#98: Why Would Anyone birth without drugs?
A letter to my pregnant friend
Dear pregnant friend,
Just a few more weeks until you meet your baby. SQUEE! You asked me questions about birth and I’ve been wary of sharing unhelpful platitudes, of projecting my stories onto yours. This note is my attempt at a loving and thoughtful answer.
I was lucky to get the input of a true mentor: Pam England, a former nurse-midwife who authored Birthing from Within: An Extraordinary Guide to Childbirth Preparation and Ancient Map for Modern Birth: Preparation, Passage, and Personal Growth for the Childbearing Year1). She speaks from years of experience as a childbirth educator and birth story listener, meshing the practical and spiritual. Her words helped me to unpack my thoughts and behaviours, before and especially after birth, and I hope they’ll help you, too.
The quotes in this piece come from:
my discussion with Pam England — marked with 💕
her book Birthing from Within — marked with 🌀
her book Ancient Map for Modern Birth — marked with📍
1. The work of pregnancy
I understand you’re worried about birth, my friend, and you’re not alone. Pam shares the reassuring idea that “worry is the work of pregnancy” (and positive thinking is not the answer):
🌀 In fact, an overconfident first-time mum who thinks she has it all figured out, worries me. […] Some people believe that exploring fears or worries makes them more likely to happen. In fact, worrying effectively [can help] shift from frozen, fearful images of not being able to cope, to more fluid images containing a variety of coping responses.
🌀Worry can help you use your imagination and creativity to awaken hidden sources of courage and power within you.
Bingeing on external information isn’t effective worrying, though. You know me: I was that pregnant person who voraciously consumed birth books and birth studies and other people’s birth stories (in the shape of podcasts, online discussions, and videos); I attended different kinds of childbirth classes and info sessions at several hospitals. I knew that birth is unpredictable, yet clung to the belief that doing my homework would help me to achieve the right birth. I have compassion for that prideful, anxious, controlling part of me, now.
If you have the same tendency, let me share one of Pam’s helpful metaphors:
📍Gathering external information is an essential Task of Preparation […]; however, for some it can become a time-consuming preoccupation leading to a hoarding of nuts of research and opinion berries in the pursuit of “getting it right.” Another part of you, the Huntress, is not satisfied solely by such nuts and berries and is hungry for an internal search for self-knowledge. The Huntress is not hunting something “out there” but instead watching the “habit mind,” the ways of thinking that keep you stuck in routines.
🌀 Many birth classes teach from the ‘outside’, from the perspective of the professional. Yet, knowledge of anatomy and the stages of labour can often seem irrelevant in the intensity of contraction. The pregnant woman needs to know about labour and birth from her own perspective, she needs to be prepared for birthing from within.
2. Preconceptions
You had already received contradictory messages about the right way to birth, even long before you were pregnant and hooked on Cochrane reviews / Instagram accounts celebrating the sacred feminine. Sometimes it gets overwhelming!
Some people view birth as an event to manage according to protocols; they’ll expect you and your birth to follow certain steps or rules. Other folks will tell you that birth is “beautiful” or “magical”, that your body will just know. You may gravitate towards one of these poles—could you ask yourself what lies behind that preference?
📍Before learning what is “out there” in the birth world, ask yourself: What do I believe or assume to be true about birth, pain, babies, mothering, and hospitals? What assumptions are motivating me to make—or not make—certain decisions? What is inspiring me to read about one topic and not another? Am I choosing to read material that matches familiar assumptions?
3. Epidural or no epidural? That is not the question
Let’s take the example of a pregnant woman who says she wants to give birth without drugs. Pam says she would ask her how she knows to want or not want an epidural, and then build on those motivations—without applauding or criticising the decision.
💕You could ask: On a scale from 0 to 100, how certain are you that the way to cope with labor is through an epidural? If it’s less than 100, she is thinking of other ways to cope. Let her speak about how she sees herself coping—even if it is only for the time before she has an epidural, or if the epidural does not work 100%—and build on these ideas. […] She is telling you what she knows she could try or do, instead of you telling her. This is empowering.
When she asks what drives a decision to not want an epidural, Pam says she often hears about external motivators:
💕I [hear]: “people will be proud of me”; “I'll be brave”; “I can tell my family that women can birth without drugs.” […] We don't want to congratulate her for wanting to [birth without drugs], because that would be external reinforcing. […]
The final step of her initiation is: Supposing you have done your very best, but labour was not what you expected in some way or fashion, and you [had] an epidural. What would you tell yourself about that? Through an empathic conversation, self-judgment can shift to self-acceptance, and the meaning the mother is giving to say, having an epidural, changes too. This may help lessen the emotional trauma and self-judgment after the birth.
If someone hasn’t had this kind of preparation,
💕When [labour is not] what she expected, she [may] say: “my body failed me” or “I'm a weak person”. I hear this all the time [in birth story listening sessions]. And neither one of those are true, but she goes to self-blame, instead of looking at the culture that did not prepare her.
📍It takes a certain kind of courage to labor without drugs, and it takes a certain kind of strength to ask for and accept a drug that you hoped you would not have.
4. Birth plans
Focussing on your intrinsic motivation does not mean that your external environment doesn’t matter. Your physical birthplace, the people around you, their behaviour and attitude and words matter a great deal. Again, I’d encourage you to ask yourself how you know that specific things matter to you, and to build on that. Maybe you won’t be able to listen to your carefully curated birth playlist or to use the birthing tub, or someone will be stuck in traffic. You can feel safe, heard, and respected without these specific things—and vice-versa.
📍Although your birthing environment is not always within your control […] do whatever is possible to create a supportive external landscape for your internal landscape, your emotional well-being.
This brings me to birth plans. I think drafting a birth plan can be helpful to crystallise and express what matters to you, for yourself, and to some healthcare professionals. But birth plans can also keep you stuck in an adversarial posture (I want this! I don’t want that!) and give you an illusion of control.
📍If you are going to write a birth plan, the first step in the process is not researching options, asking others what to do, or filling out a form2. The first step is to begin within: if you don’t want the frightened or defensive part of you to do this task, consciously invoke your thoughtful Birth Warrior to understand what is motivating you to write a birth plan and what is really important to you. […]
A Birth Warrior knows that she cannot control the attitudes, assumptions, or actions of others with a piece of paper listing her preferences. She knows the importance of building rapport and maintaining relationships with others through direct and respectful communication. When there is a difference of opinion, she does not take it personally. She knows when to stand her ground and when to yield.
5. Process vs. outcome
My dear friend, your worth does not depend on a particular outcome. That’s true whether you do achieve a birth ‘goal’ (it doesn't make you superior to other folks) and whether you don’t (that doesn’t make you a failure).
💕Most of the evidence-based literature is talking about [health] outcomes. […] It's important to have that concept to evaluate medical care. […] But you're having a birth from the inside. You're not seeing it from the outside or statistically amongst all the other women giving birth to see if the management is working.
💕When you think about trying to achieve an outcome, there's tension in your body. However, when you say: I'll just do my best and get as much help as I can from the ancestors and the medical people. Whatever happens, I'll survive emotionally and physically and even though I’d prefer this to be easy, it might be an ordeal. […] The elders have to start using conversation like that, instead of adolescent positive thinking.
📍Sometimes determination and wishful thinking can be confused with intuition. Overreacting, making assumptions, and having a strong attachment to an outcome can interfere with personal clarity as decisions are being made.
Last but not least, during pregnancy, we often focus a lot of our attention and worries on birth (especially, but not only, as first-time parents). I certainly did! I believe birth is a powerful rite of passage that deserves a lot of attention (Pam calls it a heroic journey). And at the same time, that does not mean it is the end-all.
💕There is no outcome because your life is a story that's crocheted from first breath to last breath. It’s just the same thread being crocheted through your pregnancy, through the labour and postpartum; then you go on to making birthday cakes for your kid... It's one continuous experience […] and opportunity for self-love and self-discovery.
I wish you much, much love and discovery.
I also recommend the lovely Heart-Based Pregnancy Journal: Cultivating Intuition, Connection, and Resilience for Pregnancy, Birth, and Postpartum by Nikki Shaheed, who trained under Pam England.
PS: My newsletter about / for multicultural families went live yesterday! You can read the first issue and subscribe here:
That book came almost 20 years after Birthing From Within and dispelled some of the misconceptions about her approach: “that it is a crunchy granola approach focussing on birth art to the exclusion of practical information and that it is only useful to mothers planning natural births.”
You don’t have to use an existing birth plan template and tick its boxes. You can come up with your own document! If I did mine again, I think it would be one paragraph to introduce ourselves + two bullet points.
You legend! This is beautiful. The only thing I would add is that the birth won't define how you are as a mother. I didn't have the births I imagined but my goodness they're in the past now and no one is going to judge my parenting because of them, least of all me! Good luck to your friend x
What a beautiful note. I wish someone had sent it to me before my pregnancies. (And that I knew about these books!) Best of luck to your friend!