How To Bring More Pleasure And Joy Into Your Birth (And Why It Makes A Difference!)

If you want to minimize sensations of pain and even move them into pleasure, this episode is for you! Debra Pascali-Bonaro and Adriana explore how you can bring more pleasure and joy into your birth, and why doing so can help you not only have a better experience, but also help support your birth physiology for a more flowing birth. Debra shares with Adriana a wide range of actionable suggestions on how to prepare during pregnancy, what to set in place and advocate for during birth, and ways to continue to show up – from a place of pleasure and joy – even if you need interventions or have a belly birth.


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How To Bring More Pleasure And Joy Into Your Birth (And Why It Makes A Difference!)

Adriana Lozada: Hello hello, Mighty Parent or Parent-To-Be. Welcome to Birthful. I’m Adriana Lozada, and in today’s episode we are going to explore how you can bring more pleasure and joy into your birth, and why it matters that you do so! 

My guest for this today is the amazing Debra Pascali-Bonaro, who is a birth and postpartum doula trainer, childbirth-educator and world renowned inspirational speaker. She’s the director of an award-winning documentary (which you may have seen!) called Orgasmic Birth: The Best-Kept Secret, and the author of the book The Ultimate Guide to Sex After Baby: Secrets to Love and Intimacy.

This conversation is part of our Birth Beyond the Clinical Experience series, and so far in this series we’ve talked about the stages of birth from a holistic point of view, we did that with Whapio. We’ve looked at how you can get comfortable with the intimate nature of birth that was with Nicole Malia Shapiro, we’ve explored the purpose of childbirth pain with Rhea Dempsey, and also the importance of flowing with your hormones so that you and your baby can have an easier and more connected birth and we did that with Dr. Sarah Buckely. I find that all of these episodes converge at the intersection of the mind-body connection and physiology, and guess what? That’s also where pleasure and delight exist. 

So, if you’re looking to flip your birth experience from one of fear and anxiety to pleasure and joy, and even bliss, then this episode is one you definitely want to listen to until the end, because it’s filled with actionable suggestions from Debra on how to do just that – even if your birth requires interventions. I think my favorite suggestion was flipping the Pain Scale into a Comfort Scale. 

You may also notice that there’s a bit of overlap with this episode and Dr. Sarah Buckley’s episode, as well as with Rhea Dempsey’s episode, because frankly, when talking birth physiology, everything is interconnected— but here we’re coming at it from a different lens. Remember, the idea of presenting you with all these points of view is so that you find the one that best resonates with you. 

You’re listening to Birthful. Here to inform your intuition. 

Adriana: Welcome, Debra! It’s so fantastic and great to have you here on the show. And it… you know, you’re one of those people that your name has popped up in my doula career for years and years and years, of course.

Debra Pascali-Bonaro: Aw, thank you!

Adriana: Yeah, ’cause you’ve been doing this for such a long time. I mean… so tell us a little bit about yourself. How did you get into this birthing world?

Debra: Aw, thank you. Well, first it’s a pleasure to be here with you, Adriana! I think, like many doulas, we come into it with a passion.

And it really started even before that with the birth of my oldest son and. As I was preparing for that birth, I did so much educating about childbirth and really looked back in what I call my “herstory”— really knowing the stories of my great-grandmother and grandmother and mother’s births— and they all birthed upright and moving, and talked about birth with joy and pride and pleasure and no fear.

And here I came into birth at a time where birth was moved to the hospital and medicalized. And I had to really advocate so hard for just being able to move around and eat and drink and do things that my ancestors just took for granted. That spurred me into wanting to become a childbirth educator and helping all people, all women, partners, fathers, really understand their choices and options and that led to being a doula, ’cause I started being invited to attend births with the people that were in my classes. And before long I was doing all this caring, I didn’t have a name for it. And I actually read this article in 1987 in Mothering magazine about a doula and had a light bulb effect of like, wow, “I’m a doula and there’s a name for this.”

And I really ended up at the very beginning, in the very first meetings of doulas anywhere in the U.S., and certainly that places it in the world, so I have been able to see the doula movement really grow everywhere.

I am a DONA International birth and postpartum doula trainer. I also— other than my doula passion, which is certainly so strong— I’m a Lamaze childbirth educator and also a teacher trainer with Lamaze, and I am the director of the documentary Orgasmic Birth: The best kept secret, co-author of the book by the same name.

Really being driven to give voice to the pleasure and the passion and the love that’s possible in birth that we sometimes lose when we get so focused on the fear and the pain that’s prevalent today. And I add that I chair a global initiative called the International MotherBaby Childbirth Organization, and now a new co-chair of our combined initiative with FIGO, the obstetricians of the world, in really looking at how we can improve and have a safe and respectful positive birth for mother, baby, and family.

So I say I wear all these different hats, often working directly with parents, working with doulas and the grassroots, but also working at what I call grass”tops” through ministries of health in the United Nations. So giving me a really interesting vantage point, both nationally and globally, about what’s happening in childbirth and taking that to really be able to help every person understand their choices and options, and I hope they have the birthday desire.

Adriana: How are you seeing this culture change? Is it changing? And it does, it requires big initiatives like what you’re doing with MotherBaby to actually get some change.

Debra: Yeah, it’s really interesting. I mean, to look back in some ways… And it depends where we’re talking because the world is so different and some countries always kept a fairly good model, where the United States really over-medicalized birth, so depending on where we are… but looking from a U.S. perspective, there were some things that were actually better, some years ago, that have gotten worse.

And certainly our health disparities— our racial disparities are just terrible. I mean, there’s just no words, but just incredible sadness in my heart when I look at our maternal and infant mortality rates. And then look at how our African American women are dying and having near misses and morbidity at such higher rates than white women and other ethnicities.

So the U.S. over-medicalized in a way that people believed if medicine was good, then more of it would be better. And we’ve actually worsened outcomes, but not only on the physical level, on the emotional level. I see far more women today than some years ago that are experiencing birth with disappointment, sometimes with disrespect. And sadly too often looking back with birth trauma and other words. 

Where I think other countries in the world are doing, some better than us and some worse than us on both outcomes, both on the physical or the emotional. But I do think we’re at a time of change everywhere. I think the awareness of a system that’s gone too far, I kind of call it a “broken” or “dysfunctional” system, at least we’re talking about it.

We are aware that there is a problem, and I have to believe that’s the first step in being able to make the changes that are needed. And I do feel that in order to make those changes, having global initiatives that have 12 steps so you can break it down and analyze what are you doing well in your community and your facility, in your practice, and where do you need to make improvement.

I think there’s great evidence. It’s good to have research out there, but we need a template on “How do we put the research into action?” And that’s what I see on the global front that we’re doing now, and doing it with collaboration, with all different organizations coming together. And that’s somewhat unique, because in the past we didn’t have as much collaboration. We often had things that we differed on, and I think today we’re really coming together and saying our differences are minimal, but our focus on creating a safe, respectful, and positive birth for every person is really the driving force.

Adriana: Absolutely. And I will throw in the show notes of the link to the 12 steps that you guys came up with for that template, in terms of a very macro view of how to improve the system. But let’s get to the meat of this episode, which is more of a super micro view of: How you can improve birth for yourself by considering bringing pleasure into it? 

Debra: Yay!

Adriana: Yay! Tell me: “pleasure” and “birth” are not two words that are usually associated together. What does that even mean?

Debra: Yeah, and I really appreciate it, because this is what I feel is so missing on every level! But for the individual when you’re approaching birth today, the language out there is really all about pain and people can’t imagine that birth can be anything else. But I’ve even done a look around the world from birth art and like going back, there’s beautiful art, even from the 13th century, of women giving birth with smiles, with joy. You can just feel it around them that there was pleasure. 

And pleasure can be on all different levels. So depending on where people are thinking, I always say to them first just, you know, “How do you define pleasure?” It’s good to kind of put it into your mind. And there is pleasure that some people go to right away, which is more on the sexual pleasure. And that’s certainly important, because I totally believe, and evidence shows that birth is a part of our sexuality. And so the things that do turn us on in life, we can use as turn-ons in birth that can help truly take pain into pleasure. But there’s also all kinds of things and pleasure that we can do.

I love dark chocolate. I love wildly dancing for three minutes in the middle of even a challenging day and kind of shaking off the challenge, and having this moment of pleasure. So pleasure, for me, is finding the little things that make us feel good, and in childbirth this can be certainly during the actual surge that we’re feeling and can truly… I work with thousands of people, that “pain” is not a descriptor.

They might feel sensations. It might be hard, it could be challenging, but I work with a lot that truly the word “pleasure” can come in, even in the midst of feeling the intensity of labor. But even if we are feeling it as pain, the moments in between the waves, right? We have that intense work, and then we have those pauses and breaks, and that’s where we can bring in pleasure too— that dancing or singing or moving.

So, for me, birthing and pleasure is really our birthright, but it takes exploring pleasure and we birth the way we live. So I would really say to all the listeners: What are you doing every day for pleasure? And how can you bring some of those things into your labor and birth, whether it’s during sensation or in between? And just that thought, just the effort to do that, can totally transform your birth experience.

Adriana: Well, and I love that mindfulness, rethinking of our big experiences in our life and our deep-held beliefs. I think there’s really a lot to it of what you were saying, how so many years ago people birthed with smiles, people birthed in a different way, and now we really associate it with negative outcomes and pain.

And it’s something that a lot of people fear, or dread even. And having that idea of just stepping back and going, “Hold on a second… Is this something that’s coming from me or is this something…?” ’cause, you know, if you haven’t had a child, you’ve never gone through it. But there’s all these expectations already put into what the sensations and experience are gonna be, that I love that just stepping back and taking the time to reconsider that.

Debra: We’re disconnected! You know, if we went back a hundred years ago when birth was at home, we would often have been at the birth of our siblings, if we have younger siblings. We might’ve been at the birth of cousins, if we had younger cousins, ’cause families lived near each other and mothers went to help each other in birth. Or if our mother had a good friend and they had younger children, she might have gone to offer support. So it’s really hard, I think, now today, that the first birth we often see in real life (other than television) is our own.

And so this growing fear and disconnection does leave us in this place of just “afraid,” and afraid of pain. And sadly, what the mind focuses on is usually what we get. And so being able to step back and ask where these beliefs came from, but also to seek out, if you don’t have your great-grandmother’s positive stories, we need to seek out people that are having positive birth experiences that resonate with something that we might want, and really listen and ask: How did they achieve that?

If people had really painful experiences, I like to ask them: What would they do different? Because sometimes in hindsight and learning more about the broken system, they see ways they can change it. So learning from birth stories is so important. And then internalizing that to what can you take away and how can you reframe what you believe? 

So I often teach people in person from childbirth classes to medical students, and one of the things I love to do is shut the door, set up the classroom, and when people arrive, instead of letting them come in, I make them sit outside ’til the exact time. So they often can’t believe that they can’t come in, but when they come in, I say, “I’m really sorry. I had to clean the floor. I found the classroom today a little bit dirty. And what I didn’t realize is I found this substance to clean it with, and after the fact I read it, that it could cause itching. So I’m really sorry, but I quickly ran and got some medication. So as you’re sitting here this evening or this day, you know, I’m gonna be checking in with you about every 30 minutes or so to just see if you’re itching, and we’ll use a scale from one to 10. And if you start itching, just kind of let me know and we’ll check your number. And if you get high on the number, then I have some medication for you.” 

Well, as I’m saying this, of course, people are kind of horrified that they can’t believe they’ve come into a classroom that they’re sitting in that’s gonna make them itch. But already a fair number of the people are itching. They’re kind of moving their arm and scratching their neck, or their head, or their shoulder. And as I kind of watch them, the more I say “itch”— and those of you listening, I may have said “itch” enough times that you’re already starting to feel a little scratchy somewhere!

And, of course, I let everyone know that I’m just joking, which they’re incredibly relieved, but I let them know that the number of them that started to itch, it’s planting that seed in their mind, of: What the mind thinks the body feels. So my next question, and if you were itching at home listening, my next question is: How many times have you heard that “birth is painful”? And where could those beliefs be imprinting in us? And even a language of birth, like the word “contraction,” what does that mean for you? And for many people, “contraction” is tightening and may even be associated with pain. So I often say if we were using a word that was associated with itch or maybe we said we call it “an itchy experience,” I bet you we’d find people all over in labor itching.

So we really need to identify that mind-body connection, and, I think, change the language that we prepare for birth with— and use a language that means “whole,” “healthy,” and, I think, “pleasurable.”

Adriana: And I can relate so much to that story, because every time I get an e-mail from the school nurse saying that there’s a case of lice in the school, immediately I’m like, “Oh, my head feels itchy just thinking about it.” Yeah, it’s so true. So how are some ways… I love the idea of reconsidering our wording as well, and how you feel with the word “contraction” or the word “pain,” and what would be a better alternative. 

And I think also for “pleasure,” I encourage the listeners to just figure out if a word is not resonating with them, find a word that does. Because— and this is like full disclosure— like every time through the years that I’ve heard you talk about pleasure and birth I’m like, “But is that setting an unrealistic expectation? Is that something else that people are going to be disappointed at?” 

And the more I read recently to prepare for this, I was like, “Hold on!” If “pleasure” is not a word that’s working for you, maybe it’s “intimacy,” or it’s “curiosity,” or it’s just switching it to something that makes your experience enjoyable, frankly.

Debra: Yes, totally. And, again, recognizing that we’re not saying that there might not be moments of pain (if that’s what you call it), but you can definitely minimize it. Some people actually take it completely away out of the pain zone, and other people move it deep into pleasure. You know, we’re all different on the scale and we don’t know what our labor will ask of us.

I always say too, you know, our baby is 50% of the equation— and often when we have our desires for birth, we’re not often considering that we have the baby’s desires too, and sometimes they’ll require something else or desire a different path. So we have to be prepared in a broader sense for what birth can be, but I do think, re: languaging, as you’re saying, is really key. And having a toolkit of, whether you call them “pleasure,” or “fun,” or “joyful,” or “loving” things that you can do. Because even if I’m having the worst day— and it might be really painful, whether it’s emotional pain or physical pain— there’s still things I can do for a minute or two that can take it away from that and bring my focus elsewhere. And those are the things that I feel are not setting people up to be disappointed in labor. They’re setting you up to have a kit that you can call upon. So even if you’re finding it challenging, you can still have a birth with love and wholeness.

Adriana: That reminds me of my… One of my favorite sayings is that “We can do hard things.” We can absolutely do hard things. And there’s a lot of value to reframing how you approach birth more than a laundry list of things you want and not want and. To step away from that laundry list and be more in this idea of how you want to feel, what you want the experience to be. Because as you were saying, even in the worst of days, you can mindfully have those moments where you can control how you show up.

Debra: Yes. Attitude, right?

Adriana: Yes. What do you say to people in terms of how to help them bring pleasure into that experience? Or not be left in a place of despair and trauma, and even worse, feeling resentful of their birth experience?

Debra: Yeah, and that’s such an important question because sometimes cesarean or belly birth is really the safest option. And if this is happening in labor, we wanna do it with love. So one of the things I think to find pleasure is it’s all about really honoring wholeness, which means it’s still okay to grieve that this wasn’t what you want.

But in order to get to pleasure, we have to honor all our feelings. And so we need to take the time and emotionally express what’s going on for us. But then we have an opportunity to say “This is now the birth we’re going to have.” And “What are the elements that we can bring into it that will still bring love?”— and part of it is love yourself. I mean, love begins with ourselves. So how can you love yourself in this experience? That maybe it’s saying you’ve done absolutely your best for your baby and this is the best gift you can give them as the gift of safety. What elements about this can you send your love to your baby?

This is a time that you may be afraid of “How is the baby going to be?” So them feeling your love and nurturing, that you’re doing this to welcome them in love. And then what elements can your partner… If you have a partner, what can they do to bring love to both of you and then other elements? So as a doula, often I’m saying to people that I’m working with, “What is the song you wanna welcome your baby into the world to?”

And we have the blessing of .mp3s. So it could be a favorite artist who’s gonna sing that song and we’re gonna hum along. But I often say literally singing, your voice, singing the baby into the world, shifts the entire experience. When you are singing, it’s hard to be staying in fear. It just changes it. Especially if it’s a song that you love and you’ve prepared so that your baby will always know the song they’re sung to. 

The smells in the operating room can be strong and not necessarily our pleasure smells, but we can often have the smells that we think of with pleasure by putting a dab above our lower lip, by partners putting it on their mask.

So when we think about pleasure, I like to say to everybody, think about it in terms of love and think about it in “How do you find pleasure in each one of your senses?” So what smell, what touch, what taste? And then thinking about when birth takes a different path: What can you still bring in of those?

There might be a caress that a partner or a doula can do, a holding of a hand, a touch that can be associated with pleasure. So, obviously when we’re looking at a belly birth, the types of pleasure are going to be different than if we weren’t in an operating room with a lot of strange people, but I wanna say I’ve been with numerous people in the last years where they’ve really brought in a wholeness and their birth became a really positive belly birth for them, that they look back on with great joy and love.

Adriana: And so, tell us a little bit about the hormonal sequence of birth, because the whole ideas of of us talking about why you wanna bring pleasure into the birthing room, it’s also not just about to have it be a feel-good experience— which in itself that’s a totally valid reason— but there’s a also a physiological reason why you would wanna do that.

Debra: Yeah, and I love this because pleasure was built right into our bodies— right?— for birth! And this is also where we can show that birth is a part of our sexuality, because the same hormones that are stimulated when we’re turned on, and ultimately for female orgasm, are the same hormones in the sequence that happen in birth.

So labor begins with the baby, and the baby secretes hormones to let us know that its lungs are ready and it’s ready. And the mother’s body responds in her brain by producing a whole sequence of hormones, but one, oxytocin, (called “the love hormone” or “the cuddle hormone”), hormone of connection, is produced deep in our brain and actually has receptors in the brain that give us that sense of calm connection, but are huge pain relievers.

And then they also drip down into the body. And new research— it’s so amazing— is showing us that our uterus actually grows new receptors about 24 hours before labor begins, which I’m always saying, “How does our body know these things?” And these additional receptors are ready to greet that oxytocin in the body and those on the uterus are creating those surges— sensations, waves, whatever you call them— that are beginning to open your body, to open the cervix, to open you on every level to birth your baby.

But not only do we have those pain relievers, but our body’s so great— and athletes know this, or runners know this— that when we do activity that actually is getting painful, is challenging, our body also produces “beta-endorphin,” “the hormone of pleasure” we call it. And that hormone begins to come in there too. So those two key hormones are helping us move from pain to pleasure. Our body is designed that when we have pain, our body is there to help. Now there are other hormones: prolactin, “the mothering hormone,” and relaxin, the hormone that’s allowing our body to stretch and open, that are coming in there. And also catecholamines, which is the adrenaline and the cortisol— and, interesting enough, they’re designed to keep us safe. So, if any time during that beginning of labor, in that first stage of opening, we don’t feel safe, we don’t feel private, we feel observed, we have fear— they’re designed to slow or stop labor so we can get somewhere where we feel safe. 

And this is where it’s a real problem today, because if we do have fear, if we don’t feel safe or private, then nature is slowing or stopping us at a time that our body would like us to be in a safe environment, a private environment, so all the juicy hormones of labor can build. And this is true in sexuality. If we’re in the beginning of intimacy and something we’re afraid, or we think about three things we have to do tomorrow, that’s stressing us out, we all know that that loving feeling kind of slips away. But the same conditions that we need to flow those hormones in intimacy are the ideal hormones to flow those in birth. And when they’re flowing, not only will birth be a little bit quicker, but it’ll be gentler and it can move us from pain to pleasure.

Adriana: Just like you were saying that you grow new oxytocin receptors 24 hours before birth, we think we know birth and then think we get information like this and go, “What are we thinking?” We just need to step out of the way, because births have this… I’m just fascinated at how all these things intertwine.

Debra: Yes. It really is amazing and nature has designed this so beautifully, that it’s sad because we don’t always honor this. We don’t look at what would help, like my question is, “what would help your hormones to flow the best?” Those are the things that you wanna determine. If you’re pregnant, you wanna make sure that you’re creating an environment that is… You’re gonna open to birth, that’s gonna support your hormonal flow, that you have a caregiver that’s going to give you that intimacy and privacy that you need to let it flow. And if we ask the questions and see that connection to birth, to sexuality, to hormones, to birth, then we can help create the environment that will make birth so much more joyful.

And sadly, that’s not the case today. So often we’re in an environment that most of us would have trouble making love in. I don’t know about everyone listening, but you know, strangers coming in and out and being tied down and on a machine and not conducive to getting our normal hormones to flow. So we really have to mix this up and look at it in a new lens to really incorporate what we now know about the hormones that are designed to help us, protect us. For the baby as well, it’s really inter coordinated. Mother and baby are producing hormones together to give them both the safest, gentlest journey.

Adriana: So supporting those hormones so that they flow supporting that physiology! You mentioned your care provider, you mentioned the environment, and what are some ways that— you’ve told us a few already— but what are some other ways that people can prepare to set up that environment within a hospital setting, which is so common?

Debra: Yes, and I think it’s important to know that you can create a homebirth in a hospital. It takes a little bit more effort, but that would be my goal, is to create that really cozy environment. So again, I call it “birth ambiance,” and that’s using all your senses. So even learning that in order to produce high levels of oxytocin, we need high levels of melatonin. And melatonin is produced in darkness. So the darker you can get your space, the better. And it’s interesting that for many people, darkness is often a welcome aspect in sexuality, too, or candlelight, or dimness. So I would also add that it is really important to look at melatonin production in the last trimester of pregnancy.

So new data is really showing that when the sun sets, so should your devices and that we’re getting a little melatonin depleted as a culture with the use of technology and blue light in our technology intercepting the ability to produce melatonin. So I would encourage everyone to really think about how they can enhance melatonin and get better sleep at the end of pregnancy. But definitely in labor, dimness is important. 

Go to smells. We can really change the smell in the environment and many people use essential oils, or diffusers, or the lotions that they might put on their body. So think about the smells that’ll bring you into that space. 

I would say what you’re listening to, what do you hear, what would be the sounds you would wanna listen to when you’re being intimate and flowing your hormones— and that can be a rainforest or different set lists or different artists, so make sure you prepare that.

Again, I love dark chocolate. In labor you won’t necessarily be eating a lot, but you are gonna be drinking and having small bites of food if you’re hungry. So using those within that pleasure. What are the things that taste good to you? What, you know, drinks? Maybe flavored water that will really help you. 

But once you create the ambiance of what you see and smell and how, what kind of touch you like, the next thing that’s real important is privacy. And not having a lot of strangers coming in and out of the environment, because that’s going to constantly hold you back. So talking with your caregivers, what’s the least essential number of people coming in and out? I often ask, “Can people please knock before they come in?” So that they give you the privacy to say, you know, “Give me a minute,” or, “Yes, thank you. Come on in.” So we have an awareness, rather than people just showing up when we’re not really ready for them. And if you can’t get privacy in the room, get privacy in the bathroom because that’s a place that people do knock before they come in, and I have a lot of people that find they labor well in showers. Or just standing or rocking or dancing, and then bring in those other elements, singing, dancing. 

What are things that make you smile, that bring you joy? I always say: Have a series of YouTube clips that just make you laugh and smile. And even in between surges, if you have three minutes of just bliss, you’re going to approach the next surge feeling different.

So, bring that environment into a safe space for you. And if you can’t totally control it, do it with images, with other things, visualizations, and create in your mind’s eye that mindfulness of what is that safe, sacred, sensuous space for you?

Adriana: And when things start getting tough, because it’s called “labor,” it’s not called “vacation.”

Debra: Right?!

Adriana: Right! What are some things that people can do to… Or when it gets derailed by interventions or there’s too much observation— whatever it is, they’re being, you know, really annoyed by a monitor belt— like when things start to get derailed and in a process that can lessen that hormonal flow, what can people do to bring it back?

Debra: So one of the things I always joke around, coming from a big Italian family, as a child, we would have these huge family dinners and my cousin and I, in the midst of it all, would throw a blanket over our head and create a tent and everybody disappeared and we were in our own space. I literally say do that in the hospital.

I take sheets and throw it over, you know, a woman and her partner’s head, her alone, her and me as a doula, we can change our focus. We can really bring it down and not see the other people. And I know it sounds funny, but, you know, often when I do that, we get inside and we have a giggle because we do feel like we’re three years old again.

But when we have that little giggle about what we just did to shut everybody out, it shifts it for us. We feel different because we’ve giggled rather than sat there like deer in the headlights of strangers in there that we really don’t want there. So that’s just one, like, fun little tip. Sometimes you have to just mix it up for yourself!

Visualizations, I think, are really powerful. And I always like to have people have a safe place. So in your mind’s eye, where can you go that’s safe? Where can you go that’s pleasurable? Where can you go that’s joyful? Even with that use of technology, which sometimes can be a real advantage for us, I do have to say, I think it’s greatly overused and I would encourage people to make sure that they’re going to a hospital that has closer to appropriate use of technology. 

Always ask: What are the percentage of births that are like the birth you desire? And if you’re not seeing a good percentage of births of people eating and drinking and moving and using showers and water and balls and peanut balls and rebozos and ropes, then you might wanna look elsewhere, because I wanna make sure you have at least ten things available for you in your space that are for comfort and pleasure.

So if you can think about what are those things that you might have to be bringing, or what does the facility offer— because even a peanut ball is great, as you know, right, Adriana? We use them all the time when we lay in a bed, and just that ball between our legs makes it more comfortable and helps make labor shorter. So there are a lot of simple things, but it’s important that you prepare for them.

Adriana: Taking out of what you’re… the idea of what you think of a labor room. You’ve been all around the world, and I’m sure you’ve seen all kinds of different labor rooms. And the fact is that here in the United States, we have labor rooms that are set up for not the birthing person, but for the medical needs, with the bed being the center place. And I was joking around with an OB saying, “And, you know, there’s places in Europe that they don’t have beds in the labor room.” And they’re like, “What? What do they have then?” like, when they took the bed out of the equation, they were, like, at a loss completely.

Debra: Yeah, I mean when you think about it, the United States has the least opportunity for comfort, because we are putting you in a sick room, and, like itching (my analogy before), we know just from the room you enter can change your outcome. So if you don’t go in and change that room to a health and wellness center for you, you’re already at a disadvantage, if you put a hospital gown on and feel like a patient and, you know, get into a bed. But I came back from Austria— and it’s one of our pilot sites— and their rooms are phenomenal. They have, like, a double mattress size foamy that’s leaning up against the wall, that you could put down in the middle of the room if you wanted to use a ball on it or rest. They have this thing called a wheel— it looks like a big swing that you can swing on. They have double jacuzzis where you and your partner can get in them. They have ropes from the ceiling. They have a wooden ladder that’s double-wide, attached to the wall so you can find where you might wanna hang in sway or drop and squat when you’re ready to push.

And their bed is, like, two oval shapes and it tracks over to the corner, so it’s kind of out of the way, only there if you really want it. There are squat stools, squat bars, all different size balls, aromatherapy, 24/7 acupuncture. I mean, you walk in and it’s like walking into an active playground space! And when you just think about that, how does that change what you might do when you’re in labor?

Adriana: Yeah. I wish the rooms were so different, but making it your own and going into it to try to make it more like a spa, all the rooms should look like a spa and have this 24/7 acupuncture rather than constant electronic fetal monitoring, which evidence shows that it does not provide better results for healthy people.

Debra: Yeah. Our outcomes wouldn’t be so bad if we were using a model that supported wellness. Instead, we got so caught up with a medicalized model that we forgot how to provide the care for wellness, which is the vast majority of people. And by literally putting people into bed, putting people down, both physically and emotionally, we’ve created more pain and more difficult outcomes. So we really have to flip it around and personally develop that language of wellness and health and pleasure and really come in and really redesign. 

I bring in a hang cloth around the room. I tell people to create a little birthing altar, bring family pictures, bring your own pillow. The more you make the space yours where you could have an intimate evening, the more likely you will have a more pleasurable birth.

Adriana: I also, like, bringing a rebozo or extra rebozo or extra long cloth or shawl and tying a knot on it and throwing it over the door of the bathroom and closing it, ’cause then that’ll keep it, you know, nicely shut. And that knot makes it so that you have something you can hang on to. Having it there visually, you can gravitate towards that. There’s so much imagery of— if you look at birth history— of people reaching up and pulling down with their arms as they birth and labor, that it is such a valuable position.

So things like that, like, definitely get creative with your space. And then the team is also incredibly important. And let’s talk a little bit about this: When things are not going your way (the way you want them to be), how can your team help you out?

Debra: Well, I think, you know, hopefully on your team you have a doula and then a midwife or a doctor, nurse. One, hopefully, they are all people that really know you, respect you, and what your doula will help you do is make sure that you’re getting informed decision-making, so that in any situation you understand when things are changing for your or your baby’s wellbeing. Why? And really exploring: What are the benefits of going this way? What might be any risk that are associated with it? Are there alternatives? ‘Cause sometimes there are alternatives and you can try them first, and understanding that you have a right to informed decision-making, to either consent or refuse or just say “Not now.”

So if it’s something as simple as, you know, wanting an intravenous drip, obviously drinking water for 30 minutes and reassessing if that hydrated you enough is an alternative, and then it’s, you know, “Not now. Let’s reassess and see later.” But being a part of decision-making and feeling really respected are really two key things in having a positive birth and a positive birth memory. So even when things are needed, to be able to have your voice listened to, heard, to have all the information you might desire at that moment. And then, being a part of that decision-making.

I would hope you’d have a list of, when things might change:What might be music that would help you? Maybe there’s a special song that gives you inspiration or power. Maybe you have a special visualization right now that also connects you. Maybe on a spiritual level, there’s a prayer or a mantra that you can be reminded of or someone can say. When you develop, kind of, a toolkit, again— in all directions, body, mind, spirit— and can pull them in.

We all know— and, you know, all of us, the older you are, the more you face challenges in life— so what are past challenges and what are things that helped you to feel whole in them? Because we can really build upon what we’ve learned in life. And what can we bring in? So if we face a challenge in birth, we can do that again from our deep place of connection and wholeness and bring in love, because you’re doing this for your baby, you’re doing this for love.

And I think sometimes in birth we get so caught in the fear when things change, again, that we need to bring it back and get that love flowing. Whatever connects you to your body and your baby.

Adriana: Yeah, and I know you’ve mentioned in the past, ’cause I’ve heard other talks by you about the power of letting people know how they can cheer you on, what wording they can use to not just create affirmations, but also… When things are hard, cheer you on! As opposed to “Have this,” like, “on a scale of one to ten, how much pain are you feeling?” and “Here’s an epidural.”

Debra: Right?! And thanks for saying that, ’cause I go crazy on that “one to ten scale.” That’s why I used it in the itch thing. I mean, first of all, if we call it a pain scale and we focus on pain? If anything, if you’re gonna use it, it should be a comfort scale. So we’re focusing on comfort. So we attract what we want.

But yes, we have to really state what is it that we wanna hear from everybody. And you know, we all have words that either feel really good, or, sadly, people mean to intend them with wellness, but they push our buttons. So I say “Be bold enough.” I even tell people like, “Write down ‘These are ten things you can say to me that I’m gonna love to hear,'” you know, “‘These are things that I’d rather you didn’t use this word or this language. It’s not my language and I find it offensive.'” We have to speak up. Don’t leave it to random chance. And certainly with your partner and your doula, they should really know what is your love language. 

I often talk about that too! A book that I love, you know, the Five Love Languages, because all of us have a way that we like to receive love, but sometimes our language of love is not the other person’s language. And they’re giving love, but they’re giving it in a way that we don’t hear it or receive it. And this is why in labor you can’t leave that to random. You can’t assume that the people around you are going to give you your support in the language that you need. And sadly, in hospitals, the last point you pointed out is so often when we just say, “This is hard!” instead of being met with cheering like the side of a marathon, people cheering you on! No matter who you are— they don’t know you, but they know that this event means a lot to you. And even if you’re the last one across, they’re cheering you on, ’cause of what it means. 

Sadly, in childbirth, we just give a little wince or we just say “It’s hard,” and we’re offered an epidural— which is really pulling the rug out from under us, rather than having people say “You’re doing it!” and giving you that cheering in the language that you want to hear. And Penny Simkin, our dear mentor who we love so much, has taught us, as doulas, to create a code word, so that if we really feel that pain has become suffering, it’s reached a point where we want an epidural, we say the code word, but we certainly should be able to say, “This is hard,” or “I can’t do it,” or “Help me!”

And those many, many, many times are not requests for medication— they’re really a request, like the people at the marathon, for those around to cheer in their language, to support them and encourage them. ‘Cause when we’re in labor, we’re always gonna have those moments of doubt or fear. But you wanna make sure your team is the people. You can look into their eyes, that they’re gonna hold the trust both in birth and in you, and they’re gonna hold it in a way that truly honors who you are in every way.

Adriana: And the code word is one of my favorite things, and I think it’s a great tool for partners (if there is a partner), because it’s hard to see the person you love be experiencing such intensity, and so it can be helpful to say, “Okay, I am going to cheer you on. I can’t take it away. I’m gonna cheer you on and I am gonna continue cheering you on.”

Even though my instincts might go, like, “I just wanna give you something to take it away,” because I’m not gonna treat you like a child. I’m gonna respect that. If you really need it, you have your voice to say, “No, I’d really need this. So I will say my code word,” but until you say it, I’m gonna continue cheering. And it’s such a helpful tool.

Debra: So helpful! And I find in most hospitals, we even put sometimes a sign on the door, you know, “Do not offer an epidural.” We have a code word just to remind the staff that they shouldn’t come in dangling the candy. And these days they’re constantly coming in saying, “You know, the anesthesiologist’s going to lunch. You sure you don’t want it now?” And so if we keep that out, and put the power into the birth giver, they’ll make the wise choice for themselves.

Adriana: They will. Absolutely. Debra, before we’re about to wrap up, but is there anything that you wanted to say about pleasure and birth that we didn’t get to?

Debra: I would say— and I’ll just give a nugget, I love to do so much— is that really look at what you’re thinking of, when you think about birth and sex, and look into your sexuality. I know that, for some of us, sexuality has not always been whole. Many of us are survivors of sexual abuse, and pregnancy is a time to really look at that, to go deeper into healing if sexuality has not been whole. 

And if it has been whole, Elizabeth Davis and I, in our book Orgasmic Birth, have an exercise where we say to just look at a scale of one to ten (ten being the highest, one the lowest), and rate your sexuality today. So everybody, kind of find your number on that scale. And if you’re blessed that that was a ten? Then just rock on! 

But for most of us it’s not. And what would it take to make it a ten? And I would really encourage every pregnant person and partner to really answer that honestly, and do the work to make it a ten, and do the work to connect that into birth. Because a lot of the tools that turn you on and expand into your sexuality are great tools for pleasure and birth that not only bring you pleasure, but they’re running the hormones that you need for birth to be easier and more opening.

So many people I work with, we go deeper into that kissing and touching, again, language and words, but that would be my nugget is when we leave sexuality off, I think we do some harm, because we don’t utilize some of our greatest tools. And also if it hasn’t been whole, then we sometimes haven’t done the work.

And as we know for survivors, birth can either be re-traumatizing— or, as we see in our documentary Orgasmic Birth, Helen, who’s a survivor, really focusing and using and identifying that in her birth was an incredible healing moment and reclaiming of her body. So real opportunities that exist within pursuing pleasure and sexuality.

Adriana: Debra, thank you so very much for being here today and speaking to me. This was fun!

Debra: Thank you! I really enjoyed it too, and I wish everybody who’s listening pleasure today in birth or in your life.

That was world-renowned inspirational speaker, filmmaker, doula trainer, childbirth educator, and author Debra Pascali-Bonaro. You can find Debra on Instagram @debrapascalibonaro And Debra is spelled D-E-B-R-A.

And you can connect with us @birthfulpodcast on Instagram. In fact, please share in your stories, right now – if you’re not driving- how you are going to add more pleasure into your pregnancy, birth, postpartum, and frankly life. Make sure to tag @birthfulpodcast so we can see it and amplify it.

You can find the in-depth show notes and transcript of this episode at, where you can also learn more about my birth and postpartum preparation classes and download your free postpartum preparation plan. 

Also, if you find this podcast to be your go-to resource, an invaluable resource for you, the best way to support us is by taking any one of my perinatal classes, doing one of my doula workshops, or trying out some  of the wonderful products made by our sponsors. This is what allows us to continue doing this work. 

Birthful is created and produced by me, Adriana Lozada, with production assistance from Aysia Platte. 

Thank you so much for listening to and sharing Birthful. Be sure to follow us on Goodpods, Spotify, Apple Podcasts, Amazon Music, and everywhere you listen. 

And then come back for more ways to inform your intuition.


Lozada, Adriana, host. “How To Bring More Pleasure And Joy Into Your Birth (And Why It Makes A Difference!).” Birthful, Lantigua Williams & Co., May 10, 2023.



Debra, a white woman with ash blonde hair, smiles, and is wearing a red shirt and red-rimmed eyeglasses

Image description: Debra, a white woman with ash blonde hair, smiles, and is wearing a red shirt and red-rimmed eyeglasses

About Debra Pascali-Bonaro

Debra Pascali-Bonaro is a world-renowned inspirational speaker, podcaster, filmmaker, doula trainer, childbirth educator, and author. Debra’s podcast, Orgasmic Birth heals barriers and opens the door to share secrets to more love and intimacy in birth and parenting. She brings together her passion for pleasure in every aspect of life with her Jersey Girl attitude of talking about what no one is talking about! Debra is a mother, grandmother and featured expert in parenting journals and media around the world.
Debra is also co-chair of the International Childbirth Initiative and Chair of the International MotherBaby Childbirth Initiative both of which promote safe, respectful maternity care. She is a Lamaze International childbirth educator, birth and postpartum doula trainer with DONA International, director of the award-winning documentary Orgasmic Birth: The Best-Kept Secret and co-writer of Orgasmic Birth: Your Guide to a Safe, Satisfying and Pleasurable Birth, author of The Ultimate Guide To Sex After Baby: Secrets to Love and Intimacy, and the founder and president of the revolutionary online childbirth class Pleasurable Birth Essentials, which helps expectant parents to be positively prepared for birth and focuses on the intimate and sacred nature of birth.
Debra’s passion comes from her over 30 years of working with women, men, midwives, doulas, physicians and nurses in over 40 countries bringing comfort, love, and pleasure to birth and life! Debra has been featured in parenting journals and media around the world.
You can connect with Debra on Facebook, TikTok, Twitter, and Instagram @orgasmicbirth!

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