Monday, March 1, 2010
BY DONNA NITZBERG
If Ben Franklin had been born a woman, his famous line about death and taxes would no doubt be different. The only thing certain in life, aside from death, he might have said, is the pain of childbirth.
Which of course begs the question of why something as wonderful as childbirth has to feel so terrible? So consistently? And what is it about this pain, this universal female pain, that has caused women to quake in their boots; or to welcome, even relish, it; or to foment political ideas, communities, and divides; or to inspire great works of art (as well as some lesser efforts, like the odd magazine column)?
We spoke with a few experts – an obstetrician, a doctor who takes a holistic approach to women’s health issues, two anesthesiologists, a doula and a few recent moms – about the causes, qualities, remedies and effects of pain during labor and delivery. Not surprisingly, there are a wide range of ideas and opinions. And while almost every woman wants to minimize the pain, there is a divide about whether to use pharmaceutical pain relief, something that between 70 and 95 percent of women in our area employ, or to rely exclusively on non-medical techniques, the preference of a much smaller but passionate group of moms.
For the purposes of this story, we will refer to births without pain relief medication as “natural childbirth,” although, as Dr. Naomi Greenblatt, medical director of the Rocking Chair, a holistic health center for women in Englewood, points out one should use that term lightly, because all births are, in fact, natural.
And while most believe that labor pain serves a distinct purpose in the birth process, not everyone thinks it’s inevitable. Dr. Mark D. Schlesinger, chairman of the department of anesthesiology at Hackensack University Medical Center, is safely in the death and taxes camp: “In today’s modern world of anesthesia, childbirth does not have to be a painful process.”
Where does the pain in labor and delivery come from? There are a variety of sources, of course, including an awkwardly positioned little body pressing on mom’s spinal nerves, the great exertion of pushing baby out and the tearing of tissue as baby emerges. But the most common and ubiquitous pain, known as labor pain, comes from the process of the uterine contracting and the cervix stretching.
“Basically the (hormone) oxytocin causes uterine contractions, similar to when you have your period and the muscle of the uterus contracts,” says Dr. Efrat Meier-Ginsberg, an obstetrician with a practice in Bergenfield.
These contractions then signal nerve fibers that follow a pathway from the uterus and cervix to the spinal cord and brain, where they are perceived as pain. It usually starts out feeling like strong menstrual cramps and then gets progressively more severe, she adds.
In addition to the physical sources of pain, anxiety and stress generally amplify the agony, while relaxation can quiet things down.
“Pain is an issue of perception,” notes Schlesinger, “so the psychological state of an individual will effect what they think of the pain.”
One important way that perception influences pain is through expectations. And with childbirth, expectations are incredibly fraught.
“There are many things that people bring with them into labor and delivery, a lot of phobias and a lot of dreams. Just like you have a dream of your wedding day, a lot of people have a certain image of their delivery day,” notes Meier-Ginsberg, who says she always tries to accommodate her patients as much as she can, delivering babies with and without the use of pain medication.
Overall, it’s important for a pregnant woman’s image of an upcoming birth to line up with reality, say almost all of our experts. Someone who is expecting to be able to easily fly through labor and delivery but encounters problems instead, is likely to rate the level of pain as more intense than they might otherwise.
Tara Harkins, a mother of two from Oradell admits to having high expectations for her first birth and was very disappointed in the experience overall. She says, with an embarrassed chuckle, that she was anticipating an easy delivery because that was her mother’s experience. She was thus hoping to avoid pain medication altogether. But when her water broke and the contractions started off at a crescendo, she realized that that wasn’t going to happen.
“The pain was so bad, that I initially couldn’t progress without starting off with some kind of drug,” she says. Harkins found, however, that the narcotic she was given early on in her labor affected her so strongly that she felt she had lost control.
“It took on a life of its own,” she says. Disappointed, she vowed to be more prepared and proactive for her second child’s birth.
In contrast, Ginger Brown Monplaisir, a mother of three and a dance/movement therapist from Ridgewood, says she was very scared and apprehensive before the birth of her first child, but was pleasantly surprised with a fast and easy labor. She did not end up using any pain medicine. Even though the pain was “pretty excruciating in the end,” she says. “It was empowering.”
Brown Monplaisir gave birth to two of her children without medication, embracing the pain and feeling in control overall. “I had such positive experiences giving birth, that honestly, that’s part of why I pursued having a third child.”