Phenomenology Online

A Resource for Phenomenological Inquiry

Birthing Pain

Bergum, Vangie

Birth is the art and mystery of women. We regard birth with awe; we are breathless, silent as we await the first breath of the baby. As women we birth, we become mothers, mothers like our own mothers ,like other women who have carried and birthed a child, and like our daughters who someday will carry and birth our grandchildren. As we come face to face with birthing, we come face to face with pain. The pangs of childbirth accompany the opening of our bodies to allow the passage of the baby into life in the world. Looking at the experience of birthing pain may give us more clues to understanding our nature as women, our relationship to ourselves and others, our attachment to our children, and our place in the cycle of human life: birth, death, and rebirth.

 

“The pains of labour,” says Rich (1976), “have a peculiar centrality for women, and for women’s relationship-both as mothers and simply as female beings-to other kinds of painful experience” (p. 15). What do the pains of birth tell us about ourselves, about our sufferings and our joys? Is there something in the pangs of childbirth which holds true for all women: those who pleasure and ride above the pain? those who endure it? and those who suffer? Some birthings are short and intense, some are long and exhausting, and some need medical intervention and treatment with forceps, medication, or Caesarean delivery. Is it possible that viewing pain-as-lived may reveal the sublimity and joy as well as the agony, the hurtfulness of the pain of childbirth? Our immediate appraisal of pain-as-experienced may bring to light inner meanings which go beyond theoretical and practical approaches. By coming to an understanding of the pain as experienced by women, we may be able to come to grips with the significance or essence of the pain.

 

In order to let the meaning of birthing pain show itself as it presents itself in lived experience, we must let go, for a moment at least, of some of our assumptions. For pain to show itself as it presents itself directly and primordially, we must be set free from held notions in order to attune ourselves to hear what the experience itself tells us. These assumptions, theories, and explanations about pain in childbirth may include:

 

  1. The idea that pain should be denied. As childbirth educators we have thought that by removing the word “pain” from the language of birthing, we will prepare women to take a more positive posture and therefore experience more readily the challenge and joy of the birth. Some of us talk of “contractions,” others refer to “rushes” or to “discomfort” to mean the experienced pain. While a woman’s positive attitude is important, denial of pain may create expectations not borne out in reality. What is being denied in the denial of birthing pain?
  2. The idea that pain must be relieved. The belief that pain must be relieved pervades our society: from the advertisement of “over-the-counter” drugs to the medical need to “give something for the pain.” Although we agree that human suffering must be reduced, let us stand back from our expectation that avoidance of pain is a primary and valuable goal. Rich (1976) suggests that this notion “is a dangerous mechanism, which can cause us to lose touch not just with our painful sensations but with ourselves” (p. 152). What do we take away in relieving the woman from birthing pain?
  3. The assumption that pain is only negative. Childbirth pain is a normal accompaniment of birthing and may arise from dilation of the cervix, the contraction and distension of the uterus, distension of the outlet, vulva, and perineum, and other factors such as pressure on the bladder, rectum, and other pain sensitive structures in the pelvis (Bonica, 1975). The fact that birthing is now a medical event, occurring in an atmosphere associated with sickness and death, supports our underlying belief that pain is associated with disease. As the experience of birthing pain is normal and is associated with life, one questions the value or, indeed, the possibility of comparing birthing pain to the pain of cancer, or arthritis (Melzack et al., 1980). Can pain be shown to be a positive experience?
  4. The assumption that pain can be explained. There are theories that explain pain physically, psychologically, sociologically, and culturally. These theories and explanations contribute to our understanding of pain, but they also fragment our sense of wholeness of the pain experience. Exploring the essence of birthing pain is an attempt to grasp that primordial wholeness of the experienced pain. What is the nature of this experiential wholeness?

By freeing ourselves from these and other assumptions, we may again bring to awareness what the painful experience itself shows us about the nature of its painfulness. What then is the pain of birthing? How can we interpret the seeming senselessness of the pain? Can we find meaning in the pain for ourselves as women, for ourselves as mothers, and further, but not discussed here, for the new beings born out of the pain? To find the essence, we must turn to the immediate, original experience of the phenomenon of birthing pain.

 

Birthing Pain

Let the vexed rejoice in the house of the one in travail!
As the Bearing one gives birth,
May the mother of the child bring forth by herself!
(Meltzer, 1981, p. 19)

Women(1) say that the pain of childbirth is powerful, intense, overwhelming, cramp-like, stretching, burning, pressuring, tiring, and exhausting. They say,

I withdrew into myself, had few thoughts.
I was immersed in a physical sensation, with lack of awareness of time, or what was going on around me.
I tried to find a comfortable position, was impatient, angry, and shaking.
I feared that I wouldn’t be able to stand the pain, which would be to lose myself and maybe even die.
I screamed, or wanted to scream, to bite on something, I cried because it
hurt so much.
I didn’t know what to do and needed someone to help me.
I was brought to the core of myself, pitted against myself .

In exploring these descriptions, it must continually be remembered that, as Buytendijk (1961) reminds us, birth pangs, however violent, are connected to the birth of a child and are experienced in relation to this objective event: As one woman recalled, “I reached down and took him out put him on my belly I couldn’t take my eyes off him.”

 

We will explore the experiential structure of the birthing pain by listening to the original (etymological) speaking of language and to the language of the voices of women as they attempt to re-achieve a direct contact with their own experience.

 

Bearing

The origin(2) of the word “birth,” from the Old Norse burhr or bher, means to carry, to bear children. The carrying, the holding of the child, the woman-body-vessel (Newman, 1955) is the nature of life. The nature of life for woman as the carrying vessel, is the source of distress and pain and also the source of joy. As a woman, I am this body, I am this pain, I am this joy. This symbol is vividly understood in the birthing experience. Is it possible that non-acceptance of the pain or the fear of pain comes as a result of alienation from our own bodies, fear of our helplessness, fear of our dependence, and fear of our own behavior? One woman said:

The pain is powerful, overwhelming. I feared that I couldn’t handle it. My anxieties related to how I would perform.

The fear and anxiety of this truly female experience stand in the way of drawing on the fundamental source of life and spirit we have. Fear of the pain may be a result of tales, anecdotes, literature, and medical approaches to childbirth. Until recently, the written texts about birth were from the hands and minds of men who had observed and described but had not experienced. The knowledge and support that was originally available to women, from mother to daughter, from midwife to labouring woman, from older to younger, is once more becoming available. The reclaiming of the childbirth experience has done much to dispel untruths and has reaffirmed the “reproducers” themselves as the center of the action. The mind and body are one, and as we accept our bodies, our bigness, our appe-tites, and our feelings as well as our intellect, we will regain our sense of power. Rich says, “we need to imagine a world in which every woman is the presiding genius of her own body…. Then women will truly create new life” (p. 292).

 

The word pain, from the Greek poine meaning “penalty,” is suggestive of the notion that we women are being punished for the “crime” of our pregnancy, our sexuality: that is, for our tasting of the fruit of knowledge. Rather than accepting that notion, indeed, as we acknowledge our physicality, our passion, our sexuality, the whole femaleness of our existence, we will regain our lost and alienated powers. To change our fear, the pain of childbirth must be recognized, acknowledged, and understood. It must not be ignored, denied, or passively accepted.

 

Enduring: Standing

Birth, bher, also refers to bearing in the sense of enduring. To bear, to carry on, to endure the pain is a part of the birth experience. Bearing pertains broadly to the capacity to carry oneself in a specific way; endurance specifies a continuing capacity to face the pain; suffering suggests resignation.

 

The way we bear the pain (to carry or ride above; to endure; to suffer) depends on our relationship to the experience of pain itself and to the reason for the pain-the birth of a child. Our relationship to the pain is intentional; that is, our pain is experienced by our stance in the world-as a woman of power and knowledge or as a woman at the mercy of the doctor, alienated from her body and subject to fearful thoughts and imaginings. As we accept and take hold of our power, to literally and figuratively “stand up” and actively birth our own children rather than be delivered of our children (such as in the vulnerable “lying on one’s back” position which is mainly for the convenience of the doctor), we will not deny the pain but carry it. One woman, accepting rather than pushing thepain away, said:

The breathing doesn’t make the pain any less. The breathing was to stay relaxed while you feel the pain.

We see, then, that our pain-as-experienced is empowered by our way of standing in relationship to it: our riding with it, our enduring it, or our being overwhelmed by it.

 

As we explore further the etymology of the word “birth,” we find that”to bear children” is tied to the root bara (Old Norse), meaning wave, billow, or bore. “Bore” is defined as “a high and often dangerous wave caused by the surge of a flood tide upstream in a narrowing estuary or by colliding tidal currents.” The wave metaphor has often been used to describe the contractions (the pains) of childbirth. Like each wave flowing in with the tide, the baby is carried by the contraction wave to the mother’s arms. But the wave analogy goes even further. As with ocean waves, we can have the pain wave of birthing, the sense of being carried by the pain as we ride with it, by being caught by the pain and thus enduring it, or by being overwhelmed by the power of the pain that “throws us upon the beach only to pull us out again to the sea.” The contractions of birthing, like the colliding of the tidal currents, are most painful at the point in the process when the baby moves down the “narrow es-tuary” of the birth canal. The metamorphic wave tells us about the coming and going of the pain, the developing intensity, the climax, the release, and the moment of gathering resources for the next coming of the pain wave.

 

Knowing where to stand in relationship to the coming and going of the pain wave gives us a chance to choose our experience of it. As our perspectives change, so does our experience of what is pain and what is joy. Factors which may affect our perspective are hunger, tiredness, fear, anger or our own self-concepts. It makes a difference where we stand.

 

Doing: The Cry of Pain

Labour, the work of birthing, is seen in the cry of pain. The regular, intense, continuous contractions take their toll of energy and resources. Tired, exhausted, overwhelmed with the pain of fatigue, the feeling is one of “I just cannot go on.” As Chesler said:

Too tired to say anything, I push with all my might.
I’m the Lilliputian. I may not be able to do it.
It’s beyond me to give birth to you. (1979, p. 115)

The work, exertion, effort, is not just the physical power of the uterus, nor is it just the intellectual power of the mind, but the unity of self which calls us to use all our resources. One woman said, “George said he had seen many sides of me but had not known the determination, the work, the pure effort!” In spite of this overwhelming exhaustion and fatigue, we carry on especially as we are aware that progress is occurring and the baby is soon to be born. Of course, there is no other option.

 

Work means doing something. The pain of labour demands action; it forces us to ask what is to be done. Grunting, screaming, walking, finding a comfortable position, active relaxation, breathing patterns, focussing free us from the state of passively suffering. The cry of birthing pain is commented in Isaiah 42:14 where it reads, “For a long time I have held my peace, I have kept still and restrained myself. Now I will cry out like a woman in travail, I will gasp and pant.” The Australian myth of Eingana (referred to as the great earth mother, fertility herself, the source of all life, all forms of being) gives a clue to this cry. It says,

Eingana’s travail to give birth is also the explanation of the sound made by the “bull-roarer” in the Kunapappi ritual…. Eingana was rolling about, every way, on the ground. She was groaning and calling out . . .making a big noise. (Meltzer, 1981, p. 11)

Following the home birth of her third child one woman said:

The “noise” came from where? my depths for sure. It amazed me. The bull’s roar it is a perfect description for what it felt like and sounded to me.

Comments like “perhaps you need a sedative” cause personal doubt and loss of confidence. Is it possible that the offer of medication to obliterate pain is accepted by women as it is the only support that is offered in the face of an experience of overwhelming helplessness and suffering? The offer of medication cofirms the fear that, yes indeed, we will not be able to stand it. There is nothing else to do but suffer or be medicated and thus relieved of our primordial task. This is not to say that we do not ever need the help of medication to com-plete this work.

 

Support must be there without the asking. “I needed support I needed to know I was doing okay.” Support may take the form of back rubs, direct suggestions, sips of water, a soothing touch, the words of encouragement, the presence of a caring person, and an un-derstanding of what is happening. All of these actions help us to “do whatever it takes to get the baby out.”

 

Knowing

It’s time. The baby is coming! The pains are our knowing. The pains begin; women feel excitement and apprehension. This is what we’ve been waiting for; this is it! The pains are our knowing that the time has come, but what do we “know?” We may know the stages of labour, know the procedures to expect, know the things to do, and yet we ask, “How will I handle it? What will it really be like? Each time we birth, we know more about what to expect and do, but the mystery of “this” time is still present. Each time is its own time.

 

Yet, our bodies have wisdom to deliver the baby without our intellectual knowing. Odent (1981, p. 9) recognizing this body wisdom, says:

These last years, we understand better and better what to do to help the mother become more instinctive, to forget what is cultural, to reduce the control of the neocortex, to change her level of consciousness so that the labour seems to be easier. For example, assistance by a female is always beneficial…. Women must engage themselves effectively to bring love, and at the same time to bring experience, as a mother would.

The knowing that women share with other women has been lost in the replacement of midwives by doctors (who are primarily male) as birth attendants. The challenge by women to regain control of the childbirth process is a recognition of this knowledge and of the im-portance of women sharing our knowing with women.

 

Being in Pain

It was as if the pain was all there was it would never end there would be no result … I would live it forever…. (and later) … After thepain I almost had the feeling that perhaps I imagined the pain. Was it really as hard as I thought it was?

When asked to describe the pain of birthing, we sometimes find it hard to remember. We know we experienced something deep and powerful, but we find that the words elude us:

It’s different than I’ve ever experienced; an internal rather than a surface pain; low back pain; deep pubic pain.

There is the localized, more surface pain, such as the burning and stinging as the tissue stretches to release the baby’s head, but there is also that deep inner pain which expresses itself as “being in pain.” This inwardness is also experienced by the feeling of unreality, of being in a fog, a sense that time has stopped or is irrelevant, with little awareness of the people around. “I don’t remember what was talked about. I was totally inward.” And yet in this inwardness there is an attentiveness to the deep significance of the momentous quality of the pain. One woman said, “I was annoyed when someone was making light conversation with my husband; I felt it was disturbing and irrelevant to what was happening to me.” Another said, “I couldn’t talk, didn’t want to, in fact, I wanted to be alone at this point. And another:

It was an incredible sensation being totally into myself. I didn’t have thoughts. I was really in tune with my body. I think it must be something in you that just happens. In meditation you can go so far but this was much, much different. In those last few hours there was no straying of the mind. I couldn’t talk because I was on one plane and he was on another. Mine was an inward focus.

This deeply felt experience reaches to the core and, as Buytendijk (1961) says, “throws us back on ourselves,” demands us to muster up even more strength to survive, to live through it. We need to help each other through it. As Harrison (1980) described:

I look at Marie and I see the terror of childbirth in her eyes. I feel it. I remember it. I know it can be survived. I tell her that. (Harrison, 1980, p. 105)

As we are surrounded by the deep sense of inwardness, we are forced to recognize our independence, our loneliness, our selfhood, to be conscious of our own existence. This actual self-consciousness exposes to us our wholeness, our strengths and our endurance. As was stated so beautifully by one woman, “I feel great for the process to have happened through my body, proud of realizing such stamina,strength, and determination.”

 

And the Birth! The Child

I couldn’t take my eyes off him. I cut the cord, that was really cutting the cord, really making the break from the baby. It’s one relationship, and then when he is born that relationship dies and another relationship begins.

Deliver, deliverance, the act of transferring to another. The pains are a literal expression of the narrow gateway leading to release in the expanse of life. The involvement changes from the self-as-world to the baby-as-world. The bearing, the enduring, the doing, the knowing of the pain releases to allow the birth of a new life, a new being:

Something in me was released. I turned away from my somewhat egotistic involvement in my labour towards my child, and since that moment my love has grown so that it actually hurts sometimes. (Kitzinger,1971, p. 161)

The pain is released, with possibility of a new and different pain tied to the incredible and awesome awareness of a separate being. Relief, disbelief, joy, and incredible exhilaration surround the excitement of the baby’s presence. The focus is now the child.

 

Becoming: The Mother

Phyllis Chesler (1979) wrote, “Being born with motherhood is the sharpest pain I’ve ever known” (p. 281). With the pain of childbirth we become mothers. Can pain be transformed into something usable,” as Rich (1976) said, “something which takes us beyond the limits of our experience itself into a further grasp of the essentials of life and the possibilities within us” (p. 151). What is it that can be learned? One woman remarked:

I think I have a right to feel good about myself. In a way, this birth is helping me to accept myself both the limitations and capabilities. Accepting myself is the other side of the coin of accepting the pain of birthing. I need to think further about it but have a sense that, for me, this has considerable significance.

To have experienced birthing pain offers the possibilities of self knowledge, knowledge of our limitations and capabilities, knowledge of new life, as mother, and of our place in the mysterious cycle of human life: birth, death, and rebirth. As we birth our children, we, in a sense, birth ourselves. We are mothers, like other mothers, and our daughters after us. Frans said:

Rose, the only other mother there I had something in common with her. I started to cry when she hugged me.

 

 

References

Bonica, J.J. (1975). The nature of pain in parturition. Clinics in Obstetrics and Gynaecology. 3(2), 449-517.

Buytendijk, F.J. (1961). Pain. London: Hutchinson and Company.

Chesler, P. (1979). With child: A diary of motherhood. New York: Thomas Y.

Crowell.

Harrison, M. (1982). A woman in residence. New York: Random House.

The Holy Bible (1953). Revised Standard Version. Toronto: Thomas Nelson and Sons.

Kitzinger, S. (1977). Giving birth: The parents’ emotions in childbirth. New York: Schocken Books.

Melzack, R., Taenzer, P., Feldman, P., & Kinch, R. (1980). Labour is still painful after prepared childbirth training. CMA Journal, 125, 357-363.

Morris, W. (Ed.). (1969). The American heritage dictionary of the English language. Boston: Houghton-Mifflin Company.

Neumann, E. (1955). The great mother: An analysis of the archetype. (Ralph Manheim, Trans.). New Jersey: Princeton University Press.

Odent, M. (1981, Spring). The evolution of obstetrics at Pithivers. Birth and the Family Journal, 1(8), 7-15.

Rich, A. (1976). Of woman born. New York: Bantam Books.

 

Notes

(1). Twelve women were initially interviewed and nine of these reviewed and commented on early drafts. All quotations not referenced are from conversations with these women.

(2). The origins of the words were explored through both Klein’s Comprehensive Etymological Dictionary of the English Language (1971) New York: Elseview Publishing Company, and The American Heritage Dictionary of the English Language (1969) Boston: Houghton-Mifflin Company.