My patients often tell me that they’ve watched A Birth Story to learn about childbirth. This is like saying you watched The Princess Bride to find out what marriage is like. Trust me, birth is not anything like a 22-minute un-reality show!

Many women are so sure they’ll get an epidural that they go into labor unprepared for pain, thinking it’s optional. Sorry, ladies, but that’s not reality. Here’s the reality about childbirth pain…

1. Childbirth is almost universally painful at some point for every single woman on the planet who gives birth, even if she gets an epidural.

Why? Because you won’t get an epidural until you are in active labor, otherwise known as four centimeters dilated.

Why does four centimeters matter? Studies show that women who don’t get an epidural until they are in active labor are far less likely to end up with unnecessary c-sections. And, trust me, you don’t want an unnecessary c-section.

How long will it take you to get to 4cms?

You might have hours (even days!) of contractions before you get to the magic 4cms. And these contractions can feel pretty damned active. IV pain medications are of limited use, and they really only work for the first couple of doses, and those doses only last a few hours at most.

This means that you will likely experience some — or even a lot of — pain before you ever get your epidural. 2. Epidurals aren’t always 100% effective.

An epidural is done by inserting a very long needle (that you don’t feel because the anesthesiologist numbs you the hell up beforehand) into a space in your spinal column that is about the thickness of a human hair. A very thin catheter is slid through the needle into this space, and the needle is removed. Pain-relieving medication is delivered by a special pump continuously through the catheter where it is dispersed into the epidural space. Ideally, an epidural symmetrically numbs the pain receptors of the abdomen and the legs. Unfortunately–approximately 5-8% of the time–pain relief is not symmetrical.

Because of your anatomy, this thin catheter can end up more to one side, or the other, causing one side to get very numb while you still experience labor pains on the unnumb side. Your nurse will try to fix this by changing your position, but it doesn’t always work.

Sometimes you might be numb all over except for–again due to your anatomy–randomly annoying spots on your body called “windows” that remain untouched by the medication. Despite every effort, this pesky window situation cannot always be remedied to your complete satisfaction. Sorry. That’s reality.

3. Epidurals Don’t Always Work Well When It’s Time to Push.

One of the most shocking disappointments my patients have is getting to the point where it’s time to push and feeling like the epidural has stopped working. This is because epidurals don’t always work very well on the nerves in the area being impacted by the descending bony fetal head. And there’s nothing anyone can do about it. More medication will just render you unable to push, but it won’t touch the pain. The only solution is to push the baby’s head out.

What Can You Do About Pain?

Knowing ahead of time what to expect when it comes to pain in labor can motivate you to prepare yourself, which is why I recommend birthing classes.

Today’s birthing classes are not your mother’s classes. Gone are the days of hee-hee-heeing and hoo-hoo-hooing. Today’s birthing instructors teach relaxed breathing techniques that help you feel more in control during the most out-of-control moment most women will ever experience. You’ll learn about the physiology of birth, so you understand what is happening to your body. And a good instructor will help you anticipate many of medical procedures that might happen to you and your baby while you are in the hospital, and what to expect in the first days after you go home.

I often coach my patients to think about labor like a swim in a choppy ocean. Anyone who has ever swam in the ocean knows that when you first get in the waves begin to buffet you. You get salt water in your mouth and eyes and up your nose. Sometimes you find yourself swamped by a big wave, unable to tell up from down. Like the ocean, labor is a force of nature. It moves through your body of its own accord, and you can’t control it no matter what you do.

Our normal response to any painful stimuli is to get as far away from it as possible. But labor is a type of pain that only increases the more we tense up and try to pull away. The best thing you can do is to try to relax and not fight it.

Knowledge is power, and ignorance is not bliss. Bliss would be men having to do this shit instead.

Related post: The Five Stages of Dilation