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UNDERSTANDINGPAINDYNAMICSinNORMALBIRTHPreviouslyPublishedinTHENATURALPARENTMAGAZINE-SPRINGISSUE2014
IfyouhavebeenfollowingmyarticlesaboutbirthinTheNaturalParentmagazineyouwillbeawarethatmyfocusisonnormalphysiologicalbirthandI’massumingthatyouthereaderarealsosimilarlyattuned.InthisarticleIamdelvingintowhatIcall‘paindynamics’inlabour.WhatdoImean?Wellbasicallyit’saboutwhatwillhappeninthepersonalandinterpersonalrealmwhenpaincomesintoplay.FunctionalphysiologicalpainWhenIspeakaboutpaininlabour,I’mnotspeakingaboutpathologicalpainarisingfromdiseaseordamage.I’mreferringtothenormalfunctionalphysiologicalpainofbirthing—thefunctionalpainofthemother’sbodyworkingatpeakperformancelevels.Noweventhoughthisfunctionalpainis‘healthy’pain,nonethelessit’sdemanding.Giventhatnotallofusarepracticedatgettingfriendlywithfunctionalpainthenthisfunctionalpainoflabourbecomesamajorchallengeformanywomen.Especiallyastheculturalmessage,whichbirthingwomenreceiveisthatsheshouldn’thavetoengagewiththepain,andthatinfactsheshouldremain‘comfortable’.Thisistheseductivepromiseofferedbytheepidural.PainDynamic:crisisofconfidenceAsthefunctionalintensityoflabourbuildsandtheacculturated‘becomfortable’messagestirsinthebirthingwoman’spsycheacrisisofconfidencearises,sothatnowthebirthingwomanwantsout!Inthese‘hot’intensemomentstheseductionoftheepiduralswampsanyresolveshemayhavehadbeforethebirth.Ofcourse,manywomendonothaveanyintentionofengagingwiththefunctionalpainoflabourinthefirstplace,butI’massumingifyouarereadingmyarticlethenprobablyyouarelikelytobeawillingwomanwhodoeshavetheintentionofworkingwithyourbody,yourbabyandyourpaintowardsanormalphysiologicalbirth.Buteventhoughyouareawillingwoman,yourresolvewillstillbesorelytestedatthesecrisesofconfidencepoints.So,thefirstdynamicweneedtounderstandandnormalizeisthiscrisisofconfidence.Letmebeclearhere,thisisnotamedicalcrisis.Itisanemotional,physicalpainbarriercrisis;ahittingthewall,hittingapainbarrier,hittingtheunravellingofan—‘Ican’tdoitanymore’—moment.Thoseofuswhoengageinintensephysicalactivitiesforfitness,pleasureorachievementknowthatthese,hittingpainbarriermoments,areanormalpartofthedeal—sotooinbirthing.Withinthebirthingwoman,whenthiscrisisofconfidencepaindynamicisactivated,the‘becomfortable’mindsetgainstheupperhand.PainDynamic:withinthemotherAswellasthisacculturated‘becomfortable’mindset,thebirthingwomanwillalsofaceherpersonallyconstructedstoryinregardtofunctionalpainandeffort.Youknowherstoryabouthavingahighorlowpainthreshold;herinnerchampionversusherinnerwimp;herinner
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Xenawarriorprincessversusherinnerdamselindistress;sabotagethinkingandavoidancepatternsorthemaintenanceofherresolveforembracingtheintensity.Thecrisisofconfidenceactivatesthisinternalconflict.PainDynamics:interpersonalrelationshipdynamicsWhathappenstothebirthingwoman’soriginalresolveisnowmoreinthehandsofwhoiswithherandwhattheywilldoaboutthiscrisis?Whoiswiththebirthingwomanandwhatisherrelationaldynamicwiththem,especiallyinregardtodistressing,painfulcrisisofconfidencemomentsinthemidstofchallengingexperiences.Arethepartnersandotherbirthcompanionsgoingtobecomedistressedthemselvesandwanttosaveher?Aretheygoingtobecaughtinasympathyloopandthereforeunabletoholdafirmgroundforherasshestruggleswithherinnerresolve?Dotheythemselvesholdanyconvictionforworkingwiththepainordotheyentirelyagreewiththecultural‘becomfortable’mindset?Willherbirthcompanionsconfirmtheacculturated‘becomfortable’message—‘ohyoupoorthing,yesyouneedtobecomfortable’.Orwillshehaveanybodywithherwhocanencourageheronthroughthisexpected,normalisedcrisis.Afterexaminingtwenty-onetrialsinvolvingover15,000womentheCochraneCollaborationfoundthatwithregardtonormalbirth:‘continuoussupportfromapersonwhoispresentsolelytoprovidesupport,isnotamemberofthewoman’ssocialnetwork,isexperiencedinprovidinglaboursupport,andhasatleastamodestamountoftraining,appearstobemostbeneficial.’IfyouunderstandwhatI’msayingaboutinterpersonalrelationshipdynamicsyoucanseewhytheCochranreviewfindingsstress,‘notamemberofthewoman’ssocialnetwork’;inotherwordsnotsomeonewhowillbecaughtupinasympathyloop.PainDynamics:‘ringingthecircle’Asacrisisofconfidencetakesholdtheheatgetsturneduponalltherelationaldynamicsinthebirthspace.Thebirthingwomanwantsoutandshegoessearchingthecirclelookingforherwayout—her‘saviour’.Inmanycasesit’sveryeasyforhertofindthesaviourwhowillofferthedrugs,whichshefeelssheneedsrightnow!Theobstetricteam,herprivateobstetricians‘standingorders’forpainrelief,oramidwifewitha‘painrelief’mindsetwillbeeasytargetsforherpleadingdemands.Herpartnertoocanbecomeaneasytarget,singledoutasthe‘weakestlink’duetotheirsusceptibilitytoherdistress.Perhapsthepatternintheirrelationshipdynamicistheneedtosaveher,tobetheknightinshiningarmourwhosavesthedamselindistress.Perhapsthepartnergenerallyacquiescestoherdemandsorisfulloffearandsympathyforherinthesecrisesofconfidencemomentsandthereforebecomesasofttargetforherimploringdemands.
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PainDynamics:credibilityissueEvenifherpartnerorotherbirthingcompanionsarecommittedintheorytoremainingstrongintheirresolvetosupportherthroughanypaincrisisbyofferingwordsofguidanceandstrength,theissueofcredibilitycanthencomeintoplayinwhatIcall,the‘whatthefuckwouldyouknow’moment.Withadismissivelookorutteredwordsanybodyinthebirthsupportcirclecanbefoundwantingiftheydon’thavecredibilitywithherinthisbirthingdomain.ThiscredibilityissueisanotherexplanationwhytheCochranreviewfoundthatbeing‘experiencedinprovidingsupport’issoimportant.Polly’swordspaintthepicture.Thepainwasbecomingunbearable—oratleast,IhaddecidedIwasn’tstrongenoughtodoitthistimewithmysecondbaby.Ilookedaroundatmythreesupportpeople,searchingtheireyesforanyhintofsympathy:anadmissionthatwhatIwasattemptingwasimpossibleandIcould,therefore,giveupnow.Butno,theireyesbetrayednodoubts,thoughmypartneradmittedafterwardsthathehadbeenfilledwithmiseryatmysufferingthistime.Izoomedin,pleadingly,onmymidwife’seyes:sheknewmeleastofthethree,surelyshewouldletmeoff.Buthereyesgazedback,steadfast,confident.SecondstagewasalreadyharrowingbutnowIhadtopushaswell.Ifeltmyselfbeginningtoloseit—Iwasdriftingtoofaroutnow,gettinglostinabigdeepseaofpain.Myteambegancallingmeback,demandingImakeeyecontact.ItwasonlythroughthisfocusthatIwasabletostaypresentenoughtobirthmybig,beautifulbabygirl.IwaswithPollyforthisbirth(andpreviouslyforthebirthofherfirstbaby)andasshedescribesitwasademandingexperience.Herdescriptiontouchesonallthepaindynamicsmentionedhere.There’sacrisisofconfidencemanifestinginPolly’sself-doubtingself-talk;the‘ringingthecircle’searchingforsympathydynamicwasactivated;herneedfor‘credibility’viathemidwifetoherquestionaboutwhethershecouldkeepgoingornot;herleaningintothesupportcircleduringthesecrucialmomentsinherlabour,allleadingtothebeautifulempoweredbirthingofherverybonniebabygirljustasshehadintended.Thesepaindynamicscreateadancewithunexpectedshiftsandmoves.Anintricatedanceisunfoldingwithsubtleshiftsinwhoisleading,who’sfollowing;who’sinitiating,who’sresponding;who’sholding,who’sreleasing—themothernow,thenthebaby,maybethepartnerandbirthcompanions—alladdtheirmoves,grooves,rhythmandtiming.Sothesavvy,willingwomenneedstomakeexcellentchoicesinsupportoftheirintentionsandbirthingcapacity,choicesthattakeintoaccountthesepaindynamics.InmynextarticlefortheSummerissueoftheNaturalParentmagazineI’mgoingtoexpandontheimportanceofthemidwife’srole,bylookingatsomemidwiferyresearchandtheorythatshedslightonthethemesI’vebeenexploringwithyou.
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YoucanfindexpandeddiscussionofallthepointsI’vemadeinthisarticleinmybook‘BirthwithConfidence:savvychoicesfornormalbirth.www.birthingwisdom.com.auwww.facebook.com/birthingwisdom
