‘Pain is inevitable. Suffering is optional.’
– Haruki Murakami, What I Talk About When I Talk About Running

This is a post that I have planned on writing ever since I found out that I was pregnant. No matter what happens in this pregnancy, I cannot avoid it despite it also being a major source of fear. Unsurprisingly, I have been thinking about it a lot recently!

I am, of course, talking about birth.

Birth fascinates me for more reasons than my current need to understand and prepare for it. For a start, I have been astonished by how much women want to talk about their birth experiences. Whether they had a beautiful or horrific experience or anything in between, giving birth seems to be such a life-changing and emotional moment in their lives that they can’t help but share all of the details in a way that perhaps they wouldn’t for other similarly personal or invasive events. And with little encouragement – my sister is a midwife and often just telling people this was enough for them to share their stories with me, someone who at the time neither cared nor wished to hear them!

(As a quick aside and I’m sorry if this sounds rude – please don’t tell me your own birth stories now. With only a few weeks left to go, I’m trying to limit exposure to stories that might stress me out unnecessarily and I will ask if I want specific advice. You’ve all been so fantastic so far that I know I can rely on your help when I need it!)

It makes me sad that this suggests that there remains a need to share these experiences that is otherwise unfulfilled. That birth is still unspeakable, something that women do behind closed doors and aren’t supposed to talk about. I can’t help but connect this reluctance to speak about birth with the influence of the Patriarchy – this is certainly true of so many other women’s health issues, such as periods, after all.

Worries about the effects of birth on our bodies also scream of internalised misogyny – why is it so to important to be thin again? Or to keep our vaginas tight? The fear associated with these changes seems to goes well beyond reasonable worries about prolapses or incontinence, and remind me of Robbie Williams famously describing the birth of his child as being similar to watching his favourite pub burn down. Thanks for that…

Beyond my feminist concerns, birth also exists at a curious intersection between my medical self and, well, the rest of me.

Before I started this process, I literally could not understand why anyone would refuse medical advice or intervention. I have such faith in the medical profession and the rationale behind their decisions that it seemed wilfully arrogant to suggest that becoming a mother suddenly meant that I knew better than my doctors, especially when there is no doubt that medical intervention has saved lives.

This may be a sign of my privilege – the NHS and my experience of it has generally been positive, which I know is not the same for everyone. I also have enough basic knowledge that I can question recommendations and crucially understand their opinions, which makes it so much easier to trust medical advice.

Instead, I saw stories about damaging or unwanted medical intervention as literal scare stories, graphically described in one podcast as ‘birth rape’, and strongly believed that they could be blamed on poor communication or a rigid adherence to birth plans that were no longer realistic. These horror stories angered me as they just added to an anti-medical bias and I could only see them as confirming the unhelpful rhetoric that an intervention-free delivery is somehow better. With a similar blind faith, I believed that a medical birth was the better choice as the risks were lower. If we’d been talking a year ago, I can tell you with 100{f9264c1b08ec794f1cf6cd6d13ef8a87ec0de6a492dab0f81db5d3b37fb3799c} certainty that I would be having my baby in a hospital-based unit with an epidural and wouldn’t be that sad if a Caesarean section was suggested. Medical me up!

But as soon as I started telling people about my pregnancy, this certainty began to waver. Not my faith in medicine but my belief and acceptance of other options, and importantly my understanding that, while a medical birth may be more controllable, it is not necessarily better.

The first person to really bring this home and encourage me to listen objectively to birth experiences that weren’t horror stories or medical dramas was my cousin. She is a hypnobirther and had her second child as a home birth, complete with birthing pool in her living room. She has been fantastic and hasn’t flooded me with information, but has made certain that I wasn’t blinkered by my medical nature and knowledge. Her main concern was that my medical focus meant that I had forgotten that birth wasn’t an illness. If I had only heard ‘bad’ stories, how could I believe that a ‘good’ birth was possible? She knows me well enough to accept that I would never want a home hypnobirth type delivery but hoped that I could find a middle ground between the two. And she was right – the major disadvantage of the medical model is that I had only ever heard about what had and could go wrong, and I was afraid.

Recently, this fear of birth, or tokophobia, has been used as another reason not to talk about birth. It has been claimed that the bad experiences plastered across social media are putting people off having babies or encouraging demands for elective Caesarean sections. Honestly, I find this attitude both hugely patronising – way to quiet the little, delicate women – and extremely unhelpful, particularly as my experience has been completely the opposite!

Yes, I have been terrified by the traumatic stories but I have also been encouraged and enriched by the better ones. And I needed both sides, both ends of the spectrum – if I remained convinced that labour would only be painful and difficult, I would have been so fearful that my stress and adrenaline levels would have been sky-high, which is known to have a detrimental effect on the progress of delivery. Equally, if I had only believed the positive stories and become convinced that I could guarantee a pain-free, easy labour with the right preparation, I cannot imagine how shocking reality would have been!

Well actually, I can imagine it as Jess Fostekew discussed this in an episode of the Guilty Feminist in June 2018. In exactly the dichotomy that I have come to resent, she felt she had to choose between a ‘clinicalised, hospital-bed drug-filled manic birth…or a lovely one.’ She went into labour convinced that it was going to be a pain-free dream. If you listen to her story, from 13:30 to 24:55 in the clip below, you’ll hear that this wasn’t exactly what happened…

As with everything, knowledge is power!

Literally the only thing that I know for certain about how I will experience birth is that it will be painful, likely fucking painful, and any attempt to suggest otherwise is frankly naive and potentially dangerous. I have had period cramps and they can be fucking painful! Why would labour be different? And I cannot help but feel that claiming birth isn’t painful is another example of where the pain women experience is underestimated. Don’t forget that the ‘discovery’ that period cramps hurt was considered newsworthy not that long ago! And I was ruefully amused to read in a book written to prepare dads for fatherhood that birth actually wasn’t that painful after all. Thanks once again, Patriarchy! Let’s make women who do feel pain and need support feel weak and like a failure.

But I also know that everyone experiences pain differently and this is the key! I only need to look to the world of kink and BDSM to see that sometimes pain can actually be pleasurable. And even without any hint of masochism, there is also no doubt that each of us experience pain differently – this is why managing chronic pain syndromes is so difficult. For example, I have seen so many patients whose hips or knees were worn down to nothing with arthritis but still plodded along, feeling only mild discomfort, alongside others who are completely debilitated by objectively lesser degrees of damage. Neither is wrong, neither is more stoical or stronger; their experiences of pain are just different.

And this is what I really needed to hear and why sharing birth stories is absolutely essential. I needed to hear that birth is painful so that I could prepare myself for it, but also to learn about coping strategies. I needed to hear that breath control, TENS machines, baths and paracetamol can ameliorate the pain until it is manageable – not absent but manageable. In what might have been the most useful part of the antenatal classes we attended, I needed to hear that each contraction only lasts a minute and, should my baby be in a good position (and I am doing everything I can to make sure that she is!), I should experience no pain between. Even when contractions are close together, there would still be gaps for recovery. With a normal labour, the pain is not constant no matter how bad it is. And if I don’t have a normal labour or if the pain becomes too much, my medical core remains strong and I know my other options – why suffer when there is a pain relief available? Accepting help when it is needed is never, ever a sign of weakness.

I genuinely don’t know what will happen when our baby comes. I am fortunate enough to have never really experienced Pain with a capital P – no broken bones, no severe illnesses or injuries – so I don’t know what I can cope with. I also don’t know how difficult my birth will be as family history of big heads and bad positioning suggests it could be tough, but I am still hoping for the best and our current plans are to just see what happens!

Again, I am hugely fortunate that the structure of the birthing unit where I am registered allows us to keep our options open – the midwife led unit is literally next door to the labour ward. For me, this is a vital part of creating that relaxed and comfortable environment that is so encouraged. This does mean that medical intervention is more likely as it does not require an ambulance to access it and so isn’t for everyone, but I need to know that I can easily and quickly access medical support if I am to try managing in a less clinical environment first. Under these circumstances, I am almost, almost, looking forward to it.

Because this is what I need to do to meet our baby and, as we keep being told, that makes almost anything that comes before it worth the effort and pain.

Fingers crossed that they’re right!