There is a curious paradox which no one can explain.
Who understands the secret of the reaping of the grain?
Who understands why spring is born out of winter's laboring pain
Or why we must all die a bit before we can grow again?
-The Fantasticks

The pain of childbirth is legendary. All our lives we have been impressed with clenching, frightening stories of women in labor, incoherent with unrelenting pain. These images are primarily myth. Unfortunately, centuries of bad press have led to a pervasive fear of this most powerful, even fierce, natural resource of womankind.

We all want to do what is most humane and healthy for women and babies. That labor is painful for most women is true. Yet, most of the time, women are capable of coping with the pain. In the U.S., the rate of epidural anesthesia, in which most or all sensation of labor is numbed, is approaching 80%. Does it make sense to alter or remove pain from the experience of most women because of the extreme pain of a few?

It is also essential that we realize that there is no obstetrical medication that has ever been proven safe for the fetus. All medications given to the mother reach her fetus, and there is no guarantee of harmlessness.

As I write this article, I am in Illinois awaiting the birth of my stepdaughter's third child. My husband and I have helped this family with the births of their first two boys, both born at home, both born without any pain medication of any kind. When I
asked Lori about the pain of her labors, about whether there was value in that pain, the answers she gave me echoed those I have heard from women for 20 years.

Being fully awake, aware, and acutely sensitive during the entire labor and birth immerses a woman fully in the miracle of life. The birth would not be as rewarding for her if there were not challenge involved in the process. Her pride, awe, and respect for her body and how much she is capable of are magnified and enhanced by having given birth using her own physical power. Labor helps her know and prove herself as a woman.

Lori also talked about how labor and birth serve as preparation for parenthood. Once a baby comes to a family, everything isn't going to be sunshine and blissful dancing. Parenting is hard. The immensely hardwork and pain of labor mirror the reality that once the baby is here, there will be hard work and pain. She also has come to believe that her painful, more difficult second labor strengthened her bond to her more needy and difficult second child. She likened this to the strengthened bond that comes to any loved ones after facing hard times together.

What brought out the most excitement in Lori as she talked was the immediate reward of labor. After going through so much hard work to get the baby, there's elation! As pregnancy and birth give way to parenting, the memory of elation following birth reminds her that, yes, there are hard times with the baby but that the hard times can also give way to lots of joy with the baby. And it's that joy that helps all the difficult times seem not so bad.

The exhilaration after giving birth that Lori talked about is a physiological reality. Those of us who attend women in labor can attest that the elation is far stronger for women who are unmedicated. (It can even, although rarely, contribute to bringing a woman to orgasm as her baby passes from her body.)

As painful events happen in the body, substances known as endorphins are produced. Endorphins are natural opiates, whose purpose is to alleviate pain. Once labor has ended and the pain stimuli are gone, there is a rush of the effect of the endorphins, resulting in a profound openness, receptivity, and euphoria. The result is a woman physiologically primed by nature to bring her independent newborn into her arms and fall in love. With the baby wet and warm from the mother's body, bearing the imprints of its passage through her most sensitive and emotionally charged places, she is ready to begin the long bonding dance of new motherhood.

It is interesting that, compared to women worldwide, it is mostly among American women that the rates of medication are high. For reasons of culture and belief, American society and medicine operate on the conviction that it is ridiculous for women to suffer in order to have a child.

Women in Holland, however, believe that pain in labor is normal and don't even imagine that they might do something to change that. Dutch women are encouraged by their midwives, who remind them that it's only pain! It's not illness; it's not death. It's only one day out of your life you'll be OK. Giving birth is a heroic act. Women in labor are in the strongest moments of their lives, and they are capable of the bold greatness of childbirth.

The Dutch midwives say that without pain there is less feeling of coming into motherhood. They feel that labor pain triggers the mothering instinct. Midwives in Holland, who are the care providers for over 70% of all births, also believe that there is more postpartum depression in women who do not have pain in labor.

The medical steps needed to eliminate pain require an increase in interventions that can occasionally be painful in themselves and can lead to complications. Perhaps more important, interventions and medication lead to less autonomy in birth, which the Dutch believe is the single most important factor in healthy childbirth. The stronger the contractions and the harder the pain, the better it is for the effectiveness of the labor. Virtually all women can cope with the pain, unless there is an abnormal condition in the labor.

A study done comparing women in Iowa and Holland found an interesting difference between them. The Iowa women believed that labor would be horrible and that they would need medication. They did. The Dutch women believed that they would be able to deal with the pain of labor without medication. They did.

Although it might take a new cultural revolution to convince women in Iowa that labor is not horrible but normal, elemental, and commanding, individual American women can begin to reaffirm for themselves their ability ,to labor strongly, on their own. After all, the baby has to come out, and no one can do it for them. Labor pains are primal growing pains. Medication in
labor isn't truly given for pain, it's given for fear-fear that the pain will get worse, fear that it will prove unmanageable, fear of loss of control. Could it also be that the fear we are medicating ourselves for is the fear of the mystery of our own bodies?

While we are trying to sort out these complex questions and issues, there is a simple and practical way to bear the pain of labor without obstetrical medications. Any pregnant woman planning her birth needs to surround herself with people to assist her who believe that birth works. Whether these people are friends, family, or professionals, if they are confident that she
and her body can work together to produce her baby on her own, then she probably will. Buoyed by faith in herself and by a circle of companions who are steadfast in their trust in this phenomenal process, she can enter labor, face and cope with the pain, give birth, come to a justifiable pride in herself, and move beyond pain into euphoria and joy.

- This article first appeared in La Gazette, February 1995.

- Reprinted from The Doula Magazine