The Danger Of Having Unrealistic Expectations

screamMy wife and I vividly remember the anesthesiologist’s statement: “You may feel a little pressure.” She spoke the word gently, as if to imply that’s how it would feel, and we believed her.  Epidural blocks, she explained, don’t numb the sacral nerve roots that deliver sensation from the pelvic floor so my wife would likely feel something as she entered the last stage of labor and our son began passing through her birth canal.  But we were both reassured. A mild bit of pressure seemed no threat to our hope of having the same experience my sister-in-law had with her first child: she’d had to be told when to push at the final moments because she couldn’t feel anything at all.

My wife’s block had incompletely numbed her left side, however. Where my sister-in-law couldn’t move either of her legs, my wife could have stood alone on her left one.  But, again, we were reassured as the pitocin-induced contractions the monitor told us she was having remained for her a distant, almost imperceptible cramping.

After 36 hours of peaceful—almost boring—labor, though, she began to feel some real discomfort on her left side. Over the following hour it built to the point where we were both starting to feel a little panicked about it. The anesthesiologist was called back into our room. She adjusted the position of the epidural catheter and dialed up the dose as high as she could. My wife’s pain continued to worsen, however. “There’s nothing else I can do,” the anesthesiologist finally said apologetically.

The last five hours of my wife’s labor were a nightmare. She was in agony. When she finally wrapped her mind around the idea that this was just how it was going to be, she buckled down and literally talked herself through it. I was utterly traumatized standing at her bedside without leaving once for the entire time, unable to do a single thing to help her.

A DOCTOR’S MISTAKE

Though she was certainly well intentioned, our anesthesiologist made a crucial error: she only described the best possible outcome of the epidural block, not the worst, and in doing so failed to prepare us for what actually happened. As a result, the entire experienced was transformed. Though the physical sensations my wife felt would have been no different had she been better prepared for them, her (and my) experience of them would have been far easier to endure had we been properly warned (even though I’m an internist, I had little knowledge of the detailed workings of epidural blocks). Because neither of us were expecting her to feel the degree of pain she did as a result of the anesthesiologist’s statement, we worried something might actually have been wrong, which transformed the pain’s significance from inevitable but ultimately joyful into something almost wholly frightening.

I’ve watched many physicians make this same mistake in other ways, thinking their honest and full description of a test or procedure will create undue alarm or scare their patients off from having it and so stop short of full disclosure.   But in my experience, patients are far more upset (as we were) to be caught off guard and unprepared for something unpleasant. When explaining colonoscopies to patients, for example, I always make sure to describe just how unpleasant most people find the preparation. When I send people for nerve conduction studies I tell them outright that they’re painful. Interestingly, most later report the pain wasn’t as bad as they thought it would be.

You could certainly argue in taking this approach I’m causing my patients more suffering in anticipation of an unpleasant experience, but most tell me they’re more grateful for having been warned. In my view, experiences like my wife’s and mine are far worse.

DISCONNECTS BETWEEN EXPECTATIONS AND EXPERIENCE

I would argue further that the reason many of my forewarned patients report to me the experience wasn’t as bad as they expected was precisely because I warned them it would be bad.   Though I’ve used a medical example here, the impact of any disconnect between our expectations and our experience is felt in almost all contexts.  Our expectations of our experiences dramatically color not just how we experience waiting for them but the experiences themselves.  Four scenarios exist regarding expectations and experiences.  We can have:

  1. Low expectations and a poor experience, where our low expectations can mute the disappointment or even the discomfort we feel at actually having a poor experience.
  2. Low expectations but a good experience, leading to a pleasant surprise.
  3. High expectations and good experience, in which we get to enjoy not only the anticipation of looking forward to something fabulous but an experience that actually lives up to our expectations and therefore feels thoroughly satisfying.
  4. High expectations but a poor experience, in which we often emerge bitterly disappointed or even traumatized.

THE BEST STRATEGY

The “gain” at which we set our expectations tends to be more a matter of habit and disposition than conscious intention for most of us.  Some of us expect little, perhaps as a way to defend against disappointment, accepting the cost of a muted or absent anticipatory sense of joy.  Others of us can’t help having high expectations, basking consistently in the glow of anticipation but often paying a different price:  the painful disappointment that comes when experiences fail to live up to those high expectations.  Even worse, sometimes having unrealistically high expectations prevent us from being able to enjoy our experiences at all.

I honestly don’t think one strategy is better than another but rather that different strategies are better suited for different types of people.  If you observe yourself to be continually disappointed by experiences you feel you should be able to enjoy, you may do better by consciously lowering your expectations somewhat.  Likewise, if your expectations remain so consistently low you never think things will work out for you, you may find yourself plagued by a gloomy pessimism that blocks you from savoring a truly enjoyable part of life—the anticipation of good things—and you might work on allowing yourself to expect just a little more.

Though we all may have a built-in set point at which we unconsciously tend to set our expectations, that doesn’t prevent us from consciously grabbing the reins and adjusting them up or down to suit our needs.  Certainly it would be ideal if our expectations always perfectly matched our experiences, but as the quality of many experiences is hard to predict, we might do better to adjust our expectation of how much we think we’ll enjoy or dislike an experience based more on how we know those expectations will affect us than on how accurate we may think they’ll turn out to be.

My own personal preference is to know up front as much as I can about both good and bad experiences coming my way.  For me—and, I’ve observed, for many others—not knowing what’s coming when anticipating something bad creates even more anxiety than having full knowledge of how bad what’s coming will be.  Knowing the limits of the “badness” I’ll be facing enables me to focus on preparing for it rather than on managing my imagination’s tendency to inflate it beyond all rational proportion.  For me at least, the devil I don’t know is far worse than the devil I do.

Though soon after the anesthesiologist left our room for the last time my wife and I had both become resigned to having a different experience than we’d expected, after our son was born (perfectly healthy) we received another surprise:  my wife’s left-sided pain actually became worse, located now not low in her pelvis where her uterus was appropriately contracting down to staunch any bleeding, but rather high up in the left upper quadrant of her abdomen where it had absolutely no business being. When I glanced worriedly at our obstetrician she only shrugged in confusion. The anesthesiologist was called back in one last time, gave my wife a narcotic, and the pain finally faded away, never to return.  To this day, however, my wife regards the last five hours of her labor as one of the worst experiences of her life.  The only thing that saved the day was that it was followed immediately by one of the best.

Next WeekPsychosomatic Symptoms

32 comments to The Danger Of Having Unrealistic Expectations

  • barbara

    You are SO right. After a routine physical, my gynecologist advised me to come in if I had any bleeding. I had a very slight amount so made an appointment at which she told me she’d do an endometrial biopsy right in the office. And that it might cause a little bit of cramping, but the discomfort should be minimal. I never felt pain like that in my life! I was literally yelling from the pain, and felt completely traumatized afterward—for several days. I also felt betrayed. When I went home I did some research on the procedure and found out that for people like me (who had c-section delivery and never had menstrual cramps) the pain can be excruciating and can be eased with a shot of Xylocaine prior to the procedure. (I can’t even imagine if I had had to do that for 4 hours.) The good news was that the biopsy was negative. But still..

  • marcia

    That anesthesiologist obviously came from the same school of physicians who describe the “discomfort” associated with natural childbirth WHEN THE WORD IS PAIN!!

    I actually had much more pain and more complications with my second child’s birth, but this time I knew what to expect (and baby #1 was a ten-pounder!) Spinals weren’t as safe and epidurals hadn’t come along yet, and natural childbirth was THE way to go. I’m glad to have had the experience but I wouldn’t do it again for a million dollars. Not without at least TEN board-certified anesthesiologists in the room. Just in case.

    My doctor had told me that nobody could tell me what it was going to be like…and he was right both times. He also told me that Lamaze would NOT take away the pain but I’d learn a lot from the classes, but still, no one could tell you in advance what labor was like. I love him for his honesty to this day.

    Marcia: Isn’t it fascinating how knowing what to expect (your second time around giving birth) doesn’t reduce the pain but can affect your ability to withstand it?

    Alex

  • Toni Bernhard

    How I wish everyone in the medical profession could read this post! My husband and I had a similar experience when our son was born. We diligently attended pre-natal classes in which the experience of the onset of labor was meticulously described. Then a few days before my due date, I got a backache so severe that I was crying out in pain. All I wanted to do was lie on the bed but my husband, wise soul that he is, convinced me to take a “trial run” to the hospital (which was a 45 minute drive from our house).

    On the way, my water broke in the car. By now we were, just like you and your wife, afraid that something was going terribly wrong. Hours later, having given birth to a healthy baby boy, we were told, “Oh, that’s something we call spontaneous back labor. It doesn’t happen very often but when it does, you feel the contractions in your back instead of in your front and the baby is born without protracted labor.” Like you and your wife, our experience of childbirth was not a joy filled event, but a downright scary one.

    I can only hope that now, almost 40 years later, pre-natal education is more thorough. I so appreciate the approach you take in your medical practice.

  • Rhea

    Did you have to take me back to those specific 5 hours of my life? I’d like to forget THAT part of the 41 hours. Good thing our kid is so darn cute. I guess that’s nature’s way of ensuring you have a joyous feeling after a horrible one.

    Love,

    Your wife (and mother of your beautiful baby boy!)

  • janet

    I agree with you 100%.

    43 years ago when I gave birth to you, my Lamaze training had taught me what to expect, so I wasn’t surprised or frightened by the intensity of the pain and the experience was absolutely joyful. The breathing techniques I learned, while probably not reducing the pain, gave me the feeling that I had some small amount of control over what was happening, which I believe had a mitigating effect on the pain.

    But nobody warned me that giving birth was the easiest part of being a parent.

    Mom: Ha!

    Alex

  • I had terrible experience last month at Mayo, while getting a botox injection in my leg.

    A new doctor (for me) decided that the previous doses (200 mm and 100mm, were too high). He decided to cut the dose to 37mm, but REALLY twine that needle around (ostensibly, his deal was to place a small dose precisely, vs. a large dose which would disseminate.) In his probing he elicited a profound muscle spasm, and I began my screaming (no sissy, I). He continued the torture, and when he left, the nurse said, “He hurts other people, too.”

    Sadist? Anti-Semitic? I don’t know. I know the procedure, while uncomfortable on previous visits, was never like that. I was unprepared, and so, shocked. I cried for hours. If I had been told it might be painful, and maybe had some anesthetic offered, I might have reacted differently. Expecting pain, I would have known when was “too much” pain. Instead, I was sent into shock.

    Preparation is exceedingly important. It equates to having one’s eyes open in life. vs. traveling in denial. If one knows what is (potentially) before one, one may make better choices.

    I will never forget his leaning over me and saying almost gleefully, “I am sorry I hurt you.” I could hear Dr. Mengele!

    That doctor gives doctors a bad name.

  • I love reading your posts—and the comments—because you are not only an experienced doctor, father and husband but a human being! My doctors have saved my life a few times already so I won’t complain, but I do wish they would practice “full disclosure.” I don’t need anyone to protect me from the truth, but maybe they should ask their other patients if the would rather be coddled or informed.

    The scary, “these are all the ways you could die” speech isn’t particularly welcome, but a description of what to expect is. Oh, and I agree that people should be warned on that colonoscopy prep…but encouraged to get one. A day or two of discomfort is a lot more pleasant than colorectal cancer treatment with advanced disease.

    I’ll look forward to your next post.

    Best regards,
    Elizabeth

  • helen

    Barbara, the exact same thing happened to me. I had 2 more endrometrial biopsies after that but they were both done in the hospital under general anesthesia at my insistence.

  • Dan Aylesworth

    When I was born, I didn’t sign up for all this hard stuff that comes our way.

    Congratulations on a healthy son!

    Daniel

  • Chris

    Question: If some of us are happy and able to accept the “surprise” factor in #2, why can we not accept the surprise factor of a #4? Each is a surprise. In each case, we realize and accept that we have been made no guarantees (as the informed consent documents say).

    I think that the expectations that we have of medicine are a whole different set of expectations, culturally based. I think all of them are unrealistic to a pretty great degree. In your examples, Alex, we expect complete pain relief in childbirth, in surgery, post-surgically, procedural and post-procedural. In our culture, we expect to be pain-free or pretty close to it, as our birthright.

    I am an “old” lay midwife, and my experiences, both personal and professional, of the pain of childbirth are worlds apart. In my experience everyone expects pain. And there is an armamentarium of coping mechanisms besides medication/nerve blocks/anesthesia, available to deal with the pain.

    I now believe (I have joined the ranks of establishment medical professionals) that only the elite athletes understand that there is pain, there will be pain, and they have made a bargain to deal with the pain of pushing oneself to their limits. The rest of us are pretty much on the side of guaranteed comfort/convenience. To repeat, I believe that this is our cultural inheritance.

    Pain is a crucible that we go through, that we must go through. It comes at predictable and unpredictable times in our lives. Emotional pain is no less painful than physical pain. Chronic pain will wear you down, even with experience and the development of coping skills.

    I think we should anticipate pain with a mind to development of coping skills. I think we should get our physical selves in the best shape possible, so that we can physically endure a long bout of pain—either 5 hours or chronic pain that goes with a chronic condition or a degenerative condition. I think we should know our bodies, our weaknesses, our muscle groups, so that we can figure out what we might do, aside from medications and anesthesia, to deal with our pain. Nutrition. Working out. A disciplined mind. Etc. And then, in the end, I think we should better develop our sense of acceptance that (some level of) pain is inevitable.

    Chris: I certainly agree with you. However, accepting of pain as we may become and cognizant that there is no real growth without it, I also believe in all circumstances in which pain is coming our way, forewarned is forearmed.

    Alex

  • Hazel

    This comment began as a question, but the blog gave me enough clarity that in writing the question I came up with the answer also!

    I expect SO much from myself that I’m often crippled into inaction. I thought this was because I had such low expectations of myself that I was afraid to begin because I would probably mess up really badly.

    I wondered if I should expect MORE from myself but it felt like that would make things worse somehow…

    …but as I wrote that, I realized that the opposite is true: I expect so much that I’m afraid that what I CAN achieve will never be enough…gotta LOWER the bar to achieve HIGHER (or oftentimes to achieve anything at all). Wow! Thanks!!!!

    Hazel: What a brilliant realization. Thanks for sharing it.

    Alex

  • nina

    Hmmm. I am a hospice nurse and I have to try to explain the death experience. I realize that people hear what they WANT to hear, so I tell them all that I know. But…I must assess what their understanding is of what I said. They rely on me very heavily and it is an awe-inspiring responsibility to serve them.

    For instance, most people do not want to suffer with pain or anxiety while dying. I review their medications, suggest a few alternative therapies and medications and really try to make my teaching brief and succinct. The caregivers are taught many shortcuts and secrets of my trade and I keep communication open with them all the time. The tricky part is when I am alone with the patient and they have wishes that they will not share with the family. Then the experience gets confusing to the caregivers.

    Nina: You perform a wonderful, invaluable service. What experience could any of us want more knowledge about than what it’s like to die? Of course, none of those who’ve had the experience can share it, so people like you can only do the best they can. Rest assured the rest of us are thankful for it.

    Alex

  • Paul

    Dr. Lickerman,

    Were you a fly on the wall at my last session with my psychologist?

    “if your expectations remain so consistently low you never think things will work out for you, you may find yourself plagued by a gloomy pessimism that blocks you from savoring a truly enjoyable part of life—the anticipation of good things—and you might work on allowing yourself to expect just a little more.”

    I am working on dispelling the sense that I am “hot-wired” for a gloomy fatalism (“it is what it is”), although after over 1/2 a century, it is difficult. I just celebrated my 56th birthday and I was so focused on the fact that mother’s cancer was first diagnosed when she was 56 and she was dead by the time she was 60, even though my father lived to be 87, I couldn’t take comfort or hope in that.

    Thanks for providing a framework within which to better think about matching expectations to experiences.

    Paul: I truly believe no amount of inborn “wiring” is unchangeable. Consider the wealth of new studies showing just how plastic the brain is, how it can be physically re-wired even into advanced age. Just how this physical re-wiring relates to re-wiring of attitudes and thinking no one knows, but if the brain can do it, so can the mind!

    Alex

  • Jill

    When I was younger, I had many breast cysts which required aspiration. Time after time, doctors tried to convince me that no anesthetic was required (“it’s just one needle for the aspiration; why do you need another needle for the anesthetic?”). I learned from experience that I did indeed need the anesthetic; the needle for the aspiration was a larger, more painful one, while the needle for the anesthetic was a smaller one that was much more easily tolerated. Nevertheless, one doctor after another tried to tell me that the aspiration procedure was not painful, even as I was writhing in pain on the table. One time a nurse, clearly annoyed, told me to hold still because the doctor couldn’t work under those conditions. Another time a doctor agreed to give me an anesthetic, then came at me with the aspiration needle instead. When I questioned her, she said, “Oh, you caught me!” and then reluctantly switched needles and administered the anesthetic she had promised. Over the years, only one doctor consistently respected my request for anesthetic…and I will always be grateful to him for that.

    Jill: Stories like yours make me burn…

    Alex

  • Jill MacGregor

    Hi Alex,
    Thanks for sharing this experience that you and your wife had.

    I am totally with you—I want want FULL DISCLOSURE at all times. Other people’s filters are not useful or helpful to me when I am entering a situation where I only have a handful of details. I’ve often wondered why this need for information is so strong in me—if maybe I’m taking things to an extreme because of my need for detail. I’ve often felt a little jealous of people who could live and *ignorance is bliss* type life…maybe that would be easier.

    But I digress from your original point. Information allows us to set expectations, prepare ourselves for possible unpleasantness and allows us to look at our fears before they really materialize. I couldn’t help but think as I read this post how especially frustrating the whole situation must have been since you were a doctor. Sometimes we learn just as much from people’s bad examples and their good examples.

    Enjoy the Holidays!
    Jill

    What if Santa Brought You What You Asked For?

  • Tony LaPorta

    My wife is an anti-drug sort of person. It was her intention to have our first child without pain killers.

    About four hours (labor was twelve hours in total) into an induced labor, she changed her mind. The doctor was called and he made a comment I will never forget. He said, “They do not call it labor for nothing.” We had a total of four epidural children.

  • Maria

    Information is power. And information can also help you change your expectations. I highly recommend “The Median isn’t the Message,” a short essay by the late Stephen Jay Gould. When he learned that he had a terminal cancer, they told him to expect to live for an average of 8 more months. He found out everything he could about the cancer and understood that he could also expect to live much longer. He died twenty years—and many wonderful books—later.

  • I’m with you, Alex. I want to know worst case so I can prepare for it. But sometimes ignorance can accidentally be bliss.

    “By the time anything starts hurting very much you’ll get an epidural.” That’s what my sister reassured me as the big day approached. I was in labor before I learned that the hospital in our small town wasn’t set up for epidurals! The nurses gave me a little something to take the edge off—can’t remember what it was—but it didn’t take off much of anything. What a gift from my sister, though. I was so uncharacteristically NOT worried that the morning of Katie’s birth I kept thinking, “This day might be kind of fun.” And it was…eventually.

    Maureen: A great example of how having low expectations (in this case, for pain) minimized the dread of a painful experience. Glad you were able to enjoy it…eventually. 😉

    Alex

  • sandy

    Alex,

    I just want to say how much I love reading about your “well-examined life,” not just because it is a rare quality, but also because of how many lives and minds you touch through your job while possessing this quality. Your posts motivate me through the right mix of science and spirituality, for which I am thankful.

    Sandy: Thank you so much for taking the time to say so.

    Alex

  • Hi,
    Great article! I completely agree, expectations play a key role regarding how happy we are. I recently thought about this too. I invite you to have a look at Role and importance of “expectations” in being happy and tell me what you think!
    Thanks, Nick

  • Kunal

    Can’t recall where I read this, but sometimes this works:

    Happiness = Reality – Expectation

    You’d try to keep H > or = to zero (i.e. a positive number). The more you increase the expectation, the smaller H becomes and ultimately starts going negative. 😉

    Kunal: You know, I kind of like that. Hmm…

    Alex

  • Amy

    Hmm…I’m an anesthesiologist and work a lot on L&D (and love it). I’m very much in favor of prenatal classes for preparation, keeping expectations reasonable (good outcomes much more important than whether you followed the birthing plan exactly), and recognizing that labor is, for most women, hard work and a highly individual experience, even from one child to the next. I also totally agree with Chris the midwife that culturally we tend to expect minimal pain/uncertainty/disruption in our lives, but we need to learn to adjust/cope/be flexible. Most people are so very devastated by a complication or poor outcome because they never imagined that possibility.

    I don’t agree that the last five hours of labor should be agony…I’d try to replace the epidural, after a repeat assessment from the obstetric and anesthetic standpoint. Anything from a malfunctioning epidural pump to placental abruption can present with breakthrough pain. Post-delivery pain can also be critical.

    -AM

    Amy: I honestly don’t know/remember if those things were thought about or not. The epidural wasn’t replaced but repositioned twice. I guess her result was just her result.

    Alex

  • susan*5

    I think the key here is that for different people different levels of expectation work better—and perhaps also for different situations. In general I think that for tests and procedures full disclosure is best of side effects, post treatment care, etc.—frequently I have to find this info. from first person accounts—it seems to be some cult-like secret at the hospital.

    However, there was one time when I think a doctor tried to make something sound worse than it would be and looking back, I think this terribly traumatized me and dulled my sense of joy for years afterward. When my wonderful baby was born I was concerned that he might have problems because of my illness during pregnancy—but he seemed to be really alert and healthy at birth. Later the doctor came in when I was alone, standing their in my Johnny shirt, and slowly told me all the horrible things that might happen to my child in increasing levels of severity ending with death. Every time I would ask, “Is that it?” he would say, “Well actually, there might also be…” I did some reading later and for his condition the odds were not good. But the doctor MIGHT HAVE TOLD ME that in cases where the baby was already so healthy and alert the chances of a good outcome were far greater!!! It turns out my child has fairly minor problems that can be lived with. Looking back after many years, I think that he told me this way because he wanted me to be upset so I could be more easily controlled—so they could study my child’s rare condition. It may have worked partly. I resisted some of the tests that they put him through, but I cannot forgive myself that I allowed them to do two full CT scans on his head before 1 year of age. They said, oh look it is normal aren’t you happy? But I just looked at them. Didn’t they know that I had been numb inside for ages, just so I could continue to function and do what needed to be done? I hate to be a downer, but maybe it needs to be said.
    Maybe also it is true that in life some things are going to come along that are painful and bad and hard to deal with. Maybe caring about each other and helping each other as best we can is all that we can do.

  • nina

    OK, it’s me—the hospice nurse again. By law we have to tell you everything we know about tests and procedures. I would love to tell everyone that “everything is going to be OK.” The way that you approach challenges in your life will be the way you face your death. So, unless I know your “style,” I have to tell you everything that I know.

  • anonymous

    Dear Nina,

    NO state has a law that requires us to tell patients “everything we know about tests and procedures.”

    The only standard—and this is established by the courts, not the legislature—is “what information does a reasonable person require to make an informed decision?”

    This means yes, I should tell you that it is possible that the epidural will not relieve all your labor pain or even may not work for you at all, or that there is a 1% chance of severe headache afterward, but no, I should not tell you that IF you have an undiagnosed brain tumor with raised intracranial pressure and IF I accidentally puncture your dura with my needle you might herniate your brain and die.

    OK, that was extreme, but you get my point—the standard in my state is that if an event occurs less than one time in a thousand, it does not need to be included in the informed consent discussion. Of course, anything the patient asks should be fully and honestly disclosed.

    If I had to tell a patient “everything I know” about a test or procedure, the baby would be out before I finished. More importantly, a patient may be scared away from something they need because of fear of a very remote risk—the “worst case scenario” of ANYTHING, even something as benign as a blood test or x-ray, is DEATH. (e.g. small lesion found on routine CXR—> inconclusive needle biopsy—> open biopsy—> post-op complication—> death from what turns out to be benign lesion).

    Everything is a balance between risks and benefits, and the benefits must outweigh the risks.

  • Lisa

    What about preparing someone who is a hypochondriac or an excessive worrier? Can their imagination make a situation worse than it really is?

    Lisa: You always run that risk. I try to be as explicit as possible with my patients who I know worry excessively to try to limit their worry, always cautioning them not to let their imaginations run rampantly negative, as many do. When I’m discussing the risks of, say, a medication, I tend only to highlight the most common ones and try to be reassuring in whatever way I can (eg, side effects are mostly reversible, most people tolerate most medications just fine, etc). I think you have to know the person to whom you’re talking well to be able to make the best decision about how to prepare them for potentially unpleasant experiences.

    Alex

  • Kathi

    Alex, I just discovered your website and this is the second post I read. I very much enjoy reading your reflections, as well as others’ reactions to them.

    Like many people, Rhea and you discovered that an epidural during birth is no guarantee of an easier or pain-free birth. I encourage you and your readers to check out http://www.hypnobirthing.com if you are interested in learning about a completely different approach to birth that enables many women to enjoy a beautiful, gentle birth without medication or intervention.

    As you point out in this post, our mind’s expectation of an event can have a very powerful effect on our experience of that event.

    Gentle birth is not simply a refusal to use drugs or an effort to “cope” with the labor. As the HypnoBirthing website notes, “in the absence of fear and tension, or special medical circumstances, severe pain does not have to be an accompaniment of labor.” By learning and practicing deep relaxation and using affirmations and other methods to condition our minds to a different expectation of the birth experience, many women can birth “in an atmosphere of calm relaxation, free of the fear that prevents the muscles of [their] body from functioning as nature intended them to. In this calm state, [their] body’s natural relaxant, endorphins, replace the stress hormones that constrict and cause pain.”

    I write this not to invalidate the experience that many women have had of pain in labor, but to encourage more people to investigate another way of approaching their birth. As a woman who has had two babies without medication, and as a birth companion and midwife who has attended many births, I can tell you that gentle birth exists as a reality, and is worth pursuing. The typical approach of our society to birth, including that of most traditional childbirth classes, doctors and hospitals, doesn’t make it easy, however. If you keep an open mind as you read more about HypnoBirthing, you may be surprised at how logical and simple it really is.

    Thank you for your posts.

  • marcia

    What an interesting and diverse group of responses. All I know is after having two babies without medication, I QUIT. 😉 No, really, that was just all the family God gave me.

    Alex, I actually felt like I managed the pain better the first time around because I was so caught up into having a drug-free delivery—remember those days? Epidurals hadn’t been invented yet. If they had, I would have demanded six. At least. But I did feel like an athlete for the first time ever in my clumsy, bookwormy, girls-don’t-play-sports life. I was just amazed at what my body could do. I grew those big babies and then I fed them too. I gained tremendous strength & insight from their births.

    But with the second one, everything went wrong that could go wrong (failed non-stress test, immediate induction—I vote we remove Pitocin from the market immediately unless it is mixed with some tremendous painkiller because it sure does make it more intense), fetal distress at the end, crash carts all over the place, but all’s well that ends well. I went into birth #2 with the assumption that since I had a 3-year-old ten-pounder at home, baby #2 would just slide out, like at a playground. NO such luck. I guess after 3 years your cervix goes back to ground zero or something. Also, for baby #2, I had to stay up all night and this is never good for pregnant people. I was so exhausted.

    Nina, God bless you for the work you do. I sat for days and watched my mother die. But I made sure she had no unnecessary interventions. When it’s time, it’s time.

    And listen, Alex: Your mother is right. Wait till that precious baby turns 16! Your days of sleeping thru the night are O-V-E-R again! At least when he’s in the next room screaming, you know where he is. Oh wait….sometimes they do that at 16 too, or they just have music that sounds like constant insane screeching. Just like we did.

  • Jade

    I just found this site now; hope it’s not too late to post. I had a #4 scenario for my “routine” screening colonoscopy three years ago, and suffered PTSD as a result. Totally trusted my doctor, but he betrayed my trust by promising me I could be awake for the procedure and “watch the screen,” but then gave me a large amount of an amnesia drug BEFORE THE PROCEDURE EVEN BEGAN, passing it off as merely a “sedative” to relax. Never explained it to me. I lost memory of almost two hours afterwards and awoke in mid-sentence arguing with a nurse. I totally, completely freaked out, and experienced rage, insomnia, anxiety, and severe depression for months afterward. Doctor never apologized, although I wrote a letter to the endo center and spoke with him on the phone. Result: loss of trust in medical providers, fear of ever needing a procedure or surgery again. (What else do they hide from me ??) Life-changing experience for me. If I could erase one thing in my life, it would be that experience…

  • Barbara

    Whoa. The thing everyone is missing here is the use of pitocin. It can cause extreme, unnatural, intensely painful contractions. Been there. An unsupervised nurse laughingly turned up my dose. The consequences—placenta previa, an almost dead baby, and me feeling like I had been beaten up and abused. I never had another child. My beautiful girl did live. But I will never understand why my child and I were so disregarded and abused.

  • TW

    Now this wasn’t labor so it wasn’t 1/100th of what your wife went through … but I had a tooth pulled for the first time last year. The oral surgeon waved away my fear of pain and said a local shot would cover it and I’d have nothing but “pressure.”

    He came in, gave me a small shot, and waited five minutes. He started pulling and I let out a squeal. “Pain or pressure?” he asked. “PAIN!” I answered. “Are you SURE it’s not just pressure?” “Yes, quite sure.”

    He gave me another small shot and we waited five minutes. He came in, gave a big YANK and I let out a blood curdling scream. “Now you’re overreacting. That’s just pressure.” he told me. “NO!!! PAIN!” I answered. He actually got angry with me at this point and said, “I’ll give you ONE more shot but if that doesn’t work, I don’t know WHAT to tell you …”

    So at this point, he gives me a LARGE shot of Novocaine. He leaves the room and I start SOBBING. I am shaking all over and a nurse comes to me and comforts me and says, “It’s okay … it’s not just you. He’s not good with people.”

    So he comes back in. I’m STILL shaking and tears are running down my face and he doesn’t even acknowledge it.

    I felt him moving around in my mouth. I was waiting for another painful pull. And the next thing I know, they’re pulling the tray away and they’re done. As he walked out the door, he said, “Looks like there was a nerve wrapped around the tooth. You’re done.”

    They had me lay down in a waiting area and I went into shock. I was shaking and shivering and couldn’t stop crying. My husband came back and thought something catastrophic had happened. To this DAY, I blame the doctor. Why get angry over a patient’s pain? I would’ve accepted that I was being a baby about it but the “big” shot of Novocaine wiped out ALL pain … and then he tells me there was a nerve wrapped around?!

    Anyhow, my point is that I’m agreeing with you … be honest and upfront about what to expect. They came at me with “This is nothing. A little pressure.” Give me the worst case scenario and then I’ll be pleasantly surprised if it’s better. By NOT preparing me, I went into shock.

    I can’t imagine going through that with birth.

    TW: Sounds like it was a truly awful experience.

    Alex

  • Carmen

    All this talk about expectations seems a bit absurd. I had three children naturally. Oh indeed it was painful; however I researched the natural childbirth enough to know what to expect. I knowingly decided that I was having them naturally; my mother had 9 children all naturally. I do agree that the patient must be informed of their choices; however the patient must make an informed decision on how they want to proceed. I believe it is the responsibility of the patient to ask questions. What happened certainly does sound like an awful experience yet this could of been avoided if the patient would of researched a bit more. Unfortunately the doctor may have minimized what was going to happen; that was the first mistake; the next mistake is believing the the doctor’s decision is absolute…. lest we forget they are human and subject to error like all the rest of us.

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