Pain in childbirth - can anyone help me with my thinking around this?

[SomersetBelle]

I gave birth 18 months ago and it was the most horrifically painful experience of my life so far.

I think about the birth a lot, and wonder why on earth I was so determined to go without pain relief.

I am also more and more aware of the inequalities and pure horror associated with childbirth around the world. There was a picture of a maternity ward in Manila in the paper today which made me feel so angry.

I am a feminist but not a very well read one. I am learning so much from the posters and threads on here and was hoping someone could help me advance my thinking around childbirth to help me articulate my feelings. Can feminist theory help me?

Agree with so many posts here. Yes, sakura also like men becoming experts on childcare and infant feeding in the Victorian era. Heartbreaking the advice they gave out to women on how to raise their babies. Newborns deprived of food and cuddles in order to build character.

I think we're still feeling the repercussions of that now with so many of us turning to experts to tell us how to raise our children, we no longer rely on our instincts or advice from others who have been through it. 200 year old guidance from male doctors is handed down from generation to generation.

Agree that women are reclaiming childbirth and that medicine doesn't like it. Look at the BMJ article on the safety of homebirth which was proved to be flawed and yet they still wouldn't retract it. Then on the basis of the article, it started a discussion that some women should be forced to birth in hospitals for the good of their baby.

I don't know a single mother, whether giving birth at home, hospital or unassisted who isn't trying to do the best for her baby. To talk about taking away that choice makes my blood boil.

SOH I agree, I have spoken to someone who holds the same belief - you didn't visualise hard enough for a positive outcome. It baffles me. There is only so much influence anyone has over their labour, to an extent we have to deal with the hand we're dealt and it may not always be what we wanted.

Blaming women for how their birth turned out, I often think, is just part of trying to make money out of selling your own technique for great birth and then when it doesn't work - blame the woman for not trying hard enough.

Women tend to blame themselves enough after having a EMCS or forceps etc without having it piled on by experts. It affects them greatly and is also one of my huge bugbears.

Hope your experience was better.

Great birth? I'll take the credit.

Bad birth? You didn't try hard enough.

Nothing empowering about either of those messages.

Certainly most of the advocates of drug-free birth have been men. Grantly Dick-Read wrote 'Childbirth Without Fear' and was the founder of the Natural Childbirth Trust (as it was originally called). Frederick LeBoyer wrote 'Birth Without Violence' - advocating water birth. Dr Fernand Lamaze developed the Lamaze technique, advocating breathing techniques to aid labour. Michel Odent is probably the most prominent current obstetrician advocating natural childbirth - he regularly pops up complaining that having fathers at the birth doesn't help women. (Interestingly, those last three are all French, and France - I think - has a much higher rate of intervention than the UK).

But there are also strong women advocates - Ina May Gaskin in the States for example.

Another fascinating book I read was 'Birth' by Tina Cassidy, which described how our evolution as human beings (bigger brains, standing upright) had led to a childbirth process which was difficult and painful, unlike less evolved animals who were still suited to it.

There was quite an upsetting thread on MN recently (can't remember the title or even what forum it was on) where women shared their experiences of painful births and being denied pain relief and there was a palpable sense of anger from some women that the experience of pain during childbirth was somehow downgraded and treated as less deserving of treatment than other kinds of pain - the relief of pain is a priority in operations and other procedures but treated as a natural part of the process in childbirth - and women just have to suck it up.

This is an interesting topic for me. I'm just getting down some stuff I know, but will probably return later with a bit more about how I feel........

... exactly, the blame is terrible - as PH says everyone's experience is different (in fact my two birth experiences were wildly different).

It has to be about supporting choices and the process of labouring and not making women feel guilty about their choices. ... better painrelief is always welcome as an addition to my menu of choices though!

Hmm, I believe in personnal choice. If you don't want pain relief fine... if you do fine. I was taught that pain relief was administered by women to help women (Willow Bark tea) donkeys years ago - until the Catholic Church decided pain in childbirth was punishment for the original sin committed by Eve and murdered all the wise women and Midwives of the day.

I agree most medics (male and female) and also a lot of MWs are not aware of the trauma of a birth overmedicalised for the sake of it (and avoiding be sued).

Women who want pain relief are routinely denied it (how inhumane is that) and forced to labour on their backs in stirrups in the UK today - horrific unnecessary pain for the woman. That is showing hatred to women, not devising a way of eleviating the pain if a woman chooses it.

Pain relief with drugs will always have side effects, so long as these are clearly communicated with an educated decision by the woman going through the labour why does anyone comment.

By the way I have never ever seen a man sneer at a woman who used pain relief or needed a CS - but I have seen plently of women do so.

Katiebeau This>> That is showing hatred to women, not devising a way of eleviating the pain if a woman chooses it

I think you're right and also the way women are spoken to in labour. If you watch OBEM you can see how disrespectfully some of the women are spoken to, like they are children.

When I had DD I had pethidine which I found dreadful, made me spaced out but still in pain but unable to move to soothe myself. My waters broke and I slurred at the midwife to tell her. She told me to go to the toilet to check. I tried to get out of the bed to check but couldn't move. She snapped at me "can you not just put one foot in front of the other?".

I would never speak to someone like that, never in my professional life and especially not to someone as vulnerable as a woman in labour.

Possibly only rivalled by the way some HCPs speak to the elderly.

Oooh - this thread moved on while I was typing out my last post.

I found my first labour traumatically painful (although mercifully brief) and I get a bit teary when I think about the prospect of my second (due in late November). I don't think I could have been better prepared for labour (see my reading list, above ) but I was still unprepared for the amount and type of pain that I experienced. And I really do think that it's IMPOSSIBLE to theorise about pain management in childbirth if you haven't experienced it.

You can doubtless do a lot of interesting research and make detailed observations, and become more experienced at the practice of delivery, but you CANNOT make pronouncements about appropriate pain relief in childbirth if you haven't experienced it. You simply don't know.

And - also - everyone's experience is personal. I don't know if it's possible to measure pain (I don;t think so ) but even if two people experience the same level of pain, their response to it will still be different. Therefore, blanket pronouncements on appropriate amounts of pain relief in childbirth are completely misplaced.

There should be appropriate pain relief available at every stage of labour, administerable at the woman's request, without judgement or pressure.

And I agree with whoever said that the lack of research and progress into childbirth pain relief is indicative of general attitudes towards it.

Dirgeinvegas - some of those MWs from OBEM must surely cringe watching back how they speak to and treat women!! One poor woman was begging for pain relief, told it was too early then soon after she was at 10 cms.

Recent family experience of someone totally denied any pain relief (not even gas and air), uncomplicated, not too long labour, forced to labour on her back in stirrups for FS!!! I was so angry for her and she didn't twig that was 1970's shit practice.

Where does Balaskas and the Active Birth movement fit into this?

Balaskas did a great job in fighting for women to be allowed to birth in positions not on their back and this does happen now but in reality, I suspect most women do.

The bed dominates the room, women are encouraged to push lying on their back and holding their thighs. If I know that this position is shit for pushing out a baby then so do trained MW & obstetricians. But a woman birthing on the floor on all fours is harder to observe than a woman on her back on a bed. Sod how much extra pain she feels in this position and the complications which can come with it.

I had a friend who wanted to birth on her knees, leaning over the head of the bed and was told she wasn't allowed by a MW at a hospital in Yorkshire. She'd arrived fully dilated, ready for the second stage and was still denied a choice in birth position for no good reason.

Katie my sister had a similar experience. Was told she wasn't allowed pain relief because she was coping well without it. She told them she really wasn't but they insisted she was fine. Horrific to go through that experience and feel like your feelings aren't being validated and that someone knows your body better than you do. She has refused to consider having more children because she found birth so traumatic.

I think the issue is that there are two conflicting paths for feminism to take on this issue. Firstly, I think it's absolutely true that male obstetricians took over from female MWs and imposed medicalised delivery to suit themselves - stirrups, lying on our backs, etc. and women absolutely should be reclaiming childbirth as their own individual experience and be able to dictate how they want it to proceed.

But, unfortunately, there are too many finger-waggers telling us what we SHOULD want, to the extent that there is almost as much orthodoxy in the other direction - pain-free home births etc. Genuine clear sightedness about the kind of birth you want is almost impossible, certainly for a first delivery when you really don't know what to expect.

So we should be advocating for pain relief in labour to be taken seriously, but unfortunately, this can often be see to conflict with the movement to de-medicalise childbirth.

Just to clarify my last post - because I think that the reference to 'finger-wagging' might be seen as derogatory. I think that the natural birth movement has become a rival orthodoxy (led by men, as demonstrated by my initial post), which leads to women feeling that they have to have a birth which is either/or. And chances are that the HCPs looking after you will be on one 'side' or the other, leaving you feeling disempowered if you want something different.

Treats you sum up brilliantly the difficulties I have with this subject, thank you.

As others have said, I think that the lack of progress in childbirth care in hospitals is indicative of women falling low of the priority list. At the same time, a focus on 'natural' childbirth seems to me to help keep this priority low. II wish women had access to proper information....

I feel let down by the NCT and my midwife who told me that my body wouldn't give me more pain than I could handle. And when it did and I truly wanted to die, I felt like I'd failed. I also, like others here, was forced to give birth on my back as baby needed monitoring. I wanted to go on all fours but was refused. I'm welling up about it even now.

Thank you to everyone who has posted here. This has given me tremendous food for thought.

This is really interesting reading for me.

I actually wanted to go back to a pointy sakura made about male ob/gyn and midwives: why do men want to get involved in this field? There are so many men who are ob/gyn consultants. Why? Why are they so interested in spending their working life treating women at their most vulnerable, when they can't possibly empathise in any way? What do they get out of it? I have never been able to understand it. It's not that I didn't had good care from male consultants during my first pregnancy (saw exclusively women with the second), it's just that I didn't know what they got out of it and what their motives were for being there.

It makes me feel a little uncomfortable even saying it - I'm all for equality of opportunity :) - but it just seems weird that men want to muscle in on something (the potential to get pregnant and give birth) that is pretty much the key difference between us and them.

What do you all think? Do you care? Do you think it is part of the problem?

'But childbirth has always been led by and seen as a female thing? I think the pressure on women to have "natural births" comes from other women - not from men??'

Not read all the thread but this struck me - I think the pressure to have a 'natural birth' comes from women but the main problem is the interventionalist stick you on your back on a bed and tell you what to do is a male thing.
IME women will let you labour how you like unless very influenced by men (male DRs, obs etc)

I feel uneasy about men at birth. I had a male midwife, felt incredible uncomfortable about it and yet felt it wasn't politically correct to ask to change (probably wouldn't have happened anyway).

Its not just men, I want my birth support person (a MW for this baby) to be someone who has given birth themselves. Someone who understands the emotional aspects and not just the physical. I think that's my issue with male obs/mws. They can't possibly understand the complexity of the experience. It's not a medical event (usually anyway) it's birth and it changed me as a woman. A man will never understand that. Sorry if that sounds horribly sexist but that's how I feel.

Yes it is a very good question. Especially given the number of women who state that they would hate to be cared for by a male midwife - the same feelings presumbly apply to obsteticians, only the numbers of men involved make it very unlikely you would get a choice. Women who say they would not like a male MW are regularly laughed at on MN, but I think it is entirely understandable that someone would not want a male stranger in the same room as them during labour and delivery. For women who have been sexually abused or assaulted, it can be very uncomfortable.

I experienced both extremes of childbirth with my boys, super medical and a home birth with no pain relief. The second was so much more empowering. I had done a hypnobirthing course and felt no fear. Most importantly, as I was on my own turf I felt much less compunction to do what the HCPs told me I had to do (routine examinations etc, not actual advice about my safety or the baby's). A few days afterwards the community midwife tried to tell me off about it, as if I had not the right to refuse to let a stranger into my fanny within 2 minutes of meeting her!

With DS1 the anaethetist who botched my epidural came to see me afterwards and sneered at me that next time I should get an epidural earlier as I clearly wasn't the sort of person to cope with pain. Luckily there was a case review and he was made to apologise to me face to face. He was a junior doctor, about 25 at most and with absolutely no respect for the women he was supposed to be helping. Actually I think a lot of his contempt came from his own fears about not being able to control the siituation (and about having caused me some serious damage due to his inexperience and incompetence). Sorry that was a bit off topic.

I don't think its off topic TPL I wonder if control is some of the appeal? Control and rescue. One my pet hates is phrases like "we'll deliver your baby here/then". Actually, the mother does the hard work in most cases and the ob/MW just catches (and even that isn't always necessary - would be less so if women could labour freely). It gives the credit to the wrong person. Also disempowering and I think a lot of our birth practices are structured around the idea that women can't do it themselves, they need saving.

I think the problem re midwives and ob/gyns is not one of sex, setting aside the situations where the woman giving birth is a survivor of assault. IMHO, the issue is whether the person, male or female is able to empathize and treat the labouring woman respectfully, respecting her feelings. Of course a man is capable of doing this sensitively. Not all men are though, and not all women. The most insensitive MW at the birth of my DD was female.

To me, saying a man cannot be a sensitive, respectful MW because he can never give birth is like saying a female doctor or nurse is incapable of treating a man with prostate or testicular problems sensitively, because she can never experience those. By definition, most medical professionals are never going to experience every issue faced by each of their patients.

And all births are different, so just because a MW has given birth, doesn't mean that she will be any more sensitive to a woman giving birth if she is not that kind of person. I'd rather have a sensitive respectful male MW than a female midwife who has given birth five times, each time with minimal pain and is insensitive enough to think that any woman who is experiencing extreme pain is exaggerating.

All this is NOT to say however that there is no sexism in the birth process around the issue of pain.

This is the thread I referred to above, where women discuss their experiences of being denied pain relief in labour. I found it quite a harrowing read.

Mumsnet followed it up with a webchat with the president of the Obstetric Anaesthetists Association, which was informative inasmuch as it dispelled some of the (to me) myths about the impact of epidurals in labour.

Incidentally the President of theObstetric Anaesthetists Association is a man - and I share tortilla and sakura's question - why are men in this field?

Lisiathus I understand your analogy but I dot agree. You're not patient when you're giving birth, you're not ill. Yes, I would rather have a man who could empathise than a woman who couldn't but the most important thing for me would be having someone who understood, who done it. Someone who'd been pregnant etc.

I realise I don't speak for all women.