Managing pain: expectations vs reality
A long and extremely painful labour ending in an epidural left Liddy feeling ashamed and traumatised. She tells her story and reflects on how having some more realistic expectations about managing pain might have changed how she felt and the choices she made.
My expectations
When I got pregnant I knew very little about birth, so I did everything I could to prepare. I did a one-to-one hypnobirthing course, read birthing books and countless positive birth stories, watched birthing videos, and followed hypnobirthing social media accounts.
I decided I wanted a physiological, unmedicated birth - apart from maybe some gas and air. This seemed like a reasonable decision based on all the information - I’d learnt a lot about the risks associated with an over-medicalised maternity system. But I also accepted that I might have to decide to have a caesarean or other medical interventions to ensure me and my baby were safe.
These were my expectations: an unmedicated birth without medical complications or coercive interventions would be a manageable and positive experience. It was within my control to feel good and strong during labour. Breathing and relaxing was the key to coping with the pain. Knowing that the contractions were doing a good thing - birthing my baby - would mean I would be able to embrace them and their power. Any intense pain would only make up a very small percentage of my time in labour. What happened to my body during birth was completely up to me. It would be the hardest but also the most amazing and empowering thing I would ever do. I would experience love like no other when I met my baby for the first time.
So I was feeling excited and confident. I practiced my hypnobirthing breathing most days. My ideal scenario was that I'd be in the midwife-led unit at the hospital, dim lights, hands-off midwives, in the birth pool.
And as luck would have it, that’s exactly where I ended up. But that didn’t result in a positive experience. Instead, it was earth-shatteringly painful and traumatic.
My reality
I was so happy when I went into spontaneous labour just before my due date. I did everything I could to help my body with the process and keep the oxytocin flowing. I watched my favourite films, ate yummy snacks, cuddled with my partner, and pictured meeting my baby. I stayed active, listened to my body and moved into the positions that felt right. I breathed through each contraction, providing my muscles with the oxygen they needed.
20 hours later, I arrived at the midwife-led unit as my contractions were getting more and more intense. I heard a midwife ask my partner if I’d been practicing hypnobirthing breathing because I was doing so well, which made me feel so good. Despite the increasing pain and my exhaustion, I was still feeling positive. I was doing it! I wasn’t scared and I kept focusing on the fact that I would get to meet my baby soon.
The previous several hours had matched what I’d been told active labour would be like. I had gone inwards, entirely focused, breathing. Time was strange. But then, shortly after getting into the birth pool, it changed. The pain went up to another level - each contraction was beyond brutal. I was no longer an active agent in my own body.
I couldn't understand why I couldn't keep focused and relax - it wasn't how it was supposed to be. I needed to try harder and be stronger, I thought. I was drifting in and out of consciousness between contractions. I tried to root through my prepared toolbox, but I was struggling to think or remember anything. I asked the midwives to tell me my options. I tried gas and air and then a Dihydrocodeine tablet, but neither made any difference. I felt like I was being tortured.
After about 4 hours of this shockingly intense pain, I didn't feel capable of anything anymore. The midwives had kept telling me I was doing great, but I wasn’t. I couldn’t feel where my baby was or if he was still moving - the pain was obliterating everything. I desperately needed it to stop.
So I asked for an epidural. I felt defeated and sad. I felt like I was giving up. I believed I was putting me and my baby at risk of more interventions for no good reason. But the thought of another contraction filled me with a dread like no other.
I was told I had to wait for the epidural because an anaesthetist wasn't available. Utterly terrifying and devastating news, delivered with very little compassion.
The epidural was eventually administered, and about 2 and a half hours later a baby left my body. All I felt was relief. Relief that the pain was gone. Relief that the baby was okay. I held him, watched my partner hold him, fed him, ate tea and toast, smiled for pictures, and messaged family to tell them the news. I didn’t really feel like I was there though. I felt like I was only pretending to be a happy, loved-up first time mum. I was in shock and so horrified by what I had experienced - there wasn’t room for anything else. I felt horribly guilty for not feeling any real joy that day or any obvious love for the baby in my arms. He didn’t feel like mine.
“I started obsessively remembering and thinking about the birth and the pain”
Searching for answers
The wildly difficult first weeks of motherhood went by as my body began to heal from the birth.
I started obsessively remembering and thinking about the birth and the pain. I searched for possible explanations and reasons for why it had been so bad - I scrolled endlessly through online forums reading other women’s experiences, talked about it with family and friends, listened to birth podcasts, emailed birth trauma peer support services, and re-read my birth books.
I tried to accept that there were lots of factors that would have impacted how I experienced labour pain which weren’t within my control. The length of my labour. How tired I was. The unknown position of my baby. The shape of my pelvis. My pelvic floor. My brain chemistry. Just luck?
Ashamed and traumatised
The dissociated feeling towards my baby persisted for many weeks after birth, not helped by a difficult breastfeeding journey. My love for him grew to dizzying heights a few months in, but before this the guilt was immense.
Despite all the validating evidence and information I found, I still felt like I’d failed by having an epidural. I believed my mindset and actions would determine how the pain would affect me, and so when it was awful it felt like it was my fault. But then I knew deep down that experiencing that level of pain could never have been a positive experience… so then I felt like I'd failed myself for not asking for an epidural sooner.
Before giving birth, I had felt confident, capable and strong. I believed I would be a great mum. Feeling like a failure for not being able to manage a ‘normal’ birth meant I lost my self-belief. I felt broken, weak, and a burden rather than a help to my partner in looking after our baby.
As the weeks went on I sank into a deeper and more frightening hole. I couldn't stop thinking and getting upset about what had happened. Remembering the pain and helplessness would leave me sobbing on and off all day, and I couldn't sleep. I struggled to concentrate on basic daily tasks or conversation.
A couple of months postpartum I realised I had developed symptoms of post-traumatic stress disorder (PTSD) and I started seeing a counsellor. It made me feel even more weak and useless. Not only had I not coped with birth, but now I couldn't let it go and it was ruining my time with my baby.
“Traumatic feelings were made worse by the fact that I expected to be able to manage the pain”
Expectations affecting trauma
Make Birth Better defines trauma as ‘anything that left you feeling intensely afraid, out of control or helpless’. Maybe the pain I experienced would always have led to trauma. But I think that these traumatic feelings were made worse by the fact that I expected to be able to manage the pain. When this wasn't the case, my sense of powerlessness was shocking and frightening. I felt terribly ashamed that I couldn't cope.
I think this delayed me asking for the pain relief I so desperately needed. Perhaps if I’d felt able to ask sooner, the pain at that level wouldn't have gone on for as long, and it would have been less traumatic.
If before birth I'd viewed my agency in relation to my choices rather than my ability to cope with the pain, perhaps I would have felt better about how it went. It might have left more room for me to feel positive about how I’d navigated my way through, even if the pain itself was still a negative experience.
Reflections on my hypnobirthing education
Hypnobirthing offered me plenty of good advice and information around birth, lots of which served me well in making informed choices and feeling good during my pregnancy and first hours of labour. But lots of the messaging cemented the unhelpful expectations I formed around how an unmedicated birth would feel.
I was encouraged to use breathing and relaxation techniques to ‘handle’, ‘cope’ and ‘manage’ pain - these words have connotations of success and failure heavily attached. Affirmations told me ‘I can do anything for 60 seconds’. But I couldn't face another 60 seconds. ‘My surges aren't more powerful than me because they are me’. But they were more powerful than me. ‘Every contraction brings me closer to my baby’, so it would only make sense that I'd want them to carry on. But I reached the point where all I wanted was for them to stop - so what did that say about me as a new mother?
In so many of the positive hypnobirthing stories I’d read, people attributed how great they’d felt during labour to their preparation and mindset. So many expressed how proud of themselves they were for staying calm and not using medication.
All this negatively impacted my sense of self-worth. Letting go of the self-blame has been a huge barrier in trying to recover from PTSD, and lots of that existed because of the explicit and implicit messaging from across the hypnobirthing resources I accessed.
I wish I’d had some more upfront information about the range in severity of pain that can be experienced in labour and the contributing factors outside a person's control - and not just whether or not the fear-tension pain cycle is avoided. I wish that I’d been encouraged to make choices that would make me feel safe, as well as avoid physical risks. I wish I'd been aware that feeling unsafe because of extreme levels of pain was a very possible and valid reaction to birth. Maybe then I could have avoided the birth dissonance I experienced. Maybe then I would have asked for help without feeling shame and fear.
“I’m not a failure because my experience was harrowing rather than empowering”
Moving forwards
I try to pull out the positives from my birth story as I re-write and re-tell it: I worked through my toolkit of options as I’d prepared, and ultimately I accessed what I needed to feel safe. Unmedicated labour meant I felt unsafe and an epidural allowed me to reconnect with my body - and I birthed my baby, which is incredible. I feel sad that I didn’t feel good or proud of this at the time.
The belief that how I gave birth says something about me as a person lingers. But every day I spend with my baby I realise all the amazing (and terrifying!) ways I can impact him as a person. How I gave birth to him isn’t one of them.
But it does still impact me, at 6 months postpartum. How I experienced unmedicated labour was luck of the draw, and I'm not a failure because my experience was harrowing rather than empowering. I know this rationally - but believing it emotionally is still hard a lot of the time.
I think I will always grieve for what I've lost over these last months. But on good days I am very hopeful that a combination of support from my friends and family, therapy and time will help me fully recover from the PTSD. I've just started to be able to recognise my own strength again. Some confidence and pride is seeping through from time to time, as the trauma grows smaller.