I suscribe to Midwifery Today and this Facebook Q and A showed up in my email today!
How do you explain the “pain” of labor to your clients?
I describe the pain as pain. Real pain. Not as “waves” or “extreme menstrual cramps.” Like the kind of pain you may have never felt before. I also describe it as productive pain. Breaking a limb or having a chronic medical condition is a type of suffering. I think it’s important to differentiate between the two. Labor pain will end and there’s a tremendous gift at that end. I think it’s a disservice to downplay the intensity of the pain in labor.
—Kerri Jackson Pelz
I tell them it can be a gentle tightening in their bellies that feels like a sweet hug, it can feel like sharp period cramps, it can feel like a bear hug that takes your breath away, it can create pressure in your pelvis and down your thighs, it can sometimes feel like your uterus is turning itself inside out and pulling itself over your whole body! And at the same time, I share that labor pain is unlike almost any other because the sensations are a sign that all is right, that their beautiful, powerful uterine muscle is doing the work to get the baby out and we will be celebrating and supporting that magnificent work. My mom always told me labor was “pain with a purpose and when it is complete you will have a beautiful baby in your hands.”
—Roseanna Azarow Ebert
I talk about the neurosis held in their pelvis and their inability to open their body without fear—the only way out is through.
—A Roar Usha
We talk about it all: pain, working muscle, etc. We also talk about what’s normal and what’s not.
—Amy Vater Haas
There are so many words to describe the sensations of giving birth. The wider the vocabulary and the less use of the general word “pain,” I think may help the birther.
Period cramps times 10.
I decided to think of it as strong period cramps, which I was used to. That helped me get through them. Nine hours, drug-free birth.
I describe the powerful straight muscle action of the fundus, Arnold Schwarzenegger-strong, flexing and stretching the weaker circular muscle fibers of the cervix over the baby’s head, like a turtleneck. I focus on the break between contractions when the fundus is relaxed. Stretching and cramping are usually down low in the abdomen or lower back.
The body is working double-time to get the baby out, that is why it is called labor. Depending on who I’m talking to, I might add that, “it’s called laborbecause it is work; it ain’t playtime!” I want women to know how intense it can be, and how they can and should attempt to breathe and find peace in between contractions, to get ready for the intensity of the next one.
I tell them it hurts, and it is really intense. I explain that it starts slow and easy and builds, so you can learn to cope with it and have time to find comfortable positions and ways to ease the pain. I also tell them that it only hurts during a contraction, so they get a break in between. I advise them to surrender to it, to do what their body tells them to do, to eat light meals as long as they feel like it, and to stay hydrated. I believe that I have to be honest with them about what they will feel and not try to sugarcoat it. Although they will have pain, it is different for everyone, but their body is made to give birth and they will not be alone.
—Vicki Gilbert Ziemer
Intensity: your body is talking to you. Pain is something wrong.
I’m not a midwife but I’ve had four homebirths. To me, the fetal ejection reflex was exactly like downward vomiting. Powerful, uncontrollable, spasmodic, heaving. So that’s what I tell people, it’s like vomiting in reverse.
Words carry power. I never use the word “pain” when explaining the work a woman’s body is doing to give birth to her child. I explain in copious detail exactly how the biology of birth works.
I would use the word “pain,” hot, sharp, ripping pain. It was horrible, but I would do it again to have that natural high after the birth is complete. And, yes, I had a homebirth.
I do not use the word “pain.” I find few women, when reflecting on their homebirth, actually use the word “pain” themselves. I use all the words used to describe pain, but without the P word: intense, exquisite, powerful, overwhelming, distracting. I usually settle with experience words and avoid connecting it to biology or function. I describe how the patterns of contractions may begin slow and manageable and increasingly become more insistent. I encourage her to attend to the contractions as they come. In early labor, to stop, pay attention, and ignore everyone around her. I find that if early labor is ignored until she is desperate with pain, then things become unmanageable. She can sort of practice and tap into the delights of the endorphin rush earlier. It is not the place of the midwife to verbalize a woman’s story. An experienced mother will have already determined the words she wishes to use. I will not be manufacturing fear in a new mother by asking her to expect agony or ripping pain. I can only describe to her the stories I have had reported to me by mothers. I do not intend to diminish your own experience of the feelings of labor, but “pain” is seldom a word I use when discussing physical aspects of labor.
I don’t shy away from the word “pain” but I talk about how we can influence and reframe the experience of pain. That there is a difference between pain and suffering. I tell my clients the truth: that giving birth was the most painful and the most ecstatic experience of my life. I wish I could do it again!
I always remind them that the rest periods between contractions are painless and that contractions last about one minute. It’s astonishing how few people know this; it’s often not taught in prenatal classes. No wonder Millennials are terrified of birth. They think it’s endless hours of unremitting agony; it isn’t. And to stress the point, I tell them that during second stage, when the contractions space out to about every five minutes (they were about every three minutes in early labor), that if someone had an “hour of pushing,” they would be working for only about 12 minutes. None of that describes what is felt, but duration and timing are a super important part of the pain dialogue when it comes to birth.
Labour PAIN = purposeful, anticipated, intermittent, and normal.
My daughter, Shellie Dacko Rucinski, used to say to everyone when she was pregnant the first time, “It’s only a day and I can do anything for a day!” She talked herself right into a four-hour labor. But it’s true; you undermine yourself when you make it about what you are feeling and not about what you are doing.
I tell them that there is a wide range of sensations that they may experience. A lot of people do experience pain, and it could be anywhere on a scale of 1 to 10. They may not have pain, just intense sensations. I also tell them that many of my clients have orgasmic births. And that is true. I find that if they know of the possibility it’s much more likely to happen. It’s pretty amazing how many women experience orgasmic births when they know it’s possible.
—Paula Matthew White
Birthing rhythms and expansions.
—Maha Al Musa
I never use the word “pain.” I always say it typically will require your attention, your focus, your energy, and the periods in between contractions will likely be shockingly restful. I also explain that what’s happening is within them, it is them, and if they can create that type of intense energy, they can also gather what’s needed to focus and move through it.
I never had pain when birthing naturally. Discomfort, yes. Hard work, certainly, but not bad enough to be called pain. I had lots of pain when given Pitocin with my first, so I vowed never to do that again! Instead of pain, I experienced power … a power much stronger than myself. I knew it was God’s power, therefore I was not afraid of it, but let myself be open to letting God’s power flow through me! I realized I had to keep my muscles relaxed, so I put all my effort into staying relaxed, open to accepting the power surging through me. I tell my clients the more they tense up against the contraction, the more pain they will have. The more they try to remain in control, the more contractions will rage against them. They just need to relax and be open to feeling God’s power coursing through them. Many people liken contractions to waves. This is a good analogy. But I take it a step further. While each contraction may be like a wave, labor is like the whole ocean. We cannot swim against the wave; we must float on the wave, going with it to shore. Floating in saltwater, which is isotonic with our own body fluid, makes it so easy, much easier than floating in the freshwater of lakes or pools. It is in fighting to stay afloat that we drown; in letting the waves carry us where they will, we float safely back to shore.
There is a spectrum of what people experience, and I have been to painless births. However, even those births were described as intense. I am not afraid to discuss pain and I use that word. I do not mislead or give guarantees. I also individualize women’s experiences and work with trauma prevention and non-judgment over what their experience might be and tools they have for coping already. I talk about how sometimes earlier labor can even be more painful than later in labor if the baby is coming down on top of the pelvis and trying to engage. I also talk about the hormonal feedback loops, once baby engages, that assist in coping. For those with a history of sexual abuse, we discuss somatic responses and how we can hold them in those moments. We talk about coping tools for labor and parenting in their own lives. This is life preparation, not just birth prep. And for those who have birthed before, whether challenging or not, we don’t talk as much about this topic, but I also believe that every labor is different. It’s important to be impeccable with our word.
—Nicole Franklin Morales
Read the long chapter called “Tell Them About the Pain” in my last memoir, Midwife: An Adventure.
It’s work. That’s why it’s called labor. It’s not necessarily painful. All pain is subjective. After my first, I was sad that no one had warned me about the post-delivery perineal pain.
For me there was pain, but not it was not unbearable. When you think of what has to happen during birth, it needs to get your attention. You need to be aware of what is happening so that you can make necessary arrangements regarding what, where, and who you need for the birth. The work we do to get our babies here helps us value who and what they are, as well as giving us the strength to continue our care-taking of them.
—Lisa Patch Goldstein
Surges are power and become most painful with resistance.
I remind moms that the choices they make prenatally influence their birth experience and they can do a lot to reduce the possibility of feeling pain. I remind them that everyone has a different experience in birth, some painful and some not, and it is a journey they are working through. I explain to them that they are created to birth and to, instead, focus on their ability to handle the discomfort. They can have support in a lot of different ways to help them through any discomfort; emotional or physical, they may experience. I remind them that God is with them and when they surrender to this birth journey, He shows them how amazing birth can be.
To not use the word “pain” is a disservice to women who experience labor as extremely painful. As in life, there is pain, there is joy, there is hard work, and there is satisfaction from working hard. We, as women, are strong and are survivors!
It’ll bring them to their knees, will require strength and courage, and they will never be the same! My unassisted homebirth nearly 50 years ago was so empowering, it was my call to becoming a midwife.
I think that the work and power of labor can be painful; it was for me. I thought if I did everything right there would be no pain. Contractions are definitely like waves on the ocean, and you have to allow your body to work with you to bring that perfect child, filled with love, for you to experience. I talk with mothers about how important it is to visualize every part of how they want to labor. God answers prayers. I have seen pain-free labors and I believe perception and being physically fit is so important. There is no woman more beautiful than a laboring woman glowing with God’s power.
I try to take a lot of time explaining the physiological process of what is happening in their body, from the hormone cocktail and the pain response to the action of opening the cervix and baby moving through the bones, and how that can feel. I like to think if they have a better picture of what’s going on, it eliminates that fear of the unknown, which in itself can enhance feelings of pain. I try to prepare women for the intensity, so they know they’ve got a thrilling, absolutely knock-your-socks-off experience coming their way. We laugh together as I tell them if they’ve been a pantywaist their whole life this is about to change them and show them how awesome and strong God made them. I try to focus on the necessity of facilitating their “labor brain,” and that beautiful place that carries them through hours of contractions. I’ve seen one-hour labors with great-grand multips, in their field dresses, push out a baby like a lazy swinging porch on a sunny afternoon … but they all are deep in their labor. No one escapes the absolute, magnificent, overwhelming power of labor, and that’s the point!
I use storytelling. With my seventh baby, I experienced contractions as bear hugs around my ribs. The hug was so tight it hurt. When I inhaled, the pressure increased. When I exhaled, I got some relief, and I could feel my uterus squeezing my baby down toward the birth canal. I got the idea to take long, slow, deep breaths and to feel my baby hugging me with inhalation and me hugging my baby on exhalation. That pure focus kept contractions almost painless! Crowning was another matter.
Normal labor sensations are not pain … they can’t be … pain is the way our brain tells our body to move away from danger. We can’t move away from birth; we must move through it, so our brain would not send pain signals to the body during labor and birth. If there is true pain, it can be an indication that something is not quite right, and it’s appropriate to seek support: chiropractic, acupuncture, massage, etc. Unfortunately, the word pain has been associated with the sensations of labor and birth and so, sometimes, birthing mothers may feel pain because they expect to. We need better word-medicine.
I thought about it in terms of muscles working very hard, doing something they weren’t used to doing. Same as other muscles when you work them extra hard. For me that made the “sensations” at least understandable. Also, my midwife was very encouraging and told me I sounded like a “mother lion!” I have never forgotten that.
It is the gift that brings the changes in our brains that enables us to give birth and become mothers. Welcome it.
Experience can be different than theory in any birth setting. Health care providers need to remember that what a woman experiences in birth, whether described as painful or “experiencing intensity,” is respected and honored and not twisted to further a specific theory.