Really Teaching Lamaze: The Power of Pain

Abstract

In response to a reader's question, this column discusses the benefits and uses of pain to facilitate childbirth. Childbirth educators are urged to help women understand pain, so that they may work with pain and appreciate the role it plays in providing them with the inner wisdom to give birth.

Question:The women in my Lamaze classes want to learn what to expect in labor and a few coping strategies, but they have no interest in experiencing birth. A typical question is “Why feel pain when I can have an epidural?” Discussing the potential risks of medications and/or joys of natural childbirth does not seem to influence their choices. How can I prepare women for the pain of labor without reinforcing their decision to avoid pain at all cost?

Answer: The dilemma of pain is at the heart of a common misconception about the goal of Lamaze preparation for birth. Historically, Lamaze breathing and effleurage were substitutes for the drugs responsible for women experiencing labor in a fog and giving birth anesthetized. Actually, learning a variety of ways to cope with the pain of labor continues to be an important part of Lamaze preparation. Therefore, we should not be surprised that most women come to classes thinking Lamaze is simply a way to reduce the pain involved in childbirth. If the goal of Lamaze is to eliminate pain in labor, the epidural certainly “works” better. But Lamaze is not simply techniques to eliminate pain. Lamaze prepares women to trust their inherent ability to give birth and to begin to understand that pain, while a fact of birth (and life), is meant neither to be eliminated nor endured. If women are to have confidence in their ability to give birth and to trust their inner wisdom, we all need to have a better understanding of pain and its important role in childbirth.

If women are to have confidence in their ability to give birth and to trust their inner wisdom, we all need to have a better understanding of pain and its important role in childbirth.

The pain of labor and birth is a paradox. Strong, powerful contractions hurt, yet the stronger and more powerful the contractions, the more effective and efficient labor is likely to be. Often, we think of pain as “bad,” but the pain of labor is expected, predictable, and so much a part of the natural process of birth that it is considered normal. Thinking of the pain of labor and birth as “good” is difficult to understand because it is contrary to our way of thinking. It is paradoxical. Pain, whenever we experience it, is always an important message given simply and directly by our bodies. The message of pain—whether from a too tight shoe, a too hot platter, or tense shoulders—demands response. We remove the shoe, pull our hand off the platter, or massage the tension away. Our response to pain, often without even thinking, stops or eases the pain and in doing so solves the “problem.” Without pain, we lose a vital way by which our bodies protect themselves. The pain of labor is not simply an unpleasant side effect of the stretching cervix, contracting uterus, and descending baby; feeling the pain and then responding to it has the power to actually facilitate the process of labor and birth.

Unrestrained by fetal monitors, intravenous devices, and confinement to bed, women respond by changing position, rocking, walking, rubbing, massaging, and moaning. There is no prescribed way in which movement in labor unfolds. Women try any number of things, eventually figuring out what works best. And as women get comfortable, try to feel better, and actively “do something,” their contractions gain strength, the cervix stretches, and the baby settles into the pelvis, rotates, descends through the birth canal, and is born. Focused awareness, responding to what she is feeling, and finding a rhythm evolve as the woman experiences the pain of her labor. Knowing what to do, often without thinking about it, is inner wisdom at its best. These women are not suffering, not passively enduring pain; they are on a personal journey only they can take. Their pain guides them in their journey.

Sheila Kitzinger tells the story of her daughter's water birth: The baby's head emerges and startles everyone (except the mother) with its size. Surprise turns to alarm as the shoulders appear to be stuck. No one says anything, but worry is clear. And without hesitation, responding only to what she is feeling, knowing nothing of the potential crisis, this wise woman gets on her knees and leans forward, and her baby is born effortlessly. One of my most vivid memories of my daughter's labor is frantically trying to comfort her while the Jacuzzi was slowly filling. She had already labored 10 hours with her baby in posterior position at –2 station. Fatigue was taking its toll. She climbed into the partially filled tub and restlessly moved forward and back on her knees while holding on to the edge of the tub. Mary moved rhythmically, in a daze, ignoring suggestions from her husband and me. In those moments, her baby rotated, and labor flew—another example of the power of pain and inner wisdom.

Pain management takes on a different look from this perspective. Our teaching communicates the value and power of pain. We teach women to respond to pain in ways that are likely to facilitate labor. It is still very important to learn a variety of coping strategies and comfort measures for labor; however, the goal is not pain reduction per se but using pain as a guide while women move through labor. Women need to understand that the comfort measures they use and the ways they use them depend on what they are feeling, on what feels right, and that requires listening to the messages—including pain—their bodies give.

We teach women to respond to pain in ways that are likely to facilitate labor.

Over and over, we have to emphasize, “You know how to give birth. You know just what to do.” Birth stories are a powerful way to build confidence. And stories of everyday pain and responses to that pain—coping and comfort that do not need to be learned from a book or a class—help women begin to believe they have what it takes to get through labor. Reinforce the message with pictures, slides, and videos that depict women as strong, capable, fully experiencing labor, and responding to—not enduring—pain. (Epic Women, a slide series by Harriet Hartigan, is just one example you might consider using in your classes.)

Anything that interferes with a woman's ability to experience her contractions or to respond to them in a variety of ways has the potential of interfering with the progress of labor. With this in mind, you should devote class time to helping women make plans for ensuring that the environment in which they labor is the least restrictive possible. For many women, this may mean spending much of labor at home, surrounded by family and friends who are not afraid of providing love and encouragement as they meet the challenges—including pain—of their birth journey.

Over and over, we must emphasize, “You know how to give birth. You know just what to do.”