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.”