Monday, May 08, 2006

Is pain empowering?

One of the often touted benefits of natural childbirth in general, and homebirth in particular, is that tolerating the pain of labor without resorting to an epidural is empowering. I wonder about that.

The meaning of pain is culturally mediated. Different cultures and different religions have vastly different ideas about the meaning of tolerating pain. Some see pain as enobling or even cleansing. Most don't apply any positive value to tolerating pain when relief is available.

Of course, if a woman feels empowered by tolerating pain, that's fine. She is perfectly entitled to do that. However, she should not assume that other women share her values. I suspect that the majority of women would rate tolerating labor pain without medication as akin to tolerating a root canal without novocaine. Sure, you could do it, but why would you want to?

Perhaps this is where some of the disconnect arises between advocates of natural childbirth and other women. It may be that other women are not impressed and might even react with disdain (which they shouldn't do because it is rude) to the notion that tolerating labor pain could ever be empowering. That value is simply not a part of their cultural or religious background.

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19 Old Comments:

When the pain is of a productive and natural sort, I'd say it is absolutely empowering. My early phase pain was mild compared to the rest, but it was not to be ignored. It somehow connected me with every other mother, human or creature throughout history. I roared out that power through 90 second contractions, rideing each wave then spending time between joyfully chatting with my husband and moving as the sensations guided me. By the 28th hour of my labor, after my water broke, I was having real pain which was hard to bear. I felt my body and spirit growing stronger with each contraction even as the pain started to tear down my handle on reality and my conscious control of my body. For a couple hours my husband read psalms aloud with great emotion - this helped too in building me up, they mention trials, enemies, and pains mostly in the context that God would faithfully carry the sufferer through.

By transition I was in the hospital for a medical safety net since things had progressed so slowly as yet. I was exhausted but my body was still going strong without me. For a while I felt tortured since I was so out of control, and my body wanted to push long before time. I couldn't step out of the way and let my body take over, as the urges hadn't lined up properly for some reason. I did not feel powerful in the moment.

That changed when my baby had finally moved past the lip of cervix he was stuck on for hours. I discovered this myself, and simply gave myself permission to finally answer the call to push. Now I was powerful, I *knew* how capable I was to do the rest, and my body, mind, and spirit had not broken down through the long trial behind me. Instead they had performed beautifully even when I doubted I could go on. I was made to do this and was helped through and built up it every step of the way. The pain of delivery was nothing. I was finishing a job well done, if not gracefully handled. I took my baby to my breast a far stronger woman than I'd been just 2 days before.

By Anonymous Jamie, at 5:41 PM  

After experiencing two natural births, the one thing that has stayed with me because of my births was that I learned how to work through difficulty. It wasn't a contest about how much pain I could withstand.

I have used these skills throughout my life, especially in motherhood. When faced with trials, often the best thing to do is breathe through them - not fight, not complain, just relax and get through it.

What I hear most often from women is that "I'm getting an epidural. I have nothing to prove." And this is puzzling to me. I had nothing to prove either! I just did what made sense to me. I never approached childbirth with the intention to prove something, to wear it as a medal, "look what I endured!" At both of my births I had no idea that I would be able to get through them without medication, until I did.

Why would you want to go through it instead of just getting medication? For the deep, deep knowledge about your body and your capabilities that you can't learn elsewhere. For the rich experience.

Women ought to be comfortable during birth. For many women that means embracing the whole experience - pain and all - and finding that what stays with us is not the memory of the pain by itself. Pain is a part, but not the defining feature, of birth.

By Blogger jenn, at 5:42 PM  

It is not the actual pain that makes a woman feel empowered, it is the endorphins that are not surpressed by managing the pain of labour.

Also, not surpressing the pain (ie make you no longer feel anything fromthe waist down) makes a woman disconnected from the birth of her child, she can respond to the messages that her body is sending her, she doesn't need to be shown how to push, or when etc...
The "high" that comes with the endophins that a woman feels after birth is something that can't be duplicated with a medicated birth, this "high" also helps a woman bond directly after birth, making ppd less likely.

By Anonymous Anonymous, at 5:46 PM  

We also find that birth just hurts a whole lot less in home births!

When women aren't in bed, kept still so the monitors don't jiggle, they are able to sway and rock to help babies get into more gracious positions that facilitate quicker and less painful labors and births.

When women are allowed to moan and even holler with their contractions, moving the energy through their bodies and the air, they are able to find resonating tones that also move labor along nicely.

Moving and swaying - moaning and hollering - are disconcerting in the hospital setting. There aren't enough nurses to tend to a woman considered "needy" because she insists on staying out of bed or "making noise that scares the other patients." One thing I offer nurses as a doula is a human monitor holder so the woman *can* move around while also solving the why-she-needs-to-sit-still-in-bed issue. I have always been thanked for helping accomodate both the nurse and client at the same time.

It also needs to be said that not all women consider labor to be painful at all. I have assisted at extremely sensuous labors, where the atmosphere was much more sexually charged than pain-filled. I believe the pain issue is very much culturally defined - and in some segments of this culture, pain isn't a bad word... but a word of triumph and a celebration in the same way some find running a marathon gloriously statisfying. (Myself? I'd find a marathon horrific torture, but have found natural birth - even of a 10 pound 6 ounce child - exhilirating!!)

Discounting what women choose, whether it is an epidural or a medication-free birth, isn't kind to any of us. We each have to live with our own choices.

Once again, it is choice that is the issue at hand.

By Blogger Navelgazing Midwife, at 7:30 PM  

Very well and wisely spoken by everyone else. And don't forget the fact Dr. Amy that narcotics are not healthy for babies and epidurals cause problems. You'll likely try to debate this (I feel like your opening posts are all loaded, setting us up for your real intention... hope that's not true!).

I especially second N.M.'s comment that pain simply is not as bad out of hospital. Both for the motility issues and the lack of fear. I can't TELL you how many women who have said to me "but that wasn't even very hard! What are people talking about?" Even a good dozen or so 15 and 16 year olds, who chose out of hospital birth on their own.

Midwives help women prepare for childbirth much, much, much better than OBs do. Most OOH birthing women are also more independently motivated to seek out information about birth and knowlege = power. I hope the posts above show you that natural birth IS empowering for women. I don't disagree that, like all interventions, narcs and blocks have their place, they absolutely do. But in my professional opinion, pain relief options aren't for pain, they're for problems. There's a great secret out there, Dr. Amy, and it's not that labor is hard, it's that women are strong!

By Anonymous maribeth, CNM, at 8:28 PM  

errr.... mobility, not motility. And, PRIVACY is huge in successful, easy birth (something vastly lacking in hospitals).

By Anonymous maribeth, CNM, at 8:31 PM  

I appreciate that some women find the pain of childbirth empowering and that's fine. The fact is, though, that the overwhelming majority of women do NOT find the pain empowering.

I am suggesting that these points of view are culturally determined. In other words, there is nothing inherently empowering about tolerating pain. However, if you come from a background where tolerating pain is considered a positive value, then you feel good because you tolerated it.

Conversely, if you don't come from such a background, tolerating pain is simply a matter of personal preference. Therefore, you are not giving up or failing to achieve something; you are simply doing what is right for you.

It seems to me that one of the areas of controversy about natural childbirth is the subtle (and not so subtle) implication that women who don't have pain medication have actually achieved something.

By Blogger Amy Tuteur, MD, at 8:43 PM  

I believe, Amy, that YOU have the belief that homebirth advocates believe un-medicated births to be an acheivement of some sort. In my world of midwifery, there is a very important (and valid) place for narcotics, analgesics, and anesthetics. And it isn't in the home - it isn't safe to have any medications for pain in the homebirth setting.

Women I don't even know here - and I - have attempted to move the focus of the discussion from heroic pain/med-free birth to WHY homebirth makes it easier to have a pain/med-free birth, but it seems the cultural aspect really is what you are driving at. The acculturation of a hospital birth isn't discussed, however. Why not?

I agree with Maribeth CNM that your posts seem baiting and really do not seem to desire any sort of serious open-minded discussion. If this is so, and I am suspecting it is, then "debate" is a misnomer. I know *I* am listening, but Amy, are you even trying to hear what we are saying?

(I would never, in a million years, expect a change of heart, but it would be a delight if you even had half a second of consideration for what we are saying. It is this exact feet-in-the-cement attitude that pushes women away from doctors who have zero inclination at dialogue. I hope you are aware that your words are weighed and you are representing an entire industry of medical doctors and their ilk.)

By Blogger Navelgazing Midwife, at 9:35 PM  

Well said, N.M.

Dr. Amy, I feel like this is coming from somewhere inside of you. Do you want to share and dialogue about your births? Are you working through something? I know this sounds patronizing, especially in light of our recent history, but I honestly don't mean it that way. I guess I just don't understand why now, when you're out of OB (instead of still catching babies) all these issues come to your attention?

Most American childbirthing women these days DO NOT come from a cultural point of view supporting natural birth. Remember, most of our mothers were put to sleep and had babies pulled out of them. That was the only story I ever heard, for sure. Instead, I came to natural, OOH birth midwifery and childbirth by being in hospital (assuming it best) and seeing how royally things got so messed up in hospital.

Dr. Amy, how many unmedicated births would you say you've attended in your career, or more properly, what percentage? How many women have you attended through nearly every contraction, rather than just coming in at the last minutes? I just want to know your point of reference here.

If you'd ever like to attend a few homebirths, I invite you.

By Anonymous maribeth, CNM, at 9:52 PM  

Maribeth, CNM:

"Dr. Amy, I feel like this is coming from somewhere inside of you. Do you want to share and dialogue about your births?"

I'm happy to share, but first I'd be interested in what you think were my experiences based on what I have written. It will be interesting to see if your assumptions about me are correct.

"Dr. Amy, how many unmedicated births would you say you've attended in your career, or more properly, what percentage? How many women have you attended through nearly every contraction, rather than just coming in at the last minutes? I just want to know your point of reference here."

Again, I am happy to share that information. First, though, I'd like to know what you expect to hear. It will be interesting to see if your ideas about obstetricians actually apply to me.

By Blogger Amy Tuteur, MD, at 10:02 PM  

Actually, because of the history you shared about working with midwives, of having a doula, I don't assume anything. I think you're a bright woman and a that you know evidence well enough to know that natural birth is superior for babies. I think you're a strong enough woman to challenge yourself beyond what you seem to think your clients capable of. I don't assume, as much as I wonder - why this debate, why now? What is inspiring you at this point in your life to put this much energy into a homebirth... waterbirth... natural birth... debate? Us, we face it everyday.

By Anonymous maribeth, CNM, at 10:19 PM  

I don't support the use of drugs during childbirth, not only because of the risks and dangers involved to mother and baby, but also personal beliefs. To me, a baby is pure, beautiful and sacred. The thought of involving drugs in the birth of a baby sickens me. It's just such a contrast- pure innocence, being born amongst needles and injections.

I heard someone recently, expressing their disgust at a current affairs program in which change tables in public 'Parent's Rooms' were tested for narcotics. The tests were positive. I asked that person, why aren't they as horrified at the idea of drugs during childbirth?

By Anonymous Kerrie, at 5:54 AM  

What I find empowering about home birth is the woman in labor being in control of her birth. She labors where she chooses and how she chooses without technologies SHE and HER baby don't need, being forced upon her. Women have said they perceive being much more comfortable at home. Some women are more comfortable in the hospital setting. IF there is no indication for the hospital setting, the woman should be permitted, without judgmental attitudes of providers, to have her birth where she chooses. AND, if a woman chooses an elective C/S, she should have the same support from the provider community. It is her birth, and we should all support her choice.

By Anonymous Anonymous, at 7:20 AM  

kerrie, I think your comments indicate an incredibly judgmental attitude.

It's just not your business. You don't know what other women are experiencing and what other women can tolerate. You don't know if her inability to process the pain she's experiencing is actually hindering her labor and harming the child.

I'm not sure why this is a "debate". On what day did all this stuff become other people's business?

If you want to homebirth, eschew all pain medications ahead of time, swim with the dolphins during labor, or whatever, fine. If you don't want people telling you you're a bunch of selfish, ignorant loons, then don't go telling women who've opted for an epidural or any other pain management treatment that she's "on drugs" and ruining the "purity" of her baby.

If pain "empowers" you, go for it. Hell, there are people who get off big time on pain - just do a google search on sadomasochism, bondage and torture and you'll find scads of people who've built a lifestyle around worshipping pain, and that's fine - that's their personal choice. But don't knock a woman who might feel as if the pain is beginning to overpower her and interfere with her ability to be in control.

The best policy is to educate yourself about what you can expect during labor, spend some time thinking honestly about what you can or cannot tolerate, and never say never. I've known women who went in swearing they were never, ever, ever going to have any medication for pain, and who screamed for an epidural half an hour into labor. I've known other women who were quite open to the possibility that they might want something for the pain and who never ended up wanting it at all (myself included - two 11+ pound babies, vaginally delivered, no pain meds, very short, relatively easy labors, fabulous hospital delivery experiences that I wouldn't trade for anthing).

Besides, going in with an attitude that pain medication is badbadbad and you will nevernevernever succumb turns labor and delivery into some kind of competition between you and your preconceived notions. It's wasted energy. It's a loss of focus. If you're politicizing your labor in some way, or turning into a proving ground for an agenda, you're pretty much shortchanging yourself, your husband and your baby.

You know, it's declarations like kerrie's that always leave me with a really bad taste in my mouth about the whole homebirth thing. The absolutism, the militancy, the judgmentalism - these are all serious red flags for me. I tend not to trust people who think and speak that way.

~T

By Anonymous Anonymous, at 8:29 AM  

btw - that changing tables in a public restroom test positive for narcotics in no way indicates that parents are using narcotics. I would imagine a changing table in a public restroom makes for a pretty convenient surface for setting up paraphernalia for certain kinds of drug use. I've actually seen a documentary in which public restroom changing tables (and floor, and sink area, etc.) were indeed used to facilitate drug use among homeless teens.

By Anonymous Anonymous, at 8:32 AM  

I don't know so much that it is the pain itself that is empowering. My first birth I knew I wanted an epidural and the pain that I endured while waiting to get one was horrible for me. I didn't feel empowered by that AT ALL. However, the whole experience of my first birth wasn't very empowering. I went into it with the attitude of "my doctor will tell me what to do and what the right choices are" I had done all sorts of reading on how to be a good little patient and not make any decisions for myself.

My second birth was completely different. Yes, it was different because there weren't any meds used, but mostly what made it different was my attitude going in. I had done thourough research ahead of time, knew what decisions I wanted to make and why I wanted things like that, and knew that I needed to make the calls for the birth. That is where my empowerment came from.... not from the pain, but from my knowledge and the feeling that I was calling the shots.

If I were to be planning out a birth and had decided that I wanted an elective c-section for x,y, and z reasons and then ended up stuck in an elevator having a natural, vaginal birth, I am sure I wouldn't find that to be an empowering situation at all as it wouldn't be based on any of my personal choices. So, I can see that it isn't the pain that brings forth the empowerment (in most cases, I think). But perhaps a greater number of women who birth in certain ways (such as with no meds) feel empowerment because it was their studies that led them to the birthing decisions they made and also the fact that they had to go against the grain in order to have their experience.

By Blogger Erika, at 2:43 PM  

After having one birth in hospital and one at home I would say that pain can be empowering, but as others have said - the pain isn't (or doesn't seem to be) as bad at home. I constantly had to refuse pain medication when in hospital and was told over and over that I was making "too much noise" and "might scare the other patients". I was made to feel that owning the pain and working through it was a waste of time and "why not just have some gas or pethidine" etc.
With my second birth - at home - I felt totally empowered not just because I had a medication free birth (my 1st was med free too) but because I was totally supported in my choices and I could labour as I saw fit.

By Anonymous Anonymous, at 2:02 AM  

Hope I'm not too late to comment on this discussion. In my experience, the empowering part of birthing naturally came from several sources: First off, the knowledge that pain meds are not good for my baby and the desire to protect my baby from exposure. Secondly, from the satisfaction of having planned and prepared for a drug free birth and the knowledge that the planning and preparation did what it was designed to do. Third, the combination of the physical, spiritual and psychological "rite of passage", if you will, and the confirmation that indeed my body is capable of performing so beautifully in the act of bringing forth a much loved new child. And yeah, I think the endorphin high must be similar to that experienced by a marathon runner, only so much more so, becaused it is combined with such powerful emotions, including relief and feelings of such utter love and gratitude. So, yeah, definitley empowering. As far as cultural contextt, it depends upon how it's framed, I guess. If I had planned on a medicated birth and had to go natural for whatever reason, I would hope that my care provider would at least try to provide a context for being proud and feeling unplanned natural birth was an accomplishment, and proof of my strength and ability.

By Anonymous Jenny, at 12:37 PM  

my first son was born in a hospital. He was breech and had to be delivered c-section. I wanted a natural birth, and if I had known better I would have had one, at home. my experience was a hospital experience. it was not bad, but it was not good either. My belief is that the birth of your child should be intimate. For me, intamate is in my home. I am four months preg. and plan to have my next baby the way i want.At home. Not the way the hospital says "it has to be".

By Anonymous Anonymous, at 10:55 PM