Attention birthing women: This will be the hardest work of your life. It will test you on every level. Childbirth education is very helpful, yet there’s no way to know how you will feel physically and emotionally until you’re in it. There are many schools of thought on how to cope, what to call the forces of labor (contractions or surges?), and how to label the feeling (pain or sensation?). I like to keep it simple: it’s really hard, and yeah, it hurts. And, you are stronger than you know, and you can do it. Whether or not you plan to use pain medication or epidural anesthesia, know that you have what it takes within you to get through however many contractions you choose to feel fully. Do your preparation, trust in the birth process, and believe in yourself.
But once you get to the hospital, whatever you do, for God’s sake, maintain some decorum and do it quietly! And if you can’t do that on your own, we’ve got something for you that will fix that problem quite nicely. Then, we can ALL be comfortable.
Is that the unspoken message women receive from hospital staff during labor?
This recent article by Danielle Campoamor is one of the best I’ve read on birth culture from the maternity care consumer perspective. Fear-generating language about pain in labor like “torturous” and “splintering” notwithstanding, she reveres the “incredible capabilities of the female body” as “miraculous and devine.” And it’s a great read that illuminates a rarely recognized but very real hurdle women face when they walk into the hospital to birth their babies. That is, our culture is such that even the most outspoken, independent, confident women can feel silenced and self-conscious in labor—afraid to make noise, afraid to “take up space.”
Campoamor points out that this feeling of inhibition is all the more significant since it is present at the very time when a woman should feel most free to do whatever is needed to handle her experience.
A culture that holds laboring women more or less to the usual social norms and stifles their full expression during birth is one that limits women’s coping mechanisms. It limits women’s ability to feel powerful, strong and fully cared for as they journey into motherhood. It dishonors women. And it does a lot more than that–it is counterproductive to normal, physiologic birth. Feeling self-conscious and anxious about how the people around you might be judging your coping behaviors is stressful. Emotional stress triggers catecholamine release. Excess catecholamines exacerbate the experience of pain and inhibit oxytocin—the hormone that keeps contractions strong so labor can progress normally.
As a culture, are we simply uncomfortable with the primal nature of birth?
Susan Diamond, RN, writes in her compelling book Hard Labor, “When faced with the forces of labor…all the inhibitions and trappings of our social selves are peeled away as our bodies thrust and heave, vomit and grunt, cry and leak. The animal is there for all to see.” Modern humans are cut off from the natural world of which we are a part. Does the same disconnection that leads to destruction of our environment cause us to collectively recoil when faced with the human animal during childbirth?
The epidural rate in the U.S. is around 60%, and is closer to 80% in some states. There are a lot of reasons for that, a full discussion of which is beyond the scope of this post. Midwives are not “against” epidurals—they can be a godsend and many of the women in our care use them with our full support. The problem is the indiscriminate promoting of epidurals as the first line answer to any woman’s need for any kind of help coping with labor. The problem is the lack of training and support for hospital staff to provide nonpharmaceutical forms of labor support.
So why do women feel inhibited to make noise and otherwise “take up space” in labor, and what might that have to do with epidural rates? This inhibition can be due to the woman’s social conditioning, as discussed in Campoumor’s article. There is another factor as well. It’s one of the roots of the social conditioning the woman arrives with, and it can exacerbate her self-consciousness in the moment. I’m talking about the discomfort with, and sometimes utter disdain for, the sounds of normal, physiologic labor in hospital culture. What’s the surest bet to silence those moans, grunts, and cries quickly and completely? You guessed it—epidural.
There are different qualities of vocalizations in labor. When women are panicking or otherwise having trouble coping, their sounds are anguished. When you hear noises that sound like suffering, the natural, compassionate tendency is to want to fix it for the woman. I wish there were more inclination in hospital culture to first help women reduce fear and anxiety and to provide other comfort measures like position changes, assistance with breathing techniques, massage, and hydrotherapy. (And I’m talking about belief in and enthusiastic initiative in providing this kind of care, as opposed to a half-hearted, “Um, wanna sit on the ball for a while, or do you want to just get the epidural now?”) Sadly, women are typically steered straight in the direction of anesthesia as soon as the going gets tough.
All that said, I can appreciate the kind desire to alleviate what appears to be true suffering as quickly and completely as possible by bringing out the big guns from the get go. Even those caregivers who believe in and would like to provide more nonpharmaceutical labor support face obstacles. They may be busy caring for several women. Most receive little or no training in hands-on labor support and little or no encouragement from their institutions and peers to provide this kind of care.
But there is another kind of labor and birth noise that also seems to trigger in many caregivers the unspoken reaction called “make it stop.” It often leads to overt or subtle pressure on the woman to get an epidural, even though she is doing just fine without it, thank you very much.
Some women who are coping very well with labor are relatively quiet. Most need to make some noise. Some need to make a lot of noise.
Here’s the thing: women who are in kick-ass labor AND are coping well AND are naturally vocal AND are “in the zone,” unconcerned with/unaware of how they sound or appear? They usually sound a lot like a woman having really great sex.
People can get all twitchy and uptight around that.
Outside those rooms, it is common to see raised eyebrows with comments like “What’s going on in there?”
And yes, unfortunately, it is not uncommon for hospital staff to actually ridicule women who are vocal in this way (outside their earshot, of course—thank God).
Those who snicker and eye-roll say more about their own sexual hang-ups than they do about the laboring woman.
Mitigating these aspects of hospital culture is part of a hospital-based midwife’s job. Doula support helps, too, and should be available to every woman via insurance coverage (that’s another post!). And, it should be said that it’s also a consciously chosen part of the job for many physicians and nurses. Those doctors and nurses who maintain a commitment to woman-centered care and physiologic birth have my deepest admiration since they courageously swim upstream, often with little or no support from their peers.
For midwives, it’s an explicit, integral part of our training. For most of us, it’s in our blood. We help women feel free to follow their own bodies’ directives, doing what they need to do and making whatever noise they need to make.
We ensure that at the very least, women feel our heartfelt blessing to scrap social conventions and let the human animal lead.
We create (and sometimes have to guard) an atmosphere that allows birth to be what it is—an instinctual, sacred, primal act.
This is one of the many essential intangibles you won’t find on our CV’s or official job descriptions. We hold space for birthing women to take up all the space they need.
Space for the full, free expression of raw feminine power and vulnerability.
Space for the messy, noisy beauty of birth.
© Camille Williams and Wake Up, Mama! 2015
Wake Up, Mama! 
Love this post!
I distinctly remember in my first labor how much I DID NOT WANT to make awful mooing noises, like my friend had warned me I would make. And then in transition, my one clear insight was that to do this labor, I was going to have to go to places I didn’t want to go — noise, and poop, and cesarean being my three trepidations. Luckily, the first two trumped the necessity for the third.
And with my second birth, the only time my midwife put a foot wrong (except for not believing me when I called and told her that 1. I walked home from work and 2. I was in active labor) was when she walked into the house to me ooooooing through the last contraction of transition and first grunty pushy contraction and without watching me for a few minutes first, told me to ‘try being a little quieter…’ That still chaps my hide a little bit, and even in my labor fog, I was annoyed that she hadn’t been around to know that this coping mechanism was working beautifully and would presume to shush me. You do NOT shush the laboring woman!
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Katherine–the compelling part is, even YOU felt that way–someone who later became a midwife herself! Similarly, I was amazed and dismayed at how nervous I felt nursing in public with my first baby. ME. Feminist, women’s health care provider, and breastfeeding advocate! These cultural taboos are ingrained even in us, those who consciously reject them.
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Your blog is beautiful and real! Thank you Camille!
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Thank you, Andrea ❤
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This was wonderful! With my 2nd birth, things moved so quickly and I was pretty loud. I felt a little embarrassed about it after the fact, but during the intense labor, it was what got me though it.
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It really can get you through it, crazymommy10 ! Swearing helps, too!
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I was told by the on-call doc to watch my language.
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I’m sorry to hear that, Amy. You were denied another effective coping technique! http://www.forbes.com/sites/frederickallen/2011/04/21/use-foul-language-to-relieve-stress-and-pain/
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Thank you for lending your powerful voice to this often ignored issue, Camille. There really ought to be some sort of campaign to educate hospital workers about the value of honoring and welcoming the primal sounds of birthing mothers. Thank God my wife birthed our babies at home with wise midwives who never inhibited the moaning and toning that helped her transform pain into power.
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Thanks you, Scott! Epidurals are so common now, partly because they are encouraged and in some cases pushed in the hospital as discussed, and also partly because so many women arrive at the hospital with longstanding plans (sometimes even before pregnancy!) to get one ASAP. Willingness to provide non pharmaceutical support aside, there is so little opportunity for hospital staff to even observe physiologic labor and normal coping behaviors. One reader commented on FB, “I have often thought that hospital staffs have become more uncomfrtable with women’s sounds as we see more and more epidurals. They sometimes have difficulty differentiating real pain and inability to cope with ‘noisy coping.’ ” I completely agree that this is part of the picture.
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As a young nursing student, I thought, “Why are these woman screaming. It seemed counter productive to the process. Well, that all changed when I labored quickly and without medication for my second baby. I screamed every time I went into a contraction,…which was most of the time. I was completely uninhibited and it felt wonderfully liberating and helpful. It was my way!
I couldn’t have possibly wanted to tame myself. I felt like I was riding in a hurricane. But after my baby was born,….it was like still waters, an amazing calm after the storm. It was beautiful and I wouldn’t change a thing.
Thank you for you wonderful post!
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Thank you for sharing your beautiful story, Natasha!
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Interesting article. I feel like I made more noise (Grrrr-ing the baby out I guess) with my 2nd and 3rd babies who were born at home (at least my husband seemed surprised after the birth of the second that I made “more noise”).
I think the hospital encouraged me to push a certain way (OK, deep breath, hold it hold it, a little longer) and I ended up holding my breath a little too much. They ended up popping an oxygen mask on me towards the end, not a huge deal but I think it was kind of distracting.
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That kind of directed pushing is often necessary with an epidural on board, but usually not when a woman can fully feel the pressure and urge to push.
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When I am in labor, my noises sound like I’m doing singing vocal exercises. I’m still surprised when my neighbors didn’t wake up when I was having near precipitous labor with my second–our houses were a driveway apart from each other! And when I was at my midwife’s house for my third, I felt like the force of my birthing song could push off the roof! I never felt so grounded than when I was at the pinacle of each contraction and my voice was ringing. I don’t remember what my noises were so much with my first because I was so exhausted (I had dinner at about 10pm, went into labor at 6:30am, had part of a cereal bar around 8am and part of a corn muffin at about 9am, then had baby at 2:38am the next morning) but I wish I had been able to be more present at her birth. I do know that I couldn’t care less about how anyone felt about my noises. There’s a fabulous invention called ear plugs 😛
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One of the first births I ever witnessed was one of the most amazing–a mom giving birth to twins. She was an opera singer and was beautifully vocal during labor, then sang to her babies as soon as they were born.
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When I had my second baby, it was a VBAC, and I was forced to have an epidural. I didn’t want one, as the epidural in my first labor largely contributed to my c-section, but was told I had no choice. I asked for the medication to be kept as low as possible, but during the pushing stage, every time I would make a noise the nurse would freak out, demand to know if it was “pressure or pain,” and turn up the epidural – even while I was begging her not to!
That birth was awful for so many reasons, and all of them were named Nurse.
During my most recent birth (number 6), I kept loudly telling everyone that I couldn’t do it. My husband and the overwhelmed nurse attending me (who clearly had never seen an unmedicated birth) kept trying to reassure me that I could do it, that I was doing fine, and I remember thinking that of course I could, but I just needed to SAY that, and I couldn’t understand why they didn’t get it, LOL! I kept thinking, “Don’t they know? This is just what you say when it’s almost over!” Silly in retrospect, but it made sense to me at the time! That birth was lovely. 🙂
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When I had my second baby, it was a VBAC, and I was forced to have an epidural. I didn’t want one, as the epidural in my first labor largely contributed to my c-section, but was told I had no choice. I asked for the medication to be kept as low as possible, but during the pushing stage, every time I would make a noise the nurse would freak out, demand to know if it was “pressure or pain,” and turn up the epidural – even while I was begging her not to!
That birth was awful for so many reasons, and all of them were named Nurse.
During my most recent birth (number 6), I kept loudly telling everyone that I couldn’t do it. My husband and the overwhelmed nurse attending me (who clearly had never seen an unmedicated birth) kept trying to reassure me that I could do it, that I was doing fine, and I remember thinking that of course I could, but I just needed to SAY that, and I couldn’t understand why they didn’t get it, LOL! I kept thinking, “Don’t they know? This is just what you say when it’s almost over!” Silly in retrospect, but it made sense to me at the time! That birth was lovely. 🙂
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It sounds like the nurse in your second birth was well-meaning and trying to be supportive–I’m glad the birth was lovely for you even though you didn’t necessarily need all the verbal reassurance! Your story of those two births illustrates how powerful nurses are. Midwives and doctors are of course important, but the labor and delivery nurse really can make or break the birth experience in terms of the woman feeling supported and empowered.
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I was the same way! I felt so empowered afterwards because I went all natural but a few months later my husband told me that him nor the midwife nor the student midwife really thought I would go through with going all natural because I screamed too much and kept saying that I couldn’t do it. Now I feel silly and embarrassed about the whole thing and I’m seriously thinking about not letting anyone other than my midwife in there with me for the next baby.
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Don’t be embarrassed! I have heard midwives say that they know a woman is almost there when she starts saying she can’t do it. Birth is hard work! You need people around you who get that, although I hope your husband can learn to be one of them! (And the midwife really should know better!)
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LOVE THIS! I’ve shared it on my facebook page.
You’ve hit upon one of the HUGE problems with hospital birth. NORMAL birth sounds are and misinterpreted, misunderstood, and discouraged.
Not only is being shushed inhibitive for the laboring mom, but if she is in early labor when admitted to the ward, hearing the screams of other laboring women can strongly influence her decision to accept an epidural asap.
I’m a homebirth doula, and I love the different sounds laboring moms make. One woman stood in her kitchen, banging her head repeatedly on the kitchen cupboards, repeating “Fuck!”… over and over. She was coping beautifully!
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Thanks for sharing it and for your comments! Is it Penny Simpkin who talks about women finding a coping “ritual?” Well, cupboard head banging is certainly not the most common one, but whatever works 😉 And as mentioned, I am a firm believer in swearing for those so inclined!
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Thanks for the shout-out–I love your post! Thank you for adding to the discussion from the labor and delivery nurse perspective.
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I decided to birth with a midwife (in Texas) and got a lot of flack from family. However, she was incredibly supportive and wonderful throughout labor. The only thing she ever told me regarding the noises I made was to try to make them lower in pitch so I wouldn’t hurt my throat. I didn’t feel in control of the noises I made. I did what helped me feel better. I was in the zone and so out of it that I didn’t even notice anyone else around me. I had a water birth for my first and only baby and I thought it was a painful but very positive experience. I support every woman having the birth she wants and needs. I think it is a shame that most women in hospitals don’t receive support to birth and manage their pain in other non-medicated ways. Women deserve options.
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“Women deserve options.” That really says it all in 3 words, doesn’t it?
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Lovely post. About 20 years ago pain management became mandatory for hospitals. They had to make epidurals widely available and manage pain for women in labor. Now we have swung the pendulum in the opposite direction in many hospitals. We need to balance this some how and continue to meet each individual’s needs.
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I don’t know how pain or the discomfort of labor is handled at hospitals anymore; in the early 80s, the anesthesiologists I worked with would be called to Labor and Delivery to administer the epidurals — and they often returned to Surgery after coaching and educating the laboring mother, who then chose to not have the epidural. I was happy to observe that process.
I had read somewhere that remaining mindful of others during labor was a path (or perhaps a challenge) to maintain dignity — and remain better connected with my husband and midwives during my labor. I never felt shushed for my first labor in hospital, or pressured to act in a certain way. I believed at the time that my energy would be best spent staying out of the way of my body and allowing it to do what was necessary…..so I remained quiet.
I remember yelling quite loudly when my doctor pulled on the forceps to assist my son’s birth. Once that discomfort was over, I was quiet.
For my other two births, my children were present. I refrained from making any sounds that could be interpreted as pain, I didn’t want to scare them. They seemed to have no problem with all they observed, as their reaction was wonder and joy. It was important to me to remain grateful for every thing that was done to help me birth my children, so that my caregivers knew that my courage was in direct proportion to their reassurance, which was very true for me.
On the culture of silence in hospitals: It seems possible the Labor and Delivery Units are separated from other wards due to the noise that often accompanies childbirth. I remember my mother telling me that during the Baby Boom, the hospitals were so crowded that she labored in a hallway on a gurney, with women screaming all around her. Nobody thought to tell her that everyone labors differently, and that loud vocalizations are normal.
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I love your post. I’ve had three natural births. The first started at home but ended in hospital. The second and third both in birthing units and were fantastic and very much led by me. I was very lucky to be present at three of my sisters five quite wild births (home birth, mountain community in Spain and in a bus in Portugal) Be free in birthing 🙂
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I thought I was the only one who read “Hard Labor”. I felt like Susan Diamond was secretly recording my story and it led me to believe I wasn’t crazy after all. Bring on those birthing sounds…or not. Whatever it takes to get you through your labor is fine with me! I had one woman who was a theatre major. She sang Broadway musical show tunes while pushing – she felt like she could control and coordinate her breathing/pushing easier. It worked! I just wish I had photographed the looks on my coworkers and the residents faces whenever I stepped outside my room!
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