Attention birthing women: This will be the hardest work of your life. It will test you on every level. Childbirth education is very helpful, yet there's no way to know how you will feel physically and emotionally until you're in it. There are many schools of thought on how to cope, what to call the forces of labor (contractions or surges?), and how to label the feeling (pain or sensation?). I like to keep it simple: it's really hard, and yeah, it hurts. And, you are stronger than you know, and you can do it. Whether or not you plan to use pain medication or epidural anesthesia, know that you have what it takes within you to get through however many contractions you choose to feel fully. Do your preparation, trust in the birth process and believe in yourself.
But once you get to the hospital, whatever you do, for God's sake, maintain some decorum and do it quietly! And if you can't do that on your own, we've got something for you that will fix that problem quite nicely. Then, we can all be comfortable.
Is that the unspoken message women receive from hospital staff during labor?
Huffington Post writer Danielle Campoamor, who gave birth recently, illuminates a rarely recognized but very real hurdle women face when they walk into the hospital to birth their babies. That is, our culture is such that even the most outspoken, independent, confident women can feel silenced and self-conscious in labor -- afraid to make noise, afraid to "take up space." The author points out that this feeling of inhibition is all the more significant since it is present at the very time when a woman should feel most free to do whatever is needed to handle her experience.
A culture that holds laboring women more or less to the usual social norms and stifles their full expression during birth is one that limits women's coping mechanisms. It limits women's ability to feel powerful, strong and fully cared for as they journey into motherhood. It dishonors women. And it does a lot more than that -- it is counterproductive to normal, physiologic birth. Feeling self-conscious and anxious about how the people around you might be judging your coping behaviors is stressful. Emotional stress triggers catecholamine release. Excess release of these stress hormones exacerbates the experience of pain and inhibits oxytocin -- the hormone that keeps contractions strong so labor can progress normally.
As a culture, are we simply uncomfortable with the primal nature of birth?
Susan Diamond, RN, writes in her compelling book Hard Labor, "When faced with the forces of labor... all the inhibitions and trappings of our social selves are peeled away as our bodies thrust and heave, vomit and grunt, cry and leak. The animal is there for all to see." Modern humans are cut off from the natural world of which we are a part. Does the same disconnection that leads to destruction of our environment cause us to collectively recoil when faced with the human animal during childbirth?
The epidural rate in the U.S. is around 60 percent, and is higher in some areas. There are a lot of reasons for that, a full discussion of which is beyond the scope of this article. Epidurals can be a godsend, and many women who choose midwifery care use them with our full support. The problem is not the epidurals themselves, it's the indiscriminate promoting of epidurals as the first line answer to any woman's need for any kind of help coping with labor. The problem is the lack of training and support for hospital staff to provide nonpharmaceutical forms of labor support.
So why do women feel inhibited to make noise and otherwise "take up space" in labor, and what might that have to do with epidural rates?
This inhibition can be due to the woman's social conditioning, as discussed in Campoamor's article. There is another factor as well. It's one of the roots of the social conditioning the woman arrives with, and it can exacerbate her self-consciousness in the moment. I'm talking about the discomfort with, and sometimes utter disdain for, the sounds of normal, physiologic labor in hospital culture. What's the surest bet to silence those moans, grunts and cries quickly and completely? You guessed it -- epidural.
There are different qualities of vocalizations in labor. When women are panicking or otherwise having trouble coping, their sounds are anguished. When you hear noises that sound like suffering, the natural, compassionate tendency is to want to fix it for the woman. I wish there were more inclination in hospital culture to first help women reduce fear and anxiety and to provide other comfort measures like position changes, assistance with breathing techniques, massage and hydrotherapy. (And I'm talking about belief in and enthusiastic initiative in providing this kind of care, as opposed to a half-hearted, "Um, wanna sit on the ball for a while, or do you want to just get the epidural now?") Sadly, women are typically steered straight in the direction of anesthesia as soon as the going gets tough.
All that said, I can appreciate the kind desire to alleviate what appears to be true suffering as quickly and completely as possible by bringing out the big guns from the get go. Even those caregivers who believe in and would like to provide more nonpharmaceutical labor support face obstacles. They may be busy caring for several women. Many receive little or no training in hands-on labor support and little or no encouragement from their institutions and peers to provide this kind of care.
But there is another kind of labor and birth noise that also seems to trigger in many caregivers the unspoken reaction called "make it stop." It often leads to overt or subtle pressure on the woman to get an epidural, even though she is doing just fine without it, thank you very much.
Some women who are coping very well with labor are relatively quiet. Most need to make some noise. Some need to make a lot of noise.
Here's the thing: women who are in rip roaring labor and are coping well and are naturally vocal and are "in the zone," unconcerned with/unaware of how they sound or appear? They usually sound a lot like a woman having really great sex.
People can get all twitchy and uptight around that.
Outside those rooms, it is common to see raised eyebrows with comments like "What's going on in there?"
And yes, unfortunately, it is not uncommon for hospital staff to actually ridicule women who are vocal in this way (outside their earshot, of course -- thank God). Those who snicker and eye-roll say more about their own sexual hang-ups than they do about the laboring woman.
Mitigating these aspects of hospital culture is part of a hospital-based midwife's job. Doula support helps, too, and should be available to every woman via insurance coverage. It's also a consciously chosen part of the job for many physicians and nurses. Those doctors and nurses who support woman-centered care and physiologic birth are especially committed and courageous since they are often swimming upstream with little or no support from their peers.
For midwives, it's an explicit, integral part of our training. For most of us, it's in our blood. We help women feel free to follow their own bodies' directives, doing what they need to do and making whatever noise they need to make. We ensure that at the very least, women feel our heartfelt blessing to scrap social conventions and let the human animal lead.
We create (and sometimes have to guard) an atmosphere that allows birth to be what it is -- an instinctual, sacred, primal act.
This is one of the many essential intangibles you won't find on our CV's or official job descriptions. We hold space for birthing women to take up all the space they need.
Space for the full, free expression of raw feminine power and vulnerability.
Space for the messy, noisy beauty of birth.
Camille Williams is a mother, wife, midwife and writer. She writes about parenting, life in a bicultural family, homeschooling, midwifery and women's health, spirituality, politics and world travel (for starters!). She writes for fellow explorers on the path of living fully, bravely and truly -- while trying not to take it all too seriously. Come visit her blog at Wake Up, Mama!