Not all cultures associate pain and labour, but it is central to any discussion of birth in the UK. One of the most common fears of pregnant women is that labour will be horrifically painful and that they will not be able to cope.
There is the odd mother who claims to have had a completely pain-free birth, but it is true to say that most women will feel something, and usually something quite intense, during the course of their labour. This means that realistic preparation for coping with the sensation of labour is a necessary part of any antenatal preparation. What is equally important, however, is that we do not approach the topic of pain in such a way as to create unnecessary fear in the mind of the expectant mother. Fear significantly impedes a positive birth; adrenaline is produced and this is known to inhibit the first stage of labour. It can even increase the pain by means of the fear-tension-pain cycle (Dick-Read, 2004).
Conventional antenatal teaching focuses on pain relief first and foremost. Implicit in this approach is the idea that unmanageable pain is the main story, yet the experience of women who have had a natural birth suggests otherwise. Giving a woman an understanding of the nature of labour pain, her in-built capacity to cope, as well as exploring techniques for minimising pain before pain relief options, helps to inspire confidence and trust in her own body. This positive attitude can feed directly into her labour experience, often reducing her need for consequent pain relief (Nichols and Gennaro, 2000). A woman who expects to cope has a much higher chance of doing so (Williams et al, 2008). While it is not the role of the birth professional to dissuade a woman from pharmaceutical pain relief – in fact, a well-timed epidural can sometimes mean the difference between a positive or traumatic birth experience – it is essential that the focus is on reducing fear and inspiring confidence if we are to help women have positive and empowering birth experiences (Nichols and Gennaro, 2000).
Understanding why it hurtsThe pain of labour is a normal side-effect of a natural process. As birth professionals we know this, but it is surprising how few women do. When a woman understands that the uterus is the biggest muscle in the body (in terms of mass) and the work it needs to do to dilate the cervix, they more readily understand the analogy that labour is like running a marathon or climbing a mountain and stop viewing it as a purely medical experience. Though marathon runners admit to nerves before a big run, they would rarely say they were outright terrified. Likewise, when women understand that the pain is simply the consequence of their body working hard and not an indication that there is something wrong, they are less frightened. Women become aware that physical and mental preparation are absolutely necessary.
An exploration of the cocktail of hormones released by the pituitary gland to control labour can also be useful in enhancing both a woman’s understanding of the physiology of labour and her confidence that she will cope. Oxytocin, often dubbed the ‘love hormone’ (Odent, 2001) is thought to be the prime initiator of uterine contractions and is released in a pulsatile fashion, making contractions rhythmic. As a result, the first stage of labour is not just one long pain but a series of contractions that come and go, increasing in intensity as labour progresses. These gaps between contractions can become the focus of labour, a life-line even, and women can use them to relax and recover.
Within this cocktail of hormones are beta-endorphins, which have been described by Dr Sarah Buckley, an Australian GP and author, as ‘nature’s pat on the back’. Endorphins are naturally occurring opiates that act both as a natural painkiller and a pleasure centre. Endorphin levels increase throughout labour, and have been shown to reach the same levels as found in male endurance athletes at the peak of their exercise on a treadmill (Goland et al, 1988). Knowing that as labour progresses a woman’s body produces its own form of pain relief is music to the ears of many and very confidence boosting.
This line of teaching can also be used to emphasise the more intense pain that inductions can give rise to, and the consequent need for pain management that might otherwise not be necessary during a natural birth.
Beyond managing expectations, it is also important to explore ways of coping with the labour itself. Understanding that the pain of labour is not a given, but can be hugely reduced by being active (Andrews and Crzanowski, 1990), using water (Cluett et al, 2004) and with adequate emotional support (Kennel et al, 1991), can inspire a woman to explore her birthing options more fully. She will recognise that she has the capacity to make decisions that will not only positively effect her labour outcome but also the extent to which she feels pain throughout the process.
The more women are supported antenatally to ‘get their heads around’ the concept of pain, how it might be minimised and how they are naturally designed to cope, the better they are likely to fare in labour itself. In my experience, such women breathe more fluidly, are capable of relaxing between contractions, and often need little more than periods of quiet reassurance to remind them that they are capable and coping well. As one woman once aptly said when recounting her birth story: ‘I found it painful, but I completely surprised myself with my ability to cope. It made me think that I could cope with anything.’ Fostering this capacity to cope and self-belief should be the goal of anyone who is preparing a woman for the life-changing experience that is birth.
Nicole is the author of
The good birth companion. If you would like to contact Nicole, then please email:
nicole@buddhabellies.co.uk
RCM CommunitiesHave you ever come across or had an experience of working with a woman who has claimed to have a pain-free birth? Join the discussion at:
http://communities.rcm.org.uk
References
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Dick-Read G. (2004)
Childbirth without fear: the principles and practice of natural childbirth. Pinter & Martin: London.
Cluett ER, Nikodem VC, McCandlish RE, Burns EE. (2004) Immersion in water in pregnancy, labour and birth.
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Goland RS, Wardlaw SL, Blum M, Tropper PJ, Strark RI. (1988) Biologically active corticotropin-releasing hormone in maternal and fetal plasma during pregnancy.
Am J Obstet Gynecol 159(4): 884-90.
Kennel J, Klaus M, McGrath S, Robertson S, Hinkley C. (1991) Continuous emotional support during labour in a US hospital. A randomized controlled trial.
JAMA 265(17): 2197-201.
Nichols FH, Gennaro S. (2000)
The childbirth experience: In: Nichols FH, Humenick SS. (Eds.).
Childbirth education: practice, research and theory (second edition). WB Saunders Company: Philadelphia: 66-83.
Odent M. (2001)
The scientification of love (revised edition). Free Association Books: London.
Williams CE, Povey RC, White DG. (2008) Predicting women's intentions to use pain relief medication during childbirth using the Theory of Planned Behaviour and Self-Efficacy Theory.
Journal of Reproductive and Infant Psychology 26(3): 168-79.
