Giving birth hurts like a B. There aren’t a lot of ways around it, although there are a handful of methods for lessening that pain. I’ve seen videos of women in apparent agony who breathe deep sighs of relief after receiving epidurals, and then serenely chat their way through their newborns’ deliveries, all “I’m having a baby; no big thing.” I had an epidural, and serenely (excitedly) chatted my way through labor, but at about eight centimeters started throwing up, and soon after discovered myself in a world of pain (totally normal, nothing’s-wrong pain that my doctor fully expected). This propelled me into mama-bear pushing mode, grew increasingly intense through delivery contractions, and disappeared the moment Mr. Kaspar landed on my chest. (Hello, Baby! Hello, endorphins!) When I recall that delivery experience, however, I don’t really remember—in a tangible way—how much it hurt. I tend to think (and report) that it wasn’t terribly bad. But Aaron always shakes his head, mystified, and tells me, “Um, the pain was pretty bad, babe. Remember? You were screaming?” … To which I shrug, “No big thing.” Maybe this is nature’s way of convincing us women to go another round. We’re so saturated with hormones during and after delivering our babies that the pain—while very much a part of the experience—doesn’t end up defining that experience, except as a badge of badasshood as it dawns upon us that we can handle pretty much anything, now that we’ve birthed a baby.
As more women opt for home births—which don’t include pharmacological pain intervention, obviously— others are choosing ‘natural’ birth in hospital settings, and using alternative pain relief techniques throughout the process of labor and delivery. Interestingly, a recent study out of Liverpool, England takes stock of a bunch of childbirth pain-management data and brakes it down into the three categories of What Works, What May Work, and Insufficient Evidence (i.e. not enough studies around hypnosis to say one way or another... although I know a family who used successfully used hypnotherapy during a particularly arduous childbirth experience). The findings: while epidurals and inhaled analgesia fall without question into the What Works column (no surprise there), they also create more negative side effects than non-pharmacological pain relief methods do, from vomiting to increased C-section risk. Non-pharmacological pain techniques like water immersion, massage, acupuncture and relaxation techniques fall into the What May Work category—and there is far less data around these methods, so perhaps with more studies, their categorization will shift up a notch—but not only do they carry with them a lower risk profile, women who opted for these methods reported greater overall satisfaction with their birth experiences. This is super relevant, as the whole point of pain relief is to serve the women experiencing the pain, right? Since pharmacological pain relief methods do carry with them some definite risks—and since women report greater overall birth experience satisfaction when utilizing alternative, lower-risk approaches—it seems logical that the less aggressive forms of pain management should be first in line, before doctors bust out the big guns.
In fact, the researchers who compiled the British report conclude, “Women should feel free to choose whatever pain management they feel would help them most during labor," adding "women who choose nondrug pain management should feel free, if needed, to move onto a drug intervention.” The article I’ve linked to that summarizes their findings, too, adds, “In addition, healthcare professionals need to tell pregnant women about the risks and benefits of the different methods of pain control.”
This may sound obvious, but doctors aren’t necessarily aware of — or on board with — options around pain management that don’t involve drugs. This woman’s account of her natural childbirth in a hospital (which was deliberate and highly planned on her part... i.e., she selected a doctor who was on board) included a comparing-of-notes with another mom who delivered on the same day, and who had an epidural, sheds some light on the reality of pain management options in hospitals today. She writes:
“When her doctor came in for a visit I heard him speaking with her about what a saviour the epidural was. Despite her immense pain, she did agree with him, but I wonder if she could have experienced the kind of post-birth freedom and bonding experience I was having, would she still feel the same? In fact, she told me how much she envied me during labour, walking the halls and using the shower which she so desperately wanted access to, but couldn't use since she was attached to her bed by the epidural, IV, and catheter. Her doctor had never presented her with the option of a walking epidural and she had not known about them.”
This account reflects the author’s positive feelings about her own natural, in-hospital birth choices (and post-birth experience… though I'm sort of loathe to promote the idea that moms don’t feel as bonded with their babies after pharmacological pain intervention...), as well as discrepencies between different doctors’ knowledge and presentation of options, even within the same hospital. It’s definitely not a given that doctors will even offer up alternatives to the more hardcore pain management options before enlisting them.
My doctor recommended the epidural to me up-front, because my labor was induced with Pitocin (more on that here, and here). He said something along the lines of, “This is going to hurt... a lot,” and I heeded his advice, opting for full-on pain control. In my case, because one intervention was already in progress, heavy-duty pain management made sense, and I don’t regret taking advantage of it. But from what I’ve read and heard, most doctors are pretty pro-epidural for even non-induced labors, and many women now choose to have the epidural as a matter of course (because yes, looking head-on at childbirth pain is totally scary, especially for first-timers). Many doctors, I’m guessing, also recommend the epidural because it renders childbirth pain—at least in part—optional. Why suffer if you don’t have to, right? Yet that my husband was more scarred by my experience of the pain than I was (“You were screaming,” vs. “No big thing”) suggests that perhaps a doctor or partner’s compassionate feelings toward women in labor—and desire to appease their pain-- while very much appreciated, don’t account for the hormone-help that nature’s busy bestowing upon those laboring mamas. We don’t necessarily need the full medical monty when it comes to birthing. What would be great is if doctors were aware of studies like this recent one, and seriously suggested lower-risk options like relaxation, massage, and water therapy to women experiencing labor-pain, before rolling out the needles and masks. This, based on studies and women's reported experience alike, should be standard hospital-birth procedure.
Did you have an epidural during childbirth? Were there any downsides? Did you deliver without pharmacological pain intervention? In a hospital? Do you think doctors know enough about non-drug pain options for women in labor? Do moms? Thanks for your thoughts on this!