Birth is extraordinarily variable. Some people have pain free births and others experience births so difficult that it literally brings them to death’s door. If we were to show this with a graph, I believe that it would look like most biological phenomenon do; it would be a bell-shaped curve:The pain free birth (0) and the birth where a cesarean is the only realistic option (100) are both quite rare. For most women labor is somewhere in the middle (say 40-60); it is tiring and painful, but also liveable and repeatable. Naturally, you want to be as low as possible on this difficulty scale. What determines where you place? Whether your labor will be 7 hours or 37 hours? How challenging the contractions will be?
Seven things: your genetics, age, health, the baby’s position, your ability to relax, support and knowledge.
Genetics: The shape of your pelvis and your genetic predisposition for labor play a large role in determining what type of labor experience you have. You really don’t know about this one until you have a few kids. Your mother’s, aunt’s, and sister’s birth experiences might give you a hint but will not predict your experience. Will your body be happy while pregnant or will you be an emotional and physically crippled mess? Is your pelvis tall and narrow or relatively wide and flat? You can’t change the genetic cards you were given at your own birth.
Age: The late teens and early twenties seems to be the ideal time to give birth, biologically. Once you get to your mid thirties there is a shift, and beyond that point births tend to become more difficult.
Health: The physical strength and tone of your muscles, particularly the muscles in your abdomen, legs, and pelvic floor, will have a strong effect on your labor. Labor is called labor because it is physical work: birth is one of the most active physical events of your life. Going into birth in good physical shape is like beginning a marathon fully trained and prepared. Going into birth after months of little or no physical activity is like beginning that marathon the same way. Ouch! It’s not going to be pleasant. Having a good diet (eat a rainbow of fruits and vegetables every day) and exercising are two of the most important things you can do to have a good labor and birth experience.
Baby’s Position: Some presentations are easier than others. Anterior is best position for birth and most babies are born this way. Posterior (“sunny side up”) is much more difficult and associated with stalled labors and a higher percentage of delivery by cesarean. A breech presentation usually requires delivery by cesarean (depending on the opinion of your caregiver). A face first presentation or transverse presentation are positions that can not be delivered safely vaginally and require birth by cesarean. Having good muscle tone (exercising, doing pelvic tilts, and being active and upright) encourage a baby to be in the correct position. But sometimes that baby will be malpositioned despite one’s best efforts.
Relaxation/tension: The uterine muscles need to contract vertically to open your cervix. When you are relaxed they do so efficiently. When you are tense your abdomen muscles constrict against your uterine muscles and make the contraction both more painful and less effective. It’s no accident or mere coincidence that every “natural birth” approach spends a great deal of time and effort teaching relaxation. It really works. Here’s a quick personal testimonial:
When I was in labor with my first baby I started to panic in transition. The contractions were coming with high frequency and intensity. At the beginning of one of these contractions our doula said: “Drop your shoulders.” I focused on relaxing my shoulders and I was surprised to realize that I had tensed them almost up to my ears; they dropped about 4 inches when I relaxed them. As I relaxed, the whole contraction changed.I knew (from having just recently endured several of these intense contractions) what was expected: the contraction would increase dramatically in intensity to more than double it’s current pain level and after staying there for a good couple of breaths it would come back down and dissipate. When I relaxed my shoulders that expected increase in pain didn’t come. The contraction stayed at about it’s current level of intensity and then tapered off. It was an amazing difference, just because I made a conscious effort to relax! I was so impressed. This relaxation stuff really works!
Support (or lack thereof): Having the constant presence of a trusted support person helps labor immensely. A companion is a great boon, even one who does no more than stand by and listen, watch, hold your hand, and offer occasional words of encouragement. Feeling alone or abandoned are not good emotions to experience during labor. Fear and resentment lead to tension, which makes the entire experience much more difficult.
Knowledge (both of mom and care provider): There are so many things that can help labor: knowing how to move and breath, having a lot of coping techniques to try when the intensity gears up and what worked previously is no longer helping. And knowing when a particular intervention may or may not be appropriate. Amniotomy (breaking the water), pitocin, epidurals, other forms of pain relief, an episiotomy, or a cesarean all have their place, and they can all cause unnecessary trauma if used inappropriately. Educate yourself about birth and choose a competent and compassionate health care provider.
Two of these six factors you have no control over (genetics and age). The next two are partially in your control (health and baby’s position), and the remaining three (relaxation, support,and knowledge) are thankfully all within your control, and they have an enormous effect on your labor and delivery.
As a hypothetical example, let’s say that Lucy is average in every respect, and without any interfering factors is going to have an average first time birth that we would mark at 50 on our scale. How much could relaxation, support, and knowledge improve her experience? I think it could move her all the way down to 30 (let’s say that’s 6 hours of labor, 30 minutes of pushing, and a very happy mom and baby after the birth.) How much could lack of preparation, poor support, and negative anxiety and tension harm the experience? I would say move her up to 70 (that’s 26 hours of labor, 3 hours of pushing, and mom and baby are an exhausted and traumatized pair of people postpartum.) Do I really think it could make that large of a difference? I do.
So that’s my birth philosophy: Exercise, eat well, learn to relax, educate yourself, and choose good support people. Even if things you can’t influence place you up near the top of that difficulty scale, these positive steps will only help. Birth is an act of submission not within your control, but there is so much that you can do to prepare your body and improve your experience.
No matter how it happens, it can be beautiful.