Pregnancy: What the Indian Woman Always Wanted to Know But Was Afraid to Ask


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Conversation with Nutan Lakhanpal

One truth we gain from living through the years, Fear brings more pain than does the pain it fears.

John Golden

CHILDBIRTH IS A natural and universal phenomenon, and yet the knowledge of it among average women is rather haphazard, incomplete, or distorted.

A woman generally has a vague notion that childbirth involves unbearable pain and danger. This notion is formed as a result of the distorted tales heard during adolescence or later. What can be pieced together from gossip, movies or fiction draws a picture of passive pain, to which a woman has to submit in utter helplessness. A negative attitude during labour causes her entire body to tense up with fear.

If one undergoes unendurable pain, one passes out as a rule, i.e. loses consciousness. This is nature’s safety mechanism. However, women in labour may be rendered unconscious by drugs, but never by pain. Hence, what pain can be felt, can be endured.

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PAIN PERCEPTION

Pain and childbirth have been associated with each other for so long that normal uterine contractions are often referred to as pain.

Uterine contractions and pain have become synonyms. A woman is often told that pain is the signal of labour. In France, labour wards in many units are referred to as the ‘Hall of Pain’. Women who have had babies also talk of ‘the pain’ hence a temporary connection between words and nerve centres takes place.

The uterine nerves signal the beginning of labour to the brain. The brain translates it inevitably into pain, anticipating it.

When the human body is healthy and functioning efficiently, the organs constantly send streams of messages to the brain to inform it of their working. Coming from various internal and external sources, these messages have to compete with each other. Hence many of them get ignored completely.

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However, when the potential force of the brain is reduced, say, by shock, we can painfully feel the working of internal organs, e.g. shocking news can cause a stomachache or a pain in the throat.

In labour, the potential force of the brain can be reduced by a whole lot of negative feedback over a period of time, resulting from the expectation of unbearable pain. In other words, if you expect pain, it can impair the normal activity of the brain, and make you feel greater pain. Each negative feedback regarding labour received over the years has the same effect as drops of water falling regularly at the same spot on a hard stone. Millions of drops do succeed in making a dent.

It is therefore important to think positively about labour. Think of it as a natural experience. As you grow up you experience menstruation, intercourse, and then childbirth. It is a normal and natural function of your body.

When labour is allowed to be natural and drug-free the body releases endorphin hormones that are natural painkillers and give a feeling of well-being.

THE BRAIN, THE BOSS

When a woman is in labour, the uterus contracts. Stimulus is received and sent to the brain by the nerve endings in the uterus. If the brain interprets it as ‘fearful pain’ the protective mechanism which advocates flight or fight will take over a woman’s body. As a result, the woman, incapable of flight, will fight each contraction by building up muscular tension throughout her body. Along with general muscular rigidity, her uterus will also become rigid and offer resistance to the uterine muscles working towards birth. This is perceived as pain.

However, if the woman understands that the strain her body is undergoing is part of the physical strain associated with the expulsive efforts of her uterus, of which she has no reason to be afraid, the contractions will be a new experience for her. The muscles of her uterus will work unhampered by fearful tension and with each contraction get closer to birth, so that the woman will have a shorter, less painful, labour.

Hence the pain a woman will feel in labour will greatly depend on her brain’s interpretation of ‘pain’, as either something fearful or as something to work with.

SYMPATHETIC NERVOUS SYSTEM

When the sympathetic nervous system is stimulated by fear, it restricts the blood flow to and from the uterus. In the absence of adequate fuel and no effective means of disposing of waste products, no organ can function optimally. This is one of the most serious influences of fear on the reproductive organs, and is directly responsible for many of the unpredictable complications of an otherwise normal labour.

According to Langley and Anderson (1893-94), stimulation of the sympathetic nerves to the uterus by fear causes the uterus to appear pallid, firm and bloodless, but when the stimulation is removed, it rapidly fills with blood and becomes an elastic, deep pink uterus. A bloodless, white uterus can lead to urgent distress of the fetus and a Caesarean may have to be performed.

Impairment of circulation is a cause of pain, because the blood flow is too weak to dispose of the byproducts of metabolism. Restricted circulation can also give rise to severe pain in the muscle tissues of the uterus thereby prolonging the process. Even if the bodily organs are in order, e.g. the pelvis is adequate for the baby’s head, and the baby is in the correct position for coming out, psychological fear and its associated pain—not real pain—can make labour long.

Fear and its effects not only prolong labour but are also responsible for haemorrhage and tissue injury in the mother, and anoxaemia (less than normal concentration of oxygen in the blood), respiratory failure, and exhaustion in the newborn.

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