Pain and the brain…

What will labour feel like and can I cope with it?

This is the question almost every pregnant woman is most concerned about. However you plan to cope with pain, be it with drugs or without, the most important thing is to be informed.

Pain in childbirth is subtly different from other pain you might have experienced in a number of ways:

1)       In labour pain does not equal damage or danger. It does not mean that anything is wrong. It has a purpose: bringing your baby out into the world.

2)       However intense they are, contractions only last about a minute and then are gone. It might be the longest minute of your life, but still just a minute.

3)       Although it may seem endless at the time, your hormones will ensure that very soon you will have only the vaguest memory of the pain of labour. That is why a large number of women choose to do it again and again.

But labour pain also isn’t totally alien. We have all experienced pain at some point in our lives – be it a short sharp bang on the thumb with a hammer or the on-going aches of period pain. So you are not going in totally unprepared, consider what coping techniques you have learnt already in life and how you might apply them.

One of the most important parts of pain coping is just that: coping. This means not allowing the pain to take over your every thought or make you miserable. There are a large number of techniques which you can learn from books and classes: focusing on the breath or an image, repeating a word or phrase over and over, movements and positions. All can be extremely helpful in coping with pain.

Positive mental attitude goes a long way in labour. This means keeping a clear, open and positive frame of mind for what ever might come up. Being there in the moment and dealing with what is happening, not getting stuck in the past or racing ahead to what might happen next. A positive attitude does not guarantee a short painless labour, otherwise we would all have beautiful pleasurable labours whilst eating chocolate cake. But what you can try to minimise is fear and resistance to the pain, which then increase your physical and mental suffering.

Pain and the brain:

So what is the science behind the brain in labour? We have 3 sectors of the brain. The outer part, or neo cortex is also the most recently evolved and differentiates us from all other animals. This rational brain is responsible for logical thought and problem solving. This is the part that we inform when we read and through conventional information-based child birth classes, but unfortunately it is the part that we need to relax and put to one side in labour. Our logical brain cannot control birth, however much we might wish it could. This task belongs to the reptilian brain, the inner core and oldest part of our brain which controls our essential bodily functions, and the mammalian brain which houses the hypothalamus and pituitary glands which are responsible for hormone control.  This system is very sensitive to emotions and our fight/ flight response  can be activated by adrenaline pumping through our system. A key element to all relaxation techniques recommended for birth is that they regulate the breathing and heart rate. If we are tense and high on adrenaline we are alert, and “in” the higher brain. Blood is moved from our major organs and inner muscle groups, including the uterus, to the outer muscles, ready to make our escape. Adrenaline also neutralises the effect of oxytocin, thereby slowing down the labour, which may then need to be speeded up again by artificial syntocin.

The brain produces a number of different substances during labour: Opioids and endorphins which are both pain relievers and mood-lifters and are related to morphine in their potency and pain fighting abilities. They also fuzz your memories into a more rosy glow afterwards. Prostoglandins which ripen the cervix ready for the birth.

Oxytocin contracts the uterus, gives a sense of pleasure and floatiness and allows milk to let down from breasts.

All of these are produced by the body as a natural part of birth and can be inhibited by higher brain action (self awareness, thinking, logic) and stress .This is when synthetic copies (such as prosoglandin gel and syntocin) are used in hospital births in order to augment the body’s natural processes. However when given in artificial form, rather than produced by the body, the feedback loop is by-passed and the body can quickly become out of balance and the labour can become too intense, requiring further interventions. In a normal feedback loop, the nerves in the body pick up a sensation which is communicated to the brain, in response the brain releases hormones which then produce a physical response. This is an endless circuit where the body senses and responds to the ever-changing nature of labour.

The voices in my head

What you are saying to yourself and what you hear from others is key to helping you cope. The difference between hearing yourself say- “I can’t do it” and “I can do it” or hearing “you can do it” is enormous. The words feed into your brain and become part of the feedback loop. This is why having a supportive birth partner and birth attendants is so key to most women’s’ delivery. A study showed that the presence of an active birth supporter speeded up the birth process and reduced the amount of interventions- use of epidural for example reduced from 55% to only 8%

The ecology of pain

Getting the environment right to let your monkey brain do it is the advice of midwife Ina May Gaskin. If you are in your higher logical/ thinking brain your body will not be able to do what it needs to- adrenaline will keep your muscles tight. There are so many intricate systems involved in birthing, that providing an optimal environment – one free from stress, dim lights, with support, ability to move around and access to water – allow women’s’ bodies the optimal environment for birthing and handling pain.

For some pain is all child birth is about, for others there is no acknowledgement that pain is part of childbirth. If you “do” your techniques right, if you relax enough, if you chose to see it as pleasure rather than pain then pain “should not” be part of childbirth. Both may be true for some women and some births, but not all women all of the time and to believe that if you have experienced pain then you have not done it right is a double damning. Equally to anticipate agony will probably reinforce your suffering. What we might say is that whilst pain is a part of childbirth for many, suffering is not necessarily a component of birthing. It’s all in the mind. And with pain this is a key insight.

During my second home birth which I found more painful than my first, I wished there was some sort of “perfect” pain reliever, like an ultra-paracetamol- harmless to you and baby, ensuring you can be fully involved in the birth, with no side effects. But unfortunately there isn’t.

We are extremely lucky to live in an age where there are a number of pain relievers during birth, but each comes with their own implications and side effects and must be carefully considered.

Check out this article for a range of natural pain coping techniques…

Lucy Pearce

A version of this article first appeared in Modern Mum magazine