In the natural labor world, there are tales of a mystical, magical creature: the Unicorn Birther. The Unicorn Birther is a woman who somehow reaches near complete dilation with little to no discomfort and only mild, infrequent contractions. Many people confuse the Unicorn Birther with women who manage their labors extremely well, utilizing breathing and other techniques. I commonly see patients who have studied Hypnobirthing who resemble Unicorn Birthers in their calm demeanor, but a true Unicorn Birther is something very different. Women who cope well with labor will still communicate discomfort and have contractions in short intervals that build both in intensity and frequency as the labor progresses, while Unicorn Birthers will look at you, smiling and bewildered when asked about discomfort, reporting only a little tightening or pressure. The other type of woman who is often confused with a Unicorn Birther is the woman who has a very fast labor, what is referred to in the medical community as a precipitous birth. However, anyone who has taken care of a woman delivering precipitously or anyone who has had such a labor can tell you that it is far from a serene experience. This labors are usually fast and furious, with strong, frequent, and painful contractions that seemingly come out of nowhere and result in a bright red, mad and screaming infant in under four hours. This is very different than a unicorn labor.
It has been estimated that as many as 1% of women fall into this category, reporting little to no pain in labor, but it is still a fascinating experience to work with the real life, walking and talking version of these tales, even when you have seen it before. Just recently, I helped a Unicorn Birther deliver her baby, staring at her in disbelief, as she bounced around the labor room, contracting only every six or seven minutes, smiling, laughing, with perfect makeup and beautiful eyelashes at a good eight centimeters of cervical dilation. I would watch each contraction peak on the monitor, but her smile was unmoved. Sometimes she would touch her belly, feeling the firmness, and state that she “thought” that one may have been stronger. I found myself surprised and relieved that she was aware enough of her body to come to the hospital rather than having her baby on the kitchen floor.
However, very interestingly, of all the Unicorn Birthers I have delivered, I have never had a single “easy” unicorn delivery. Each one of my unicorns have, in fact, had a malpositioned, usually sunny-side up or OP, baby that did not descend into the pelvis without a whole lot of encouragement. This may be why the sensations of labor are so different for these patients, the lack of decent with a cervix that somehow dilates nicely despite the baby remaining high in the pelvis. In each of my experiences with unicorns, once their babies finally did descend, typical sensations of labor ensued and suddenly they looked like normal laboring women, though they often delivered so quickly that the story remained that the labor was essentially pain free.
So, what can these Unicorn Birthers teach us mere mortals about pain in childbirth? Probably something we already intuitively know: that much of the pain of childbirth comes from the forces of labor moving the baby against resistance: the resistance of the not yet fully dilated cervix, the resistance of the muscles, soft tissue, and bones of the pelvis, and finally the resistance of the vaginal wall. When we lessen the resistance, the pain of labor is reduced. This is why epidurals contain medicine to relax the mother’s muscles, not just numb pain sensations. This is why labor tubs relieve pain, the buoyancy lessens the effective weight of the baby moving through the pelvis, thereby reducing the friction acting against it. This is also why mothers who have labored previously often do not feel painful contractions until much later in labor process, as their tissues and pelvis are already stretched and do not resist the descent of the baby to the same degree. This is why meditative methods of childbirth are the most effective. Women learn to control their responses to discomfort and relax their bodies, allowing their labors to progress in an easier fashion. It is also why alternative positioning that promotes an open and relaxed pelvis is usually more comfortable and effective than more constricted positions.
Ultimately, birth is something you must flow with, not fight against
Dr. Michelle Aristizabal is a board-certified General Obstetrician and Gynecologist in Montclair, NJ. She is the author of Natural Labor and Birth: An evidenced-based review of the natural birth plan and runs a busy, private practice, with a special focus on supporting women who desire low-intervention, un-medicated births.