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Pain Management in Labor

Labor Pain

Advice to Pregnant Women About Labor Pain Relief
From the Maternity Center Association


The Maternity Center Association (MCA) is the oldest national advocacy group working to improve maternity care for mothers and babies. MCA recognizes the importance of labor pain relief and carries out research, education and advocacy to support women and health professionals in this area.

MCA's advice to women about labor pain relief

As early as possible in pregnancy:
  • learn about options for labor pain relief — including full, accurate, balanced information about pros and cons of various drug- and drug-free methods
  • set your goals, considering this information and your values and preferences
  • take action to help reach your goals.
For help with all three steps, see MCA's special online resources, How will I cope with labor pain? You will find trustworthy information, help with decision-making, tips and resources for putting your plans in place.

Choose your maternity caregiver and birth setting wisely, and be sure that you will receive support for your pain relief and other goals.

Consider arranging for a friend, family member or doula who will be with you to provide continuous supportive care during labor. Labor support lowers your likelihood of using pain medications, having a cesarean, giving birth with vacuum extraction or forceps, and being dissatisfied with your birth. Labor support has no known downsides.

Understand and be prepared to exercise your maternity rights, including your right to informed consent and informed refusal.

Responsibilities of health professionals and health systems

MCA believes that health professionals and health systems have responsibility to ensure that all pregnant and birthing women have:

  • access to full and accurate information about labor pain and ways to relieve it, consistent with legal standards and rights to informed consent
  • access to a choice among drug- and drug-free options for labor pain relief
  • support for their decisions about pain relief.

Download the Executive Summary(PDF) from MCA's "The Nature and Management of Labor Pain" project (best evidence on many labor pain topics).

See other Responses from Maternity Center Association:

Pain Management
by Jennifer N. Ayers-Gould, BA LPN ICCE

When preparing for and anticipating birth, most women will undoubtedly have questions and concerns about the pain of labor.  They have heard the horror stories of their friends and relatives and the analogies that giving birth is like passing a watermelon out of your mouth.  Women are bombarded with stories about the miracle of drugs and epidurals for pain relief and how they could have never done it without help from pain medications and their "savior" physicians and anesthesiologists.  It is no wonder that women who have never before birthed are scared to death that they will not be able to handle the pain of childbirth and are in utter trepidation when thinking about what it will feel like.

Yes, birth can be painful.  For some women, it can even be pleasurable!  The sensations which accompany labor and birth are primal feelings of your body opening up and preparing for the emergence of a new human being into the world.  Fear and mistrust of the birthing process can be the greatest contributors to one's perception of pain.  This is not the pain which accompanies a stubbed toe or a broken arm, this is pain with a purpose.  Labor pains do not signal that something is wrong that needs to be fixed.   It is pain which urges a women to open, trust, and surrender to it.

The single most important thing a woman can do is trust in the process of birth; trust that her body was made to birth; listen to her body and follow its cues.  When a woman surrenders to birth, steps out of the way, and allows her body to do what it needs to do, she will experience less pain during labor.  Knowing and believing that birth is not a medical procedure, but a natural unfolding of the process of life will allow one to be open and accepting of the sensations which accompany childbirth.  Understanding the process and having complete faith in oneself eliminates fear which creates the tension which magnifies the perception of pain.

It amazes me that when a woman becomes pregnant, she takes great precautions to avoid anything which may harm the baby: alcohol, drugs, radiation, excessive temperature changes, over-exertion, etc., but as soon as she begins to experience any discomfort in labor, without a second thought is asking (or begging) for narcotics to dull the pain.  Is she not still pregnant?  Does she not consider that whatever pharmacological agents that enter her body will also have an effect on her unborn child?  Why all of a sudden is it "safe" to expose the baby to these harmful agents? And particularly at a time when the baby needs to be fully strengthened and alert for the work of leaving his mother's body and adapting to life on his own?  Not only does every (unnecessary) intervention have an effect on the child, but also impacts the mother's experience of birth.  By numbing ourselves to the powerful and empowering sensations of birth, we are becoming detached from our physical-spiritual-emotional beings.  When we dull the pain of childbirth, we are also dulling the myriad of other sensations which accompany birth. 

The sensations of childbirth call us to be submissive to the awesome power of life.  Labor waves, like great ocean swells, sweep over us and overtake us.  They humble us in their magnitude, call us to surrender to their pull and flow with their mighty power.  The pain sensations cause our bodies to react by releasing hormones which will naturally put us in a state of higher consciousness, a sort of "birth euphoria.."  The hormones also effect our babies and stimulate them in preparation for their transition to extrauterine life.  This is not senseless torture, this is truly purposeful pain.

When women understand the sensations of labor and birth, accept the process as normal and natural, trust in their bodies to give birth, approach childbirth without fear, and stop allowing the misinformation of our overly-technocratic society to adversely affect them, they will be able to integrate the pain of birth into the process of birth; the process of birth into the process of life.  They will be able to see that what we are told must be fixed was never broken at all.

© 2004 Starr-Rhapsody Creations.  All Rights Reserved.

 

Complimentary/Alternative Therapies for Labor and Childbirth
by Carolyn Rafferty, RN, BSN

Americans spent nearly $14 billion on alternative therapies in 1998 and there were more alternative health care provider visits than primary health care visits (McFarlin, Gibson, O'Rear, & Harman, 1999). Complimentary and alternative therapies are the fastest growing areas of healthcare. The main difference between conventional medicine and complimentary medicine is the inclusion of the emotional, spiritual, and physical components of well-being; complimentary methods utilize the client's own energy to enhance the healing potential. The inclusion of complimentary therapies in maternity care vastly increases the choices available to women throughout pregnancy and childbirth (Tiran & Mack, 2000).


Therapy Modalities that use the Gate Theory of Pain Control

The gate theory of pain control is described as a transfer of nerve impulses, pain sensations, which travel along a sensory nerve pathway; according to the gate theory, only one sensation can travel on the pathway at a time. If the sensory pathway is occupied by a sensation caused by stroking, massaging, hot water, electrical stimulation, or pressure the pain sensation is effectively blocked from getting to the brain and being perceived as pain (Lowdermilk, et al, 2000).

Acupuncture and Acupressure

The ancient, traditional, Chinese art of acupuncture is the process of inserting thin needles in the body at any one, or more, of the 2000 specific points thought to control, correct, or alter various aspects of body function. The obstetric use of acupuncture is used most readily by midwives and has gained popularity over the last 20 years (Beal, 1999). The first deliveries recorded that utilized acupuncture for pain relief, were done in 1972 in England. In addition to intrapartum and postpartum pain relief, many women find acupuncture useful for relieving pregnancy discomforts such as nausea, headache, hemorrhoids, and backache. The World Health Organization sites sufficient evidence supporting the therapeutic effects of acupuncture for it to be considered as an important part of primary health care and that it should be fully integrated with conventional medicine (Tiran & Mack, 2000).

Acupressure is similar to acupuncture, however, no needles are used; rather, the hands, fingers and/or thumbs are used to create pressure over the same stimulation points. Shiatsu, Japanese for finger pressure, can relieve symptoms of pregnancy such as, breathlessness, hemorrhoids, nausea and vomiting, carpal tunnel syndrome, heartburn, edema, coughs, urinary frequency, cramps, insomnia, lumbar-sacral pain, headaches, and fatigue (Tiran & Mack, 2000).In spite of the potential benefits of acupuncture and acupressure, and the growing interest in complimentary and alternative therapies, very few hospital systems integrate either treatment modality; women seeking them must seek independent practitioners and gain permission to utilize the treatments in their chosen birth site (Beal, 1999).

Hydrotherapy

Warm water, in the form of a Jacuzzi bath, shower, or a simple warm soak are methods of hydrotherapy. Warm water has been used for it's healing powers for centuries, and it has been found effective in managing the discomforts of the first and second stages of labor. Hydrotherapy is an economical and drug free method of utilizing the gate theory mechanism of pain reduction. Basically, the hot water competes with the pain impulses for neuropathway access. Hot water effectively blocks the sensation of pain while allowing the woman's body to relax and allow her body to work at moving the baby closer to birth (Teschendorf & Evans, 2000).

There are virtually no side effects with hydrotherapy; women and fetus may experience tachycardia if the water is too hot; the baseline fetal heart rate can rise 10-20 beats per minute during the bath, but return to baseline within 30 minutes after the bath. The water temperature should be monitored closely and maintained between 96° and 98°F. Most women report a more satisfying birth experience and better pain tolerance when the tub is used during labor (Teschendorf & Evans, 2000). It is important to mention that getting in the tub too soon, before labor is really active, could slow labor progress (Simkin, 1995). Infection control protocols are used to reduce the potential of infection (Teschenforf & Evans, 2000).

Transcutaneous Electrical Nerve Stimulation

Transcutaneous Electrical Nerve Stimulation (TENS) utilizes electrical impulses that are sent to the skin and may work by increasing endorphins at the sight if stimulation. The laboring woman controls the intensity of the electrical stimulation via the battery operated control device that she holds in her hand. A tingling sensation at the site of the electrode elicits the gait response as the neuropathways sense the tingling rather than the sensation of discomfort. There are relatively no side effects, however, TENS units may cause interference with electronic fetal monitoring. The benefit is that some women find great relief and are able to delay or avoid epidural anesthesia by using them (Simkin, 1995).

Subcutaneous Water Papules

Subcutaneous Water Papules are a method of pain relief using a similar principal to TENS. This was established in Scandinavia and is not wide spread in North America. This technique may help some women avoid pain meds. Injecting sterile water just under the skin on the lower back causes four small papules. The strategically placed papules provide pressure and employ the gate method of pain reduction. There is a stinging sensation for 20 to 30 seconds after each injection. Subcutaneous Water Papules are primarily used for relief of low back pain and pressure in labor (Simkin, 1997).

More Complimentary Therapies

Aromatherapy

The practice of aromatherapy is an ancient art and the term "aromatherapy" was first used in the 1920's. Over the last 10-15 years aromatherapy has been gaining in popularity. Women benefit from massage with essential oils that have therapeutic properties. Some of the oils that are used in labor and delivery are used as adjuncts to conventional pain relief measures and they include: clary sage, lavender, mandarin, and jasmine; they may be added to massage lotions, used to scent the room, or added to the bath. Only a those with experience and knowledge of the effects produced should use essential oils with pregnant or laboring women (Tiran & Mack, 2000).

Hypno-birthing

Hypnosis is a state of deep relaxation that offers a sense of extreme well-being. When hypnosis is used in labor the perception of pain can be greatly reduced. If the client truly believes that it will work for her, and she has practiced her method of induction adequately, it can be a truly remarkable source of pain relief (Tiran & Macke, 2000).

The founder of Hypno-birthing TM is Marie Mongan; her philosophy is, that every woman instinctively knows how to birth, and that when fear is replaced with knowledge, and a faith that her body will work the way it was designed to work, her birth will be experienced with satisfaction and fewer interventions. Through a series of classes, the woman learns about the natural flow and rhythm of labor, breathing patterns, and visualizations; the goal is to reach a sense of profound relaxation through fear release and self hypnosis enabling her to have a safe, satisfying birth (Mongan, 1998). Dr. Goldman, a practitioner of Hypno-birthing says, " The goal is not painless childbirth but to be in control from start to finish" and "to have a warm picture of labor as apposed to [a picture of'] panic" (Kelomattox, 1999).

Cold and Heat

The use of cold and heat provides a very inexpensive comfort measure. Heat feels great on an achy back. Warm compresses to the perineum help avoid tears and episiotomies. Heating pads, hot water bottles, or homemade hot packs can be very effective. A hot pack can be made by filling a cotton sock with rice, adding a bit of lavender oil, if you like; then tie it closed and warm it in the microwave for a few minutes; the warmth and smell of lavender is appreciated by many. After the birth, cold packs to the perineum decrease swelling and provide a local numbing effect (Simkin, 1997).

Herbs

Herbal remedies are the earliest form of medicine and have been a historical part of many cultural healing traditions. Until the 1800's people routinely consulted herbalists for health care (Tiran & Macke, 2000). Herbs are used medicinally to cure many illnesses and it is important to remember that herbs are medications. Herbs can have side effects just like other drugs; they must be taken with respect and it would be best if the use of herbs were shared with health care providers. Tiran & Mack, (2000) report that the World Health Organization calculated that 75% of the world's population uses traditional medicine and most cultures use herbs for the transitional moments of dying and being born.

An increase in the use of herbal therapies has brought about additional education needs for many health care providers. The health care provider should be knowledgeable and current with herbal medicine. The main principals of herbal medicine are; holism, an entire body approach to health care; individuality, a treatment plan tailored to the specific client; diversity, many philosophies are accepted; empowerment, the consumer takes responsibility for their own healing; and connectedness, a connection to the earth and plants used to create the herbal remedies.

Historically herbs have been used for childbearing by various cultures; the safety and efficacy of their use has not been well documented. Herbs are used in pregnancy as antiemetics, to augment labor, slow bleeding, encourage lactation and much more. Certified Nurse Midwives (CNM) and Certified Professional Midwives (CPM) are more likely to use herbs. The most common herbs used by CNM's are herbs to facilitate labor; 64% of CNM's responding to a recent study said that they used blue cohosh, 45% used black cohosh, and 93% used castor oil, to stimulate labor; and raspberry leaf to enhance uterine tone, and evening primrose oil to expedite cervical ripening. More reporting of statistical data surrounding the safety and efficacy of such practices would make more CNM's comfortable with the practice (Beal, 1999).

References:
Beal, M. (1999). Acupuncture and acupressure: Applications to women's reproductive health care. Journal of Nurse-Midwifery, 44 (3), 217-230.
Kelomattox, K. (Producer) . (1999, September) . NBC Dateline. New York: National Broadcasting Company. Lay, M. (2000).
Lowdermilk, D. , Perry, S. , & Bobak, I. (2000). Maternity and women's health care (7th ed.). St. Louis, MO: Mosby, Inc..
McFarlin, B., Gibson, M., O'Rear, J., & Harman, P. (1999). A national survey of herbal preparation and use by nurse-midwives for labor stimulation. Journal of Nurse-Midwifery, 44 (3), 205-216.
Mongan, M. (1998). Hypnobirthing- A celebration of life (Expanded ed.). Concord, NH: Rivertree Publishing.
Simkin, P. (Producer), & Wilbert, D. (Director). (1995). Comfort measures for childbirth [Film]. (Available from Penny Simkin, Inc., 1100-23rd Avenue East, Seattle, WA 98112)
Simkin, P. (1997). Simkin's ratings of comfort measures for childbirth. Waco, TX: Childbirth Graphics.
Teschendorf, M., & Evans, C. (2000). Hydrotherapy during labor: An example of developing a practice policy. MCN, 25 (4), 198-203. Tiran, D. & Mack, S. (Eds.). (2000).
Tiran, D. & Mack, S. (Eds.). (2000). Complimentary therapies for pregnancy and childbirth (2nd ed.). London: Harcourt Publishers Limited.

Copyright 2001 Carolyn Rafferty, RN, BSN

 


Sterile Water Injections for Relief of Back Pain in Labor

Regardless of the various comfort measures available; such as hydrotherapy, massage, acupressure, counter pressure and position changes; some women find the pain of back labor difficult to bear. Therefore, many women today are turning to the epidural for the relief they need. However, the epidural comes with many risks to both mom and the baby. Is there any more natural alternative?

History
In 1965, Melzack and Wall introduced what is now known as the "Gate Control Theory" which suggests that nerve cells from touch fibers can actually close the gate on pain signals to the brain, thus giving the perception of minimized pain. Therefore, for a woman in labor, the brain has the ability to influence the course of her labor and her perception of pain.

In 1975, Melzack and Fox determined that the perception of pain could be altered by introducing a brief period of pain. This, in turn, would alleviate the chronic back pain. An example of this theory is the use of a TENS (transcutaneous electrical nerve stimulation) unit. The TENS unit sends pulses which interrupts the brain's awareness of pain and may also cause a release of endorphins which is the body's natural pain coping mechanism.

Then in 1989, Lytzen, Cederberg, and Moller-Nielsen presented their study on "Relief of low back pain in labor by using intracutaneous nerve stimulation (INS) with sterile water papules" in a medical journal. This study included 83 women with lower back pain during the first stage of labor. These women were given injections of sterile water intracutaneously over the sacrum. All but six of the women noticed instant and complete pain relief which lasted up to three hours. The procedure could then be repeated. Sixty-seven of the eighty-three were pleased with the results.

Trolle, Moller, Kronborg and Thomsen introduced their study of "The effect of sterile water blocks on low back labor pain" in the American Journal of Obstetrics and Gynecology in 1991. This study contained 272 women complaining of severe low back pain. The women were randomly assigned to receive either a sterile water injection or a saline solution block. There was a significantly higher degree of analgesic relief for those in the sterile water group (89.4%) than those in the saline group (45%). No adverse effects were noted and the patient satisfaction was high.

Sterile Water Papule Injection Diagram


The Procedure

The woman's back is cleansed. Then 0.1-0.15cc of sterile water is injected intradermally into four places on the women's sacrum. Preferably, the procedure should be done with two people doing the injections simultaneously. The injections cause an intense burning sensation which lasts 30-90 seconds. Relief from the procedure should be noticed in 2-3 minutes. Because of the intensity of the pain, the woman should have constant support and encouragement during the time of the injections.


Conclusion
Sterile water injections is an excellent alternative for pain relief due to back labor. Even though it may not provide relief from contraction pain, often once the back pain is alleviated, the laboring women can cope better with her labor. Likewise, often the relaxation of the back can assist in the proper decent and positioning of the baby, leading to a shorter labor. With no known side effects and no medications entering the body, sterile water injections may become the choice for the relief of back labor for many laboring women.

References
Fox E.J., Melzack R. "Transcutaneous electrical stimulation and acupuncture: comparison of treatment for low-back pain." Pain 1976 Jun;2(2) :141-8.
Lytzen T, Cederberg L, Moller-Nielsen J. "Relief of low back pain in labor by using intracutaneous nerve stimulation (INS) with sterile water papules." Acta Obstet Gynecol Scand, 1989.
Melzack R, Wall, P. "Pain mechanisms: A new theory." Science, 150 (1965) 971-979.
Trolle B, Moller M, Kronborg H, Thomsen S. "The effect of sterile water blocks on low back labor pain." Am J Obstet Gynecol. 1991 May;164(5 Pt 1):1277-81.

BIRTH AS SHEER PLEASURE
by Ingrid Bauer

Inevitably, in discussions about unassisted or natural birth, the topic of pain-free birth rolls around. When it does, I wonder if striving for a "pain-free birth" doesn't inadvertently miss the potential beauty of natural birth itself. I don't believe birth is meant to be pain-free-in fact, I believe it's far more than that! I believe, and have experienced, birth to be downright ecstatically, blissfully, orgasmically pleasurable. "Pain-free" doesn't even come close to describing that experience. That's like calling a high sexual union with your mate "pain-free", or the most breathtaking sunset you've ever seen "ugly-free". For I think that as long as we're focusing on getting rid of, or avoiding pain, we're focusing on the wrong area and we're completely missing the point.

There's also the idea that birth is painful but simultaneously pleasurable. Which is it? I just can't buy into the whole "no pain, no gain" paradigm, or the description of the "joy pain", or sacrificing to experience joy. How is pain joyful? How is joy painful? Given the opportunity and knowing it was natural and healthy, wouldn't you forgo the pain each and every time? I think the folks who believe that no woman should have to suffer through childbirth have the right root but, through fear and ignorance (and perhaps greed in the case of the pharmaceutical industry), have climbed up the totally wrong tree.

I don't deny at all that these things get very mixed up in our cultural conditioning and most of us have confused and enmeshed the two. Most of us, unfortunately, have instances in our upbringing and lives where pleasure and hurt were closely connected and became entwined. For some people this goes as far as masochism where no pleasure can be experienced unless there is pain (or a lot of intense therapy).

But is this natural? Does this happen in nature when there is no interference? Would undomesticated animals raised in a natural environment really endure a painful situation willingly because they also somehow convinced themselves it was pleasurable? I wonder.

When my first child was born 15 years ago, I had read Grantly Dick-Read's book "Childbirth without Fear" and Ina May Gaskin's "Spiritual Midwifery" (with all that mention of "rushes"!) and theoretically at least believed birth could be pain-free. But I realise now that that was an intellectual decision. I didn't really believe, didn't really know, that nature is utterly benevolent and founded on pleasure. My first labour at home, midwife attended and interfered with (though we both didn't realise it) was uncomplicated. At the time, I described parts of it as hard work rather than pain, and the emotional and mental and even physical highs were significant, but much of the physical part definitely wasn't super pleasurable. I mean, it didn't compare favourably to great sex or anything. And I now believe that is what birth can be like-like really, really great sex. The whole time. Not just emotionally, but physically, spiritually, holistically.

I believe there is a positive place for pain in nature. I think it serves as a valuable warning sign that something is wrong or should be changed immediately. For example, a cut or a burn might warn of a sharp or hot object and the hand is immediately withdrawn.

I have had the experience of changing my way of eating (and watching my son and husband) with the result that burns and cuts, even very deep cuts and 3rd degree burns, hurt only for an instant and then never again unless they are banged. I believe that in a fully healthy situation, this is what pain is for-a momentary and very temporary danger warning.

Prolonged pain is, in my opinion, a sign of blocked energy, whether physical, emotional, environmental, or other. I don't deny at all that pain arises (and denial is just a symptom of another kind of pain I think). I understand that there are millions of women for whom birth is extraordinarily difficult and painful and I don't discount or question the reality of their experience. I'm not talking here about denying feelings or striving obsessively for some ideal and judging yourself if it is not reached. Pain, both physical and emotional, is still a regular, even frequent, companion on my life journey, especially in those areas where I am still learning what my natural expression is or where I am reluctant to make certain changes. But I no longer believe that this pain is inherently necessary or natural, as in "birth (or menses) is painful", or "burns/cuts hurt while they heal", or "teething hurts", or "rejection is devastating".

I now look to these examples of pain as indicators that something may be amiss or require change. When pain arises, I try to thank it because it is a clear indication that something is out of alignment, that life energy is being blocked or resisted, either in my body, thinking, acting, environment, or the way in which I interact with my environment (such as eating, speaking or physical activity). And then I try to find a way for the life energy in me to flow more freely.

So, how does this idea of pain as blocked or resisted life energy connect more specifically to birth? I guess the best way I can explain it is to relate it to the birth of my second child. Before this birth, I felt as though there were several areas I had been working on, consciously and unconsciously, to free up my resistance to that powerful energy of life, which moves through us all the time but seems particularly present during birth. I believe all of these things together contributed to my birth experience, that there is no one way to release these blocks, but I do know my thinking played a major part. Here are some things I did:

I immersed myself in the beauty of powerful birth lore. I explored and unravelled my fears around accepting full responsibility for my own pregnancy and birth, releasing my power away to no one and nothing but Love itself. I created an unhindered birthing environment that was safe, dark, private, silent, free of strangers or any outside interference or intervention.

I released a lot of energy in my body that had been used trying to digest indigestible food by changing to a primarily raw, organic, dairy and grain-free, instinctive way of eating about 2.5 years before my baby was born.

I felt really "in" my body and my beauty and my sexuality. I enjoyed my nakedness and my physicality. I moved and exercised my body a lot. I came to believe, really believe, that Nature/God/Spirit is LOVE, pure and simple and that love is everything, everywhere, always.

I sang, sang, sang. For me personally, sound is a powerful tool for moving energy and releasing blocks (I think this is one reason some women make "unearthly" sounds while birthing). During my pregnancy, I not only spent months rehearsing and performing Mozart's Requiem with a large choir and orchestra, I sang all the time and practiced toning.

Toning is using sound by singing notes, usually one at a time, to consciously clear energy channels in your body. Some systems use specific notes for specific "charkas" or energy points in your body, but I just used intuitive toning, letting my body dictate which note it "needed" at that particular time. I also used this during birth and after my baby was born if he was crying through pain or unexplained tension. I would let his sound and body "give" me the note and tone while holding him against my solar plexus. All the tension would noticeably flow out of him through my voice and he'd stop crying and relax immediately. (Carrying a child and moving, as in active garden work or brisk walking, also helps release tension for the baby.)

I had tremendous faith that birth is a natural process and that my body knew what to do, and I looked at all my fears and doubts about that before the birth. And I believed that I was strong, powerful and beautiful enough to match the very strongest energy of birth. I think very often fear arises when we believe this energy is more powerful than us rather than realising that we are part of it. I appreciated the support of a partner who believed, without doubt, that I could birth as easily as the semi-wild horses he had seen giving birth, particularly if there was no interference.

With this second birth, I went into active labour very suddenly and without warning just after 3:00 am. I was taken aback by the intensity of the contractions. For some bizarre reason (fear!) I decided to time the contractions even though I hadn't planned that and had no idea what the timing actually meant! They were five minutes, five minutes, then three minutes, three minutes, then two minutes, two minutes, progressing rapidly.

I didn't realise how fast things were going and sank into fear mode. If these first 6 contractions were already this intense, how would I ever stand 10 more hours? After all I was an older mom, hadn't had a baby in 12 years, and this was going to be hard! Immediately, my abdomen was gripped with incredible pain. I couldn't stand straight. I bent over grasping the sink and rolled and rocked and moaned with every contraction. Despite the intense pain, I was "coping" well.

But all of a sudden I remembered. I realised that even as I was rocking and moaning with the contractions, part of me was actively resisting and holding back against the powerful life energy that was coursing through me. I was still split, hadn't fully embraced or committed to that energy, and was being painfully pulled between the two choices. It became crystal clear to me in that moment, that the thing, the only thing that was causing pain in that moment was NOT the strength of the birthing energy, but my fear and resistance to it. The more I resisted, the more it hurt.

I decided to completely move into that energy, as part of it, rather than against it or bravely alongside it. I had a good look at the next contraction. The words "This is only sensation" came very clearly, out of nowhere, into my awareness. I decided I wanted to feel this sensation, not resist it, no matter what it was, no matter what it felt like. I wanted to be and feel alive, no matter what that might mean! I consciously opened my arms, heart, sex, and body to it. I was willing to experience the very centre of it, now, in this very moment. And WOW!!

Forget about pain-free! In that moment, literally within seconds, that overwhelming pain was transformed to the most intense orgasmic pleasure. And I mean intense. Those contractions were powerful. Contractions came one upon the other with rarely more than 5-10 seconds between, and often less (not like my first birth where I slept between contractions!). I felt sometimes close to the edge of being overwhelmed and falling back into fear (have you ever been so happy that you're afraid you can't take any more and it's going to end? It's a bit like being at that edge).

But then I opened my mouth to sing and didn't stop. I just melted right into that life force, flowing like an open channel through my body, out my mouth, out my sex, out my heart. I wish I had a tape recording because apparently I sang some incredibly beautiful melodies ("not like any birthing sounds I've ever heard" said my good friend, who caught the last bit and has been to several home/unassisted births). I don't remember what it sounded like, (except one note); I just remember the feeling of the energy.

I felt everything within my body: the cervix opening, the baby moving down, the bones cracking apart slightly, his head emerging. No pain, no burning, just oh so luscious sexy sensual wet alive moving fullness. There was absolutely no pushing at all. I just kept breathing and singing and wasn't aware of any contracting or bearing down in my uterus, just smooth movement. Just before he emerged, I instinctively arched way up and then lay forward again (I was on hands and knees), as it felt almost like he was moving "around a corner".

Exactly two hours and 10 minutes after the very first twinge, he came out to the waist into his papa's and my hands and paused there between contractions, opened his eyes, looked around, and sang "Oh" on the exact same note I was toning. Then he whooshed out on the next contraction and I took him in my arms.

That birth changed me, changed so many things in me, showed me the true beauty and pleasure of Nature and birth, cracked my heart wide open. I can hardly read a single book on birth now-even the most progressive, alternative natural birth book-and not think that somehow, something utterly vital is missing. Something nobody ever told me about. So much emphasis is on how to handle the physical pain. Nobody ever prepared me to simply fully embrace the sheer sensual pleasure of birth.

I am so grateful for this experience and this learning. It has touched me in places that go far beyond parenting and my relationships with my children. It continues to motivate me throughout the challenges that life brings and gives me new perspective on the painful areas that arise. It has given me concrete evidence that when I choose to merge fearlessly with that powerful energy that moves through all of life, when I identify and overcome the blocks and resistances, be they physical, emotional or whatever-there is only incredible joy, pleasure and bliss.

Ingrid Bauer is a writer, speaker and natural child-rearing activist who lives with her partner and 3 children on an island on the West Coast of British Columbia, Canada.

This article was first published in the Instinctive Birth issue of MIDWIFERY TODAY magazine, Winter 2003, #68. It is adapted in part from emails, which originally appeared in 2000 on an unassisted childbirth email list.
Since then, Ingrid has given birth to her third child, a daughter, who was also born quickly, blissfully and unhindered into her hands.

 

More Information & resources dealing with pain management in labor & birth:

Does Childbirth Have To Be Painful?
http://www.unhinderedliving.com/painful.html

See alsoHomebirth, Hypnobirthing, Spiritual Birth, and Waterbirth

Birth Balls : Use of Physical Therapy Balls in Maternity Care
by Paulina Perez

Birth Ball
Birth Ball
65 cm Size is Recommended for BIrth

 

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