Tuesday, July 17, 2012

Pain (and Pain Relief) in Labor

I love reading birth stories. They're incredibly cathartic, emotional, thrilling, even the "boring" birth stories. In fact, I wish everyone a "boring" birth story, because no excitement means no complications and no scary situations! So whenever a friend has a baby, I wait anxiously to read or hear her birth story, because I want to share the experience with her, to empathize, sympathize, commiserate, and celebrate with her. Reading other birth stories lets me understand my own births in a broader context, gives me insight into how other women perceive and experience birth, and demonstrates the attitudes of other practitioners and other facilities.

In reading a birth story the other day, I was amazed by how often she mentioned the pain, how she couldn't wait to go to the hospital and get the epidural, and how she mentioned the agony and doubling over and how excruciating it was. Now, I've given birth three times, and, yes, it hurts. A lot. No question. But she seemed so focused on the pain, so obsessed with getting the pain over with by getting her epidural.

I totally understand. I really do. Birth is intense, contractions sometimes feel like they're never going to end, and pain trumps reason. And when I had my first baby (as this was her first), I'm pretty sure I was quite focused on getting to the hospital and getting the pain over with.

I don't mean to belittle her experience. Indeed, some women experience pain more acutely. Some women have lower pain tolerance than others. And I'm sure that some women experience contractions as more painful or have more intense contractions than others. And reading her story, it sounds like her water had broken and was slowly leaking over the course of several days, and I well know that contractions without the bag of waters intact are far more powerful and intense than those that are cushioned by the amniotic sac.

All of that said, the reason I bring it up is this: I think that if you fear the pain of labor, or if you are focused on when you can have relief from that pain, the more painful you will perceive those early labor contractions to be. And if those early ones are "that bad," how much worse will the later ones be?

Again, labor is painful for most women. There's no getting around that. But there's a psychological element to pain, and I think that's where childbirth classes and preparing for labor and getting your head in the right place can really make a difference. There are many techniques out there for handling labor without medications. There's the well-known Bradley and Lamaze methods. There's Hypnobirthing. You can take classes or read books or listen to podcasts to learn about these methods. But even if you don't use a specific method (as I didn't), you can still prepare yourself emotionally and psychologically to expect and handle the contractions and associated pain.

Even with my first labor, I felt some obligation to delay the epidural for some time. I don't remember why, except that, even then, the limited knowledge I had was enough to know that getting the epidural too early can cause problems. As it was, I got it far too early, at only 4cm dilation. It probably would have been smart to be mobile longer in that birth, although there's no way to know if I would have been able to give birth vaginally to my large-headed, OP child. I do remember that I opted for the narcotic pain relief first, so that I could delay an epidural, even though I had been in active labor for quite a few hours by then and was very tired of it.

My self-education after that birth led me to consciously delay the epidural even longer with my second birth. I think knowing pain relief wasn't something I could have made me willing to work through the pain rather than resent it. Every contraction, after all, leads you closer to the prize. Every contraction is worth it.

I'm not saying that every woman should or wants to experience a drug-free, natural birth. By the end of my third birth, I didn't really want to, either! It happened that way almost by accident, because I had decided that I wouldn't have an epidural long enough that there wasn't time to get one. My mindset was such that this pain was something I just had to get through, and there would be a baby eventually as a reward. There's nothing wrong with getting an epidural. It doesn't make you weak or less of a woman or mother. It doesn't make your child's birth less meaningful or less enjoyable. Indeed, it might make it more enjoyable, given that you can relax a little and not be in so much pain!

I do want to stress that the longer you are mobile and not lying on your back, the more likely you will successfully give birth vaginally, so if you don't need the epidural, put it off a little longer. The reasons are basically that being upright will help move labor along, the pressure of the baby's head on the cervix will encourage it to open and efface, and being able to change positions can relieve pressure on the umbilical cord, increasing blood flow to the baby and reducing the risk of an emergency situation. To put it succinctly: Lying on your back is about the worst possible position for labor and delivery.

What it comes down to is, don't be afraid of the pain of labor. Don't dread it. Don't go in worried about how much worse it's going to get. Be aware that there will be pain, and learn about ways to relax in between contractions and get through each surge. Know that you have the option of an epidural if you want one, but don't think you have to rush to get it. It will be there when you're ready.

I can compare it to the aftermath of surgery when they give you pain meds and tell you not to take them more than every six hours. You sit there, watching the clock, waiting for the six-hour mark so you can pop another Percocet, because the previous dose wore off an hour ago. If you're sitting there watching the clock, just waiting until you can take another pill, those minutes will be excruciating. But, if you're distracted and doing other things, you might be aware that the pain is returning but not be focused on it until you glance at the clock and realize that it's been six hours. At least, that's how it is for me.

Everyone experiences pain differently, and, as I said, for some it is less tolerable than for others. But if there is a psychological aspect to pain, which there usually is, then you can reduce the pain by reducing the expectation of pain. And the most important thing to remember is, eventually, it will end no matter what you do! You will have your baby, and labor will end.

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