Two different news stories about the pain of childbirth recently caught my attention. The first was a story about a well-known accused criminal serving time in jail. His lawyers are asking that he be freed to get proper medical care for his kidney stones. “It is common knowledge that the pain associated with kidney stones is worse than childbirth,” wrote his lawyers in papers filed with the court. To back up their claim, the lawyers sent the judge a link to a website in which women who have experienced both support the lawyers’ assertion. One woman wrote, “Childbirth has nothing on kidney stones. When you are in labor the pain is like a wave. With a kidney stone it is constant. I would have 10 births before ever wanting to go through the pain of a stone.” Although I found it interesting that childbirth was the standard against which the pain of kidney stones was measured, I think our culture in general doesn’t “get” the role of pain in birth.

Labor pain is unique. It is part of a normal, physiological process rather than associated with injury or disease. It is protective and instructive. Laboring women seek a safe environment and helpful companionship for birth. When free to move and respond to the pain of contractions, women most often choose positions and movements that not only increase comfort, but also promote labor progress. It is important to discuss the differences between normal labor pain and pain associated with pathology in childbirth classes. If asked, students will usually come up with those differences themselves – that the pain starts out slowly and over time builds; that there are breaks between the painful contractions; that women perceive the pain differently; and most importantly, that labor pain is pain with a purpose. At the end, the result is a mother holding her new baby in her arms. 

Along a similar vein, Dr. Denis Walsh in the UK is getting headlines for his recommendation that more women forgo epidural analgesia in favor of unmedicated birth.  Here you can listen to an interesting debate between Dr. Walsh and Dr. Maggie Blott on whether birth should be painful. Dr. Walsh cites the mother’s opportunity to experience birth as a rite of passage and strengthened bonding with the baby as benefits of natural birth. For many women, working through the pain of labor is an invaluable rite of passage. In addition to the joy of meeting their newborns at birth, they experience exhilaration at having “conquered” the pain of labor much as mountain climbers revel in having reached the summit. Endorphins, which contribute to this exhilaration, are an important part of the “hormonal cocktail” that promotes mothering behaviors. Research is telling us that many medical interventions such as epidural analgesia interfere with the hormonal orchestration of labor and birth. Dr. Sarah Buckley has written extensively on this subject, especially in her article, Ecstatic Birth. 

Dr. Walsh calls for women to rely more on natural methods of pain relief such as yoga, hypnosis, massage, and birthing pools. In addition to a thoughtful discussion on the role of pain in birth, childbirth educators need to spend time in class presenting and practicing nonpharmacologic pain strategies. Pregnant women need to understand better the role of pain during labor and birth and effective ways to deal with it.