Pain, Pleasure, and Birthing

It’s time to get into what’s really on most of our minds about birth. Even if we know about it and understand it. But what about the PAIN?!  I hear that, completely. It’s very valid. This is the only time a woman pushes out something much larger than anyone has ever experienced. Usually anything that goes into a vagina is nowhere NEAR as close to the size of a baby’s head and body. I heard someone recently refer to it as “I felt like I was trying to poop out a watermelon.” (Side note: it’s normal for women to feel like they need to have a bowel movement during the birthing process. The lower colon and rectum are pushed almost completely out of the way so that the baby has room to come through. Of course it feels like poop! Get over any gross-out feelings or shame about that before we go any further. Pooping and bleeding and sometimes vomiting are all a completely normal and sometimes necessary process of birth. You have FULL permission to do whatever is needed without feeling any shame at all. Case closed).

So, with this post, I’d like to discuss the concepts of pain, pleasure, the in betweens, and how it all relates to birth. I’m going to touch on the myths about these themes, the realities and truths, and everything else that leads up to how we came to “know” this about birth. And, yes it can be very painful. It doesn’t need to be as painful as it sometimes is, and that’s why I want to discuss how to work with yourself or your partner or your family member as birth comes into the room.

It is a reality that everyone seems to know birth can be an extremely painful experience for women. However, it is a little known fact that some women in all cultures across the world have practically painless births. How is this so? How can one person experience a physical act as sheer terror and another has the opposite effect. Maybe it’s even orgasmic and like ecstasy. What do we have to learn here?

Plenty.  Ina May Gaskin (one of the nation’s leading midwives, she is a serious bad ass…I dare you to look her up and watch some of her videos). She encourages us to think of birth from a new angle than the norm. The other act that involves sexual organs is of course sex. Sex can be painful or extremely pleasurable and ecstatic. This all depends on the skill and sensitivity of the partners,feelings of safety, readiness, and willingness. Same thing with tampons. I remember feeling extremely uncomfortable (and still do) with the usage of tampons at times. Sometimes I’m still surprised at that because sex can be so pleasurable and full of ease (as long as I’m ready and willing like those above factors point out). These experiences can sometimes depend on how the woman is taking care of her body. How cold it is that day. The speed of the interaction with the vagina. The use of caffeine. Everything comes into consideration here when we’re talking about the female reproductive organs. They are so extremely sensitive. As they should be! What a blessing and gift to this world that women and their experience of sex, birthing, and any interaction with their own sexual organs can teach us all about slowing down, respect, tenderness and deep listening.

About pain and birth. The perception of pain varies greatly from woman to woman. An interesting fact to note is that most women in the United States find it to be a strange concept that they would birth without some form of medication or intervention. In many other countries and cultures, most women do not expect medication and if there is pain, it’s not focused on. It’s seen as part of nature and medical intervention and pain relief are used only when it’s an emergency.

Pain is an interesting thing to examine among human experience. Women seem to think about pain in different ways depending on what we think is the cause. Documentation of midwifery talks about how women go from hell to heaven within a few seconds once they understand and have a realization about how to work with the extremely powerful energy of birth. Of COURSE it is so much easier to feel accepting and understanding of such a challenging physical process when the people in the room are encouraging and supportive. If someone is frightened by labor, it’s going to be painful.

Painless birth. Then there are the women whom have such painless birthing experiences that they don’t realize they’re in labor. They think their cramps are the beginning of labor and suddenly their baby is crowning (when the head begins to show). That can come along with its own complications and feelings of being too fast at times.

Hollywood. What have they taught us? We don’t hear of these cases that have ease as often because Hollywood has informed what we think and feel about birth just like the media largely informs how we think about everything if we are not careful. Our culture’s legacy has taught us that birth is about fear, anger, pain, rushing, absent partners whom the woman is enraged at, babies wrapped up and clean and immediately cutting the umbilical cord, and that the doctor is the hero. Typically, that’s what we see right? Think about the birthing scenes you’ve witnessed on TV and in movies, or about the image you have of birth. Scary birth gets high ratings. It’s dramatic and entertaining and a little traumatizing to watch those scary births…but we can’t look away. It’s like the car wreck. Don’t look, but how can I not look? The problem is that isn’t what real birth is actually like most of the time.

I know I learned all of those things outlined above. Even though I knew a little bit about my birth story, and that most of it involved so much love from both of my parents, I believed the Hollywood version. When I eventually learned about what birth could look like, I felt extreme levels of grief, anger, and shame. When I learned more about my own birth story and that it involved some things that seemed so unfair to my dear parents (and to me too as the little one taking my first birth of air and life), I was shaken. I knew I had to learn more and that I had to educate myself if I were to ever be able to work with this material. In the birthing world or in the psychotherapy world or in my own story if I ever have my own children. It was simply a must.

Safe vs Unsafe. When we feel safe in birth, what happens? Imagine that you’re trying to have a bowel movement. A great example I’ve heard of childbirth educators asking parents is “I’m putting $200 next to this bowl in the middle of the circle. If any of you can come up here and poop in the bowl, you can have the $200.” Who wants to or even may be able to do that? It’s the same premise when we ask a woman to give birth when she’s uncomfortable, not ready, and being monitored by people she may not trust.

Safe.  When we feel 100% safe to go poop (not the office shared bathroom), we usually have privacy, quiet, comfort, cozy, calm environments. For the mama to feel safe, she needs intimacy, supportive people, knowing she is making progress, dilation, positive happy hormones, the feeling of having a voice and informed consent, rhythm, a sense of having all the time in the world, and blood flow to the uterus. Doesn’t that sound fabulous?

(Side note: this above piece is true for the most part. I’m talking about normal, natural childbirth. There will always be situations when things are set up to be easy, and then they are derailed and things get complicated and we need the fancy interventions. And that’s ok. We’re not shooting for a perfect birth here. We’re just shooting for support, love, and safety for all. The cycle of love, ease, and pleasure seems to flow naturally when it’s able. Usually that can happen when people are working together to keep the mama and the baby in the very best interest. Even when interventions are used, there can be complete safety and love. There are so many things we can do to make birth the best possible experience, even when there are hard things that happen. Part of this is giving both parents adequate support and resources. Remember to check any belief that all interventions are evil, they save lives sometimes! The key is sometimes they’re not necessary.)

Unsafe. When we feel unsafe in birth, this is what it might look like: the uterine sphincter (like an opening / closing door from the uterus into the birthing canal) is closed and tight, the body is tense and holding, people are rushing around, adrenaline and stress hormones are high, caregivers are stressed, the moms and the caregivers are in their nervous system that responds to the need to fight / flee / freeze, blood flow goes to the head and the limbs and away from the uterus, uninvited and unwelcome people are in the room, people make harmful and insensitive comments, progress is slowed / stalled, pain sky rockets, an fear / tension / pain form a nasty cycle. That sounds so painful I don’t even like writing about it.

I know I already discussed this safe and unsafe piece in another post, but it’s intertwined with the feelings and experiences of pain in birthing. They simply come together. The point is not to make sure the woman stays in the safe zone all the time. The point is that we notice when she enters the unsafe zone, we help her come back to safety so that she can have periods of resourcing between periods of stress. I love how the woman who trained me as a doula (Katie Wise), made sure that we understood that we are not there to make birth perfect. We are there to support the mama so that she feels as safe as possible, as much as possible, and that she feels she and her support system made all the right decisions. That her wishes and decisions are respected and honored.

Orgasmic Birth. This is when we hit the jackpot. Many women accept or want pain medication before they even know what the experience will be like without meds. There seems to be a lot of surprise when people mention orgasm and birth in the same sentence. For me, it completely makes sense. I’ve heard and read of multiple accounts of women feeling extremely sensual during the process. It can be like love making. (In fact, kissing, eye contact, and nipple stimulation can often help birth be wildly easier). Sure there are highs and lows, during one phase you may feel like you have the nastiest flu. And during another you may feel so high like you’re on the best drug that ever existed.

Birth is sexual. It definitely is. How can we avoid that? The organs that drive us to be sexual, the hormones that are involved, the fact that a baby is coming into the world because there may have been sex involved….all of that says, birth is sexual. Birthing is an extremely sensual process and we must remember that so that all of the woman has permission to be in the room while she does the most extraordinary thing that her body knows how to do. Birth can be a process where the woman can heal past sexual trauma. She gets to reclaim what her body and sexuality mean to her. Whatever women discover about birth, even though there may be some of the most intense and horrible moments, many discover that parts of it can actually feel incredibly good.

Let it be good. There are multiple testimonials in Ina May Gaskin’s book about women having orgasms during birth both in home birth settings and in the hospital. They write of feeling blissfully enhanced with long lasting effects, feelings of power and positivity about themselves and their bodies, feeling very sexual and gratified, and having experiences of their bodies that they had never known before. Some women whom didn’t have a physical orgasm of muscle describe a feeling of euphoria that felt similar to the bliss they experienced with sexual pleasure. That it felt like “the biggest orgasm I’ve ever had, except it wasn’t really an orgasm, it was like a whole body orgasm.”

The Kinds of Pain. Birthing usually hurts at some point, that’s just normal. Yet it’s a different kind of pain than what we are accustomed to. When we’re injured and feel pain the urge it to run or fight, the feeling says “we are being damaged! Get help.” The pain of birthing has a different message. This message is about letting go, surrendering, going with the flow, release feelings of fight, and trust. Once women learn these things, birth usually tends to ease up and progress further. Without knowing this, many women respond in the same way that we do when we’re injured. We sometimes think we need to fix or reduce what’s happening. It sounds counter-intuitive, but what we need is to let it all happen, to work with it, because one way or another, that baby is coming out. Once women are able to change their position, attitude, and maybe the atmosphere of the room calms, things can wildly change. Of course, they usually need help doing this! This is where the birth partner or caregivers come in. The women who do their best to understand how to work with “rushes” or “surges” (nicer words than contractions…contraction just sounds like pain), seem to have the most chance for ease and orgasm at birth.

Pain in the Now vs Pain that Follows. Another thing I hadn’t really considered until recently is that a lot of interventions help women escape pain during birth (it also takes away all feeling, so even if the birth ends in intervention, the baby and the mama get so much benefit from going through as much labor as they can. That can be tough for partners who see their woman in pain and think “Why did she go through all that if this is where we end up? It’s key to remember that the most laboring can happen, it does the baby wonders).

Back on task…What I never heard about was the pain that is experienced by women after birth, that is sometimes a result of the interventions that had saved them just a few hours or days ago. Most women whom give birth with the least amount of interventions necessary, will be finished with the majority of the pain after the baby is born. Often, the women is euphoric, floating on the love hormones. If pain is there it’s usually pushed into the background or even completely forgotten. Women whom experience different interventions usually have more to consider and deal with once the birth has ended. For example, did you know that with an epidural injection, there is a small external fixture inserted into your skin right next to your spinal cord? I definitely didn’t know an epidural came with that! These considerations can be something less time consuming, like having to lie in bed for a day while the feeling in her legs comes back, to recovering from major abdominal surgery where the strongest muscle in her body is cut and stitched up and her abdominal organs get completely moved around and shifted (Cesarean birth). Sometimes women don’t fully know what an intervention is going to be like, and they agree in a heated  moment of intensity. Sometimes there is regret of not fully knowing what it would be. I’m not voting for one way or the other. What I’m voting for is informed consent about every single possible intervention that is offered. I’ll spend another entire post about interventions, what they actually look like, the effects they could have on mother and baby, and how to weigh the priorities of decision making.

The last thing: Pain and Suffering. Penny Simkin is one of the nation’s leading doulas and educators about birth support. She describes pain as being something that can’t be helped and will usually change (doesn’t last in the exact same way). She describes what most women describe as their worst fear being not about the actual physical pain, but that they will be overwhelmed, helpless, out of control, and beyond their limits / acting in a shameful way. This is a fear of suffering and we can get lost in the thought loop about it all. We all know if we expect and know that something is going to happen, it has a way better chance of happening. Sometimes we are our own self fulfilling prophecies in the birth room. We fear something and it’s so big in our mind, that it ends up being what happens. This is why some birth professionals recommend that moms work with a therapist to fully investigate her biggest fears, why they exist, and how to work with it. We all have different triggers and fears. Some women cross the line from pain into suffering when they get exhausted or they feel something has interfered with their confidence or their way of coping. If a woman is in a situation where she’s birthing and also dealing with thoughtless caregivers, lack of emotional support, rigid boundaries and rules, and complications, of course she may begin to suffer. We all would. If a woman understands her pain, feels nurtured and encouraged, and have people whom are confident in her while giving her space to move around, she may feel mastery and a sense of well being as she responds to the pain. Instead of suffering, she begins to cope. There are so many coping techniques to learn if you’re supporting a birthing mama. I highly encourage you to do some reading or get the services of a doula if you’re interested in using extra techniques that help coping occur. Some short term suggestions are acupressure, massage, rhythmic breathing, sound making, changing movements and positions, hypnosis and other relaxation techniques. There is a plethora of information available. And one thing to NOT do: DO NOT read “What to Expect When You’re Expecting”. I haven’t even read it, but I’ve heard multiple trusted sources say that everyone knows about it, but it’s a book that promotes fear and blows things way out of proportion. That it takes all the joy and beauty out of the full spectrum of pregnancy, birthing, and early parenthood. So, cross that off your list.

Resources: Check out “The Birth Partner” by Penny Simkin for all the tips you could ever want. If you’re looking for a more narrative type read, try one of Ina May’s books (one of my favorites is “Ina May’s Guide to Childbirth.” If you’re looking for a doula, you can google doula matching internet services or try these people if you’re in Colorado: Lisa Waldo, Boulder Doula Circle, The Family Garden, Kate Sessions, The Birthing Assistants of Boulder, and multiple other doula groups / networks that are tailored specifically toward helping you figure out how you want to deal with the process of labor and birthing.

Thank you for your presence here, in my next post I’ll keep delving into some of the major tenets to know about working with the birthing process. I’m taking it step by step and doing my best (in a world where there is SO much to learn), to keep it digestible, pepper in more information as it feels appropriate and helpful, while also covering all the big topics so that you can further your education as you feel sparked and interest. Until next time, warmth and love, Alicia


About Alicia Patterson

Alicia Patterson is a Psychotherapist / Dance Movement Therapist, Birth Doula, Bodyworker / Energy Medicine Practitioner, Dance and Yoga Facilitator in the Boulder / Denver area.
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