In the last month of pregnancy, the cervix softens and ripens like a piece of fruit. Contractions of the uterus become noticeable, and the baby settles into the pelvis. The contractions become stronger, the cervix stretches and opens, and the baby moves lower and rotates, eventually moving down the birth canal. With each contraction, pain sends a signal to the brain and oxytocin is released. With the release of oxytocin, the contractions increase in intensity. As the pain of contractions increases, more oxytocin is released and the contractions become harder.
The pain of labor is what most women worry about. It is important to understand that the pain of the contractions in labor is valuable. It is an important way in which nature actually helps women find their own ways of facilitating birth. In a very real sense, the pain of each contraction becomes a guide for the laboring woman. The positions and activities she chooses in response to what she feels actually help labor progress by increasing the strength and efficiency of the contractions and encouraging the baby to settle in and move down the birth canal. When the pain is entirely removed, the feedback system is disrupted and labor is likely to slow down and become less efficient. As labor progresses and pain increases, endorphins (much more potent than morphine) are released in increasing amounts. The result is a decrease in pain perception, quite naturally. Nature's narcotic! The rising level of endorphins also contributes to a shift from a thinking, rational mind-set to a more instinctive one. Endorphins create a dream-like state, which actually helps women manage the tasks of birthing. Inner experiences become more important than the external environment. As labor progresses and the pain of labor increases, women “go into themselves,” become much less aware and, at the same time, much more focused on the work of labor, and are able to tap into an inner wisdom.
A woman surrounded by family, friends, and health care providers who remind her of the power of labor and encourage her quietly and patiently is a woman who is not afraid. Her support team is totally present and comforts her as she does the hard work of labor. She eats and drinks and, even if labor lasts a long time, she has the energy she needs to persevere. She rests between contractions. No one looks at the clock. Everyone trusts the process of birth and believes that she has the strength and the wisdom to give birth.
In a very real sense, the pain of each contraction becomes a guide for the laboring woman.
The woman moves in response to what she feels. Whether she gives birth in a hospital, birthing center, or at home, she is able to use a wide variety of comfort measures; for example, moving freely, listening to music, taking a shower or bath, and having her feet and hands massaged. She is able to create an environment that is just what she needs as she does the hard work of labor and birth. She pushes her baby down the birth canal, responding now to the pressure of contractions and the baby as he rotates through the pelvis and moves down the birth canal. She moves, changes position, and grunts, sometimes holding her breath—all in response to what she is feeling. In this way, she not only protects the muscles of the birth canal and perineum but also protects her baby as he is born. A great surge of adrenaline insures that the mother is alert, even if her labor has been long. She is totally focused on her baby, ready and eager to embrace him. Baby is eager and alert, too. The stimulation of his journey has primed him for the transition to life outside the womb.
With her baby in her arms, the mother is engrossed, excited, at peace, proud, and astounded at the miracle she has produced. No one tells her what to do. They know that she knows what to do—not because she and her baby have read the books or attended Lamaze class, but because their journey has physically and emotionally prepared them both for this moment. The weight of her baby on her belly helps her uterus contract and expel the placenta. Baby stays warm in his mother's arms. Baby knows just what to do to survive in the world he has entered. He is awake and looks around. Within seconds or minutes, he has his hands in his mouth and is smacking his lips. Unpressured, he slowly but methodically crawls to his mother's breast and self-attaches. As he nurses, his mother's uterus contracts, insuring that bleeding will not be excessive. The two greet each other unhurried, confident, and unpressured. Together, over the next hours and days, they will get to know each other and fall in love.