Childbirth

Emotions are usually excluded from childbirth. This may seem like an extreme statement in view of the many photographs that exist of delighted fathers behind masks looking at their newborn infants. If the mother is not overmedicated or exhausted, she may also look delighted. More likely she is dazed. The baby very often just cries, its first emotions being fear and deprivation. There is a current tendency toward 'natural childbirth,' in which at least the mother is not too drugged to experience the event with joy, and after which the baby is encouraged to snuggle close to the mother rather than to be separated from her. As Leboyer's photographs show (Childbirth without Violence), this is much better for the baby, whose face looks serene and even joyful. But the first statement still holds true if childbirth is looked at as the whole event, starting with labor and ending with the birth, not just as the few minutes after birth itself.

Medicated childbirth might better be called 'technical birth,' since more than medication is involved: compulsory enemas, fetal heart monitors with electrodes screwed into the baby's scalp while it is still in the uterus and which immobilize the mother, delivery tables with stirrups, and dazzling lights. Even if, as is the modern fashion, the father is permitted to attend, there is very little for him to do, and the mother will be mostly out of contact in a Demerol haze. Many people conscious of emotional health try to arrange a mixed kind of birth, where the technical aids are not completely intrusive, and where some natural childbirth methods are used. Others go all the way with natural childbirth. But as it is taught in most prebirth classes, natural childbirth is not natural. It consists of educating the mother in a series of breathing techniques that will enable her to simulate medicated childbirth, only without the medications. In other words, usually the aim is the same—a pain-free, essentially emotion-free, controlled labor in which breathing and relaxation techniques take the place of anesthetics. Admittedly, being unmedicated is being free to feel emotions at all stages, and to enter into unimpeded contact with the baby. And some books on the natural methods do advise women that it helps to remain in emotional contact with the husband. Some, referring to methods from body-oriented therapies derived from Reich, even stress the need for keeping the mouth open and maintaining eye contact with the husband or helper during difficult phases, and encourage the woman to 'breath the baby out' rather than to push (although pushing may occur involuntarily). Some natural childbirth instructors are also sensitive to how an openness to the emotions leads to an open labor and delivery of the child.

In sum, it would be more accurate to say that in current practice there are three kinds of childbirth technical childbirth; the kind of natural childbirth that aims to keep the mother above the experience of birth (it is sometimes known as 'psychoprophylactic' childbirth, meaning that the mind is used in the control of pain); and the kind of natural childbirth which aims to keep the mother in the experience. Emotional First Aid is useless in fully technical childbirth, useful as a standby in psychoprophylactic childbirth, and an organic part of natural birth. A fully natural childbirth, for modern Western women at least, is a deeply emotional experience. This may be because it involves the letting go of many emotional conventions. Advocates of psychoprophylactic childbirth often give examples of primitive women who give birth to children without pain and without any emotion. Whether this is desirable or not (and the lack of emotion suggests a measure of resignation in these women), it is hard to imagine in women of our society. In fact, the tendency of women to become overwhelmed by emotions during childbirth is traditionally well known, though feared. The image of women screaming in childbirth strikes terror into our hearts and has been used as justification for the advance of technical childbirth. The idea that perhaps it helps the woman to scream has apparently been lost. According to some sensitive obstetricians, much of the pain associated with childbirth can be traced more to emotional blockage and inhibition and the consequent physical tensions than to the essential pain of the process of opening up the birth canal. 'Tense woman, tense cervix' is a traditional axiom. Of course, medication can relax the cervix. But emotional contact and discharge can relax the woman.

A normal childbirth consists of three stages: a longish period of labor in which regular contractions open the cervix; a brief period known as 'transition' when contractions are irregular and the cervix opens the last few centimeters very rapidly; and a period of delivery when the baby is being expelled down through the vagina into the world. There is nothing predictable about the emotions during childbirth, but in broad outline:

—During labor, emotions may not be particularly intense, although sadness or anger may occur if the process becomes fatiguing. More likely in some cases, there is a general anxiety that produces some signs of 'freezing' and slows down the labor. Contact and support from husband or helper are essential during labor. This includes eye contact, which may not be necessary, or may even be annoying if the woman wants to curl up quietly and let the process unfold slowly, but which becomes necessary if the woman freezes. The best guideline is that if the woman expresses no emotion, it is not necessary to insist on eye contact. But if the woman does express emotion, whether anxiety, anger, or sadness, eye contact will help it discharge and let the organism move. This is consistant with EFA.

—During transition, pain may be intense and emotions powerful. Eye contact and breathing are as important as during any EFA emergency. It may be particularly useful to encourage the woman to express the fear or anger in the eyes, as in the simulations suggested earlier. It is also essential to encourage the woman to make sounds. It is not necessary to scream, although of course if she feels like screaming, she should be encouraged. But sounds open the throat and let the wave of breathing flow down the body. Some of the measures suggested in the EFA of grief, to keep mouth and jaw relaxed during crying, are useful to childbirth. In transition, most anxieties come to a head. Terror may be felt. Bad experiences from the past, with the woman's own mother, or even apparently from the woman's own birth or what she has heard of it, may come to the surface. During periods of panic, constant effort is necessary to have the woman remain in eye contact. Rage against the husband or the baby about to be born may emerge. Accept it all. Don't create it, any more than in normal EFA, but encourage it to surface once its presence is apparent.

—During delivery, the prevalent emotion is joy. It may at first be a harsh kind of joy, with a component of anger. The woman feels back in control of the process, and exerts a newfound power in pushing the baby out. Unfortunately, many midwives and nurses encourage a very harsh kind of pushing. This may lead to panic in some women—the new-found power is fragile—and if this occurs, eye contact is essential. Or the pushing may be angry, even hateful, with a kind of 'I'll show you' quality. Women who have had more than one child tend to experiment in later deliveries with pushing more gently. It is in fact possible to 'breath the baby out,' with pelvic movements similar to those of sexual intercourse, and many similar sensations. The spontaneous joy of delivery is often inhibited by false ideas of modesty and the rush of sensations normally associated with sex. Delivery can be, in fact, an orgastic experience. (This is emphasized by at least two woman writers, Kitzinger and Newton—see Suggested Further Reading.)

After a birth in which emotions have emerged into contact, and the woman may have opened some of her deepest feelings from her personal history for the first time to herself and her partner, and in which delivery is experienced as an ecstatic discharge of the excitement accumulated over months of pregnancy, there is no problem with sharing the joy. The baby, in being brought from the internal embrace of the uterus to the warm external embrace of its mother, is able to share in the joy too. It rarely cries, but reaches out softly, with its eyes, its voice making exploratory sounds, and with its whole body as it snuggles into the mother's skin.

The best use I can imagine for this book is for childbirth instructors and prospective parents, who can perhaps discuss the possibility of using EFA during childbirth, negotiating whatever contract seems best, while keeping in mind that the reality will always surprise them.