Monday, February 1, 2010

Painless Childbirth, An Emotional Rant

So, I bet when you read "An Emotional Rant" you thought to yourself, "What else is new?" :) But I want to go off on a topic that I find intriguing and confusing.

What is "painless childbirth?" If you are at your midwife's office, you might see an advertisement for a class that can help you achieve "painless childbirth." In other childbirth camps, an epidural can supposedly give you "painless childbirth." When my husband and I first discussed the possibility of me birthing unmedicated, he questioned why I would want to deal with the pain if it wasn't necessary. In other words, why would I choose pain when I could have "painless childbirth?"

Where did we all get this idea that childbirth was supposed to be painless? Please please please don't get me wrong, I am not saying this in frustration toward laboring women. Who I'm really ticked at right now are the medical care providers and the childbirth educators who are setting this unrealistic standard by which we are supposed to measure our birth experiences.

"Painless childbirth" is a possibility with some women. But it takes a lot of factors to make it possible. Your baby needs to be positioned well. Your labor cannot be flying along at lightening speed. You have to reach an extremely deep level of relaxation and not have something disrupt it. You need to be well rested. It's not very likely with an extremely prolonged labor. It's more likely in a birthing center or in a home birth. You would need the right coaching or support from your birth partner and/or care provider. You need an absolute minimal amount of intervention. In fact, all of the "painless" births I've watched on youtube were tub births.

Another possibility is that you go to a hospital to be induced (before labor has started), and you are allowed to receive your epidural before the Pitocin kicks in. You have no negative reactions to the epidural, and you pop in a movie and wait out your dilation stage. When your nurse has determined that you've hit 10 centimeters, your baby just happens to be in the perfect position and is a lovely 7 pounds even. You have good strong arms or good helpers, somehow your legs get into the perfect position, and you push 3 times before your baby gently slides out with no tearing and no episiotomy. You hold your little one for nursing and a snuggle. And when your epidural wears off, you feel fabulous. There's another "painless childbirth" scenario!

Do either of these sound like one of your births? If so, you are one lucky lady!!

I'm not trying to be negative. Both of these pictures sound great, but there are so many variables in these two equations which can go wrong and make your would-be painless childbirth a real disaster (or at least, a painful childbirth).

Let's take the first unmedicated birth. Most women have their babies in hospitals, because they feel it is safer for them and for their baby. This automatically means a few things will take away from their comfort level. Either they will arrive early, but they'll be poked, prodded, checked, and disturbed enough that they can't stay relaxed enough for a painless birth. Or they will arrive late enough in their labors that they're headed right into or coming right out of transition, and being triaged and checked in at that stage is bound to make things painful.

What if there are some complications in your delivery? Got a posterior baby? A bigger baby? Something a little off in the heartbeat? Strep-B positive? There's no way to relax easily through these things.

What if, while you're trying to relax, you have a labor and delivery nurse trying to check your cervix every hour or suggesting you have an epidural now? That's no fun.

In other words, with a hospital birth it is practically impossible to experience painless childbirth, because there are too many distractions which will take away from your relaxation and increase your anxiety.

How about the epidural birth? Well, I know a lot of women who enjoy their epidurals and don't have negative side effects. But a huge percentage of them have episiotomies, vaccuum extractions, etc., at the end of stage two. Only some of them are lucky enough to have the perfect sized or positioned baby, and their pushing stage tends to be prolonged a bit. They might not experience a lot of pain during labor and birth, but they are likely to have a good deal of discomfort after birth with stitches and very strong uterine contractions, which typically seem stronger after epidural births. (Could it be that "painful" unmedicated births make postpartum cramping seem milder? I don't know.)

Don't get me wrong, I'm not thrilled about the fact that childbirth brings pain with it. I've never had what I consider a painless childbirth experience. I hope I haven't previously misrepresented myself on this blog. My second birth was more comfortable than the other two, and the contractions were mostly painful toward the end and during transition. Also crowning was painful. My third birth was very painful. The tension was high, my labor was fast and hard, the lip on the cervix was very painful to have pushed back, and crowning (again) was pretty darn ouchy.

How should I measure these two births which I compare? Were they failures? Should I even bring in my first birth? If I even ignore the feeling of helplessness and confusion that pervaded during that labor, should I reminisce yet again about the immediate postpartum hours when the epidural was wearing off and I practically went into shock? How about the weeks and weeks of pain from the 4th degree tear or the yeast in my milk ducts?

So do we need to become masochists to enjoy having babies? I hope not!!

What I really think is that we need to have reasonable expectations, and our health-care providers and childbirth educators should assist in this. If a woman is choosing to go unmedicated and is experiencing increasing pain, a provider or labor and delivery nurse should respect that woman's decision and not undermine her by suggesting an epidural as she hits transition. Having pain during childbirth is not a negative reflection of the care (unless the care is negligent and increases the pain). And childbirth educators should beware of promising that "if you're doing everything right" you'll experience "painless childbirth." That's like promising a sales-person that if they do everything right than they'll someday be rich, or that a truly talented actress will eventually become a celebrity. Such outcomes are possibilities, but there is no guarantee!

Where is all of this ranting coming from? Well I've now talked to two women who took hypno-birthing classes, and they both had great births and did terrific jobs in their labors. Unfortunately, their teachers had given them the expectation that, as long as they were doing everything right, they shouldn't experience pain in childbirth. While each of these women labored, they experienced considerable pain for different reasons, and it increased their frustration and pain and detracted a little from the experience.

It has been sobering to hear these stories (though I'm sure they are both dealing fine and have great attitudes just the same). I just feel that it was irresponsible for their teachers to instill such unrealistic expectations about labor and childbirth. Telling someone that it shouldn't hurt if they're doing everything right is only going to create feelings of self-doubt in a woman when it actually does hurt (for whatever reason - the position of the baby, the level of anxiety, etc). All the self-doubt will do is make it even harder for the woman. This isn't fair. She is doing a great job and should feel so.

And the same should go for the woman who labors with an epidural. In a small way, I actually admire my friends who are very accepting about the more difficult post-partum periods that tend to follow epidurals. I know so many women who think that episiotomies are not a big deal. They don't mind taking stronger meds for post-partum cramping. They are at peace with the idea that a slightly more "painless childbirth" yielded a slightly more painful post-partum. At least they have reasonable expectations. I was devastated to be in so much pain after my first birth. I'm sure that it only made things worse.

So if anything productive is to come of this rant of mine, I hope it's this: Childbirth is an incredible feat, and I hope that you and your provider don't ever try to measure how well you've done (or are doing) on how much pain you experience. If you had a killer labor, you are a rock star! If you had an easy labor, you are a rock star! Childbirth is not a contest to see who can suffer less.

If you want a positive labor, do all that you can to take care of yourself, get a respectful, supportive provider, choose a good location, take a good class, educate yourself, and make well-informed decisions about your labor. Then do your best and trust yourself. You may find that you are amazed at how comfortable you are, or you may find that the pain is stronger than you expected. But believe in yourself and your decisions. You are doing something amazing!

That is all. Happy birthing, Ladies!! :)

No comments:

Post a Comment