Some thoughts on labour from Verena Schmid

THE FALSE PROMISE OF A PAINFUL BIRTH... When considering spontaneous birth and also how childbirth is organised in a society, we have to take into account the lifestyle a woman and her family enjoys, because this affects the way she gives birth. In addition we need to understand that a society’s general values are reflected in the way in which births are planned. People experiencing a monotonous lifestyle, without ups and downs, in a technologically oriented society which is disconnected from female cyclical changes, will choose a birth which is linear, in terms of industrial and technological measurements. People who feel more connected to nature will seek out a physiological birth, following a cyclic rhythm through labour and they will try to ‘go with the flow’. Furthermore, women who strive for excellence, who accept life’s cyclical processes, will choose to give birth as consciously as possible.

A linear way of living always attempts to shut out negative feelings, and people who live this way are always surprised when suddenly one of life’s rhythms makes itself felt. When a woman living a life which has been planned in a linear fashion faces these very real experiences, she is totally unprepared. She feels divided between her inner, instinctive model of birth and that which society imposes as normal. As a result, a conflict emerges between two profound needs: the need to follow one’s instincts, and the need to belong to a group. Since, in this case, biological needs are in conflict with cultural needs the woman feels frustrated and inadequate in terms of her existence as a woman and mother. She is confused, so she seeks help from experts.

Let us now take the example of a technological birth, which takes place with an epidural sited. The promise of a painfree birth cannot be kept in reality. This is not only because epidurals are not available to all women, it’s also because they can only be administered when the active phase of labour has begun. This means that women simply have to come to grips with the idea of pain. But they aren’t prepared for this and they struggle against pain, so suffer all the more keenly. What’s more, postnatally they don’t experience intense satisfaction from endorphins, which they would if they were to have a physiological birth. The lack of endorphins from birth results in more painful sensations after the birth. And the lack of a feeling of satisfaction reduces or prevents any wish to repeat the experience and have other children.

In reality, labour cannot be avoided on the journey into motherhood. When attempts are made to ‘simplify’ the birth process and its dynamics by suppressing pain and therefore also hormonal production, these processes have to be faced later on without facilitative hormones, so recovery, convalescence and the relationship with the baby are much more difficult.

Brigitte Jordan surveyed how birth takes place in four different cultures (Jordan, 1992). She showed that women who suffer most during childbirth are those who have been falsely promised they can have a so-called ‘painfree’ birth with the help of an epidural. These women are unprepared for the early pain of labour and unmotivated to face it so it is perceived as being worse than later pain in labour experienced by other women. This is partly because the compensatory mechanisms (of endorphin production) only properly kick in during the active stage of labour. By contrast, women who suffer the least are the ones who are motivated and prepared for pain and feel ready to put up with it. This is particularly the case when their social environment also shares this attitude and accepts pain. In fact, pain becomes considerably worse when women try and suppress it. It becomes manageable when it is accepted without protest.

It seems to me that labour often becomes pathological when birth attendants, who are frequently seen as a guarantee of safety, take complete control of birth. Risks arise as a result of medical intervention—as we shall see, when we consider the side-effects of pharmacological forms of pain relief—and caregivers’ interventions create problems which may continue long after the birth has taken place. These problems may include loss of sensitivity, permanent injuries to the central nervous system, and backache. With the technological management of birth, risks and problems also increase, instead of being reduced, as is promised, and this, along with caregivers’ tendency to intervene tends to make labouring and birthing women very passive. In reality, surprisingly perhaps, it seems that women therefore suffer more in societies which are focused on wellbeing.

From Verena Schmid's book, Birth Pain: Explaining Sensations, Exploring Possibilities. Note that a companion edition for pregnant women is also available, Birth Pain: Power to Transform.