There’s something perverse about an entire industry predicated on the concept that excruciating pain is good for women. I’m talking, of course, about the natural childbirth industry, and the books, blogs, courses, videos and celebrities that comprise it. The”natural childbirth industry isn’t always sure that the pain of labor exists, but they are sure that if it does, it’s desirable that women feel it.

The unalterable bedrock of “natural” childbirth advocacy is that women should refuse effective pain relief in labor. The “ideal” situation is for women to embrace their pain and pretend that it is “good pain.” Of course, there is no such thing as “good pain”: they just made that up. The pain of contractions and the pain of vaginal distention do not differ in any way from any other kind of pain. It is not carried by different nerves, it is not conducted through the action of different neurotransmitters, it is not routed to different areas in the brain. It is exactly the same as any other kind of pain. So the take home message of NCB is that the excruciating pain of childbirth should be ignored.

And not merely ignored. What’s worse is that the NCB movement pretends that women are improved by experiencing the agonizing pain of childbirth, although they cannot think of any other instance in which human beings are improved by agonizing pain. The irony is that “natural” childbirth advocates have beliefs that are strikingly similar to the Victorian clergymen who opposed anesthesia in childbirth when it was first introduced in the second half of the nineteenth century. The clergymen believed that is was wrong to abolish labor pain with anesthesia because God intended for women to feel the pain. NCB advocates appear to believe that it is wrong to abolish labor pain because “Nature” intended for women to feel the pain. There is precisely zero concern for the effect of that pain on a woman herself.

The natural childbirth movement routinely demeans women who do not want to tolerate the pain. They are portrayed as weak, as “giving in,” as uneducated and uncaring because they don’t understand the “risks.” Or worse. The ultimate insult, implied, but not always stated is that “authentic” women can and should accept the pain, and that, therefore, women who opt for an epidural are somehow less womanly.

There is one strain of NCB advocacy that simply denies the reality of the pain. In this view, the pain of childbirth is psychosomatic in the true sense of the word. It does not reflect actual neurologic signals, but rather the social conditioning of women by a medical, technocratic culture. Pain is a manifestation of the fact that the woman has not “educated” herself that the pain doesn’t exist, doesn’t “trust” birth, and, once again, is not an “authentic” woman.

There is another strain of natural childbirth advocacy that acknowledges that the pain exists but that it can and should be “managed” in ways that are “natural” and inherently ineffective. The goal is not to abolish the pain; that would be wrong. The goal is to tolerate the pain so that the incentive to abolish it will be reduced. Hence the emphasis on hypnosis, water, and labor support. The pain is real, the pain is severe, and it is acceptable to reduce the pain. But it is only acceptable to reduce the pain in ways that involve no technology, and it is never acceptable to actually abolish the pain.

The “support” people in the NCB movement exist primarily for indoctrination. The childbirth educator exists to convince women that pain is good for her, and pain relief is bad. The primary function of a doula is to interfere with a woman’s desire for pain relief. At every point, the doula counsels the laboring mother that she does not “need” pain relief, that she’s doing “great” and she “can do it,” with “it” being enduring labor without an epidural.

At the fringes of the natural childbirth movement is a group that not only denies the existence of the pain, but inverts it. Childbirth is not painful, it is pleasurable. No remotely plausible physiologic explanation is advanced for this claim, beyond the inane observation that the tissues that produce the pain of childbirth could, in different circumstances produce sexual pleasure. The explanation makes as much sense as the claim that kicking a man in the groin could induce orgasm because sexual pleasure can be produced by contact in the same area.

Why are NCB advocates so invested in the idea that women should experience excruciating pain in labor? Why are they invested in the idea that women benefit from experiencing labor pain? Why do they direct the bulk of their efforts, both before and during labor, to pressuring women to forgo effective pain relief? Why do these efforts include misinformation about the risks of epidurals, and insinuations about the fitness of the laboring women as a mother, and even insinuations about her fitness as a woman?

I don’t know all the answers to these questions, but I do know this: it is inherently wrong to ignore the pain of women and to pretend that agonizing pain is good for them.

This piece first appeared in April 2010.