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Fear, surrender and transformation in birth.

Pain in childbirth, like emotional pain, is an opportunity to understand ourselves better, to gain insight, to call forth the vast sources of courage, strength, and stamina inside ourselves. Giving birth has the potential to alter who we perceive ourselves to be, and what we believe is possible for us to do and become. Yet ours is a society in denial of pain, both psychological and physical. Our medical system exemplifies this by treating symptoms with medication instead of trying to find the causes of pain (or lack of progress in birth). In Chinese medicine, the opposite is true.

Pain is something that women experience very differently. Could it be that a pregnant woman's attitude and preparation going into birth affect how she feels about the experience afterwards? Clarifying values, making informed decisions based on knowledge of all the options, and preparing psychologically can make the difference between a positive and negative experience. Our own attitudes may in turn affect the next generation's experiences, just as our mother's may have influenced ours.

Why do so many American women regard pregnancy as a nuisance and birth as a painful ordeal? Do our attitudes about birth reflect our subconscious and conscious feelings about our bodies, our sexuality, the messages we received from our mothers and the values of the culture? Many pregnant women fear the pain of childbirth and losing control over their bodies. Danielle Crittenden, in her article in The Wall Street Journal referred to the fetus growing inside her in parasitic terms: "feed[ing] off and distort[ing] her figure..." as if the miracle of new life was instead a cancer.(1)

Why do so many of us fear the natural process our bodies are designed to do? We shouldn't underestimate the influence of attitudes regarding birth passed down to us from our mothers and grandmothers, many of whom were victims of a terrifying, painful ordeal which they entered into without adequate education and were made to endure alone, without the loving support of their husbands or mothers. The resulting legacy of fear has been imprinted upon us. Actually, it has only been in the last 15 years of so that it has become common practice for men to go into the delivery room and be a partner in the birth process. When I mentioned to my 87 year old grandfather that my husband was present when both our children were born, my grandfather found this incomprehensible and said he would be "embarrassed" to share such an intimate moment with his spouse. It simply wasn't done in his day. Historically, birth was a mysterious female rite of passage whose secrets were forbidden to men.

Have American women fallen prey to the barrage of advertising which places so much more emphasis on women's appearances than their accomplishments? Advertising seeks to convince women that their bodies are never "good enough" (and they need their products to make them better), so it is not surprising that in a culture where most women regard their bodies as inadequate, women have lost trust in their ability to give birth naturally. Furthermore, the depiction of birth on television and in movies does not contribute to positive attitudes about birth. In preparing for her labor, a women may want to think about how the media and her family have influenced her altitudes and feelings about giving birth.

Next to pain, the biggest fear women have about birth is losing control. Yet ease in childbirth requires the woman to have the courage to trust and surrender. The contemporary woman has often had to be very much "in control" to gain respect in the workplace. Now she must surrender to a force of nature over which she has little control. For some women, this prospect is terrifying. Danielle Crittenden, in the afore mentioned article, wrote that she wanted to be "knocked out by a truck" during her labor, preferring to watch TV and "feel absolutely nothing," rather than experience childbirth. It is a paradox: the woman who in birth surrenders, demonstrates strength, courage and trust, not weakness! Furthermore, having discovered that she was able to go beyond what she perceived were her limitations during labor, as a new mother she draws strength from her birth experience when she is confronted with the challenges of parenting a demanding baby.

How can a woman prepare for birth and make the process an enriching, validating experience? Pregnancy is the time to explore her values and figure out what she wants her birth to be like, to ready herself psychologically. She may want to ask herself, "What do I need in order to feel safe?" Is it having a special friend present or a professional labor partner? Is it knowing the neonatal unit is down the hall? Another valuable question to ask is, "What is the hardest challenge I ever accomplished and in what ways did I cope?" Did she tough it out alone, focused and determined, of did she need a lot of encouragement and praise? By understanding how she deals with stress and how she is best supported, she can prepare for her birth experience.

A recent study by Drs. Kennell and Klaus of continuous labor support at a hospital showed that laboring women who had a female labor companion had shorter labors, fewer medical procedures, and fewer complications and cesarean surgeries than those who labored alone.(2) It is important for the pregnant woman to take control of the circumstances by educating herself on the issues and making congruent choices. Having done so, she can feel safe enough to relax during labor. Because while she can control where and with whom to have the baby, she cannot have complete control over the process of her labor. "Letting go" can be very terrifying unless she has confidence that her caregivers and labor companions support her desires. With psychological preparation, and by using various techniques, (which can be learned in a birth preparation class), a woman can trust that her body knows how to give birth, but feeling safe, encouraged, and supported is essential.

Giving birth can be the most empowering experience of a woman's life or it can be the most devastating. Like all of life, it is what she makes it. For the woman who doesn't realize she has a right to be informed and to make her own decisions, birth can be a horrific ordeal. On the other hand, by choosing a birthing environment which will allow her to give birth the way she wants to, with caregivers whom she trusts, and by discussing fears and practicing relaxation methods in a birth preparation class, the experience of birth can be the most powerful one of her life!

Each birthing woman needs to feel nurtured emotionally and physically. For one woman, her fears may be allayed knowing that in the hospital the most advanced technology and pain-relieving drugs are available, and she may feel more comfortable with an obstetrician than a midwife. For another woman, the hospital environment is too institutional; she can relax better at home in familiar surroundings where she won't have to contend with regulations that prohibit her from eating or drinking in labor and with apparatus which restrict her position or desire to walk, squat, or take a bath. She may feel comforted knowing she can have as many or as few of her friends and family participate in any way she wants.

Polarization regarding birthing practices exists, but there is no "right way" to give birth. Each woman has the right to give birth with whom and where she feels the safest. A childbirth educator can present the expectant mother with the advantages and disadvantages of obstetrical procedures, so she can make an informed choice. The central issue is not "correctness;" rather, it is freedom of choice based on knowledge of standard options and alternatives.

For instance, the epidural anesthetic, which virtually numbs all sensation of the cervix's opening and the baby's descent, is an option for those who want it. Yet the effects on mother and baby must be considered. Likewise the alternative to give birth without pain-relieving drugs, in the hospital or at home, should be accessible to all who are safely able to do so.

Another option some people choose is birth at home with a midwife. Most people believe homebirths are instrinsically more dangerous than birth in the hospital with an obstetrician. Yet hospitals have never been scientifically proven to be the safest places to give birth.(3) David Stewart, Ph.D., in his book, The Five Standards for Safe Childbearing, cites many studies which substantiate this.(4) The idea that birth at home is riskier than at a hospital is based on stories about birth in earlier times. What made these births so dangerous was not that they were delivered by midwives at home, but that pregnant women did not receive prenatal care, had inadequate nutrition (which creates serious complications like diabetes and toxemia), and often had too many babies. Furthermore, as Jessica Mitford describes in The American Way of Birth, women died of post-partum infection spread by the hands of doctors ignorant about aseptic technique.(5) Several studies have shown that midwives delivering babies of "high-risk" women at home under particularly unsanitary conditions had better outcomes than doctors under the same circumstances.(6)

The truth is all births present risks. Women giving birth in the hospital have a higher chance of receiving an infection, as well as a "Pandora's Box" of unnecessary interventions,(7) the so-called "domino-effect" which leads one in four U.S. women to cesarean surgery, which is considerably riskier to the mother than normal vaginal birth.(9) However, in homebirths, the risk is lack of available technology in case of an unexpected outcome during labor, birth, or postpartum. This is why midwives have a doctor "on call" in order to admit the woman and newborn to the hospital if necessary.

Many complications of pregnancy and birth can be prevented, however, by excellent nutrition during pregnancy, diagnosed through prenatal care, and handled by a skillful midwife or doctor. The research shows that planned homebirth with a competent attendant is a safe option for many healthy women.

Regardless of where or how a woman gives birth, it is essential to prepare psychologically and to create a written "Birth Plan" outlining her preferences for labor, delivery and newborn care. It is crucial to find a birth place and attendant who will support her decisions. A childbirth educator or professional birth assistant can be valuable in making these preparations. By becoming educated about her options and making choices before the birth, the woman will feel more in control. Then she can focus and relax during her labor.

Our bodies are designed to give birth and it is our blessed privilege to do so. Yes, birth is painful, but it is not more than we can bear if we are in a supportive and nurturing environment. Birth is a sacred rite of passage into one of the most of passage into one of the most important roles in society: motherhood. Through the process, we have an opportunity for spiritual transformation if we are fully conscious to experience the agony and the ecstacy of bringing forth new life.


(1.) Danielle Crittenden, "Knock Me Out With a Truck," The Wall Street Journal, Nov. 6, 1992.

(2.) Kennell & Klaus, "Continuous Emotional Support During Labor at a U.S. Hospital," JAMA 265(17) (May 1991).

(3.) Adamson & Gate, "Home or Hospital Births?," JAMA 243(17) (May 2, 1980): 1732-1736.

N. Devitt, "The Transfer from Home to Hospital Birth, U.S.A.," JAMA 4(2)(1977): 47-58.

(4.) David L. Stewart, The Five Standards for Safe Childbearing, (Marble Hill, NC: International Association of Parents and Professionals for Safe Alternatives in Childbirth, 1981), Chapter 6.

(5.) Jessica Mitford, The American Way of Birth, (New York: Penguin, 1992), pp. 29-32.

(6.) Stewart, The Five Standards for Safe Childbearing, pp. 239-240.

(7.) Lewis Mehl et al., "Outcomes of Elective Homebirths: A Series of 1146 Cases," JAMA 19(1977): 281-290.

(8.) International Ceasarean Awareness Network, 1993.

Margaret Blackstone and Tahira Homayin, Recovering From a C-Section, (Conn.: Longmeadoe Press, 1991), p.12.

(9.) ibid.
COPYRIGHT 1993 Association of Labor Assistants & Childbirth Educators
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1993, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:childbirth pain
Author:Hanna, Cordelia Satterfield
Publication:Special Delivery
Date:Jun 22, 1993
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