Childbirth and Pain
Childbirth and Pain
August 23 – September 7, 1983
By Nutan Pandit
Centuries of conditioning has resulted in our equating childbirth with pain Nutan pandit suggests that
a change in attitude towards pain could mean easier and shorter labour
“Fear brings more pain than does the pain it fears”
Although fear brings more pain, pain is no doubt a physical fact that one can’t deny. In fact, it serves a primary biological function of protection. Like the thought of pain keeps a person from cutting his hand on a sharp knife.
How people feel pain however, is totally unpredictable. For instance, one might suffer from a dull toothache that becomes suddenly intensified when one stops all activity. Or, a soldier may not be aware of his wounds in the midst of a battle. Then there are hypochondriacs who feel pain without any apparent cause.
If one undergoes unendurable pain, one passes out, that is, loses consciousness. This is nature’s safety mechanism. Women in labour may be rendered unconscious by drugs, but never by pain. Hence, what pains can be felt, can be endured.
The role of the brain and nervous system is vital in understanding how pain is felt.
The brain is constantly receiving information through one or more of the five senses, that is, the eyes, ears, nose, skin and tongue, and from the body’s internal organs.
This information is sorted, analysed, interpreted and either stored as memory or acted upon by instinctive behaviour (like withdrawing a burning finger) or by learned behaviour (like guiding one’s food to one’s mouth and then chewing it).
As the message of pain reaches the brain, it sets off an area of activity. To prevent the area of activity from spreading over the whole brain, another brain activity, inhibition, acts as a brake to the excitation. This balance between excitation and inhibition is known as the threshold of pain.
Without this balance, a pain, as small as that of a pin prick would totally overwhelm the brain.
Information is received by the brain through the nervous system. The nervous system is a complex system of nerves that carry messages to the brain from different parts of the body, skin and internal organs. These nerves reach the brain through the spinal chord. This relay of messages to and from the brain could be roughly compared to the passing of messages from one end to the other by telegraph wires.
This two-way activity of the nervous system is called reflex activity.
There are two types of reflex activity, like the inborn reflex of blinking to protect the eyes from a blow, or the conditioned reflex activity, like feeling hungry at meal-time.
A dog salivates if meat is put in his mouth. This is an inborn reflex. If however, the introduction of meat is preceded by the ringing of a bell, and this process repeated several times, the dog ends up salivating when the bell is rung on its own and no meat given. Hence, a conditioned reflex is established. A nervous pathway to the brain has been established, which associates food with the sound of the bell and so determines the response of salivation.
In the same way, breathing regularly practiced for labour, establishes a pathway to the brain which associates breathing with labour. And, when labour sets in, the brain determines the response of breathing.
Let us see what happens to a frightened, untrained woman in labour. When her uterus contracts, stimulus is received by the nerve ending in the uterus and sent to the brain. If the brain interprets it as “fearful pain”, the protective mechanism which advocates flight or fight will take over her body. As a result, the woman, incapable of flight, will fight each contraction by building up muscular tension throughout her body.
Along with general muscular rigidity, her uterus also becomes rigid and offers resistance to the uterine muscles working to dilate. This is interpreted as pain. Consequently, each contraction becomes more uncomfortable and fearful anticipation builds up.
However, if the woman understands that their body is undergoing is a part of the physical strain associated with the expulsive efforts of her uterus of which she has no reason to be afraid, the contraction will be a new experience for her.
The muscles of her uterus will work unhampered by fearful tension and with each contraction get closer to complete dilation so that the woman has a shorter, less pai7nful labour.
Hence the pain a woman will feel in labour will greatly depend on her mental condition since her mental condition will influence the brain’s interpretation of ‘pain’ as either something fearful or as something to work with.
The amount of pain a woman feels will depend on her emotional and mental state. That is, if you take a sensation of fixed magnitude and apply it to three different women, one may feel it as a great agony, another as bearable discomfort, while a third may feel it is nothing much. That is, each will amplify or distort the interpretation of pain in accordance with her mental attitude towards labour.
An interesting fact is that the uterine contractions and their associated ‘pain’ form a very short part of the total labour. Suppose for instance, you have contractions every five minutes, lasting for one minute, it will mean that in one hour you have 10 minutes of contractions and 48 minutes without them.
If the pattern is maintained for 12 hours, you will have two hours of contractions and 10 hours of rest.
If the rest periods are intelligently used and contractions handled with breathing, it is not all that bad.
A contraction of the uterus is mistaken for pain to such an extent that the word “pain” is taken to mean both,
In France, the labour ward is often referred to as “the hall of pain”. Besides, “common knowledge” repeatedly tells a woman of pain in childbirth and the experience of others seems to confirm it.
Reshaping our attitude towards birth is important. We have to begin by changing centuries of deep rooted beliefs of pain as synonymous with birth.
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