About Pain and Birth

Ann Cowlin Pregnancy Pathway best practices, childbirth education, exercise, labor, pushing, safe motherhood 0 Comments

This is excerpt­ed from our Danc­ing Thru Preg­nan­cy blog.

That Was Then…

As I became involved in the birthing field, one of the nurse-mid­wives with whom I was acquaint­ed intro­duced me to Jung’s quo­ta­tion: “There is no birth of con­scious­ness with­out pain.” (Alter­nate­ly, “There is no com­ing to con­scious­ness with­out pain.”) It struck a deep chord in me.

When I first saw the say­ing, “There is no birth of con­scious­ness with­out pain,” inter­twined with a draw­ing of a woman lit­er­al­ly giv­ing birth, the truth of the image seemed obvi­ous to me. It become hard-wired into my under­ly­ing assump­tions about giv­ing birth. The process itself com­bines intense nox­ious sen­sa­tions with mid brain emo­tion­al input into what neur­al sci­ence calls pain. For years, this real­iza­tion has dri­ven what and how I teach: Being fit and edu­cat­ed in body/mind are the tools of enlight­en­ment and self-empow­er­ment.

…And This Is Now

A lit­tle while ago I came across a NY Times arti­cle “Prof­it­ing From Pain.” While the arti­cle con­cerns the huge increase in the legit­i­mate opi­oid busi­ness – prod­ucts, sales, hos­pi­tal­iza­tions, legal expens­es and work­place cost – it restart­ed my think­ing about a top­ic fer­ment­ing in my brain between That Was Then And This Is Now: The sense of enti­tle­ment to a pain-free exis­tence. The idea that pain free is bet­ter than painful. And the sell­ing of this idea for prof­it.

Where does this come from? Try­ing to oblit­er­ate pain has led to increased addic­tion, death and oth­er adverse side effects. A new top­ic has shown up in women’s health dis­cus­sions: Increas­ing use and over­dose from pre­scrip­tion pain killers by women, includ­ing dur­ing preg­nan­cy.

Could it be that human fear of pain is being used to gen­er­ate finan­cial prof­it? (the opi­um-is-the-opi­ate-of-the-mass­es mod­el). Per­haps once the notion of pal­lia­tive care reached a cer­tain lev­el of accep­tance for the dying with­in the med­ical com­mu­ni­ty, it began to spill over into oth­er human con­di­tions (the slip­pery-slope mod­el). Or, per­haps we don’t want trans­paren­cy at all (the denial mod­el).

In the last few days, NPR has raised the ques­tion of whether the high cesare­an birth rate is tied to the pay­ment for pro­ce­dure rather than out­come mod­el? The recov­ery from cesare­an is more painful than the recov­ery from vagi­nal birth, has adverse side-effects for moth­er and baby, and was orig­i­nal­ly designed for use only for the 15% +/- of real com­pli­ca­tions that arise in nor­mal birth. So, how is it being sold to 35% of women in the U.S,? At one point, there was a seri­ous dis­cus­sion with­in the med­ical com­mu­ni­ty that if women were afraid of the pain of birth and want­ed a cesare­an, a care provider should do one. No dis­cus­sion of why it seems painful or how to deal with pain.

The Afford­able Care Act aims to improve some of the cost issues in med­ical care by shift­ing the pay­ment incen­tive away from pro­ce­dures and on to out­come assess­ment. As a result, the cesare­an rate and even such seem­ing­ly innocu­ous pro­ce­dures as fetal mon­i­tor­ing are com­ing under scruti­ny. If we tru­ly want to do a ser­vice to the moth­ers-to-be in the ACA tran­si­tion peri­od and beyond, I think we must dis­cuss the ques­tion of birth and pain.

I can think of many ques­tions that fall under this topic…Why do we call the intense phe­nom­e­non of birth “painful”? How do our genet­ics, behav­ior, train­ing and thought-process­es affect our expe­ri­ence of pain? What about the health care cul­ture – has it focused on reliev­ing pain at the expense of what we gain from work­ing with pain short of trau­ma or immi­nent death? How do we pre­pare women for work­ing with sen­sa­tion with­out auto­mat­i­cal­ly label­ing it pain? Is the “empow­er­ment” often attrib­uted to giv­ing birth what is learned by going through the cen­ter of the “there is no birth of con­scious­ness with­out pain” expe­ri­ence? These ques­tions are just a start.

In closing…

Let me address the child­birth edu­ca­tors and preg­nan­cy exer­cise instruc­tors. This is our present chal­lenge. In my work, I feel the neces­si­ty to make all pain man­age­ment strate­gies under­stand­able to my clients. I find that most of the women I see in class­es must deal first with self-dis­cov­ery before they can assess their com­mit­ment to the view of birth they car­ry in their minds. The images of birth we lay out for them to con­sid­er need to include an under­stand­ing that you can­not escape the work of birth. Being present – mind­ful­ness – can be scary and intense but it is the medi­um by which our con­scious­ness expands. Car­dio­vas­cu­lar fit­ness and strength are the source of our endurance and pow­er.