At the final meeting of my childbirth preparation course, the instructor finally broached the subject of labor pain relief. It was a topic that, up until that point, had not been discussed with much gusto. Even then, in the eleventh hour of the class, all I heard were words like "trust," "empowerment" and "self-confidence." Was this a scout meeting? Trust, empowerment and self-confidence are not anesthetics.
I was pregnant for the first time at 37. Having coped with Motrin-defying menstrual cramps since adolescence, I felt I had a reasonable pain threshold. But as my due date approached, I grew increasingly concerned about the physical experience that awaited me. I wanted more concrete information about how painful childbirth would be. I kept hearing a response from my caregivers that was vague and patronizing: "Childbirth is different for everyone."
Surely they were kidding? After several thousand years of women bringing forth life, that's all we know about the experience? Is it really so different for everyone that no general body of knowledge exists that could tell me more explicitly how much pain I was most likely going to experience? I honestly wanted to know. Generally speaking? I wondered why my teachers were talking about good pain rather than good pain relief.
For most women?
My good friend Maureen, a nurse jaded by years of treating patients in pain, reluctantly gave in to my plea to describe exactly how labor felt. She told me that until she was given an epidural, her labor felt like "a living hell." Darkly, she repeated "a living hell," then caught herself and said, "I hope that doesn't scare you." Noooo, don't be silly.
Meanwhile, my birthing teacher and all the books I'd picked up (including the popular Easing Your Labor, by Adrienne Lieberman, and the ubiquitous Natural Childbirth The Bradley Way,which came out in 1984 and was revised in 1996) insisted labor pain was "good pain." In the chapter titled "The Myth of the Painless Birth," Lieberman attempts to persuade her pregnant readers that "the experience of pain may actually help you to feel a deeper pleasure." She concludes, "with adequate preparation for childbirth, you can give up the self-indulgent and disappointing fantasy that your labor should be painless and replace it with a more realistic and ultimately more rewarding commitment to working with your pain." (italics hers)
This claim by the experts that women become better people, possibly even better mothers, for having successfully given birth without the benefit of medical pain relief, led me to wonder what excruciating physical challenge my husband should triumph over to become a superior father — and would I get to choose?
Even before my own difficult labor, the attempt to reframe the pain of childbirth as "good pain" struck me as a bit of a sham. I found myself wondering why my teachers were talking about good pain rather than good pain relief. What had been overlooked was how to deal with the type of pain I would rather live (and birth) without, and that was: any type of pain. I was skeptical that the distinction between pains would still be important to me when my uterus began contracting.
Marci Lobel, Ph.D., director of the Stony Brook Pregnancy Project at Stony Brook University, says, "Popular books written for pregnant women may overstate the effectiveness of childbirth preparation in reducing pain." Glossing over the severity and intensity of labor pain, and emphasizing the use of non-medical forms of pain management such as breathing and relaxation techniques (the cornerstone of most childbirth preparation methods) leads women to underestimate the pain involved in childbirth, and to overestimate their own ability to cope with it without the help of modern medicine.
In the early 1980s, a Canadian researcher, Dr. Ronald Melzack, and his team from McGill University, conducted studies that attempted to measure the pain level of women in labor. Using a pain-measurement scale called the McGill Pain Questionnaire (MPQ) to assess the nature and intensity of labor pain in first-time mothers, You begin to understand why euphemisms are popular among childbirth professionals.the researchers found that labor pain was rated as "severe" by 30 percent of the mothers, and 38 percent of the group rated their labor pain as "very severe." Add to this the 28 percent of laboring first-time mothers who chose the words "horrible" or "excruciating" to describe their pain, and you begin to understand why euphemisms are popular among childbirth professionals.
More than 2.5 million of the 4 million of us who give birth each year in the U.S. opt for an epidural, so why was it assumed in my class that the goal was to attempt to cope with as much pain as possible for as long as possible, rather than to eliminate the pain as soon as possible through the use of modern medicine? I was puzzled by the fact that, at the world-renowned teaching hospital where I was to give birth, modern medicine was presented merely as a backup to non-medical techniques.