my brother settled at Nana’s early rather than be rushing later on. Mom was shocked to learn, however, that she had arrived fully dilated! She had experienced no pain whatsoever. She actually hardly experienced any discomfort!

Helga Himer Photography

Helga Himer Photography

I asked for this story of my birth to be retold to me many times as a child, and Mom always swore that she had only had one ‘real’ contraction for which she had had to pause to breathe through. Again, Mom insisted that labour was not at all painful. With one exception, however, she would then stop and stretch her mouth in the widest yawn imaginable. She would encourage me to do the same and then explain, “Do you feel that stretching burning sensation around the edge of your mouth? That is how your yoni2 will feel as the baby’s head emerges and stretches you as wide as you can go. Not so bad, huh?”

My little sister followed seven years later. The only element of her birth story that stands out as I recall Mom’s retelling of it, is that her water broke at the start of labour, which was not as either she nor Dad expected since it had not happened that way with the first two. So after getting up to get towels to sop up the mess, my dad proceeded to fall back asleep! Mom re-awoke him then headed off to the hospital and by the time my brother and I woke up that morning Dad was home reporting the arrival of our little sister. No reports of pain at all.

Amongst the stories of the births of the babies in my extended family, I also recall snippets of tales of baby’s born at home to the fellow La Leche League women my mom knew. I never once in my years, growing from a girl into a woman, ever recall hearing any tales of painful or agonizingly long births. No tales of mother’s nearly bleeding to death nor babies that were saved by the heroic actions of a doctor. In my mind these sorts of possibilities were non-existent. I knew with every fiber of my being that labour would not be painful. I might feel a ring of fire as the head emerged but there was no need to worry about myself or the baby. All the stories I was told reminded me that, “Birth was a normal every day miracle.”

Then I got married and subsequently expected my first child. It was my turn to find out if the tales were true and how my beliefs about childbirth would impact my own experience.

With my first pregnancy I miscarried the baby at 12 weeks. My miniaturized ‘labour’ to deliver that tiny person was agonizingly painful—both physically and emotionally. Each contraction sent a sharp ache across my belly and through my groin. I sobbed through several hours of rhythmic contractions writhing on my bed trying to find ways to relieve the pain each time it gripped me. I knew beyond a shadow of a doubt that my experience had been painful because I had been resistant to what was happening. I did not want my baby to leave my body. This resistance, deep sorrow and fear created tension and pain. I would not release and could not trust my body. I fought the birth during the whole labour, trying desperately to avoid the truth that I was losing that baby.

Fast forward a few years and I am now sitting in my midwife’s office approximately 36 weeks pregnant with my oldest son. She asks me, “So what is your plan to cope with the pain of this birth?” I was shocked and caught very much off guard, thinking, “She’s a midwife, isn’t she on the same page I’m on? Doesn’t she know that it’s not painful?” I was barely able to construct an intelligent response that involved regurgitating some things I learned in my prenatal classes about massage, heat, breathing and relaxing. In my head and my heart I believed I would just release into the process, trust in my body’s wisdom to do what it was made to do and have no fear. I knew that the midwife was mistaken because it wasn’t going to be painful, just hard work.

True to my expectations labour was hard work. With my three babies my labours started with anywhere from less than 30 minutes to over 12 hours of a sensation that I would describe as a mild cramping or tightening deep within my groin, sometimes even a feeling like I had diarrhea and needed to go to the bathroom. I was fully aware of these mild contractions, but they required none of my attention and no one else knew I was experiencing them unless I told them. This was followed by an intensification of the sensations such that I no longer wished to walk and talk through contractions. The sensations were the same as early labour, a cramping feeling, a tightening, an ache like you feel when your muscles get tired from doing any sort of exercise. They were just more powerful, bigger, longer, stronger and this demanded my focus and attention. Through my various labours this stage took anywhere from 1- 15 hours. My belly would tighten into a hard rock as the contraction would peak and I could feel the muscles of my cervix and uterus working together to open wider than they ever had before to make way for my baby. But it was not unbearable, it was not torturous, I was not in pain. I was working harder than I ever had in my life and it was glorious.

Then came the second stage of labour, where I get to push my babies into this world. I remember it so clearly—the contraction begins like the earlier ones, but as the wave rises on its approach to the peak a new sensation is added. Now my body, with no direction from me, begins this massive push downward. I can feel the baby’s head as it moves through the birth canal—it starts out feeling like it’s going to explode through my rectum. It nearly terrifies me, but I know to expect this sensation and trust that my fear simply cannot happen. As the contraction continues and my body continues to bear down I feel a head slide further along. There is no more pressure in my rectum, just a delicious fullness in my yoni. I look forward to that feeling with each push—that moment as the head slides far enough forward to ease my poor bum and I can feel the baby fill up my birth canal. It isn’t just tolerable, it is enjoyable and pleasurable. My whole body is so exhausted. I pushed for 20 minutes, one hour or two and a half hours with my three children. I always doubt, at this point, if I can go on and I just desperately want each baby to be out so I can meet him/her. With some of my pushes there is a sharp, intense stabbing and ripping pain—I know I have torn, but I will survive. When my first child finally crowns there is an intense feeling that my urethra and clitoris have been crushed, but I don’t feel this with my second or third child. My second child arrives in such a hurry with so much tearing that I barely recall his crowning. My last baby is eased by me so carefully into my own hands. I held my own warm compresses and massaged my tissues with olive oil. Each time the intense stretching and burning threatened to overwhelm me I was able to respond spontaneously to my body’s needs to be soothed.

So, if one day Dr. Michael Klein were to interview me, and ask me about my four births and the beliefs I held before the births, I would respond:

  • As long as labour starts on its own, the contractions of labour will not be painful. I may need to stop and focus and breathe through them
  • If my  labour needs to be managed (e.g. with a pitocin induction or augment3, vacuum or forceps delivery4, episiotomy5) the contractions will be unnaturally uncomfortable—read, painful
  • If I am resistant to, or fearful of, what is happening, I will experience the sensations as pain
  • I will feel intense stretching and burning when babies crown and are born

A few months later, he would most certainly receive the results of my birth and ask for a follow-up interview. During this interview I would expect him to ask me whether or not my beliefs matched my actual birthing experience. This is what I would tell him, “I am not at all surprised that my beliefs held true and accurately describe the experience of my four births.”

He may be surprised, or not, as he is well informed, but he would need more information so I am sure he would ask me to elaborate. So I would further share:

“I will never describe what I felt during labour contractions as painful. To me it is simply the wrong word and it is far too suggestive of an experience to be feared and avoided. For me labour contractions were massive, strong, overwhelming, exhausting, intense and powerful beyond my imagination. I must digress slightly and point out that these are all adjectives I would also use to describe the experience of sex, and I would not describe sex as painful. Although I know some women find intercourse difficult and/or painful, it isn’t for me.”

I would add, “I did need to focus and breathe through contractions. I also followed my body’s lead to find positions and hands-on support that increased my comfort (hmm, do you see the sex parallel again?)”.

The only time I felt pain was when my yoni tore, as the heads of my babies were emerging from me. My skin and muscle tearing is something I feel is unnatural. Because I did not feel any pain with the birth in which I didn’t tear, I can say that the pain was very identifiably related to the isolated incidence of feeling my flesh rip. It does not, for me, cast a generalized perception that childbirth was painful – only the few moments at delivery when I tore were painful.

Helga Himer Photography

Helga Himer Photography

Again, I cannot resist the parallel with sex—if we experience a moment that is uncomfortable during sex we usually deal with it and move on. I wouldn’t avoid sex because I heard that it has the potential of being painful or because I had an isolated painful experience. I wouldn’t let one bad moment out of an entire experience become the primary or only way of describing that experience. I would instead try to find ways to make it more enjoyable and fun!

Because, I felt very intense stretching and burning upon crowning, just like I was told to expect, I will forever wonder if I might have experienced those sensations differently if I had come into my births with different expectations and beliefs. To me this is just more evidence in support of my idea that you experience what you believe you will.

I often wonder how the majority of women might experience the sensations of childbirth if, as a culture, we told each other different (yet still accurate) stories. What if young women didn’t watch movies with actresses doubled over in pain with their first contraction rushing off to the hospital as if someone were in need of life saving measures. What if instead, we saw a woman standing with her arms around the neck of a loved one gazing dreamily into his/her eyes, erotically swaying her hips and moaning in a way that reminds us of how this baby came into existence. What if we saw a beautifully curved woman gracefully floating in a large pool of warm water embracing every contraction as a cool breeze blew into her face. What if we saw a woman squatting on her hospital bed with her doctor and nurse quietly and reassuringly encouraging her with a smile? What if we didn’t hear patronizing caregivers telling us that, “It’s gonna hurt like hell, so you better have a coping strategy.” What if, instead, we heard our mothers telling us they felt like all the energy of creation was crashing through their body and they surrendered to the strength of it and wept with the joy of feeling the fullness of their yoni as life came through them? Even how my girlfriend’s mom likes to jokingly describe her daughter’s birth, “it was like a really big poo” seems like a more accurate and complete description, than ‘painful’.

What then? Would childbirth really be painful for so many? Might more of us try desperately to find the words to explain the wonderfully indescribable sensation of giving birth the same way there are just no words that accurately describe your most wonderfully indescribable orgasm? Could our experiences really depend largely on our beliefs, expectations and the language we use to describe it? I think so and I can’t wait for Dr. Michael Klein to take me as one of his research informants.6

Heather is passionate about natural childbirth at home and can’t wait to apply to Mount Royal University’s midwifery program. She wishes her mom had told her that birth would be orgasmic, then maybe she would have believed and realized that expectation. She is a long-time member of ASAC and a senior editor with Birth Issues—but she has to take a break because she is about to go on a year-long adventure across Europe with her husband and 3 children.

Editorial notes:
1. Michael Klein, Kaczorowski, Hall, Fraser, Liston, Eftekhary, Brant, Mâsse, Rosinski, Mehrabadi, Baradaran, Tomkinson, Dore, McNiven , Saxell, Lindstrom, Grant, Chamberlaine. “The attitudes of Canadian maternity care practitioners towards labour and birth: many differences but important similarities.” Journal of Obstetrics and Gynaecology Canada 31, no. 9 (2009 Sep): 827-840.
2. Yoni is a term borrowed from India’s ancient language, Sanskrit or devanagari (divine language). It can be translated by several English concepts (origin, source, womb, female genitals) and is considered a more respectful word for naming female genitalia.
3. Pitocin is a synthetic form of the hormone oxytocin that causes the uterus to contract. It can be used to artificially start a labour (induction) or to make contractions stronger, longer and closer together in a labour that is perceived to be to slow (augmentation).
4. In vacuum or forceps delivery an obstetric instrument is applied to the head of the baby in order for the doctor to help pull the baby out of the vagina at the same time that the mom is pushing.
5. In an episiotomy a doctor (or rarely a midwife) creates a larger vaginal opening by cutting down through the perineum (the skin and muscle that separates the vaginal opening from the anus).
6. For further reading on this topic, read Dr. Grantly Dick-Read. Childbirth Without Fear (Pinter & Martin Ltd, 2nd Edition: 2004).