A note about Pain

A note on ‘the pain of contractions’

The word ‘pain’ is controversial amongst the hypnobirthing community – as is the word ‘contractions’.

Pain obviously has negative connotations because it is the body’s way of communicating there’s something wrong. It is also something that is feared because pain causes suffering and the thought of pain for a prolonged period of time, is frightening.

For that reason, many practitioners omit the word ‘pain’ from hypnosis scripts and in conversation about the process. This is also based on a story Grantley Dick-Reid tells in his book Childbirth Without Fear where he attended the birth of an impoverished woman who appeared to give birth without showing any signs of pain. When he asked her afterwards why it hadn’t hurt her, she replied she hadn’t realised it was supposed to. This formed the basis of his work, the idea that fearing the pain makes the whole process far more painful than it needs to be – remove the fear and you remove the pain.

Many hypnobirthing practices continue to teach this and feel if they don’t use the word ‘pain’ (and substituting ‘pressure’ or ‘power’) then clients won’t be tempted to think about it. In the same vein, there is a belief the word ‘contraction’ also has a negative connotation, that it is too closely connected with the idea of pain and prefer to use words such as ‘surges’ or ‘waves’.

Whilst this undoubtedly works for a lot of women, and various sources on the internet claim up to 1% of women say they have a painless birth, I have always been wary of claiming if hypnobirthing is practised properly and used correctly it will make labour completely pain free. Whilst it is fact that relaxing throughout a contraction will make it far easier to manage and less painful than if the mother were tensing up, for the reasons explained above, I fear the idea of a pain free birth could potentially cause more problems than it solves. The fact of the matter is, whilst some woman rightfully claim to have had a painless birth, the majority of women will feel their contractions. The more established labour becomes, the more intense the contractions, and yes, there are points during the labour that a mother may describe her contractions as painful. But that’s OK. Contractions should be felt because they serve a very useful purpose. They let you know where you are in the process – in other words, do you have time to finish gathering the wood and berries for the cave (shopping in a supermarket in modern day!) or do you need to hunker down and make sure you’re in a safe environment because this baby is coming?: They encourage you into beneficial, birth promoting positions – There is a reason most women find labouring on their back to be much more painful than when they are upright and leaning forward, because, quite simply, it goes against gravity:  

It is a vitally important communication system – when you experience a contraction it provides hormonal feedback to the pituitary gland in the brain to provide more Oxytocin and Endorphins to progress the labour.
There is evidence to suggest the amount of pain felt by a labouring mother depends very much on her perception of the pain. According to Rebecca Decker from www.evidencebasedbirth.com (2018), an Australian study, published in 2017 found that when mother’s interpreted their pain as productive and having a purpose and a normal part of the process – they were able to cope much better with the contractions than the women who interpreted the sensations they were feeling as threatening and frightening and felt medical help was necessary to relieve the pain.

They found there were two distinct states of mind that women might experience during labour – Mindful Acceptance where a woman was focused on staying in the present moment and made statements such as ”When a contraction had finished, I wasn’t worrying about the next one” or “I lost sense of time”, and Distracted and Distraught which was linked to higher levels of pain. These women would have said “I was looking at the clock and It just felt like every minute was an hour” or “I was dreading the next contraction” or “I was distracted by the people in the room”.

So there is definitely room for re-framing the concept of pain. Unlike the pain from an injury, the strong physical sensation that you experience during labour is because a large muscle, i.e. the uterus is working hard. The sensation of the muscle working (i.e. contracting) is a positive one because it is bringing the baby closer to meeting you. But claiming labour can be pain free often means women may panic when they feel the intense sensations. If they start to panic, too much Adrenaline is introduced into the mix and labour becomes more stressful than it needs to be.

We also have to be highly aware of how our social and cultural environments can greatly influence The Nocebo Effect. The Placebo Effect anticipates a good outcome so therefore that is generally what is achieved, but the Nocebo effect leads us to anticipate a bad outcome which is, consequently, usually then experienced. In terms of labour, certainly in particular parts of the world, there is so much cultural and social focus on the pain of childbirth, inevitably, that’s what women end up experiencing.

Caregivers, really need to think about the way they present the topic of the pain of labour. Think about, for example, when women are told they will need an epidural if they are being induced because they won’t be able to cope with the pain of the contractions!!
We can see when, culturally, birth is interpreted as manageable and productive, pain is not considered that big a deal. In the Netherlands, for example, only about 22% of women give birth with an epidural compared with 61% in the USA. Interestingly, what is clear and researched based is there are a lot of different factors that can influence how pain is perceived during labour. Environmental stressors, for example, such as over-crowded rooms, bright lights and restricted movements and the mother’s relationship (as in does she feel supported) with her caregivers – partners as well as midwives! – all contribute to a perception of increased pain.

Hypnobirthing is the perfect antidote to all of this because it will help you to work with your contractions by using positive post-hypnotic suggestions, complementing birth physiology and encouraging the relaxation response through the use of specific hypnosis and self-hypnosis techniques, discussed later in the book.

If you are still concerned about how much pain you’ll be in and how long it will last, then Milli Hill (founder of The Positive Birth Movement) sums it up perfectly in her book The Positive Birth Book (2017) by patiently working out that for an eight hour first stage of labour there are only 111 minutes of contractions which means a woman is only actually actually in ‘pain’ for 23% of her labour – the other 369 minutes or 77% of labour is entirely pain free!