Tuesday, May 11, 2010
Understanding "Painless" Childbirth
So, what is up with "painless" childbirth?
A few women are rumored to have "painless" births without special preparation. I think this is probably pretty rare, but the fact that it happens is notable. The majority of women who refer to their births ans "painless" or "pain-free" are women who used hypnosis.
I think this is something that is commonly misunderstood, and I admit I didn't understand it when I was preparing for my first birth. I read the book Hypnobirthing by Marie Mongan, and listened to the CD that came with it a few times. As I understood it, Mongan was teaching that all "pain" in childbirth was a result of the fear/tension/pain cycle, meaning birth will not be painful if you are not afraid of it. I believed that what we experience in birth is a direct result of what we expect, so I chose not to expect pain. I was really oversimplifying things, and I was in for a rude awakening.
When I started having contractions (I refer to them as "contractions" here because that is what I called them at the time--I didn't buy into the idea of changing the words then) I admitted that "they hurt," but it was very manageable. They went on for quite a long time, going away and coming back, and then I was given a very low dose of pitocin, and those contractions really hurt. I was still able to cope using movement and deep breathing for a while, but I was really miserable. I do recognize that there was a psychological element to this pain. In my mind, something external (pitocin) was inflicting pain upon me, instead of it being caused by my own uterine muscles contracting. This, as well as exhaustion and pressure to dilate due to risk of infection, made it much harder for me to cope.
I think that I, as a first timer, espoused a common misconception about painless birth: believing that your birth will be painless just because you've heard of it and believe it's possible. I didn't think I needed to do anything to have a painless birth; I thought it would just happen because birth is not "meant" to be painful (right, Dr. Dick-Read?)
My understanding of this changed when I did the Hypnobabies program for my second birth. I don't know if there is really a difference in the two programs' views or if my experiences caused me to have this new understanding. I don't know if birth is really "meant" to be painful or not, but I do know that it involves a stimulus that the majority (at least in our culture) of women's brains interpret as "pain," which is generally experienced as a negative thing. Good hypnosis for childbirth provides a system for changing your mind so that the stimulus is interpreted as not painful, so that it can be experienced more positively. For me, with my second birth, experiencing it positively involved a conscious choice on my part.
Both Hypnobirthing and Hypnobabies use a technique of renaming some of the words commonly used in childbirth. This is a strange practice and, I admit, it's a little cumbersome at times, but many women find it helpful to avoid negative associations their subconscious may have with the words. One example is avoiding use of the word "pain" and using "discomfort" instead, because it is not as negative of a word. Some could argue that "painless childbirth" is about semantics, but it's really about what you choose to believe.
I believe that most women who have unmedicated births are able to find a way to experience the stimulus of the sensations of childbirth as not a bad thing, even if they do experience them as painful. In embracing a "pain with a purpose" ideology, women are choosing to tweak their understanding of the word "pain" (which is usually a negative word to describe a sensation that occurs when the body is being harmed) to include a kind of pain that is good. This essentially means changing the negative connotation of the word "pain" to be positive in this particular circumstance, while with hypnosis, we simply change the word, eliminating the negative connotation altogether.
I think some people, when they hear "painless," assume that means not feeling anything--that the "hypno-anesthesia" would be like an epidural and make them numb. It doesn't work this way. Hypno-anesthesia is very strong endorphins. It's like when you cut yourself or you twist your ankle and at first it hurts a lot, but then it doesn't hurt as much, that's endorphins. They soothe and dull pain, but they don't take away sensation. With a pain-free unmedicated birth with hypnosis, you would still feel your baby being born, it just wouldn't feel like pain to you.
Sometimes the talk of feeling "only pressure and tightening" in Hypnobabies leads women to expect that birthing waves will feel just like Braxton-Hicks waves. This is not true either. Braxtion-Hicks are just tightening sensations, for me, birthing waves (and also the pre-birth waves that can occur irregularly for weeks before the actual birth) have an extra level of intensity--what I now call a "downward pressure" which signaled to me that my uterus was now working to begin moving my baby down instead of just flexing itself for the exercise.
One of the changes in the new 6th edition of Hypnobabies is the re-recording and re-naming of a track that used to be called "Painless Childbirth" to "Easy, Comfortable Childbirth." Hypnobabies appears to be moving away from using the word "painless," which, considering all of the misconceptions about it, I think is a good move. I feel like "comfortable" is a more accurate description of how Hypnobabies helped me. Whatever sensations I felt (some of which I may have called "painful" under other circumstances), I knew they were normal and was able to not be afraid of them, which allowed me to feel calm and confident and not out-of-control or panicky (except during the cervical lip and the pushing, but I have theories about that). I wouldn't say I was "in pain," because for me, being "in pain" never involves that degree of serenity and self-composure.
I know there are some women for whom surviving the pain of childbirth provides a sense of accomplishment. It makes them feel like they are "hardcore." I, on the other hand, am not "hardcore," nor do I want to be. I can get a sense of accomplishment from seeing that I did something most people experience as very painful, and it was mostly comfortable to me, and I did it with my mind!