The Mother Lode of Pain: Getting It All Wrong at the Boston Globe

This post was published in 2006 on the original Giving Birth with Confidence blog. It provides concrete information on the role of pain in labor and shares a beautiful analogy that describes why women would want to experience childbirth fully.

Dr. Darshak Sanghavi author of “The Mother Lode of Pain,” the cover story of the Boston Globe Magazine on July 23, 2006, skims the surface of historical and empirical research and presents us with the most biased and inaccurate story I have read in many years.

At the center of the story is Dr. Sanghvi’s belief that choosing to feel pain in labor is “odd.” “Especially when there is effective, safe, and available pain relief.” He suggests that women who choose to have a normal, natural birth and experience the pain that accompanies labor and birth are “attracting notice”, “setting up an artificial trial that precedes entry into a highly selective sorority”. He goes on to say “It creates drama. It captures attention”.  His most shocking, and utterly ridiculous statement is “…reliance on pain to create meaning during childbirth indicates a constricted imagination.”

If Dr. Sanghavi had actually done a serious rather than a superficial review of the literature including consulting the Cochrane Library for the most current research and recommendations for maternity care he would have discovered that pain during labor and birth is not “an utterly primitive thing” but plays an incredibly important role.

Pain early in labor lets women know they are in labor. And as oxytocin levels rise, the uterus contracts more effectively to dilate and efface the cervix, and the pain increases. Women respond to the pain they are feeling by trying to find comfort in a wide variety of ways (if allowed any degree of freedom). They moan, change position, walk, sit in a tub of water, are massaged, eat and drink, sing, listen to music. The list is endless. The key is that each woman in labor manages her pain in unique ways that work for her. What she is feeling guides her to finding just the right thing to do. Eventually endorphins kick in and the result is that women go into a dream-like, highly intuitive state and that helps them manage the pain of contractions too. Without pain there is not the same kind of endorphin release. Not surprisingly, if pain is eliminated (with an epidural) naturally occurring oxytocin is not released in increasing amounts. The normal, natural process of birth has been interfered with and there is a need for medical interventions…starting with pitocin. Being able to manage the pain of labor actually helps labor progress by insuring high levels of oxytocin and also by encouraging the mother to move helping baby to settle into and move through the pelvis. Pain is also protective especially during second stage as the baby moves through the pelvis and is born. Women who do not have an epidural respond to what they are feeling at this stage by changing position, and tensing and releasing vaginal and pelvic floor muscles, and in that process protect the birth canal, the perineum and the baby. Pain promotes the progress of labor, protects mother and baby, and helps women find comfort. It is not an unnecessary side effect and eliminating it completely alters the course of labor and sets the stage for interventions and complications.

Women choose to experience (and manage) the pain of labor because it makes birth safer for them and for their babies. At the end of the day the reward for that hard, sacred work are feelings of elation, even ecstasy. And a baby that is alert, competent, and able to nurse easily and well right from the get go. If Dr. Sanghavi had more than a rudimentary knowledge of the process of normal birth and the important role pain plays in that process he might not think the way he does.

As I write this I am looking out the window to the sea in rural Ireland. Later today I will walk down a small lane through farmers’ fields to a little cove to swim. I could get there a lot quicker if I drove it and since the walk back up that lane is very steep in several spots driving would be so much easier. And it takes so much time to walk. The swim would be the same. I would be relaxed and refreshed at the end of my outing. But this is what I would have missed. Feeling the sun and the wind on my face. The sense of well being as I walk, slowly and them more rapidly, getting into a rhythm. Stopping to pick wild flowers (not part of the plan at the start). Picking and eating a few blackberries from the bushes that line the lane. Watching a boat on the sea and wondering what it is doing. Stopping to watch a calf nursing. Smelling the honeysuckle. Chatting with a farmer friend who is moving his cattle from one field to another. And on the way home, up that steep hill, changing the way I walk, slowing up, sweating with the exertion, taking breaks, noticing the blueness of the sky, delighting in how good the wind feels blowing my hair, stopping again to talk, now about how cold the sea was, how fine the day is. Taking gulps of icy water. Eating part of a chocolate bar. Daydreaming. Shaking my legs as they resist the climb. I arrive home refreshed, relaxed and tired. The swim happened. But so much more did too. And therefore the meaning of this lovely afternoon is totally different. I wonder if Dr. Sanghavi thinks that my decision to walk not ride to my little cove is odd and indicates a constricted imagination?

And what if I had not been permitted to eat and drink on my walk, what if I had been tethered to an intravenous and continuous monitoring (just in case I slipped and fell and broke my ankle), what if my pulse was taken every few minutes to make sure I wasn’t too stressed? What if I had to do it all in great haste? That walk would most certainly have lost its allure. In fact instead of a delightful challenge it would become a misery. The ride in the car would seem reasonable!  Like medication in labor — safe, effective and available?

I am irate that thousands of women will read an article that perpetuates the myths that pain in labor serves no purpose and that working hard in labor is “odd.”

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  1. “If Dr. Sanghavi had actually done a serious rather than a superficial review of the literature including consulting the Cochrane Library for the most current research and recommendations for maternity care he would have discovered that pain during labor and birth is not “an utterly primitive thing” but plays an incredibly important role.”

    That’s factually false. There is NO scientific data, none, zero, zip, nada that pain is beneficial during labor. If Ms. Lothian believes otherwise, then she can present, and explain the data that she thinks supports what is really just her personal prejudice.

    And by presenting the data, I mean just that, not citing a laundry list of studies that she hasn’t even bothered to read.

    The ONLY people who believe that their is a benefit to labor pain are those who stand to profit from “supporting” and “encouraging” women to endure the pain. Their financial conflict of interest renders their judgment on the topic quite suspect.

  2. mamapoekie says:

    Beautiful! makes me want to take that walk
    Sticking this in Sunday Surf

  3. Debby Amis says:

    I loved Judy’s blog. Just as a strenuous walk in the country is not pathological, neither is birth in most cases. Labor pain is unique. It is not associated with injury, disease, or surgery. It alerts the mother so that she seeks a safe environment and support. Responding to the pain of contractions with position changes and movements often facilitates the progress of labor and helps the baby to move down the pelvis. Many, many women have found incredible joy by working with their labors and fully experiencing all the sensations of birth. Natural childbirth may not be for everyone, but certainly every woman who wants to experience it should have the support of her caregivers, the freedom to move around, and the access to nonpharmacologic pain management strategies such as birthing tubs that will help her to achieve it. To dismiss women who want to experience natural childbirth is to impose your values and prejudices on others. The financial reward comment is laughable. There is much more money to be made by inappropriately inducing women and using unnecessary and non-evidence-based interventions (such as continuous electronic fetal monitoring) which lead to high cesarean rates than there is to be made in helping women discover their own strengths for birth.

  4. Kelly says:

    I really loathe how the conversation gets framed that using pain medicine during birth is exactly like having a drug-free birth, but with no pain. This is how many women and men who don’t know better see it; thus they willingly and in a non-totally-informed state submit to unnecessary interventions which often result in the classic “cascade of interventions”. I have heard dozens of women in person (and many more online) express regret they made these uninformed choices.

    To dismiss women who want to experience natural childbirth is to impose your values and prejudices on others. The financial reward comment is laughable.

    Agreed and agreed.

  5. alina warren says:

    I don’t agree with Dr. Sanghavi in his arguments but neither with Ms. Lothian. I have heard more stories of mothers that went through pain once and either decided not to have another child due to the traumatizing experience or go for pain medication the second time. This shouldn’t even be an argument, it is a persons decision if or not to go through pain.I for once don’t believe in the necessity for it but won’t stop others to think it’s right for them. But having a natural pain free birth is nothing like a lovely walk outdoors. There is no moaning or screaming involved there, just relaxation which in the case of birth is not quite true unless you are one of the very few fortunate women to have a quick naturally painless delivery.

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