[Best of Birthful] What is the Purpose of Childbirth Pain?

[Best of Birthful] What is the Purpose of Childbirth Pain?

Adriana Lozada: Hey, mighty one, with nearly 300 Birthful episodes in over five years, it may be hard to know where to begin listening to the show. To make it easier, we’ve put together The Best of Birthful Series, which showcases some of our favorite or most relevant episodes. This is one of those. If you enjoy what you hear, make sure you subscribe. It’s free and that way you won’t miss a thing. Enjoy.

Lozada: Hello, mighty parents and parents to be. Thanks again for all the love you give the show. My guest for today’s episode is the fabulous Rhea Dempsey. And we’re going to be talking about one of the biggest elephants in the labor room, which is of course the pain of labor. And so people don’t even want to talk about it as pain, well, intense sensation, whatever you want. There’s a purpose to it. Rhea has a reputation as one of the foremost thinkers on the topic of working with pain in childbirth and its connection to normal physiological birthing. And that’s what we’re going to be diving into today. Rhea, thank you so much. Welcome to the show.

Rhea Dempsey: Hi, Adriana. So pleased to be here with you and speaking to another passionate woman of birth.

Lozada: You have gotten into this sort of wheelhouse of being known for really digging deep into what it is about the pain, the intensity of childbirth. What made you get into that and start to think, and deconstruct, and figure out that it even may have a purpose?

Dempsey: Yeah. Okay, so there’s a number of threads that come together around that issue about pain. Firstly, maybe just a little bit of my own background. I was, before I had my own first child, although years ago, what we call over here a physical education teacher and an outdoor adventure sort of facilitator. And in doing that work, it’s very clear to see that for so many of us there is much more we could do and achieve with our bodies, except that our thinking, and our brain, and our sort of story about ourselves can often get in the way. So there’s a psychological component in terms of how we work with our bodies, and particularly how we might achieve what I might call peak performance. So there’s that aspect to it. And then there’s also the aspect of what I’ve come to call really this idea of functional physiological pain within the world of achievement of the body.

Dempsey: There’s certainly a total understanding that to do that there’s an engagement with functional physiological pain of our body working really strong and hard at these sort of peak performance levels. So that was my territory before I had my own first baby. And then, coming through the birth with my own first baby, which maybe we’ll get into that story at some point because it certainly points to that exchange between the particular birthing woman and what the birth culture is that she’s birthing within. For me, having my first baby really being fit and healthy and having that whole background of awareness with my body, that aspect of working with the functional physiological pain of the labor, of my body opening and all of that, that was a natural territory for me. So when I came, not only then started that whole journey of being around births, and it’s been a long time as you remark.

Dempsey: For many women, there was this aspect about the pain in labor really had such a negative and fearful aspect to it so that not only were they challenged by the intensity, but they were challenged in their minds about really whether this is something that they wanted to embrace and work with. So it’s sort of that combination, and then having that privileged place of being with so many women over so many years. Women who really are what I call willing women. Willing women who really want to have a go at working their body and their baby towards that natural or normal physiological childbirth. And still, even with that intention, finding that they would get to places in the labor where in fact they felt like it was too much and this wasn’t what they’d signed up for.

Dempsey: It was more, or greater, or more challenging. And so, that sort of edge about the pain, and then also the cultural story. It’s been sort of hijacked by these ideas about pain in a medical setting, being about things going wrong, things being dangerous, things being about ill health, which of course, in most things to do with medicine, that would be a correct assumption.

Lozada: Yeah. And because we don’t usually experience pain. I can see the physicality of it that you mentioned at the beginning. I hear it a lot from people who run, who do marathons, and getting to that point that they know their body’s going to collapse, and it’s their mind telling them. And they’re like, “No, let’s get through this. Let’s keep going.” Because they understand the physiology. Yeah.

Dempsey: Exactly. Yes. Well, there’s two things if I talk about the cultural thing, but also within that medical frame. Birth or pain in a medical context, which is escalating, would in a medical setting of ill health, or damage, or danger, really be a signal that something in the body is getting worse, and worse, and worse. But that’s not what’s going on in normal physiological childbirth, neither is it something that’s going on in somebody pursuing a marathon dream. The escalation of the intensity is really about the body having to work stronger and harder to achieve whatever it is that we’re undertaking. In our case, we’re talking about birth.

Lozada: I find that just as something as simple as talking to the mom, and sort of bringing her attention to the fact that the uterus is a big, enormous muscle that has to work really hard. That alone can kind of change her perspective of like, “Wait, right. This is a muscle that is doing all this work. When I work any of my other muscles for so long, of course they cramp up and get exhausted and hurt, but that doesn’t mean something’s wrong.”

Dempsey: Exactly. Exactly. Yes. It’s a beautiful reframing, isn’t it? What we know is the function of that physiological pain in childbirth and how important actually it is for the unfolding of the hormones. And I think, it’s in recent years, really, if I think about my history in being around childbirth, that we are just understanding more, and more, and more about what’s going on in the hormones. And that, “Surprise, surprise,” what we’re learning about the hormones sort of speaks really to an ancient sort of knowledge about what those of us have been birth workers across cultures and across time, have known to be the sort of reality. For instance, we talk about the mother feeling safe. By that we mean feeling safe in the territory that she’s giving birth in, and also feeling safe in terms of the emotional connections with the people that she’s birthing with.

Dempsey: And now we know that when we translate that feeling of safety, that that really into the hormones, it’s about, is her body system being driven more by oxytocin that the hormone of love and tending, and befriending, and feeling safe, and nurtured, and secure, or is the birth process being hijacked by adrenaline, which is around the fear, and the not feeling safe, and so on, and so on. So we’re getting to learn much more about the underlying, or the internal process of the hormones, and how that relates to the behaviors, the connections, the territory she’s birthing in, and who she’s birthing with. So we know in terms of birthing that oxytocin, when it’s naturally occurring in the mother’s body, is starting to open her heart to this baby. But not only that, that the oxytocin of course is the big driving hormone to create those contractions that also open her body. As they’re escalating, that’s bringing on that intensity of that functional physiological pain, and those contractions getting stronger, bigger, closer together, more and more potent, more and more efficient in terms of the birth, but nonetheless, more physically, functionally, painfully challenging.

Dempsey: So as that builds, and once we get to a certain peak of that sort of intensity, there’s another hormonal exchange that happens, which is the tip over into the endorphin system. When that connection happens and the endorphins come through, they’re often called the feel-good hormones, they give us that lift, they give some moderation to the painful sensations. The most important thing that the endorphins do is that they start to swamp the cerebral cortex. They take out that thinking, planning, alert brain, which really doesn’t know much about birthing at all. And the endorphins in fact start to unfold what I call the evolutionary regression.

Dempsey: So that link between the functional physiological pain, and the expression of the endorphins in response to that, is a huge trigger for the physiology of the birth to unfold because of this evolutionary regression. And so then the mother shifts into that deeper space within herself, where she knows what it’s like to be giving birth. She knows how to follow her body. The pain, the functional physiological pain is still driving, but there’s just a whole different space that she’s in, which means we usually know then that the labor is going to go brilliantly, and that that normal physiological childbirth is going to unfold. So …

Lozada: So it’s the pain that takes it to a point where those endorphins can come in, and then the flow of birth can take over and have mom not be thinking, and sort of properly give into the process.

Dempsey: Exactly. So that’s the hormonal link, but I want to know.

Lozada: Yeah. What about the cultural part of it?

Dempsey: So the cultural message seems to me, and you can tell me whether you think this holds for America as well, but the messages that the women are getting, firstly, that they should be comfortable in labor, that the birth can be convenient, and that it can be controlled. So comfort, convenience, and control. Now, partly I’ve seen this happening across the time that I’ve been working, and partly this has been enabled by some of the developments, the brilliant developments, that have happened in sort of the birth world, but developments which have had unintended consequences. So for instance the issue about comfort. I mean, I’m pretty sure through most of our prehistory, women were never thinking that birth should be a comfortable process. It’s not called labor for no good reason.

Dempsey: What has enabled this sort of idea of comfort is of course, that epidural. I come now to talk about the epidural as the Trojan Horse in the birth space, actually. I mean, having been around for such a long time, I was around working in the scene when epidurals started to first come into the scene, and we welcomed them in. We welcomed them in from the point of view of thinking, “Well, for women who really need a cesarean, this is so brilliant that these epidurals and their like can be used so that the mother can be conscious and aware when that baby’s born.”

Dempsey: But of course, for those of us passionate about natural births, we’ve seen that really we’ve been broad-sighted by the epidural in terms of this offering, this promise, this seduction of the epidural about being comfortable in labor. And so now the cultural message is, well, not only that you could be, that in fact you should be comfortable in labor. And so there’s this sort of other aspect about more and more demonizing of pain in labor, and a total pitying of women for the poor things of what they have to deal with, which really is so undermining of women’s capacity and potency for standing strong in their bodies and doing that work of normal physiological childbirth.

Lozada: I want to be a little bit of a devil’s advocate. Just for fun. Because I think you’ve hit the nail on the head, but because it’s something that’s so entrenched in our cultures now, we’ve gotten to a point that it’s like at least 60%, if not more, use epidurals. So why not be comfortable?

Dempsey: Yeah. Well, of course that’s probably the dream. For one reason, we go back to what we talked about already in terms of the hormones. We also know that, of course, epidurals, when they’re medically needed, can facilitate things to be better for some moms and babies. But we know that those epidurals, yes, they can make that comfort, but they really muck up a whole lot of other things in terms of the labor, so that babies sometimes don’t like them, the drugs. And so the baby then starts to call the shots about this isn’t okay. And so we know that epidurals boost the Caesar rate. We also know that that aspect about epidurals where women are not able to feel their bodies means that they’re unable to work so effectively in second stage to birth their babies and so on. So there’s a lot of downside. I mean, many people have written about all of this. And maybe…

Lozada: They’re not risk free and they’re not guaranteed to work either. And I think that’s part of the things that moms aren’t told.

Dempsey: There are hidden costs to that promise and seduction of comfort that the epidural is offering. I talk about the convenience, and that of course is part of the unintended consequence of what’s happening with Caesars, but also the unintended consequence of using synthetic oxytocin to start labors. Synthetic oxytocin can get the contractions going but it doesn’t do any of that feeling state, open-hearted state of what normal, naturally occurring oxytocin does, neither does it push that link between the functional, physiological pain, the endorphins, and so on. And of course that idea of controlling comes out of those things as well. So those three C’s, I think that that cultural message is very undermining of women’s sort of trust and faith in their bodies and their trust and faith in their own capacity to stay and work with their bodies.

Dempsey: But another thing that I wanted to go down to now, is this idea of what I call pain dynamics. And again, Adriana, if we go back to that idea of peak performance, if somebody’s running that marathon or any of those other physical pursuits, there’s an idea that we might hit a pain barrier. We know there’s nothing going wrong. We just know that we are reaching a point where it feels like it’s too much, too strong, and so on, and that we want to give up.

Dempsey: So, instead of calling it a pain barrier, as we might do in other pursuits, I started to talk about this crisis of confidence, that if women can be supported, understand that and normalize it just the same way you would normalize it if you were running a marathon, and know that it’s a sort of a predictable point that you might go through, and to make sure that you’ve got support people around you who also understand this and can encourage you through that crisis of confidence, that these are the points where those hormones ramp up, and that the normal birth is unfolding so beautifully.

Dempsey: It’s just that you don’t like it in those moments when you’re dealing with those contractions. So remember the cultural messages that actually women should be comfortable and that the epidural can promise that. So when women are in that space in the labor, where they’re experiencing what I’m calling a crisis of confidence, who’s with them and what they can offer at that time, I mean, a well supported crisis of confidence out of labor. Maybe it’s only four or five contractions that could be 10 to 15 minutes. It’s just that they’ve crucial moments because either they’re going to be supported through, and women will find a way to engage with a deeper rhythm on the other side of it and get onto a new groove, or that sort of default in the birth culture of the pain relief comes in…

Lozada: Well, what can be helpful to the mom in that moment? Because they can think, “Oh, it’s been this intense and this long to get to here. And I’m quote unquote, only one. I can’t do three more days of this.” And then. Yeah.

Dempsey: It’s a beautiful question you’re asking. So if women can be educated beforehand, first of all, and also with good people with them at the time, to say that, okay, maybe in pre-labor, early labor, it’s been going on and off like this for a day and you’re feeling like you’re only one or two centimeters, and so then you’re thinking, well, you’re hardly even into the game yet, in a way. And that that means, “If it’s going to take me a day for each centimeter I’m doing…” But of course that’s not the reality at all.

Dempsey: There’s a building momentum. And once women get to that next step, it’s always escalating in terms of the intensity, but also the speed at which the labor is going, so that that mother, when she’s in that struggle, and somebody’s looking her in the eye and saying, “You are here, you’re doing brilliantly and let’s just breathe through these next contractions. Let’s shift and change. Let’s do this. Let’s do that.” And move her from that point of feeling like she can’t go on into that surrendered, deeper engagement with the birth, that there’s expertise and skill in that.

Lozada: I mean, every single mom gets to a point that says, “I can’t do this.”

Dempsey: Yeah, yeah.

Lozada: It’s part of it. You have to completely give in and it takes you to the edge. So I am incredibly grateful to you for saying what you just said. These moments can happen at very different stages. And sometimes they can happen really early on, and they can be so hard on the moms because that’s not what they were expecting at all.

Dempsey: Exactly. Exactly.

Lozada: So, Rhea, if listeners want to learn more about what you do, learn more about these concepts, contact you, follow you, where can they do that?

Dempsey: My website is birthingwisdom.com.au. Facebook, there’s a little bit on Instagram. Yeah, so I think that people can find those ways to make contact, and I’d love to be having conversations with people.

Lozada: Thank you so, so much for taking the time to do this. It’s been a real pleasure.

Dempsey: And thank you for your passion about birth as well, on the other side of the world, and beautiful to be speaking to people who might hear our passion and be inspired.

Lozada: You’ve been listening to a Best of Birthful episode, and there are many more where this came from. Look for episodes with the words “Best of Birthful” in the title to continue your deep dive to inform your intuition. You can find the in-depth show notes for this episode at birthful.com, and you can also connect with us directly on Instagram. We’re @birthfulpodcast. Birthful is created by me, Adrian Lozada, and is a production of LWC Studios. The show senior producer is Paulina Velasco. Jen Chien is executive editor. Cedric Wilson is our lead producer. Kojin Tashiro is our associate sound designer. Alie Kilts contributed to The Best of Birthful Series. Thank you for listening to and sharing Birthful. Be sure to subscribe on Apple Podcast, Goodpods, Amazon Music, Spotify, and everywhere you listen, and come back for more ways to inform your intuition.

CITATION: 

Lozada, Adriana, host. “Best of Birthful: What is the Purpose of Childbirth Pain?” Birthful, LWC Studios, December 22, 2021. Birthful.com.