My definition of pain is “a mental interpretation of injurious stimulus”. The biological purpose of pain interpretation is protective and its results in muscular activity to the end that the individual may either defined by him or escape from impending danger. For instance, if a finger is accidentally put on a hot stove, almost before there is any conscious mental interpretation of what has happened, it has immediately employed by removing the injured part from the injurious stimulus. Pain is also protector inasmuch as it gives rise to experience and association which is exemplified by the small boy who withdraws his hand almost irresistibly from the cane.
There are, however pains from which we cannot escape. They may be associated with muscular rigidity, but there are some which it is difficult to explain. The pain of a carbuncle, the pain of a dental abscess and so on. But for our immediate purpose it is sufficient to recognize that such pain are associated entirely with abnormal or pathological conditions and are not in keeping with natural health.
When the natural urges to perform are associated with discomfort, it usually indicates that the physiological balance is being strained. Exercise hunger may be considered a pain; excessive thirst certainly is a pain. When the bladder should be emptied or when there is a strong desire to empty the bowels, these urges may be described as pains, but they are protective and are demands which in the natural state would be satisfied before discomforts arose.
The first stage of labour lasts twelve to twenty-four hours with a first baby and usually less with subsequent children. During these hours the contractions of the uterus increase in strength and come more frequently, until by the end of the first stage they may be occurring every three to five minutes. The cervix or neck of the womb undergoes several important changes. First it is drawn up so that it no longer projects into the vagina, then it gradually opens or dilates. By the end of the first stage the opening in the cervix is large enough to allow the baby’s head to pass into the vagina.
The cervix itself is converted into one continuous cavity. In the majority of labours the membrane rupture and the waters escape towards the end of the first stage, through they may rapture earlier, and in a few cases they do not rupture before the birth of the baby. The baby mat then be born completely enclosed in the membrane or “caul” an even which was once thought to be an omen of great good fortune. When the baby’s head passes through the cervix and into the vagina the second stage of labour begins. At once, the picture changes.
The stretching of the vagina and the surrounding structures by the pressure of the head brings into action a reflex or automatic mechanism. With each contraction of the uterus the expulsive muscles of the abdomen and chest contract as well and the mother feels an impulse to press or bear down to expel the baby. As she presses with each contraction the baby’s head advances farther and the tissues gradually stretch until the head escapes from the vagina, to be followed at once or with the next contraction by the shoulders and the rest of the body.
Labor last approximately eight to sixteen hours in a first pregnancy and four to eight in subsequent ones. When to go to the hospital depend on how far away you live. When you go to the hospital or to a doctor’s clinic, the doctor will ask you the frequency of your labor pains and their duration. He/she will check your blood pressure and examine you to find out the position of the baby and listen to his heart. The examination will also include a vaginal examination. An enema is then given to empty the rectum of stool. This is important otherwise with each labor pain, some stool is also passed and the delivery table becomes contaminated. If the pains are not very strong and the labor not advanced, the doctor may prescribe a sleeping dose so that you do not get exhausted. Gradually the pains become stronger and more frequent, and the bag of water breaks, followed by a rush of water from the vagina.
The contractions now occur every one or two minutes and are stronger. There is an increasing feeling of fullness and pressure in the rectum similar to the feeling of the passing stool, and the desire to push is very strong. Gradually, the baby pulses itself out – first the head, then nose and face and lastly, the mouth and the chin. Baby’s eyes are wiped, and during the next contraction the baby comes out and you hear a loud cry. Many obstetricians are going back to the old custom of delivering a woman in a squatting or sitting position or positions are better than lying on her side. There is increasing evidence that these positions are better than lying on the back, which really seem to be more for the convenience of the obstetrician!
The description of the events of normal labor has been given in a coldly scientific manner, since it is only through an understanding of what normally happens in the process of birth that natural childbirth can be conducted and practiced. Some may wonder why the word labor is used, but it is an appropriate one in view of the real physical work required before the baby can be born. In fact, a mother in the second stage has been heard to comment: “Now I know why it is called labor!” It will be noted, however, that the word pain has not so far been used, and it is now time to consider the question of pain in relation to childbirth.
Childbirth has been associated with pain and sufferings from the earliest times: the well-known words of the Bible, “in sorrow thou shalt bring forth children”, express this view, and similar quotations can be found in the literature of all ages. It has been known for centuries, however, the labor is by no means always painful and that many women have babies easily and with no pain. Observations among primitive communities have led to the conclusion that painful labor is mainly found in women living in conditions of civilization. This has led some to state that natural childbirth is not a painful process any more than is any other natural function.
It has been shown, that when pain does occur in labor it arises mainly from the stretching of the cervix before the baby has been born. This pain is caused by impulses which are carried mainly along the sympathetic nerves.