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Is birth painful? Is childbirth painful?

I’m just gonna say it. No sugarcoating. Is birth painful? Yes, Childbirth hurts, it is painful. Your womb is large as needs to squeeze a small human out.

To pretend otherwise is just unrealistic.

There is such thing as orgasmic birth but a 13+ hour orgasm is not a thing here (we’ll we’ve never come across that!) It will still be painful at some point.

However, there are things you and those with you can do to reduce the pain felt and keep a calm and safe environment. There are drugs, there’s massage, there’s water there’s breathing techniques, there’s essential oils and various things unique to you that will aid relaxation. With antenatal support and/or classes you can find what may help you and also what may not.

Is birth painful? In short, Yes. There are many options to reduce the pain in childbirth.

Just a quick note on “being superwoman”. 

Society puts so much pressure on women especially mothers to do everything and be superwoman and it’s not possible. But perhaps women just are  superwomen by doing everyday tasks. We’re expected to work or expected to run a home or expected to raise children and yet, still, men don’t seem to have that same pressure. The pressure we can be under can cause all sorts of anxiety, panic, stress, depression, it can be really overwhelming at times

The feelings and emotions that can be felt, as we have all this tasks and expectations upon us, are normal responses to all this. They are normal responses to having too much pressure. The theory of fight, flight, freeze can explain some of this, this is (on a basic level) where the body prepares to run from or to fight a threat/ a stress to our wellbeing. It sounds odd that we should have these feelings whilst doing what is deemed everyday tasks and it is odd. This should not be happening and yet so many do feel these things, which can then have an impact on negative self talk, thoughts of not being good enough. In my experiences these thoughts are really common amongst parents and somewhat more so within women. (But the latter could just be because of where I specialise in support).

We do not have to put up with this. There’s lots of talks about resilience, resilience to things that happen to us in life, but we don’t have to be resilient to things that cause us such stresses. We don’t have to try to be “superwoman”. We already are. If something is causing some stress or a negative feeling, something just doesn’t feel ok, then it may be time to reassess whether this has to be in your life. Some tasks don’t bring joy but need doing and that’s ok, it can be a balance.

The word “No” is something I’m learning well lately. It’s a full sentence of its own and lays boundaries, boundaries are important to own self wellbeing. It’s ok to say No, it’s ok to be selfish. It’s actually healthy to prioritise self wellbeing. Of course I’m not saying to neglect your children, there’s a balance there. There is the old saying that reminds of the instruction that is said on airplanes to put own oxygen mask on before a child’s. This is because if you aren’t well, you can’t help a child. Same goes in life really. You matter! Look at your own self care, your boundaries and what brings joy to you.

Seeking to be superwoman is no good, because you already are. 

There’s been quite the reporting about home birth in the last few months in relation to a couple of court cases. The conversation around whether they are safe has become a forefront again. In short, they can be safe. 

What is safety? What is danger?

A number of Research studies do suggest that home births does not increase the risk of mortality (death) or morbidity (medical problems) in comparison to hospital births. Further to this rates of interventions is lower in planned home births. The latter is partly to do with these not being available at home. However, it does suggest that there may be a lower need. 

The NHS website says this,

“But if you’re having your first baby, home birth slightly increases the risk of serious problems for the baby – including death or issues that might affect the baby’s quality of life – from 5 in 1,000 for a hospital birth to 9 in 1,000 for a home birth.

If you’re having your second baby, a planned home birth is as safe as having your baby in hospital or a midwife-led unit.”

Putting those figures into perspective chances are 0.5% chance of a problem for the baby in a hospital birth and a 0.9% chance at a home birth. Still relatively low, statistically. However, these numbers seem to be in contradiction with other research studies that suggest there’s no difference and possibly even safer to birth at home in low risk and some situations with a perceived added risk.

Within the NHS, families often find they are told of many reasons why a home birth may be dangerous and risky. This reasons may be “big baby”, small baby, bleeding, and even death. We’ve previously discussed the risk of death and that this does not appear to be as big as suggested but what about the other situations. The evidence on the risk of birth on many of those situations commonly mentioned is lacking. 

There are certain situations where home birth isn’t safe, such as a transverse presenting baby (lying across the womb) or placenta previa (placenta lying across the cervix/ opening to the womb). These situations require caesarean birth. 

To say home birth is not safe as a general statement is not based in any evidence. The risks and benefits in each situation is unique and for each woman and family to decide themselves. If a decision is deemed “against medical advice” then that is OK and within legal rights. As discussed above, the evidence around some of the “against medical advice” can be lacking in quantity and quality. Regardless of that, legally, a birthing woman can choose do to whatever she wants with her own body. She can decline whatever she wants too. No one should feel coerced into a decision

Final note.

Whilst debates around the safety of home births are happening there is a lack of discussion around the safety of hospital births. There are risks associated in those situations that are very rarely discussed. Perhaps, for the purpose of informed choice, these conversations are also happening. If you’re a professional and you’re questioning someone’s ability to make the right choice due to a home birth, perhaps ask if the same person was requesting various interventions would you be asking the same. If not, then maybe the person is absolutely fine to be making the decisions. 

Danger and safety are subjective. Blanket statements do to help anyone. 

Home birth is safe.

Hospital birth is safe.

Both can also cause problems. 

The decision always lies with whoever is birthing.

I have been doing a small bit of research into the use of antidepressants for postnatal depression and anxiety. In this I have struggled to find any statistics as to how often antidepressants are prescribed for postnatal women. 

In practice I know this is quite high. Most, if not all, new mothers who I see in practice that have seen their GP say they have been offered antidepressants as a first response to their depression or anxiety. The treatment pathway, according to the NHS guidance, should include the offer of psychological therapy. This means talking therapies such as seeing a counsellor or psychotherapist. In the perinatal period (pregnancy to 12 months postnatal) an appointment should be offered within 2 weeks of referral. This does seem to be hit and miss and some are told they cannot be seen by the service once they have had an assessment.

In addition to this, the ability to access this seems to depend on the offer. It remains the case that new mothers are expected to find childcare for therapy sessions that are between 9am and 5 pm. Evening and weekend appointments remain, somewhat, non-existent. This means the ability to access talking therapies for new mothers is extremely difficult. 

With all this, the offer of antidepressants seems logical. Research shows they do help the symptoms so using them will help in the immediate term. However, the withdrawal from this medication can be quite difficult and many do not wish to take them. Looking at what to expect in this is important. Antidepressants can be great for some people, there is the concern around what else is offered. Those of us who believe that the symptoms are more than a “chemical imbalance” (there’s a lack of evidence behind this but that’s another blog post) would suggest that antidepressants won’t work as a long time solution unless one continues to take them. There are those who do take them for a short period that do find they help to get through a particularly stressful moment in life and they can be wonderful for that. For some this could be the case with postnatal depression, however, for those whom I see in practice this does not tend to be the case. 

In my research I have become particularly interested in those who have been prescribed antidepressants years ago and report that they can not seem to stop taking them, they feel worse again when they stop and the dosage keeps being upped. There seems to be a lot of women who are 10, 20, 30 years on medication for what began as postnatal depression. I really struggle to find where this is ethical. What are we, as professionals, missing? Are we not looking for a “cure” for the depression/ anxiety? 

Years ago, the way society looked at mental illness was different. 20 something years ago Electric shock treatment (electro convulsive therapy) was still used commonly for post-natal depression and so some of this long-term use could be a bit of a hangover from that. Yet it does appear that the use of medication is a first offer for perinatal mental illness with a real lack of ability to access talking therapies. Working in this area for around 15 years now (as a parent and now professional) I am becoming very aware that little has changed in this time. I sit in meetings now where questions around “how do we engage the hard to reach communities?” are still being asked and yet no one seems to actually go do this. We must stop this. 

So, why am I writing this? To hope to trigger some thoughts, some discussions and some change. This is happening, I know I am not the only psychotherapist seeing this. 

Are you a professional working with new mothers? Let’s talk and see what could be different.

Are you a mother and this feels relevant to you? There are people willing to listen. I am here to listen. If you feel you can share your experience, then please do. 

A last note: medication has its place. 

This post may be quite a difficult read for both professionals and parents.

If you feel you need some support then please call you GP, a mental health charity or call a trusted friend.

When we think about maternity care  we envisage wonderful people who just want to make a persons life better. We think of caring humans who are doing what they can to keep people alive. 

Yet within this grooming is happening. And yes, the same tactics that the typical vision of a groomer of young girls does also happen in maternity care. 

How? Many ways. 

Coercion is the big one. Coercion is actually usually done very subtly and in many forms.

Power imbalances play a part. The NHS and maternity system is seen as some amazing institution (it is) and the people within it often seen as untouchable. Yes, maternity staff are very knowledgeable, they are also human, with emotions and biases. This is OK. They do, however,  hold a lot of power and with this means that those who aren’t as knowledgeable, appear to  have less power. With every power difference those that hold higher perceived power can very easily coerce. Simply because we are taught to believe what the professionals, those with authority, tell us.

We learn this at a very young age through our parents and teachers. Learning to listen to our parents isn’t a bad thing as it keeps us safe. Believing everything anyone with some authority tells us does not necessarily keep up safe (look up Milgram studies in authority for anyone interested in the deeper psychology.) 

A typical abuser will assert authority in order to control an manipulate/coerce. 

Language used in maternity and health care is often coercive. Think about conversations that are had around deciding a plan of care. “I’m not allowed”, “you’ll be against medical advice” etc. If you feel you cannot say no then it’s not consent and is legally assault. 

One for professionals who say “my ladies”, perhaps we should be using alternatives such as “women I work with… women I support”. Using the word “my” implies ownership. It implies control. 

Then we have gaslighting and guilt tripping involved. Gaslighting is a series of techniques that make the person its being done to feel confused and like they are wrong. Done to assert control and power. 

I would say, controversially, that birth debriefs (especially by the same person in the same unit) are a form of gaslighting the parents. (But debriefs are a whole other topic for another day) 

So, how does gaslighting exist in maternity? Usually if you’ve had one thoight and then come away with a different thought and not really sure how it happened. A lack of informed choice is likely happening which is coercive as the full information hasn’t been given therefore gaslit and manipulated into one way.

Again, this is not saying maternity workers are just abusing women. They’re not. There’s a systematic and societal problem teaching people that authority and power is good. 

As a birth worker and mental health worker it can be easy to assert authority to get someone to react favourably to your needs and often many do not even know they are doing it.

I believe if everyone has their power then no one needs to take any. 

I’ve worked in healthcare for around 18years now and we are STILL having the same conversations around power, control, coercion. This is NOT acceptable. It’s time to change this.

When a family asks questions we don’t like, let’s not scoff, let’s not talk about them in the staff room and definitely not in network meetings!  Take it to supervision! 

Let’s give workers decent supervision. Let’s give them decent breaks and pay. Let’s not burnout our care workers. Don’t accept toxic workplace environments. 

Parents, ask the questions, you have a right to know, you have a right to say no. Healthcare workers are there to care for you, but they are not the authority of you or your baby, you are. 

In short, society grooms is all to listen to authority. We’re therefore groomed to do whatever we’re told by healthcare staff. Healthcare staff do want to help and support. We need a huge societal shift but we also need to challenge behaviours that don’t allow for choices to be respected.