Why is childbirth painful?

[Jois]

Neat thread!

We don’t actually dislocate the symphysis pubis but a very aptly named hormone: relaxin does something to the connective tissue between the two pubis and allows it to relax, have the same effect, sort of, on the cervex - softening it to allow it to stretch to fit the size of the head of the baby. This hormone is not special to humans or even apes, chimps and primates but occurs in all mammals doing pretty much the same job.

Our evolutionary changes are pretty much settled as we are. We are getting smaller over time rather than larger and won’t again ever produce humans or near humans any bigger than we are. We don’t endure harsh conditions like Neanderthals or anywhere near enough physical activity to produce the weight and thickness of their bones. We haven’t even caught up to the average male height of the Cro Magnon. So I don’t think we have to worry about getting larger, rather we should, under current conditions, get shorter and lighter in bone structure.

So on a case for case basis we are fine as we are.

As cher3 said, looking a mortality rates in developing countries is tricky because of the lack of neo-natal and maternity care. Just the conditions under which they give birth is horrifying to me. Talk about sepsis.

Phouka, our c-section rate for baby vs “birth canal” is low. More and more c-sections are done to prevent possible damage to the baby due to prolonged labor than impossibility of fit. Remember the poor baby is born with loose cranial joins and a soft head, the head is molded to fit the birth canal as well as the birth canal to fit the baby.

We do a couple of other things to aid in childbirth - one of which is the first pregnancy has a mechanism seldom seen in later pregnancies - the phrase is something like: engaging the head… in this the baby gets seated in the pelvic girdle and stays there with its head in position (stuck so to speak) to go out of the cervix. This must be useful to the delivery of live babies because “always” happens. It is not needed on second or later births and “never” happens again. In later pregnancies the baby remains free floating until labor starts.

And the other little thing that happens in hospital deliveries is that the doctor usually makes an incision at the external part of the birth canal (vagina in this case) to prevent the tearing of this tissue. The incision helps get the baby out past this last barrier, and incisions are much nicer to stitch up and live with than a free-wheeling tear. Midwives (to the best of my recollection) aren’t allowed to do this but instead hold a cloth towards the area most likely to tear and push back to try and prevent it??? that almost sounds right. I think tears of the wild and unguided type would have done great damage to the mother, be easily infected and take a long time to heal.

[cher3]

Jois:

I think the main reason midwives don’t do episiotomies is that it’s against their principles. Most midwives are taught “natural” birth approaches and episiotomies are seen as unecessary and even harmful. The warm compress is used to relax and soften the perineum, as well as to provide support. There is some controversy over whether cutting or tearing is preferable. Anti-episiotomy types claim that a cut can actually make things worse than a natural tear–they use the analogy of snipping the edge of a cloth to make tearing easier.

I don’t know whether this is accurate or not. I had incisions made both times. The first one finished with a pretty bad tear, but the second only required a couple of quick stitches.

Okay, guys, you can uncross your legs now, I’m finished.

[Jois]

cher3, that midwife information is probably correct for now, but midwives have been doing birth-duty long before natural childbirth became (once again?) an understanding of preparation and breathing techniques. It’s hard to think of what’s done now and what was done years past and stick the whole together and have it make sense.

The episiotomy is another now and then issue. The cut would direct the tear - fashion decides if the cut is made toward the rectum with the risk of tearing into the rectum or if the cut should be made off to one side with the risk of tearing an even longer line off to the side. Straight back episiotomies are supposed to heal faster and easier (so long as they don’t go too far) and the side cut heals slower, hurts (even while healing) more and carries less risk.

I have no idea what was done 150 to 200 years ago, I’m glad not to have to know or watch!

[emarkp]

Of course, 100 (or even 30 years ago) children were being born with lower birth-weights. Hence the problem that episiotomies address might not have been so prevalent. Six pound babies are easier to deliver than eight pound babies.

As for why it’s painful (i.e. why evolution hasn’t evolved it into a pleasant process), I could speculate many “reasons.” One might be that going into pain makes the mother retreat into a safe place, which increases the likelihood of the baby’s survival. After all, it isn’t childbirth that needs to be pleasant for evolution to work well, but rather conception (as my wife pointed out).

[Alphagene]

Many animals have pain during childbirth.

Cite?

[Biscuit]

Childbirth is more painful for humans because the baby passes through the pelvis. In the case of animals it does not which apparently makes childbirth much easier (I am not sure about the other primates, any zoologists out there?).

This extra birthing burden doesn’t (unfortunately) seem to be slowing the population down

[Rysdad]

Side note: I watched my son’s birth. The ex- had had an epidural so she wasn’t in any pain. The only part that made me wince was when the doc did the episiotomy. She used a big scissors, and I could actually hear the tissue being sliced. :::eep:::

[Wood_Thrush]

phouka said:

**
This, of course, is assuming that maternal and infant mortality are traits that cannot be passed on genetically.
**

How the hell could infant mortality be passed on genetically? That doesn’t make sense to me.

[Wood_Thrush]

phouka said:

**
This, of course, is assuming that maternal and infant mortality are traits that cannot be passed on genetically.
**

How the hell could infant mortality be passed on genetically? That doesn’t make sense to me.

[Jois]

**
Of course, 100 (or even 30 years ago) children were being born with lower birth-weights. Hence the problem that episiotomies address might not have been so prevalent. Six pound babies are easier to deliver than eight pound babies.
**

What about the babies born 500 years ago? 4000 years ago? Pre-agriculture? Birthing hasn’t changed much since Cro Magnon, or 100,000ish years before that. All low birth weight?

[Jois]

Alphagene, you don’t need a cite for that, it would be painful to all concerned and under any circumstances. And then, you’d get arrested.

[Alphagene]

Huh?

[MandaJo]

Wood Thrush asked:

How the hell could infant mortality be passed on genetically? That doesn’t make sense to me.

The lack of infant mortality is what would be passed on–people whose bablies lived more often would, by definition, have more babies grow up to have more babies themselves. If having fewer babies die was caused by some sort of biological feature that did not also cause some sort of disadvantage (thus canceling itself out), we would expect to see it become increasingly common in the population.

Painful, life-threatening birth, however, came paired with the biological advantage of smarter babies: while fewer may have survived birth, the advantage of intelligence presumably meant that those that did survive were more likey to breed than their smaller-craniumed cousins.

[kiffa]

Interesting mishmash of information but the bottomline is
that childbirth is painful for many, easy for some and
a hellish experience for others. I guess we can thank
modern medicine for drugs to take away the pain, episiotomies, c-sections etc. We can also thank modern
medicine for pitocin - the drug that induces labor and
makes one want to kill any male within arm’s grasp.

Women have been finding coping mechanisms to make it easier; mother’s position during the birth process, chewing herbs or popping pills, cutting, massage. Many African women will starve themselves during the last three months or so in order to have smaller babies. These women tend to have better muscle tone than our modern counterparts just because they spend so much of the day working in the fields, in the markets, at home, carrying 70 lbs of stuff on their heads. Unfortunately their nutrition status tends to be worse. All this leads up to the point that the mother’s nutritional status and the babies birth weight are strong determinants of a healthy delivery and whether the child will survive until her/his first and fifth birthday.

I think generally you will find that women who have painful deliveries are: nutritionally challenged/lack muscle tone and body strength, small pelvis, deliver children over 10 lbs, were given pitocin to induce labor or speed it up, did not prepare herself by attending child birth classes, didn’t
get an epideral, had a doctor who had other things to do or a labor team that was overworked, a birth coach that really wasn’t all that helpful. In other words there are a host of factors that make it painful for most women which is probably why folks say that Eve’s behavior forced God to curse us with heavy labor… but then again we also have labor amnesia which allowed your mom to go off the pill and have that second or third child.

[kiffa]

Interesting mishmash of information but the bottomline is
that childbirth is painful for many, easy for some and
a hellish experience for others. I guess we can thank
modern medicine for drugs to take away the pain, episiotomies, c-sections etc. We can also thank modern
medicine for pitocin - the drug that induces labor and
makes one want to kill any male within arm’s grasp.

Women have been finding coping mechanisms to make it easier; mother’s position during the birth process, chewing herbs or popping pills, cutting, massage. Many African women will starve themselves during the last three months or so in order to have smaller babies. These women tend to have better muscle tone than our modern counterparts just because they spend so much of the day working in the fields, in the markets, at home, carrying 70 lbs of stuff on their heads. Unfortunately their nutrition status tends to be worse. All this leads up to the point that the mother’s nutritional status and the babies birth weight are strong determinants of a healthy delivery and whether the child will survive until her/his first and fifth birthday.

I think generally you will find that women who have painful deliveries are: nutritionally challenged/lack muscle tone and body strength, small pelvis, deliver children over 10 lbs, were given pitocin to induce labor or speed it up, did not prepare herself by attending child birth classes, didn’t
get an epideral, had a doctor who had other things to do or a labor team that was overworked, a birth coach that really wasn’t all that helpful.

In other words there are a host of factors that make it painful for most women which is probably why folks say that Eve’s behavior forced God to curse us with heavy labor… but then again we also have labor amnesia which allowed your mom to go off the pill and have that second or third child.
Maybe that’s evolution’s way of guaranteeing that our species will continue to grow.

[epeepunk]

Pardon me while I sock puppet for my wife, since she’s the one who has given birth, not me, I just helped ;). This was written 5/18 in the afternoon, before things branched off into episiotomies.

She has spent a lot of time on various boards devoted to birth issues so her store of anecdotal and medical information is large. Just ask her

As for episiotomies, tearing in generally regarded as better than cutting, unless your doctor and then you have to cut something.

I guess my response is this - how many live births do you need to get the genes passed on? Not that many, really. Evolution would only shift strongly if the first birth killed the mother, therefore nixing her passing on those genes AT ALL. Before the advent of forceps (which unfortunately increased maternal death rates in their original use), babies who couldn’t fit didn’t kill the mother, because the baby died, and was removed in
pieces, or if it looked like mother was going to die, the baby was often killed on purpose by those attending the birth, with hope that the next child would fit (which is actually true - even though the later kids are usually bigger, they often ‘fit’ better). Check out some genealogical data, and you’ll see a LOT of stillborn first babies (which is the birth most likely to have problems) followed by 10 or twelve live births - even if you had a c-section for the first, you technically have a better chance having a reasonable fit with the second, since the position of the pelvic girdle bones change after the first pregnancy, whether you have a vaginal delivery or not.

So, what does that mean? That means that for a long time, mothers had someone there to help them if the baby didn’t fit - that is, social birthing. By having assistance, they didn’t die if the first one didn’t fit, and that allowed for them to have more kids later, and pass on the larger head size to the next generation (pelvic proportions, if I recall my early human history right, haven’t changed much for a long time - it is the head that has gotten bigger and bigger).

So, birth ‘hurts’ because someone has been there to help. And, by the way, the rotation of the baby also makes it harder to birth completely solo - you can injure the child seriously if the mother herself ‘helps’ the baby out all by herself (bends the kid the wrong way), but a person nearer the child (standing by) can help easily without hurting the child. Again, an argument for social birth as part of the evolution process.

And by the way, birth hurts a lot LESS (and is more often successful) if you have someone there who has been through it before, just hanging out with you, being encouraging and supportive (social birth, again). If you have a doula (birth assistant just there to help with the mother’s emotional state and provide perspective and experience), c-section rates drop to about 6% (including first and later births), which suggests to me that not only are we engineered to birth socially, but the issue of pelvic disporportion is not QUITE the evolutionary question indicated by the current 22-25% c-section rate in the US. And discomfort is probably less of an issue, too.

Trust me on that one, because with 2 doulas plus my DH, I managed 66 hours of unmedicated labor, myself (okay, we all decided sleep was important, so went for an epidural to allow for that, but still ended up with a no-tear/no-stitch vag delivery of a healthy 8lb 12 oz baby boy, apgars 9/10,
WITH a head larger than average by a fair margin, too). It didn’t hurt if I didn’t fight it - AT ALL. Having people there who could point out when I was tensing up and remind me that I was doing great made all the difference. It was still EFFORT, certainly, hard hard work (hardest work you’ll ever do), but it didn’t hurt any more than running to your peak endurance level does. That personal experience plus the strong tendency of women to lose all sense of privacy and modesty during labor adds more weight to my beleif that birth evolved as a social process, not just a physical one. Heck, genetic shifts accompany social and cultural behaviors al the time - check into the rate of albinism in Navajo populations… because they are socially
valued, albinos instead of being less able to survive and procreate were MORE likely to survive and procreate, therefore adding more of a physiologically ‘detrimental’ condition to the gene pool (which wasn’t seen as detrimental at all, culturally).

And, heck, if you’ve ever seen a woman giving birth naturally, in a social process (as we are designed to), confident of the process and encouraged or reassured along the whole experience, a far larger number of them birth with
low trauma to both mother and child, which makes the whole lip over the head thing a moot point. Without the trauma, without the pain, WITH social context, evolution has served just fine, creating women who can birth with only moderate discomfort, and moderate to no trauma. Take the social process away, and OUCH!

[plnnr]

Peaches:

The “labor amnesia” phenomenon was one of the most amazing parts of the pregnancy and birth process for me to consider when my wife was expecting Lilly, Queen of the Universe.

As I watched my wife labor for 17 hours to deliver this child the thought kept coming back to me, “How on earth can a woman want to experience this again?” After Lilly slid into my waiting hands and I gave her to my wife the “magic” of the moment took over and my wife was in complete and utter euphoria. No pain, no aching. Tired, yes, but “a good kind of tired,” as my grandfather used to say after a long day of work. The misery that she had experienced was replaced with a much deeper emotional component. It went from being a “physical” experience (painful labor) to a “emotional” maybe even “metaphysical” one. A wonderful thing to experience all the way around.

Alas, no more children are in store for us. A few well placed snips of the urologists scissors made sure of that. No, there was no metaphysical experience this time. Just sore balls for about a week. A shame there isn’t a “vasectomy amnesia.”

[hedra]

some more thoughts…

1. wolves whine, yelp, or sometimes howl when they whelp - AS each pup comes out (watch a nature show sometime). Sounds somewhat uncomfortable to me (so that level of discomfort is common to other mammals, if not something you can apply universally).

2. Peaches is right - though even without drugs, I know plenty of women who didn’t hurt significantly - my sister even WITH pitocin didn’t even think about drugs. My experience and others I know suggest that within a good social and medical system, you don’t suffer, even without drugs. Education, support, encouragement, and so forth - for a NORMAL labor (94%) make for a non-agonizing experience. Not many get good support or had good info to start with - read some birth stories and see.

3. there will always be people on both ends of the spectrum - genetics is complex, so there will be women whose pelvises are too small and either they fracture themselves or damage the child, or one or both die, or they get medical help and both live and pass the genes on. There are also women who deliver in very short time, never even having FELT any contractions. That’s just the way the genes combine.

4. Since birth numbers are controlled socially as much as medically, birth itself isn’t the controlling factor for how many of which genes get into the pool. My sister would certainly add good birthing genes to the pool if she had more kids. She’s stopping at two. My sister-in-law had 5 c-sections, she makes large babies and has a very small pelvic opening. She has other genes to add, but easy birth is NOT one of them. The birth process itself is not the determining factor for how the genetic pattern will drift, at this point. And I’m not sure how much the experience of birht has mattered, genetically, for a long time. For example, socially accepted/controlled marriage age is just one other factor that has influenced numbers of life offspring. Nutritional behavior regarding pregnancy is also a cultural determinant for live birth/birth numbers.

I don’t know if the social/cultural influence is a cause or a result of the way we birth, but it is certainly tied to it closely. Straight genetics is complicated enough, but we humans have to go messing with it by adding CULTURE. (Not to mention emotions and metaphysical experiences!)

(Oh, and tears hurt less, heal faster, and have less long-term pain than episiotomies, according to my mom, who had 2 with episiotomies, 3 with tears, and 2 births with no damage - not all in that order, either.)

[kiffa]

Plnnr: haha, your post made me laugh. I hadn’t thought about how it might be painful.
How long has it been since you slammed the “gate closed”? Did you have a sperm count done afterwords?
Oh yes, congratulations on responsible procreation.

[plnnr]

Peaches:

V-Day was March 23. I was reassured by everyone who had the procedure done that it didn’t hurt, was just a little uncomfortable,“You’ll be up and around and back to work in a few days.” I suppose my Dr. (Dr. Mengele)decided to use the extra rusty, extra dull scissors that day with the extra-large gauge needle to administer the lidocaine because I THOUGHT I WOULD DIE! It was as if he was bound and determined to see just how far he could stretch those little cords (“Hm, these seem pretty elastic, lets yank on them a little bit more.”)

I also had a nervous reaction to the whole experience later that night (104 temp., vomitting, diarhea (I call it the Vasectomy Diet, How to Lose 8 Pounds in a Weekend), tremor). All in all, a horrendous experience.

I have to get my first sample checked next week, which should be a pleasant experience. In order for it to be covered by my HMO I have to take the sample with me to the hospital, register as an outpatient, and then wait to be called by the receptionist ("Paging Mr. Tyson. Paging Mr. Tyson. Mr. Tyson, you may now proceed with your semen sample to the lab. You may now proceed with your semen sample to the lab.). The indignity of it all.

Still, no more gloves of love for me (my wife can’t take the Pill). We are, as you might expect, very much looking forward to our first romp after being declared safe.