Fear and Pain: A Cultural Picture of Childbirth...and What We Can Do to Change It

What if I told you that I gave birth to my child without anesthesia or medication of any kind, without any medical interventions to speak of...and the result was a childbirth experience that was virtually devoid of any pain? That I experienced childbirth in its fullest, most visceral state, completely comfortable and aware throughout the whole process? Would you believe me?

Allow me to digress for a moment, and ask you this question, instead: What is it about childbirth that immediately conjures images of screaming pain and terror? Why is it so difficult to believe that a child can be born peacefully and with minimal pain and discomfort?

The answer, it seems, is largely derived from culture-bound ideas about pregnancy and childbirth. Simply put, American culture - from popular media, to personal anecdotes - seems to emphasize that the birth of a child is inherently a painful and difficult process, wrought with potential dangers for both mother and child, and manageable only by those with the proper "authoritative knowledge" and understanding.

As the classic Brigitte Jordan book Birth in Four Cultures reveals, this view is not universal. Women in American culture are taught that this is so. They are told to expect that childbirth will be painful and thus, they experience it as such. For women in many other cultures, this is simply not the case.

This is not to suggest that women who experience childbirth as painful are somehow to blame for their experience, or that they are doing something wrong - far from it. The point is simply to ask how the American cultural picture of birth influences the way women in our country experience this fundamental life process. With fear and pain being interrelated phenomena - one influencing the other - does this expectation that all women are doomed to have an inescapably pain-ridden birth experience increase our fear and, thus, increase our perception of pain during childbirth?

How Fear Influences Pain - And What this Means for Birthing Women

For most, the idea of pain-free childbirth is quite foreign. While I've been interested for a while in the concept of "pain-free childbirth," I really started thinking about how fear can influence childbirth outcomes when I saw this article. The study described in the article examined mothers who suffered from severe or "excessive" fear of childbirth, and the impact of this fear on their birth experience. The main conclusion of this study was that women who suffered from extreme fear of childbirth were more likely to have epidural anesthesia, induction of childbirth, elective c-section, or emergency c-section.

According to the authors of the paper, and other previous studies (cited on page 4), the heightened levels of adrenaline that accompany a fear response can undoubtedly influence the progress of labor. Many of these women had had a previous traumatizing childbirth experience (and the phenomenon of birth trauma is a topic for a whole separate post I intend to write at some point in the future).

While the fear experienced by the women in this study was extreme, the results still raise many questions. Did the women's fear (and the neurological effects created by it) directly impact the progress of their labor, as the authors suggest? Were their care providers just more likely to undertake this type of intervention because of the woman's psychological state? Or is there somehow a correlation between the type of provider (one who is more likely to perform inductions and cesareans) and the experience of fear by their patients? It is difficult to pinpoint a specific cause-effect relationship here, and the study does not directly point to any one answer.

What is known from other studies is that fear of pain can actually enhance and amplify the severity of pain. The more you are afraid that something is going to hurt, the more likely it is to actually hurt.

The question, then, becomes not one of whether or not childbirth actually is painful (surprisingly, most who say it is universally and inescapably painful are men), but how we can change the way we perceive and experience pain during childbirth.

I'll address this - along with the question at the beginning of this post regarding my own birth experience - in a future follow-up post.

Your Thoughts?
In the meantime, please let me know your thoughts! Do you think childbirth is inevitably painful? Do you think there is anything we can do to change the way women experience this fundamental life process?

Works Cited: 

Sydsjo,Gunilla; Sydsjo, Adam; Gunnervik, Christina; Bladh, Marie; and Josefsson, Ann. Obstetric outcome for women who received individualized treatment for fear of childbirth during pregnancy. Acta Obstetricia et Gynecologica Scandinavica: October 2011.