As in surgery, pain often plays a large part in complications of pregnancy and delivery. In our culture deliveries and surgical procedures are carried out in similar settings. Thus the fear associated with doctors, caps and gowns, scalpels, surgical orders, injections, intravenous fluids, and anesthesia attend both. This fear and our social programming tend to intensify the experience of pain. The process of giving birth need not be an excruciating ordeal. It can be taken matter of factly, as part of the experience of life, or it can actually be an ecstatic, joyful event. Indeed, if one observes animals giving birth, or women of certain tribes, who stop on the way to work, deliver, rinse off their babies and wrap them in a shawl, and continue to the marketplace, barely stopping to rest until the end of the day, one realizes just how natural, normal, and positive the birth experience can be. These people and the animals do not experience the fear of childbirth that we find in our society.
The fact that this fear is so endemic in our culture might, however come as less of a surprise if we examine some of the programming of the modern woman. She is constantly presented with photographs and stories of malformed babies and women who have died during pregnancy. Even the uterine contractions that occur during the birth process are called labor pains, leaving nothing to the imagination as to what one’s experience ought to be. And in our vernacular, anyone who is distraught and complaining might be described as having a baby.
Few have not heard a gory tale of a baby’s head getting stuck or of a woman’s vaginal tissues tearing during delivery, requiring painful surgical repair, though it is rare for serious complications to occur with our present level of obstetrical skill. What is not passed on with this information is that in many cases the woman’s fear causes such tension in the vaginal area that proper passage of the baby is not possible. A woman who is very frightened at the time of emergence of the infant’s head is much more likely to give a panic-stricken push rather than heed her physician’s instruction to allow it to come slowly and smoothly. The resulting tear is then the focus of the story you hear from her, and the blame is placed on herself, the doctor, the baby, or the process of birth itself. But often tension, expectation, and mental imagery is at fault.
A few years ago it would have been almost medical heresy to discuss what is today commonly accepted as natural childbirth. Numerous different methods are available, including the well known Lamaze and Leboyer techniques. All of them focus on the elimination of fear and the substitution of positive conditioning, a positive environment, and positive expectations. My approach to a delivery has been based on similar principles. First, I teach methods of deep relaxation.
After the relaxation, positive image visualization is used to help the unconscious to realize that pregnancy and delivery are normal functions of the body, and that uterine contraction involve no more discomfort than the contractions of the biceps or any other muscles of the body. The delivery is visualized as proceeding slowly and calmly. An understanding is developed that panicky feelings can actually hinder its progress and cause the very problems that the woman wishes to avoid. Suggestions similar to those given for use prior to surgery are used, along with visualizations of a comfortable birth and relaxed rest period following that. I also make clear the fact that the less fear present in the mother at birth, the more unlikely the child is to be in any distress when born, and the fewer complications for both.
As with the imagery and relaxation used prior to surgery, the images used during pregnancy tend to act as posthypnotic suggestions, and the delivery itself is much more comfortable, even with no further conscious effort on the part of the mother. Generally things can be made even more comfortable and pleasing if, during the “labor” (actually this need not be “work” at all) contractions, the Selective Awareness methods of relaxation are used, using the breathing and the contractions themselves as signals to increase the relaxation.
One of the major causes for fear and tension and their complications is that the mother-to-be often feels apprehensive, as though she should be doing more, and because there is nothing to do, tension results. A more rewarding approach is to recognize that she is free to concentrate on her own relaxation. The proper contractions will occur as automatically as her heartbeat. She can thus save her energy for the time when she will be asked to push, which does not occur until near the end of the birth.
When the physician or midwife is aware of the principles of relaxation, the birth can be a pleasant, smooth event. The practice prior to delivering concentrates on relaxation and the awareness that the birth will feel different from her everyday experiences, but that it will not necessarily be uncomfortable, because it is a natural process. She is then encouraged to visualize the proper muscles contracting at the proper times. As each stage of labor and delivery are reached, the physical changes reinforce the imagery and the ability to flow with the experience increases.
I suggest the induction of a deeply relaxed state just before going to the delivery room or at the onset of labor. I also request that the lights in the delivery room be kept as low as practically possible, that the voices of others in the room be kept low, and that the nurses refrain from using such words as pain, hurt, labor, shot, or other expressions that imply that there will be discomfort or disability as a result of what is going on. The reason for the dimming of the lights stems from a finding common to many individual Explorations that have led back to the birth experience. Many of my patients have said that at birth they were very aware of the frightening aspect of the white or green delivery room and the surrounding masked faces.
Also stemming from these experiences is my current practice of giving the infant to the mother as soon as possible following birth, because numerous times I have found among my patients lifelong feelings of rejection and loneliness dating back to being carried off by an indifferent nurse after delivery.
Following a delivery, suggestions are given to ensure adequate stoppage of bleeding and rapid healing. As with all surgical wounds, small vaginal lacerations or episiotomy repairs heal much more rapidly when they are not associated with fear. Often, even when stitches are present, the woman is able to stand up following delivery and walk comfortably to her bed.
The main principles, then, in pregnancy and delivery are:
- Elimination of fears regarding pregnancy and delivery through Exploration and deconditioning.
- Positive programming and elimination of negative expectation (such as sickness, pain, or a damaged child).
- Extensive practice in deep relaxation, focusing on breathing, with suggestions to produce anesthesia, beginning months before delivery when possible.
- Visualization of rapid healing and return of strength following birth.
The baby’s father can be included in all visualizations, including those of delivery, the postdelivery period, and the baby at three or four months.