Written by Asheya
When you think about childbirth, what springs instantly to your mind?
If you live in North America, the most likely answer is something to do with pain. Everyone knows, labour hurts. When we think about pain in labour we often think about things like epidurals and morphine, which many women decide to use before they even go into labour, and some women aren’t sure about but decide to use after they are in labour.I want to talk about epidurals and morphine and their risks in another post, so stay tuned for that! Before we even talk about how to cope with pain or manage pain, whether in a natural (physiological) way or with medication, I think it’s important to first talk about the pain itself.
Remarkably, very little research has been done into the purpose of pain in labour. You would think that because nearly every mother experiences pain in labour that some thought would have gone into identifying the reasons for the pain, before trying to figure out first of all whether intervening in that pain is actually a good thing, and second of all, how to intervene to provide the most benefit to the mother and baby, the least (or no) harm to the mother and baby, and still accomplish the purpose of the pain.
We know that pain in labour during contractions is not an indication that something is wrong, unlike most other pain we experience in our lives. So the first thing we need to ask is, when a woman feels pain in labour, what does that pain encourage her to do? This may give us a clue into the purpose of the pain.
and feels safe with, and is supported in labouring the way she feels best, most often the woman will move during her painful contractions. This movement will often be a swaying of the hips, walking, rocking, or similar movements. She will also naturally try to find a position that feels most comfortable (less pain), such as standing and leaning on something, kneeling on all fours, squatting, sitting on a birthing ball, or other similar positions. These positions make use of gravity in the birth process, allow movement, and open her pelvis.
The fascinating thing is that movement and these positions facilitate the optimal positioning of the baby in the birth journey, encouraging the progress of labour and decreasing the risk of complications. The mother often changes positions throughout the course of her labour, finding positions at different points that feel best to her, and help to cope with the pain. The pain provides feedback to the mother about what positions work at each phase in the birth journey.
It would seem that at least one of the purposes of pain is to make the birth journey BETTER (yes, better!) for the baby (and in the end the mother) by providing the impetus for movement and positions that the mother might not otherwise engage in. Without the pain to provide feedback, the mother is not able to discover which positions are the most comfortable (because there is less pain) and so optimal for the baby.
The baby actually moves during the birth journey, and is not passive but an active participant in the birth process. During my two homebirths with a midwife, my midwife encouraged me to pay attention to the baby’s movements. I had no idea the baby would be kicking while we were in labour! But sure enough, I paid attention, and my baby was definitely moving! The only time I found it hard to detect movement was near the end of pushing, when the baby had descended quite far into the birth canal. It is during the pushing stage that the baby actually goes through what are called the ‘cardinal movements:’ a series of movements that provide the most space for the baby as she moves through the pelvis and the birth canal.
The other thing that happens at a well supported birth is that when a woman feels pain during a contraction she will be encouraged to relax and breathe deeply. Breathing deeply can be a response to any type of pain, including menstrual pain, which many women find similar to labour pain. Breathing deeply allows the baby to get a lot of oxygen, which is important as the baby does a lot of work in the birth journey and needs oxygen to remain stable and have a steady heart rate.
Because not much research has been done into the purpose of pain, we have theories and questions that need exploration. Sheila Mills, a midwife from Manitoba, sent an email to me in a discussion about pain in labour. She asks, “I wonder how uncomfortable the movement of the baby through the birth canal truly is, and perhaps, what level of endorphins transfers to baby via mother as a result of her pain? I also wonder if these same endorphins influence the bonding experience a mother goes through at the moment of birth?“
And Judith Rooks, a nurse-midwife from the United States, asks, “If epidurals reduce the mother’s production and release of endorphins, what does that do to the baby’s ability to cope with the pain that must come from being squeezed through the birth canal and contractions?“
There is the possibility that the pain of contractions causes the production of endorphins by the mother that are transferred to the baby. It is unknown how painful the birth journey is for the baby, and perhaps the endorphins created by the mother in response to her own pain help to reduce the baby’s sensation of pain, making the transition from womb to world easier for the baby.
Melissa, one of the authors of this blog, wrote me an e-mail that when she was in labour the pain really captured her attention. She says, “The pain nudged me to find a safe place to labour, with few distractions, and someone to support me emotionally. It said, “HEY! SOMETHING REALLY IMPORTANT IS GOING ON RIGHT NOW THAT YOU CAN’T IGNORE!” It got me to pay attention. And without some really, really strong sensation, many of us could override labour or anything else really important for our health.”
While we may not know for sure all the purposes of pain in labour, we would be foolish to think there are none. If we touch something hot, our feeling of pain causes us to remove our hand. Pain has a purpose. Pain in labour has a purpose too, instructing the mother’s body and perhaps the baby’s body as well, to move in certain ways and release certain hormones, creating the optimal environment for a physiological, uncomplicated birth.
We would be foolish to intervene in pain without knowing the purposes of the pain, as our interventions may block those purposes, making birth more complicated, more difficult, and traumatic for both the mother and the baby.
A mother who is supported by her care providers in accepting the pain, relaxing into the pain, and doing what the pain instructs her to do, usually finds that she does know what to do, that the pain is bearable, that the moment of birth is filled with joy and ecstasy, and ultimately, that she is empowered to trust herself and her baby as they continue together on the often challenging journey of life.