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Pain in childbirth is a universal phenomenon. In Christianity, it has been regarded as the curse of Eve, and it was only with Queen Victoria's public use of chloroform for the birth of her child in 1853 that it became acceptable in our culture for women to use analgesia, or pain relief, in labour and birth.

There is a lot of fear in our culture around giving birth, and expectant mothers are often fearful of the pain. The easy availability of analgesia can reinforce the medical notion that women's bodies are intrinsically defective, and cannot give birth without drugs and other technological assistance. We are also a culture that has a low tolerance for pain, both for ourselves and those around us.

In such an environment, it is perhaps not surprising that the use of analgesia such as pethidine, epidurals and nitrous oxide gas has become the rule in the birthroom today. In 1996 over 80% of Queensland women used at least one of these drugs in labour.

While pain relief may be helpful in some situations, it is interesting to note that a woman's satisfaction with her experience of birth is not related to the degree of pain relief. After an epidural, for example, some women feel disappointed to have been unable to push their baby out, and pethidine may make a labouring woman feel disconnected and hazy.

Analgesia can also produce other problems for mother and baby. Pethidine can make a newborn too sleepy to establish breastfeeding, and affects the baby's behaviour for at least the first few days. Epidurals are associated with a greatly increased chance of forceps or caesarean section, particularly for a first-time mother. One Scandanavian study linked exposure to drugs at birth to an increased risk of drug addiction in later life.

Studies of the hormones involved in birth imply that pain in labour may play a part in priming the mother for breastfeeding and bonding. Endorphins, the body's natural pain-killers, create an altered state of consciousness which helps a woman cope instinctively with labour pain. Endorphins also stimulate the release of prolactin, the hormone responsible for breast-milk production.

Oxytocin, the other major hormone of childbirth, reaches peak levels around the time of birth, and is thought to play a role in post-birth euphoria and in bonding of baby and mother. Oxytocin levels are reduced in women who have given birth with an epidural or by caesarean section.

There are many resources that women in labour can use to avoid pain-killing drugs. The most simple, and most widely used, are the use of movement, sound, relaxed breathing and different positions. Many women become familiar with these tools in pregnancy through yoga, dance and active birth classes.

Continuous care with your own midwife or doula (trained childbirth helper) has been shown to dramatically reduce the need for analgesia. Women who use a low-technology model of care, such as a birth centre or home birth also use less pain-killing drugs. Choosing birth helpers who have confidence in us helps us to trust our bodies and our abilities.

While this self-confidence and trust is our primary resource, other non-drug modalities that can be used in most birth settings include acupuncture, aromatherapy, massage, homeopathy, reflexology, and TENS machines.

Giving birth is an initiation into motherhood, and an experience of the resilience and power of our birthing bodies can give us a deep confidence in our mothering. Like an endurance athlete crossing the finishing line, a woman who has given birth under her own steam feels " If I can do that, I can do anything." Our babies, as well as our culture, benefit when we enter mothering with such strength.

An edited version of this article was published by the Courier Mail, Brisbane, as "The agony and the ecstasy" 9-9-98

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