Mindfulness for Labor
The clock said 4 am and something was ringing.
It was my phone.
I crawled over my daughter’s sleeping body, wondering when she had arrived in the bed. My husband handed me the phone and pulled a pillow over his head.
It was Henry. “Sophie’s in labor.”
An hour later I was tiptoeing into a railroad flat in Brooklyn. Sophie and Henry were nesting on blankets on the floor. Candles were burning. She wore a pair of yellow socks and an adult diaper with a tiny bow printed on it. Nothing else. She was writhing.
Sophie is a visual artist and Henry is a musician. Sophie is also a doula. This morning I was the doula’s doula. I put my hands on her back. I could tell it was still early labor, despite the intensity. Much more work to be done before we met this baby.
And Sophie was struggling.
“It’s in my back,” she said. “It’s not going away between contractions.”
Her words, her movement, the unsettled quality during the downtime, all said to me that in addition to the sensations of the contractions, Sophie was feeling a kind of grief. This wasn’t the labor she had wanted. She was having back labor.
And, yet, here we were.
For my own first son’s birth, I had prepared to cope by scanning my body for tension and relaxing muscles through each contraction. As labor intensified, I released my jaw (it was all I could manage) and the words that came to me were: “The more I relax, the less it will hurt.” It was useful. My husband and doula were invaluable. But hours and hours into it – at labor’s highest place, when the most was asked of me, when I was beyond words and helpful reminders, when it was clearly more than I could have anticipated – what really won the day for me was my mindfulness training.
Years before, in my twenties, I’d hit a hard patch while in grad school. The stress I’d experienced gifted me with three years of a pain syndrome all over my body. It stopped me in my tracks. I could hardly carry my books. I left university with an MA instead of the Ph.D I’d planned on. But I found meditation.
With meditation, I discovered a freedom in turning towards my pain and the conditions of my life that were causing me so much difficulty. It was this that made a difference in my three children’s births. It was this that I suggested to Sophie.
As the day’s first sunlight warmed Sophie’s kitchen, Henry and I took turns massaging her back. We breathed with her.
“Sophie,” I said, “I know this is intense. I know that with the labor in your back you aren’t getting the breaks as fully as you’d like. But – right now – this is your labor. There’s a lot we can try to move labor out of your back. But …. you might want to make a kind of peace with this labor … as it is.” I paused.
She was listening.
“Maybe experiment with breathing into and making space around what you’re feeling in your back, right in this moment.” I waited. “You might try to use the breaks you do have to rest, even if you are still feeling it in your back.”
She nodded her head slowly. Her whole body relaxed.
I. Meeting Labor
As you approach labor, then, how might you handle the mighty work of birthing a baby?
Was your first thought, “Ruuuuuuunnnnnn!”?
Yup. In labor, the desire to make a speedy exit may arise.
Makes sense! Like any creature with pain receptors, we are wired to get away from what is uncomfortable and seek comfort. But in labor we aren’t under attack from a predator. We are experiencing the normal physiologic work of a body to birth a baby.
We are not separate from the natural world. This is our participation, however mediated by technology, in life continuing itself. While it may be extraordinary for you, your baby, and the community of people awaiting this baby, birth is as ordinary as it comes.
The pull to escape – or the desire for things to be other than as we would like – shows up as resistance, and this is precisely where suffering gets a toe hold.
Here’s a perspective to consider. We might even call it the first truth of labor.
Women do labor all the time. And, there’s no way around it: there is an intensity of experience to cope with to birth a baby. This is true if you have an unmedicated home birth like Sophie, if you birth in a hospital with an epidural, or if you birth by cesarean. The intensity may vary depending how your baby is born, but there will be sensations to work through. For 9-ish months you grow a baby. It then takes a couple of hours to a few days to get the baby out. Afterwards the body has to heal. These are significant changes that occur in the body over a very short time. You will feel something! No way around it.
Plus, the intensity of the experience of birth can include emotional challenges. Sometimes the hardest emotional work of labor lies in the place where expectations don’t meet reality. Sophie was prepared for the work of labor, but she had hoped – even if unawarely – it would not be in her back. For someone else, a favorite doctor might not be on call. For another, it may take hours of work to get to a place where an epidural makes sense, and then the epidural may provide more relief at one point and less relief at another. An unhoped-for cesarean may ultimately be the safest way to birth. We just don’t know.
So yes, there will be contractions – of two kinds really. There will be the strong rhythmic tightening of the uterine muscle as it stretches the cervix back over the baby’s head, and to one degree or another, there may be what we might think of as contracted emotional states that can grip us when we encounter unexpected or unwished-for aspects of birth.
II. Contracting Around Contractions, or a Second Truth of Labor
If you pay attention on any given day, you’ll notice that – hardwired by evolution as we are – most of us spend a good deal of energy in these contracted emotional states, putting up some form of resistance to things we don’t like or clinging to what is comfortable. When we carry these habits into labor (or grad school), an extra level of difficulty may enter the picture. When we fight labor, hard gets harder.
Meditation teachers offer a succinct formula for this sort of thing:
Pain + Resistance = Suffering.
While pain may be inevitable, they’ll say, suffering is optional. Or, how we relate to the challenges we encounter can change our experience of living. This is not to burden ourselves with blame for our suffering, but to point to a possible place of freedom. Rather than the autopilot of get-me-out-of-here reactivity, can we find a way to respond – perhaps with some wisdom and compassion – to our circumstances, to our challenges? Can we drop the resistance, the result of years of personal, cultural, and biological conditioning, and be with our pain, bringing a curious awareness to our physical and emotional discomfort even for brief moments at a time?
This question is at the core of mindfulness programs that have become so popular. In medicine, mindfulness programs offer patients non-pharmacological alternatives to cope with pain. Exploring how thoughts and emotions that arise in response to pain are different from pain itself, patients often find the experience of illness or injury to be more manageable. Mindfulness-based cognitive therapy has helped many who struggle with depression and anxiety to recognize and intercept the downward cascade of fatalistic or fearful thoughts and emotions. Participants in stress reduction and addiction programs practice mindfulness in relation to life’s inevitable stressors, asking: is it possible to pause, get curious about the particulars of the stress response and perhaps choose a way to restore calm other than the reflexive reach for a cookie, pill, or screen?
The training has helped many to meet life as it is in the moment, with a measure of equanimity and a sense of care for our varied experiences of living.
So, to return to our question, how might you cope with whatever work is asked of you to birth your baby?
Perhaps this will help. Midwife Nancy Bardacke, author of Mindful Birthing, shares a midwife’s secret. “When you are having a contraction,” she says, “and my fingers are on your cervix, what I am feeling is an expansion.”
Bardacke asks her students, “How does it feel differently in your body to think of these as ‘expansions’ rather than as ‘contractions?” With this question Bardacke invites expectant parents to sense in their bodies what it might be like to do something other than the habitual pull to contract around contractions.
The invitation is the same, Bardake says, no matter if it is the contractions of labor, or the contractions of life.
III. Expansion, or a Third Truth of Labor
By midday, Sophie’s apartment was flooded with light. At one point I prompted her with the phrase, “…as softly as you can…”
For hours afterwards Sophie swayed her body and moaned “…….soooooooft……” through the peak of each contraction and visibly released her body around the work her strong uterus was accomplishing.
As the afternoon wore on, we moved into the bedroom, catching the last hours of daylight. Henry and I counted Sophie’s exhales through each contraction. Soon, Sophie joined us for the counts of “threeeeeeeee…” and “sevennnnnnnn…” I was moved by the tone in which she almost sang out these numbers, as if they were the names of dear friends she was greeting over and over with each surge.
What I saw with Sophie as she shifted into the active part of labor was not the gritted jaw, clenched fist bracing of the novice ocean swimmer as a whopper of a wave approaches. Rather, it was a courageous dive into each oncoming wave with a sense of faith, or – better yet – a learned understanding that to move with the power of the ocean was where safety lay.
She struggled at times for sure, but she was able to come back again and again with an expansive sense of being with this wave, and only this wave. Not the next one. Not the one after that. This wave. This moment. This breath.
I don’t believe Sophie thinks of herself as either a warrior or zen master, but in the moment-to-moment of her labor, she was both.
If this sounds like a tall order, there is a bunch of good news. First, you’ll be happy to appreciate that as labor intensifies, the pharmacy in the brain kicks up production of beta-endorphin, an opioid neuropeptide that shifts how the strong sensations of labor are perceived. Basically, your body is making morphine. We are still gathering data, but it looks like endocannabinoids are involved as well. Runners aren’t the only ones who get high.
Then, there is the reassuring reminder that in labor, as in life, you will only need to do one moment at a time. Indeed, it’s all you can ever do.
The additional good news is that presence can be practiced.
IV. Practice, or a Fourth Truth of Labor
As Sophie labored, Bardacke’s book, Mindful Birthing, lay on her couch. I met Sophie years ago when she audited my childbirth class as a new doula. I then had the pleasure of getting to know her partner, Henry, when they found out they were expecting and attended my birth class together where they prepared for the work of labor through the lens of mindfulness.
Mindfulness is more than meditation, but meditation is where we begin. At its simplest, meditation is a way of training the mind to focus. In this approach, the gentle concentration we explore helps us access our natural capacity for mindful awareness of whatever may be coming up in our experience.
Over time, we develop a familiarity with our habits of mind and a greater ability to choose where to put our attention. We also cultivate a warmth of heart for the conditions of our lives, and the lives of those around us.
Mindfulness training usually starts with exercises that support paying attention to the body. In formal sitting practices, we observe bodily sensations as they come and go. But right from the outset we apply mindfulness to our lives, bringing awareness to the sensory experiences of everyday activities such as eating.
As we practice, we can’t help notice the internal riot of thoughts and emotions. We become painfully aware of the worrying, planning, fantasizing and judgments that run like a news scroll beneath our awareness much of the day. As we meditate and get pulled into news flash after news flash, it can feel like we are failing. But it is exactly when we catch our distraction that we are experiencing mindfulness. We are waking up to the autopilot of our minds. We then gently escort the attention back to the object of concentration: the breath, the taste of food, the warmth of the sun, the feeling of a body walking, or dancing. Or birthing. Or caring for a young child.
With practice, we begin to get wise to our minds. It becomes apparent that we aren’t quite the masters of our minds that we seem to think we are. They sort of have a mind of their own: Where did that thought come from? Did I ask for it? And that flash of emotion? We notice that we can bring mindful awareness to thinking and emotion-states themselves.
This, in turn, can give us a kind of friendly familiarity with our capacity to step back and simply be present to our experience, just as it is, with a quality of unconditional acceptance. This observing, knowing part of the mind, often referred to as awareness, comes to be a place of heartfelt rest, a place from which to calmly meet whatever may arise?—?even for moments at a time.
As we practice in preparation for labor, a question might come to us, a question to ponder as we move through contracted states in all areas of our lives: Is that which observes the pain, in pain? And if not, can we rest where there is no pain?
There is more, of course, such as practices that draw our attention to the interconnectedness of life and help us cultivate greater compassion for ourselves and others, strengthening our ability to take wise action to support a kinder, more just world. But descriptions about mindfulness have their limits. These are felt experiences. Discoveries happen with practice over horticultural time, as Bardacke describes the process of laboring.
On the day of your child’s birth then, you and your partner will meet the work of labor with presence, as best you can. You’ll focus on the breath and the sensations of the birthing body, bringing kindness, curiosity, and care to any physical tension and emotional hard spots. As labor intensifies?—?signaling that you are nearer to the birth of the baby?—?you may settle more deeply into the zone of labor, a place of presence somehow outside time and language. When resistance and reactivity kick up, as they will, you come back again and again, softening mind, body, and heart into the moment, present to the rise and fall of sensation, sinking fully into whatever rest is available, allowing the body to do its work as unhindered as possible.
A Baby is Coming
The Brooklyn street outside Sophie’s window had the electric shine of streetlights. While no one was looking, night had apparently fallen. Sophie and Henry were hours and hours into labor. We had just completed The Miles Circuit, a 90-minute sequence to shift the baby’s position, and there was a new intensity to labor. We phoned the midwives. It was time.
When Midwife Barri and her assistant arrived, they were clearly pleased with Sophie’s progress. After checking on Sophie and the baby, they stepped out to get a bite of food. Two minutes later Sophie’s water broke and I heard her start to bear down. I texted Barri. There would be no dinner for the midwives. A baby was coming.
Sophie climbed into a tub that Henry and I had set up. Sophie discovered her new favorite place to labor: immersed in warm water. A few hours later, Sophie and Henry’s son was born, a chunky nine-pounder. It was a long day of hard work. And a peaceful start for a young boy and a new family.
Happily ever after?
Except for the crying that started nine days later.
Like labor, it didn’t last forever, but for hours each day their sweet boy would weep and storm and nothing would settle him.
We were a few months from the arrival in New York of the novel coronavirus so Sophie and her 2-week-old son were able to travel – with Henry’s help – from Brooklyn to Manhattan to my parenting group. Over the next months I watched Sophie shift from an understandable desperation to stop the crying to something she maybe remembered from labor: that it is possible to breathe into and turn towards hard work, in this case her son’s diligent efforts to move through his distress and her own grief at his upset.
When the crying would start and nothing would quell it, Sophie and Henry did their best to tap into a spacious acknowledgement of yes, this is how things are right now. Holding their son, they would breathe deep and say, “We are with you.”
Ultimately, the invitation here is to experiment with meeting both the expansions and contractions of labor, life, and parenting with awareness and warmth, opening to the possibility of presence, equanimity and peace even in the hardest spots. These are true victories of the moment.
Sophie called the other day, reminding me it was a year since we spent our rather intense day together in her railroad flat in Brooklyn. We had a good laugh about the crazy-wild ride it is to birth and raise these brilliant, irascible children of ours. It was apparent to me just how much closeness, delight, and profound sense of meaning she and Henry are experiencing as parents to their growing little boy.
Mary Esther Malloy is a New York City doula, birth educator, and mother of three. She founded Mindful Birth NY in 2003 and has had the honor of working with thousands of families since. She holds an M.A. in Anthropology and has been publishing about birth and parenting for over a decade.