Rhea Dempsey is one of the foremost thinkers on the topic of working with pain in childbirth. She shares with Adriana the physiological purpose of pain during labor, why it gets such a bad rap, and suggests the pain relief paradigm is a medical construct that undermines our capacity for peak performance and body potency that ultimately facilitates birth. In other words: bring it on!
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- Pain Is My Friend (PDF download), Celebrating Birth as a Peak Bodily Performance, (PDF download), and other articles by Rhea Dempsey
- Beyond the Birth Plan: getting real about pain and power, by Rhea Dempsey
- Birth with Confidence: savvy choices for normal birth, by Rhea Dempsey
- Supporting Women for Labour and Birth: A Thoughtful Guide, by Nicky Leap and Billie Hunter
- The Thinking Woman’s Guide to a Better Birth, by Henci Goer
- Optimal Care in Childbirth: The Case for a Physiologic Approach, by Henci Goer
- Weighing the Pros and Cons of the Epidural, Penny Simkin
Related Birthful episodes:
- Working with Childbirth Pain
- Showing up at Your Birth
- How to Birth Like a Rock Star
- [Birth Stories] Giving Birth to Twins as a Disabled Person
- What You Need to Know About Birth Models (Birth What?)
- How to Avoid a “Cascade of Interventions”
- Third Stage of Labor
- [Breastfeeding] Epidurals and Breastfeeding, What’s the Connection?
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The Purpose of Childbirth Pain
Adriana Lozada: Hello! Welcome to Birthful, Mighty Parent or Parent-To-Be. I’m Adriana Lozada and as we continue with our Birth Beyond the Clinical Experience series, today we’ll be talking about one of the biggest elephants in the labor room, which is of course the pain of labor, and we’re going to come at it from a physiological perspective to talk about the purpose of these strong sensations.
My guest for this conversation is Rhea Dempsey, who is an Independent childbirth educator, doula, trainer, counselor, and author. Rhea lives in Melbourne, Australia, and has gained her perinatal understanding from decades of attending births, presenting workshops and classes, as well as writing and speaking on birth issues both nationally and internationally. And also wanna say how endearing I find it that she says “caesars” instead of “cesareans.”
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 – talking about why the pain is there and rethinking it.
This was for me a fascinating conversation of exploring the physiology but also our cultural beliefs toward pain, because, if you think about it, our cultural aversion to pain almost eliminates the curiosity of the ‘What if?’ as in, “What if I leaned into these sensations?” or “What if I explored what this feels like?” instead of bracing for it. It’s like we’re almost scared of the pain even before we feel it.
Now, Rhea is all about supporting birth physiology through unmedicated births without epidurals, but that doesn’t mean we’re here taking a stand against pain management, or telling you what to do. As ever, we believe you are an expert in yourself AND we also hope this episode encourages you to think about your own relationship with pain, and how you’ve navigated those sensations in the past. Maybe you have tattoos, piercings, or other body modifications. Maybe you’ve run marathons and have not only hit the walls along the way but gotten through them and experienced the endorphin highs. Maybe it’s been a different physical or emotional challenge that you have gotten through and so think about how it was for you, what helped you, how you got through it.
Regardless of whether you lean more toward the pain relief paradigm or the work with pain paradigm, chances are that you WILL have to experience some of the sensations that come with labor, and so we hope that learning about the physiological purpose of pain in childbirth will help lessen your fears and that you’ll do some curious exploration of what working with those sensations can mean from you.
Now, as a doula that’s seen hundreds of births, I know we can’t predict the details of labor, nor those instances when pain relief can serve as a great tool— but what I can tell you is that people are stronger, immensely stronger than they think, and that being surrounded by an encouraging team really helps.
You’re listening to Birthful. Here to inform your intuition.
Adriana: Rhea! Welcome to the show.
Rhea Dempsey: Hi, Adriana! So pleased to be here with you and speaking to another passionate woman of birth.
Adriana: Yes! Yes, and so we’d love to talk about birth because it’s so interesting, and it touches all of us to some extent. So, yeah, let’s get to doing this thing that we love so much.
Rhea: Yeah, good.
Adriana: So you have gotten into this sort of wheelhouse of being known for really digging deep into the… 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?
Rhea: 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, all those years ago— what we call (over here) a physical education teacher and an outdoor adventure sort of facilitator.
So that means that really you are… to do that work you’re sort of working with people with their bodies and working with people with their bodies in sort of extreme situations, I guess. And in doing that work, it’s very clear to see that for so many of us, you know, 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,” although it’s not only me who talks about it like that. But within the world of achievement of the body, peak performance of the body— whether that’s for health or wellbeing or fitness or achievements of one sort or another— 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, for people who are undertaking that then, that’s a challenge. There’s a challenge, but they’re not fearful of the pain, in terms of thinking that it’s about danger or disease or things going wrong. They just know that that’s what happens with those muscles pumping and trying to get that oxygen into your lungs, and that’s what’s going on with the hormones and the exchange of the oxygen in your body and so on, that that is part of that functional physiological pain.
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, yeah— but which is sort of slightly, well, I mean they all make a whole, but they’re slightly different issues. So 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, and it was certainly in the years here in Australia, at least before the whole idea of a doula or somebody who was doing that work of being at birth, separate to midwives. So I had the privilege of just being around that scene, particularly the homebirth scene, and saw that for many women there was this aspect about the pain in labor really had such a negative and fearful aspect to it so that they, 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 with 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, you know, it was too much, and this wasn’t what they’d signed up for— it was more or greater or more challenging.
And so that sort of edge about the pain, and then also the cultural story about pain in childbirth seems to have been really hijacked by a sort of a medicalized, I don’t know, linking of birth into that medical scene, seems to mean that instead of thinking about pain in childbirth as being an expression about potency and power and health and wellbeing and vitality (you know, that zing of the body working so strong and hard for achievement), 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 in most things to do with medicine, that would be a correct assumption.
Adriana: And because we don’t usually experience pain, unless, you know, 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 gonna collapse and it’s their mind telling them, and they’re like, “No, we can! Let’s get through this. Let’s keep going”— because they understand the physiology.
Rhea: Exactly. Yes. Yeah, and yet, with birth, again, as I’m saying, because of this very strong identification now of birth into that medical frame, then I think that there’s a sort of… well, there’s two things. If I talk about the cultural thing, but also within that medical frame, you know, birth or pain in a medical context which is escalating (going on for a long time and getting stronger and stronger and stronger) 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 or a, you know, rock climbing or whatever other pursuit they might do. The escalation of the intensity is really about the body having to work stronger and harder to achieve whatever it is that we are undertaking. In our case, we’re talking about birth.
So there’s a big reframing that needs to occur in terms of that embracing of that potency of the body and that physiological functional pain, which is the way I talk about it, and it’s a bit clumsy, but I think we just have to keep naming it and naming it. Naming it to normalize it, as opposed to pathological pain, which is, you know, something that’s coming really outta things going wrong in the body, but that blurring makes that very difficult for women.
And anyway, pain in labor, just for a whole lot of reasons, got just really bad press. Bad press! You know, where are the positive stories about it? They’re generally all negative stories. So women are, you know, often quite fearful about that aspect, you know— even before they start the labor.
And then, maybe I’ll just go into something that I see in terms of that cultural impact of that, or the sort of amplification that happens in the culture. And I’m pretty sure that in America it’s similar to here in Australia.
Adriana: Yeah, and before you move into the cultural part a little bit though, I wanna briefly sort of close up the concept of that “physiological” versus “pathological.” And I find that just something as simple as 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 their 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 but that doesn’t mean something’s wrong.”
Rhea: Exactly, exactly. Yes, it’s a beautiful reframing, isn’t it? To place birth in the context of the language I use that sort of “peak performance,” and, really, beautiful description, isn’t it, for what happens for women in labor? That’s a peak performance of their body, really doing that work of, of birthing that baby. So, that can mean a sort of engagement with potency and power— rather than a fearful, you know, surrendering of that process to be saved from that, I don’t know, the discomfort, the pain, and the fear of all of that. So it can be very powerful and simple, as you say. Simple.
Adriana: In my daughter’s school, there’s this framed saying on one of the classrooms and just… it’s very simple and I just love it. It says “We can do hard things.”
Adriana: And we’ve sort of gotten away from that— like, we try to do none of hard things. It’s like, “No! You can do hard things.” And the… you know, I’m sure you can speak to this way better than I can, of the rewarding feeling of having done a hard thing,
Rhea: Yeah, absolutely.
So there’s sort of two ways that I think… just, I’d like to respond to that reflection. And how beautiful for your daughter to be seeing that every day! That one, it takes me one way, to go… and we’ll go both ways, but one way is into what we know is the function of that physiological pain in childbirth, and how important actually it is for the unfolding of the hormones.
So that’s one pathway, and the other pathway to, again, is this idea, I think, about what’s going on in the culture about pain and childbirth. So, maybe we’ll talk about the hormones, and then we can come back to the cultural aspect.
Adriana: Yeah, sounds good.
Rhea: So, I noticed Adriana that you’ve had on your podcast, Dr. Sarah Buckley, who’s done that absolutely beautiful piece of work that she did on the hormones of pregnancy, birth, and breastfeeding.
Other people have done such work, but Sarah’s is so comprehensive. And I think, you know, 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 who have been birthworkers across cultures and across time have known to be the sort of reality.
For instance, you know, we talk about the mother feeling safe— and 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. And now we know that when we translate that feeling of safety, that that really into the hormones it’s about, you know, well, is their 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, you know, around the fear and the not feeling safe? And so on and so on.
So we’re, 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 to get back, then, to this issue about pain. So the way that I explain it— and this is a very simplistic explanation, I guess— so when we’ve got oxytocin, we know it’s the big driver for human interactions. When we talk about oxytocin as that “tend and befriend,” nurturing, feeling safe, feeling secure, all of those feelings, you know, across the range of relationships that we have in our lives, whether that’s with our babies or our children, or our loved ones, our family, our lovers, or, you know, wherever, that aspect of oxytocin.
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 hormone— it’s a bit more complex than this, but it’s the big driving hormone to create those contractions that also open her body. So we’ve got that beautiful, you know, whole situation going on, of the heart and the body being opened basically by this same sort of diffusion of hormone.
And of course, you would know, being a doula, that those of us hanging out with laboring women, I mean basically we’re oxytocin junkies, ’cause we are all falling in love. It’s just pumping in that birth space, that we’re all affected by that hormone and how beautiful that is. And that start of the opening of everybody’s hearts to this new baby, that village coming around that baby.
But to come back to the… so the oxytocin is driving the big contractions. The big contractions, of course, as they’re escalating, that’s bringing on that intensity of that functional physiological pain. 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.
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. Endorphins really are our natural opiates in our body. And so when that connection happens and the endorphins come through, they’re often called the “feel-good” hormone. They give us that lift. They give some moderation to the painful sensations. We have to say that, advisedly, some moderation— they don’t take it away, but I don’t think that’s even the most important thing that the endorphins do. 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.”
So the mother, then, with those strong contractions driving that functional physiological pain, which then triggers the endorphins as a response to that functional physiological pain, the endorphins start to swamp the cerebral cortex takes that thinking… I mean that thinking brain, how brilliant in our lives is that thinking brain? But it’s not great for us when it’s strongly alive in a birth situation. So the sooner it gets taken outta the picture, the better (usually) the birth is gonna go.
And 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 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 gonna go brilliantly and that normal physiological childbirth is going to unfold.
Adriana: So, 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 the person not be thinking and sort of properly give in to the process.
Rhea: Exactly. Exactly. So If we feel that fear and want to, you know, control or take out that pain, then we are really starting to interfere with something of this exchange in terms of these hormones that really are so supportive and, you know, facilitative of normal physiological childbirth.
So, you know, often people probably in America are the same as here. People are pounding the pavement, you know, or doing their spin class or those bike rides and what have you, and they’re repeating that mantra to themselves. You know, “Pain is my friend, pain is my friend, pain is my friend,” as they’re going up that hill around that bend. And of course never has that been so true as in childbirth, when that functional physiological pain has that purpose of not only it being the expression of the muscles working, but this triggering into the hormones, which is really the facilitative mix for that normal physiological childbirth. So yeah: bring it on!
Adriana: I like that, though. I really like that. That was like an “A-ha!” moment, of how you explained it, of everything coming together, of giving it a purpose, because then it allows you to tip over. Because during birth you can’t kind of give birth. You have to do it all the way. You’re all in. You can’t just like, “Oh, I think I may.” No. It’s like you’re not kind of pregnant. You’re pregnant, or not.
Rhea: Yes. Yeah, exactly. So, that’s the hormonal link.
Adriana: Yeah. What about the cultural part of it?
Rhea: Okay, I think again, in America (like Australia), you know, in terms of that idea of “pain is my friend”… in terms of other physical pursuits and wellbeing and challenge pursuits, we do champion that idea of “pain is my friend.”
It is part of the Olympics, yeah? And we celebrate that engagement of people to work with their bodies strong and hard in those peak performance, personal best experiences. And we all know the fact that that is functionally physiologically painful, what they’re doing, and we champion it. But when it comes to childbirth, the cultural message is entirely the opposite.
So that the cultural message… and I sometimes frame this in this idea of “The Three Cs.” The Three Cs, 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. 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 pre-history women, we’re never thinking that birth should be a comfortable process.
It’s not called “labor” for no good reason, you know! Hard work, body working. And yet what has enabled this sort of idea of comfort is, of course, that epidural. I’ve 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 birth scene when epidural 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 the epidurals and their like can be used, so that the mother can be conscious and aware when that baby’s born.” But of course, for those of us passionate about normal birth, we’ve seen that, really, we’ve been broadsided by the epidural in terms of, you know, this offering, this promise, this seduction the siren song, the 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.
So, the comfort aspect, certainly, epidural’s brilliant for, in all sorts of situations. But the unintended consequence is that it’s shifted cultural expectations and a sort of cultural messaging to laboring women into a totally different scene than it was when I first started, of course.
Adriana: Rhea… And I wanna be a little bit of a devil’s advocate, just for fun, because I think you’ve hit the nail on the head, but, you know, 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?
Rhea: Yeah. Well, of course that’s probably the dream! One… well, 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, you know, things to be better for some mums 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, 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, you know, birth their babies and so on. So there’s a lot of downside. I mean, many people have written about all of this.
Adriana: Well, that’s it— they’re not risk-free.
Rhea: Exactly. There are hidden costs to that promise of and seduction of comfort that the epidural is offering.
Adriana: It’s that cascade of interventions: that, you know, the dominoes topple one thing, moves to the other, other, and the other, and then you’re painted into a corner.
Rhea: Yes, exactly. So that’s part of… And it’s informing the sort of cultural message, as I say, so that women, even if they feel like they wanna have a go, they’re just getting this cultural, “Now you don’t have to be a martyr,” you know? “No, no. The epidural is the way to go, la la, la.” So it’s, I think, a cultural undermining of that capacity of women to take on the birth in its potency.
The other Cs I talk about are the, you know, the convenience. And that’s, 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, openhearted state, of what, you know, naturally-occurring oxytocin does. Neither does it push that link between the functional physiological pain, the endorphins and so on. So we can make birth convenient through those means, but it means we lose out on all of the beautiful stuff that normal physiological childbirth offers.
And of course, that idea of controlling comes out of those things as well. So those three Cs, I think that cultural message, you’re very undermining of women’s sort of trust and faith in their bodies and they’re trust and faith in their own capacity to stay and work with their bodies.
But another thing that I wanted to just go down to now is this idea of what I call “pain dynamics.” And it sort of is a next step on from what we’re talking about.
So partly, I guess, because of the cultural message about comfort, which the epidural can, you know, sort of promise— and also I think just more generally in Western cultures, you know, we are living much more sedentary lifestyles.
I’ve seen over my years what often used to be called “transition,” well, I mean, there is transition in late first stage that, you know, eight to ten centimeters, we talk about as a “transition” and it’s sort of been over time that transition is talked about the point when women feel like they “can’t go on, it’s too much, it’s too overwhelming,” and that they have that sort of those vulnerable moments where they’re feeling that it’s not possible to keep going and to move into pushing their babies out.
Mainly the literature has been, yes, about if women reach those points in their labor that it’s assumed that they’re in transition, which of course means that they’re getting quite close to birthing their baby, and that knowledge can really boost women to feel like, “Oh, okay, yeah, probably I can do it, because I’m just quite close to birthing my baby.”
But I’ve started to witness— and there was one birth in particular that really brought this fully to my attention— and remember, this sort of sits within my background of being a physical education teacher and so on, but it was a birth that I was called to, I’d been working with this woman through the pregnancy and was called to, and the midwife at the birth center where the mother was working, was having her baby phoned me to say, you know, “Rhea, you better get here quick,” you know, “This baby’s gonna be born very soon,” and so on and so on. So I dashed. The midwife was interpreting the mother’s behavior as transition. The mother was quite distressed, feeling like she couldn’t go on and so on, saying all the things that we would naturally think might have been transition.
And I could understand why the midwife was thinking that, but I guess I had a longer knowledge or interactions with these women. And it just didn’t quite ring true to me where that she was actually as far along in the labor as the midwife thought when we sorted it out. In fact, we found that the mother was actually only one to two centimeters, really.
She was just in very early labor, that shift from pre to early labor, and she was already very distressed and feeling that, you know, she couldn’t go on and that she wanted the epidural, and so on. So the midwife was very surprised. The mother, of course, we had to do a lot of work with her to help her to regroup— which we were able to, with a good team around her.
But I started to talk to the midwife and then talk, starting to talk more generally and hearing that there was this sort of misreading of the mother’s distress as being in transition was happening in more than just this case.
So I started to feel like, as a childbirth educator, that I needed to be talking about this differently. Not just always saying that “When you get into a distressing point, that’s gonna be transition,” but to talk about it differently. So I then started to talk about this idea of a “crisis of confidence,” and again, Adriana, if we go back to that idea of peak performance, you know, 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 wanna give up. But, in fact, we know that we need support to move through that pain barrier. And when we do move through that pain barrier again, in those physical pursuits, those endorphins come through that runner’s high or that bike rider’s high or that mountain climber’s high— same, same, same for birthing. So instead of calling it a “pain barrier,” as we might do in other pursuits, I started to talk about this “crisis of confidence.”
And 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, you know, ramp up and that the normal birth is unfolding so beautifully.
It’s just that you don’t like it in those moments when you’re dealing with those contractions! So, that aspect of those points, those crisis of confidence points, separate to transition happening earlier in the labor. It’s a bit, you know, more complex than I’m saying here about why that is the case. But nonetheless, as an educator, I’ve been talking about that for quite, quite some years now and speak about it quite a lot in my book and it seems to be very helpful for everybody to normalize, okay? “That’s what I’m likely to be going through,” to prepare for it in terms of the people that they have with them and also to be able to normalize in the midst of it, “Alright, here, I’m meeting this challenge and I can work through it.”
So, if that’s not the case… 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?
This crisis of confidence is not a medical crisis. There’s nothing going wrong. Everything is going brilliantly. It’s just a tough gig. So the way the mother is met and spoken to and supported at that point is crucial to what is going to now happen in this labor. Is she gonna be supported through, encouraged through that crisis of confidence? Or is the cultural sort of default of the drugs and the epidural and what have you gonna start to become part of the picture?
So in my way of understanding that, I’ve drawn on some work from a midwife, a professor of midwifery from England, and she also works here in Australia, called Nicky Leap, who had done some research some years ago looking at the attitudes of midwives towards pain in labor. Beautiful piece of work!
The core elements that I take out of it are that there’s sort of two paradigms, if you like. One is the attitude of the midwife— and I would say that this can relate much more generally about attitudes about pain in labor— is that either midwives have what we might call a “pain relief paradigm” or a “working with pain paradigm.” And if we think, again, about what we’ve been saying about that placing birth in a medical setting, of course, a pain relief paradigm is a medical construct. People in hospital or medical settings who are ill, things going wrong, damage, disease, danger, probably very important that there’s pain relief so that their healing can be maximized.
But first, we stick it into that context, and still using that pain relief framework, even though we know the pain in labor is not a signal of anything going wrong, it’s just a signal of the potency of the body working brilliantly. Nonetheless, that pain relief, you know, the menu of the drugs, the expertise of the caregivers about which drug, how often, how much, what dosage, et cetera, et cetera, et cetera.
So that’s if that woman is feeling that crisis of confidence and she’s surrounded by people who have a pain relief mindset, whether that’s the medical people who are working with her, or her own partner or support people who are feeling that pity for her, “The poor thing. She shouldn’t have to go through this. Somebody please save her. She needs to be comfortable.” So on all of that, as a sort of a cultural default, then that point of that crisis of confidence is going to be that pathway into that cascade of interventions that then unfolds.
Or is the mother— either because she’s savvy enough, or she’s lucky enough to be surrounded by people who have a working with pain paradigm and philosophy instead of skills— so this would be your running coach, your yoga teacher, your personal trainer, your midwife who considers herself to be a midwife guardian of normal birth (because those midwives know that, like I’ve explained, that functional physiological pain in labor is so important for normal physiological childbirth), and that these points of vulnerability, these crises of confidence can be supported. That women, when they move through them, will be dropping deeper into that labor, those endorphins coming through and so on, all the things that we’ve talked about previously. So that working with pain philosophy means that at that point, if the mother is surrounded by that when she’s in this vulnerable moment of these crises of confidence, is supported by that encouragement, that engagement of somebody to come close with her to engage her back into her breathing, her rhythm, her… you know, reassurance about that everything is going brilliantly.
And so she moves through that crisis of confidence. I mean, a well-supported crisis of confidence at a labor maybe it’s only four or five contractions, that could be 10 to 15 minutes! It’s just that they’re crucial moments, because either they’re gonna 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, which we then know starts to often be the start of that cascade of interventions as we’ve sort of talked about, so this idea of a crisis of confidence.
Then I talk about, you know, what’s the holding circle? So who’s with the mother? That’s not only her partner, her family, or friends who she invites to be with her at the birth, but also who are the, you know, the medically-trained people who are engaging with her? And are these people, you know, are they the sort of the enactors of the cultural pitying and saving pain relief default, or are they people— by savvy choices or brilliant luck and goddesses shining on the woman— people who have that working with pain mindset who can really, you know, hold that mother through those few distressing contractions until she gets on that back into her own rhythm and into that groove for continuing on with the labor?
Adriana: Do you find that it’s more that it’s just kind of waiting for the person to say, “Okay, I am gonna stop fighting it” or what? You know, what can be helpful in that moment? Because they can think “It’s been this intense and this long to get here, and I’m only one… I can’t do three more days of this.”
Rhea: It’s a beautiful question you’re asking, and of course it makes me put on my childbirth educator hat. That is very important, for women to have an understanding of not just the stages of labor— you know, first, second, third stage that we talk about, and also now talking about fourth stage beautifully— but to understand those phases. So that aspect about pre- and/or early labor… so some… I talk about pre-labor, early labor, established labor, and then transition in first stage. And of course, they have a different rhythm to them, and often these crises of confidence are coming… are predictable to come at points where the labor is sort of shifting gears. It’s intensifying. 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 on, you know, into the game yet, in a way, and that means “If it’s gonna take me a day for each centimeter that I’m doing…!” But of course, that’s not the reality at all. There’s a building momentum and once women get, you know, to that next step, it’s always escalating in terms of the intensity, but also the speed at which the labor is going.
Those crisis points generally are letting us know that she’s on the cusp of one of these big jump-up points in the labor. And if she can get through it— which is sort of the, you know, sadly, another part of what I do is lots and lots of counseling and birth debriefing, and for women who have been distressed about their birth or traumatized by their birth. And when we go back through the birth you know, it’s so sad for me to see that often the point at which certain choices are made, particularly around the pain… really, she’s just on the cusp of one of these points where that labor is really gonna intensify, that the hormones are gonna shift and change that the moderation of the pain, the dropping deep into that evolutionary regression.
She’s just on the cusp of it, and nobody’s been able to really, you know, support her to take that deep surrender into that shift, but rather that in a way they’re robbing of that chance in a way, and then that whole cascade of intervention. So it’s a bit more complex than I guess I’m saying here, but generally, yes, they happen on the cusp of a big change.
If women can be supported to go through them, the momentum is gonna be increasing, which means that it will be going faster than it had been before that point. So they’re all selling points, I guess, about encouraging women into that intensity, but also even with what we are talking about it’s understandable about how in those moments women need experienced people around them who they trust. And by “experienced,” I mean people who are experienced in what normal physiological childbirth takes: what it looks like, what the rhythm of it’s like, the normalizing of these sort of challenge points so that that mother, when she’s in that struggle and somebody’s looking her in the eye and saying, “You know, you are here, but you know you’re doing brilliantly and let’s just breathe through these next contractions. You’re going to…” you know, “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, which of course we’ve had worldwide over eons.
So those of us who do this work— and I’m sure you know these points very well in the work that you do, supporting the women that you work with, it’s such a gift, isn’t it?— when we can see that potency of the mother coming forward once she moves through those points of vulnerability into that strengthened place to go on with that work of that birthing and then those hormones flowing into that, you know, that love bomb of oxytocin that baby’s born and, and the mother is feeling her own potency and power. She’s totally tuned to that baby. That baby, of course, is just ready and waiting for that bonding, and everybody in the circle has gotten a bit of that love bomb as well, and we’re all really in that beautiful place of awareness of the baby and the baby’s needs and that bonding of families and bonding of communities. It’s such… what privileged work we do, huh!
Adriana: Well, it is! It’s such an honor to be able to bear witness and hold space and be able to see them get through this thing… because I mean, every single one gets to a point that says, “I can’t do this.”
Rhea: Yeah. Yeah.
Adriana: 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, of that it’s not just specific to transition, but that these moments can happen at very different stages, and sometimes they can happen really early on and they can be so hard because they, that’s not what they were expecting at all.
Rhea: Exactly, exactly. Yeah, so that we can normalize that, rather than women going in feeling like, you know, “Well, if I’ve done my breathing… I’ve done this, and it’s just gonna be some sort of smooth flow,” you know, “And I’ll meet it without any challenge because I’ve got these tools,” but it’s more… it’s not quite how it is.
So to be able to normalize that and to prepare for it so it seems to be a useful, useful concept. So I’m hoping that anybody who might be listening can find that useful as well.
Adriana: Thank you so, so much for taking the time to do this. It’s been a real pleasure.
Rhea: 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!
Adriana: That was the fabulous Rhea Dempsey, who is an independent birth educator, doula, trainer, counsellor, and author. Her book Birth with Confidence: savvy choices for normal birth, explores the issue of embracing the functional physiological pain of labor and the importance of experienced support, and her other book, Beyond the Birth Plan: getting real about pain and power explores the deeper emotional and psychological dynamics impacting birthing potential. Rhea is also the mother of three adult daughters and grandmother to who she describes as five delicious home-born grandchildren. Learn more about Rhea’s and her work at birthingwisdom.com.au or follow her on Instagram @rheadempseybirth
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And come back for more ways to inform your intuition.
Lozada, Adriana, host. “The Purpose of Childbirth Pain.” Birthful, Birthful, April 12, 2023. Birthful.com.
About Rhea Dempsey
Rhea Dempsey is an independent birth educator, doula, trainer, counsellor, and author. She lives in Melbourne, Australia, and is the mother of three adult daughters and five delicious home-born grandchildren.
Her understanding of birth has been gained over four decades of attending births, presenting workshops and classes, as well as writing and commenting on birth issues. She has presented nationally and internationally. She is recognized as an insightful commentator on the difficulties faced by people who have a yearning for normal physiological birth, when it comes to navigating contemporary birth culture.
Her book Birth with Confidence: savvy choices for normal birth, explores the issue of embracing the functional physiological pain of labor and the importance of experienced support, while Beyond the Birth Plan: getting real about pain and power explores the deeper emotional and psychological dynamics impacting birthing potential.
To find out more about Rhea’s books and work, visit her website.
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