“Labor pain, like all other pain, is a function of the whole person,
and we can go even further than that and say that the
experience of pain in labor is profoundly influenced by the
values of the society in which the woman grew up”
(Marshall H. Klaus, 2012, p. 51).
As a birth doula, I recently arrived at the hospital to meet my client, and we all had a good natured laugh at the above question written on the labor and delivery intake board. Apparently the momma before her had written “Will this hurt?” as her main concern upon admittance into the room. This is the fear that is most often discussed when women talk about childbirth, but what is rarely discussed is if pain and suffering are the same thing. We had a good natured laugh because we had talked in depth about how labor was very likely going to hurt. A lot. That is the truth folks. Birth gurus like to talk in terms of intensity and waves, and while I agree with all that, I have also had four babies. Guess what… at some point you are likely to think, “this hurts!” I want to dig into the difference between pain and suffering, and how to embrace the pain and intensity while simultaneously eliminating the suffering.
A little back story may be in order. I share my personal birth stories to show that I have had a plethora of birth experiences, and I can’t knock any of them. They were all amazing. While some were intense, and some were very painful, the only one where I would say I suffered was the one birth were I had no physical pain. I suffered emotionally. I felt alone, and like I was just another number. I doubt the attendants even knew my name. On the other hand, the births with intense pain came with intense support and love. Although I would say it was incredibly painful at times, I would never describe it as suffering. It was powerful, and hard, and raw, but I was never alone. I wasn’t scared. I knew I had help, and as a result, I didn’t suffer with the pain.
So what do I think about pain and suffering as a doula?
One of the benefits of having a doula is that I am ok with labor being hard. I am even comfortable with your labor being painful. I work to make it manageable, and I help mothers cope, but I don’t feel the need to save you from your birth experience. It is hard work, and there are definitely times where that hard work can look a lot like pain, but that is just how the body is designed to work to get a baby out. What I am not ok with is suffering, and knowing the difference between pain and suffering is key. Pain itself isn’t usually traumatizing to a laboring mother. It’s the lack of support that comes with the pain that can cause suffering. According to The Labor Progress Handbook, “It is not pain, but an inability to cope with pain that is the root of concern” (Ancheta, 2011). That is where the trauma starts. That is where we need to be wise, and offer interventions to help a mother cope when necessary.
Thinking back over when pain is discussed, it is usually in reference to an injury or illness. When I think of pain, I think of things like stubbing my toe, breaking a bone, or running a marathon. Those things are painful. They hurt because it’s our bodies’ way of telling us that we have injured ourselves, and we need to attend to the injury or stop it from progressing. We are wired to interpret pain as “I am in danger!” Pain is subjective, so oftentimes the medical providers will ask us to rate our current level of pain. I have noticed that the pain scale is often present as- “0-10; 10 being childbirth”. It is no wonder that people fear birth when we present it as a level 10; the most pain a person can be in. The problem with this is that when we talk about pain in birth, we often fail to mention having support, ways to make it more manageable, endorphins, water, breaks between contractions, and options available to moms. Maybe if we reworded how we talk about birth, women wouldn’t go into labor expecting it to be the worst thing ever. What we need is for more mothers to talk openly and honestly about how amazing their birth was; how hard or painful it was, but how strong they were. In my experience, these mothers are often quiet because they feel bad about how “manageable” their labor was compared to other mothers who are sharing, but when they stay quiet, the only stories told are the traumatic ones. The only stories heard are the hard and painful ones. Those stories become our expectations, and those expectations become out reality in future births.
We need to tell women the truth; that labor will likely be the hardest thing they’ve ever done, but that doesn’t mean they will necessarily suffer.
It is important to understand pain as a normal part of labor. The pain is a transformational pain, and it is caused by cells changing as the uterus contracts and the cervix thins and opens (Nancy Bardacke, 2012). It is a very different pain than say, a stubbed toe, and when we keep that in the forefront of our mind, labor pain is way less scary. When we normalize labor pain, we can get out of the fear-pain-tension cycle, and move into the relax-rhythm-ritual cycle” (Robert A Bradley, 2008, p. 45) they can increase their ability to cope. When we know that labor pain is normal and healthy, we can not only change how we perceive the pain, we can also reduce or eliminate suffering.
On the other hand, suffering is a psychological pain. It is a state of distress when someone feels helpless, out of control, fearful, panicky, alone, or they are no longer able to cope with the level of pain they are feeling. The standard pain scale tells us an arbitrary number related to pain, but fails to account for how a woman is coping with the pain. It fails to account for if she is suffering. If she is coping well, she doesn’t need any intervention beyond what she is already doing. If on the other hand, we can look at this mother in labor and she is suffering, we know that we need to offer a different intervention with the goal of getting her back into the cycle of the 3R’s (relax-rhythm-ritual). If the laboring woman is still suffering after an increase in emotional and physical support, it may be the time for medical intervention, because no mother should suffer through the birth of her child. Mothers should be able to look back on birth as the most empowering experience of her life, and not as a painful and distressing experience.
The secret about pain and suffering is that they don’t have to occur together. We can work to normalize the pain, while simultaneously working to end the suffering. This is important because “the distinction between pain and suffering is crucial to our understanding of women’s emotional well-being in labor” (Ancheta, 2011). An interesting tidbit is that when asked, most women don’t rate pushing a baby out as the biggest birth fear. It’s not the actual physical pain of crowning that they fear. What they really fear (but often don’t openly talk about) is being left alone and losing control (Koss, 2016). It’s that sense of helplessness that scares women, and that is something we can actually do something about.
How do we stop suffering in labor?
We help women cope with the pain of labor. We help them gain knowledge ahead of time, so that they know that this pain is transformational pain and that it is normal. They don’t need to tense up and fight it, but can relax and allow the cells to move and to change. As providers, we need to support them with unwavering faith in their ability to birth their child. Instead of watching a strip of paper that shows contractions, we watch the mother. We see how she is coping. Is she doing well handling the pain, or does she need more from us? What is her internal dialogue? Where is her mind at? Have we tried water, a heat pack, and different positions? Have we said, “You are doing amazing”? We need to do these things so that moms can embrace the intensity and pain of labor, and know that we won’t stand by and watch them suffer needlessly. We will be there. We will help them to cope, and they will do wonderfully as they bring their babies earth side.
Ancheta, P. S. (2011). The Labor Progress Handbook: Early interventions to prevent and treat dystocia. West Sussex: Wiley- Blackwell. Koss, H. (2016, Feb 6). Advanced Topics of Consideration: PMAD's & the Family, NICU, Attachment, Trauma, and Therapy Techniques. (P. S. Washington, Interviewer) Seattle, WA. Marshall H. Klaus, M. J. (2012). The Doula Book: How a trained labor companion can help you have a shorter, easier, and healthier birth. Boston: Da Capo Press. Nancy Bardacke, C. (2012). MIndful Birthing: training the mind, body, and heart for childbirth and beyond. New York: Harper One. Robert A Bradley, M. (2008). Husband Coached Childbirth. Sherman Oaks: Bantam Books.