“I couldn’t put in my mind what pain I would suffer. It was the worst pain I’ve ever had in my life. I can see the pain you know. Not feel it, I can see it.” (Laura)

“I just feel so empowered, so strong, so amazed that my body could…well yeah, just follow its instincts so utterly, so exquisitely-to just know what I needed to do. It’s like a reference for me in my whole life of the fact of how much I’m capable of.” (Kerry)

What makes these two women tell such different birth stories? Both had normal births and experienced labours of a similar length. Laura had drugs for pain and Kerry gave birth in the water without any drugs. One was traumatised and one was triumphant. English was not Laura’s first language. During labour she was largely left alone. When she finally gave birth she describes the experience as, ‘surrounded by strangers’. Laura had no idea what to expect. She never read a book on pregnancy or went to antenatal classes. Kerry on the other hand researched all her options and, as she says, read every book she could get her hands on. She had a midwife she knew for all her care, antenatal, birth and postnatal. She gave birth in the water, at home with great support people and felt in control of the whole experience.

Giving birth is about more than just the physical act of giving birth, it involves our minds, our hearts and our bodies.

The horror stories

“Awful! I really expected it to be extremely painful because mum said her labour was twenty- three hours for her first, which was me, and I was really scared. But it wasn’t as bad as I thought it was going to be.” (Sarah)

We have all heard the labour horror stories that for some reason women are compelled to tell each other-as though each has to outdo the other in surviving the world’s most traumatic birth. Sadly what women are less compelled to talk about is the sense of triumph and accomplishment they can feel having given birth without having to resort to pain relief drugs.

Fear about the pain of labour and birth frequently occupies a pregnant woman’s thoughts. Women may worry about what the pain will feel like, whether they will cope with it and how others will view them if they don’t cope.

In most areas of our lives pain is seen as a negative, frightening experience. Pain often alerts us to the fact that something is wrong with our bodies so it is natural to fear it. We are quick to try and relieve pain and treat the cause of pain, and indeed see the ability to do this as one of the benefits of living in an advanced, modern society. In childbirth, however, the majority of labour pain is the result of a normal, physiological process.

Why does labour hurt?

Pain in labour is a very complex combination of physical and psychological factors. Labour pain comes from the uterus, cervix, pelvic joints and ligaments. During the actual birth pain comes from the vagina and perineum stretching to accommodate the baby’s emerging body. Pain is transmitted to the brain by nerves in the middle and lower back. When it comes to the pain of labour, Mother Nature has not left us without assistance.  As labour progresses endorphins (natural drugs) in the body begin to rise, making the pain easier to cope with. They can also make women feel a little spaced out and detached from their surroundings. They disappear within themselves to a quiet space where all women hide their amazing strength.

“I sort of wasn’t aware of where I was and what was happening. I mean everything around me was really quite oblivious and I was just so focussed on myself and the baby.” (Tracy)

Does the pain have a purpose?

Some women experience no pain when in labour or labour very fast and whilst we may consider them very lucky they can actually give birth very suddenly and be completely unprepared for it. It can be risky for both the mother and baby.  The pain of labour makes us prepare ourselves and seek out support and safety when we give birth. It is pain ‘with a purpose.’

“Sometimes I think if the labour hadn’t been so fast I wouldn’t have had this terribly bewildered feeling afterwards. I was just overwhelmed at the fact, there she is.” (Sarah)

Does everyone experience the same pain?

There are many factors that influence our perception of pain and make labour an unbearably painful experience for women like Laura and a powerful triumph for women like Kerry. Fear and anxiety can greatly influence the perception of pain. When women are anxious they produce adrenaline, which inhibits the production of endorphins. This leads to women experiencing increased pain and also being less able to cope with it.

“It was like and alien had taken over your body. I was dreading every contraction.” (Faith)

Pain is greater if the baby is in an abnormal position, such as in a posterior position, where the back of the baby’s head presses into the mother’s spine.  Other factors such as cultural background, personality, expectations and lack of sleep, also mean that each woman will have her own unique experience of pain.

Can support make pain easier to cope with?

“She[midwife] was fantastic and she was the one who gave me every opportunity and honoured me to do exactly what I wanted to do to deliver my baby. I felt empowered, I felt supported and I felt I was actually in control.” (Wanda)

The quality of the support people women choose to be present at their births, and being cared for by midwives they get to know during the pregnancy, can affect the type or amount of pain relief needed. Research demonstrates that the presence of good support in labour reduces all forms of intervention, including a reduced need for pain relief such as epidurals and pethidine. This results in fewer women viewing their labours as negative and leading to feelings of greater satisfaction and control during the labour.

Research into women’s perceptions of labour pain after birth has shown no difference between groups of women that used very basic pain relief, such as Kerry, and those who used high levels, such as Laura.  Many women regarded the pain of labour in a positive light, as a feeling of achievement, and this supports the view that having a less painful delivery does not ensure a more positive birth experience. Other studies have demonstrated that women who report the most pain are more anxious during labour, expect to have a lot of pain and lack support from their midwife. They also tended to have long labours.

Natural methods

“Each time I went under the water I made this sort of deep sound that I visualised going through my body. I visualised it moving right down through my vagina opening up my cervix.” (Kerry)

There are several types of self help pain relief available such as relaxation and breath awareness, warm water (showers and bath), massage, moaning or groaning, mobilising, changing positions and visualisation. Massage can induce relaxation and help the body release its own natural endorphins. Combinations of these methods, instinctively used by women, often work best.

Women increasingly use complementary therapies during birth to help them manage pain. These therapies include: acupuncture; aromatherapy; homeopathy; hypnotherapy; osteopathy; reflexology; shiatsu; massage and relaxation techniques. Not all therapies are safe in pregnancy, such as with some aromatherapy oils, so always seek the advice of a person qualified in that field of practice.

Studies have shown that women who used water for the labour and/ or birth need less pain relief. When a labouring woman immerses her body in water, touch and temperature fibres throughout her body are stimulated, creating a background of pleasurable sensations. The pain sensations have to compete for access to the spinal cord. This leads to pain being reduced and lessens the need to resort to pain relief medication.

‘Gas and Air’

‘Gas and air’ is actually a mixture of nitrous and oxygen which you inhale through a facemask or mouth piece. It can be used throughout the labour and some women find it very effective in relieving the pain associated with contractions. It takes about 30 seconds for the ‘gas and air’ to peak in your body, so it works most effectively if you commence breathing on it the moment you feel the contraction start. The ‘gas and air’ does not accumulate in your body or affect the baby, as it leaves your body quite quickly once you stop inhaling it.

Pethidine

Pethidine is a narcotic drug given by injection and it generally makes you less concerned about the pain, rather than actually relieving the pain. Increasingly research is indicating that this is not a very effective form of pain relief and it has some concerning side effects on the baby. This drug can make you dizzy, nauseated and quite sleepy. It can also cross the placenta and make the baby sleepy and slow to breath. Special drugs are available to reverse the effect in the baby if this is needed. Women who have had pethidine should not sleep with their baby in bed for the first few days after the birth, as they are less aware of what they are doing.

Epidurals

“Once I had the second child at home I thought, I think I made all the right decisions when I had the first child too. I finally accepted the fact that yes I did need an epidural and the things that happened were because of the epidural and I thought I couldn’t have laboured like that for twenty four hours. It reminded me of the pain and it reminded me of why I asked for an epidural.” (Meg)

Epidurals are a commonly used pain relief in labour. While there are several types of epidural analgesia, all involve an injection of local anaesthetic into the lower back, close to the nerves that transmit pain. Epidurals work by numbing nerves and blocking pain. There is little doubt epidurals provide effective pain relief for most women in labour but they are not without their side effects. The concern is that women who have epidurals are more likely to have forceps and vacuum births due to the difficulties associate with trying to push in second stage, without normal sensation.

Unfortunately forceps and vacuum births are associated with more episiotomies (surgical cut to the perineum), severe tearing to the perineum and an increased incidence of incontinence. Women who have epidurals are more likely to have a longer second stage of labour. They need their contractions stimulated with synthetic hormones. Whilst epidurals are effective in reducing pain during labour, research has found that mothers do not seem to be more satisfied when compared to women using other forms of pain relief. Epidurals have a real and useful contribution to make to the childbirth experience of some women-like Meg who experienced a long complicated labour with her first baby.

Published 29/8/12