Pain - It's all in the mind........No, I don't mean you're a big jessie if you so much as whince at a contraction, what I mean is that the state of your mind has everything to do with how you will cope with the pain of labour.

The way I see it is there are 2 ways to look at the pain of childbirth:

1. ELIMINATE IT - I hate pain, I'm no good with pain, I have a really low pain threshold, I want as many drugs as they can throw at me the minute I feel a mere twinge.

or

2. ACCEPT IT - If I was Mother Nature, perhaps it's not something I would have included so enthusiastically in the package, but the pain is there for a reason, your body is actually designed to cope with it, so I'd better just deal with it, go with the flow & not resist what my body wants.

Midwife Nicky Leap puts this much better than I have just done.

If you think you're more like number 1, I can't really blame you. From since we were little girls, we've been led to believe that childbirth is some hideous, frightening, brutal business that unfortunately you're forced to endure if you want to have children.

And it's not surprising - from the minute hospital birth became normal more than 50 years ago, a brutal birth is what our mothers have had to suffer & the fear & loathing has been passed down through the generations.

Unfortunately, hospital birth has changed little in the past 40 years - OK, so they don't shave you or give you routine enemas anymore & you're far more likely to encounter the surgeon's knife with a caesarean these days, but apart from that, it can be as terrifying now as it was back in 1970. So, if you're still determind to choose the Elimination route, good luck to you - because if you hand yourself over to pethidine, diamorphine or an epidural, with all their side effects & likely complications, you're going to need it.

BUT your birth doesn't have to be like that. And this isn't about getting-it-together with nature either - it's about basic common sense.

Frankly, if a pain-relieving pill was available that I could take when the going got tough, that had no side effects for either myself or my baby & that wouldn't intervene with my mobility & ability to adopt birthing positions, then I'd be the first in the queue to take it. But unfortunately, even in the 21st century, such a drug does not exist - we have a pretty bum deal when it comes to pain relief in child birth & all of the drugs available have their largely unpleasant side-effects, some of which are pretty serious. So therefore, I believe it's best to face facts (child birth usually involves pain) & deal with it (find a number of ways to cope with the pain).

It's also worth bearing in mind that your body was designed to grow a healthy baby - and for 99% of women, that's exactly what it does. It follows, therefore, that your body was also designed to expel its cargo effectively when the time comes - and again, 99% of the time it will do just that without complications (and if you don't believe that statistic, please read Ronnie Falcao's inspiring account of her training).

Childbirth Consultant Andrea Robertson has written this fantastic article which explains what pain is, why we need it during labour & all the normal amazing functions of the female body. And journalist Joanna Moorhead has written a great article about her experiences of pain in childbirth called 'Epidurals are for wimps'.

A degree of pain is all part of a perfectly normal process but there are loads of things you can do to keep it in perspective & under control. For starters, you could do alot worse than visit Dr Bill Sears's web page with some fantastic pain-relieving tips. Dr Bill is a legend (see book section) and not only explains the physiology of pain during labour, but also offers 15 ways to tackle it - in the meantime, here are a few tips of my own:

1. Learn relaxation techniques - yoga, hypnotherapy & hypnobirthing can help some people as can choosing an out-of-hospital birth. If you think positively about your birth, you're more likely to have a better experience. Surf the pain wave, don't fight it & make a birth tape of all your favourite songs - singing along at the top of your voice can really help to take your mind off it. It's so important to listen to your body during labour - breathing techniques can also help, but that silly puffing & breath-holding they teach you in hospitals really ought to be avoided - not least because it restricts your baby's intake of oxygen. One recent study conducted in the United States has even suggested that being told to push by hospital staff is a 'technique' that's only been around since the 1950s & that for most normal labours it is advisable NOT to push, but to relax, listen to your body & breathe your baby down gently. It is understood that the call to 'push' came about because Drs believed it shortened labour, however, this study found it actually lengthened the second stage by an average of 13 minutes. Hard pushing is also very bad for your pelvic floor - no matter how many squeezes you've done whilst pregnant (after I had my baby, it was at least 6 months before I could sneeze with confidence!).

2. Eliminate fear - frankly, what's there to be scared of? Hospitals generally put the fear of god into most people - they're alien environments which do little to relax you, so choosing an out-of-hospital birth either in a midwife-led birth centre or at home might be the best thing to put your mind at rest. Also read Grantly Dick-Read's Childbirth Without Fear (especially the very powerful bit about 'it wasn't meant to hurt') & don't forget to get stuck into a load of Sheila Kitzinger's excellent works.

3. Choose the right carers & put your trust in them - there's nothing worse when you're in labour than a personality clash with a midwife - they can completely throw you off your concentration & relaxation. Think seriously about who is going to be present at your birth & whether they are going to help the situation or hinder it - and that includes partners, friends & mothers. Plus it's worth bearing in mind that if ANY health professional arrives at your birth who you don't like the look of (Midwife or Obstetrician), you have every right to request that they leave. They will be replaced by another who you will hopefully get on with. Having the right support has been proven to shorten labours & decrease the need for pain killing drugs.

4. Alternative pain control - Most anaesthetists will laugh in your face if you mention TENS machines, water births & aromatherapy, but they do work for some people. When the contractions get particularly powerful at least the TENS works as a lovely distraction.

On the subject of TENS, I read recently in the AIMS journal that "the Brits are the only ones to use TENS machines, due, Andrea Robertson thinks, to excellent marketing. Women think it has helped (it apparently creates a placebo effect) but Andrea says the real mystery is why women are so prepared to sell themselves short & give credit to a machine. Could this be the result of modern woman's obsession with technology?".

But probably the best & most documented form of alternative pain relief is to labour and/or give birth in a birth pool - the benefits are HUGE. I can personally endorse this after giving birth to my daughter at home in water in May 2007.

- The Water Birth Book by Janet Balaskas was my bible when I was pregnant with my first child & in labour - it's a must for anyone wanting to use a pool - I even photocopied pages & had them stuck into my notes for midwives to browse at their leisure.

- This AIMS article tells you all about the benefits of giving birth in water & how you can go about arranging it - especially if you meet with opposition from the medical profession.

- The Home Birth Reference Site provides some brilliant advice about home water birth & at the bottom of the page are some really useful water birth stories.

- The Good Birth Company is a good place to hire a pool if you're planning on staying at home - at least that way you have exclusive access & it gives your partner something to do in between back rubs. Lots of companies do it, but this was the one I used & thought they were brilliant & very resonably priced.

- A cheaper alternative is to puchase your own Birthpool in a box available from the NCT professional website & priced under £60. Good to use as a paddling pool after you've finished all your huffin' & puffin'.

- Even the Royal College of Obstetricians & Gynocologists say it's OK!!!

- And here's what the Royal College of Midwives also has to say on the subject.

Now I've said all that, I just wanted to add that because pain is a highly subjective experience, there's no way of telling whether one person experiences the same level as the next. Therefore, if you make an attempt to get through a normal birth with mininal pain relief, but for whatever reason feel that you can not go through with it, there's nothing at all shameful in asking for stronger pain relief. Again, it's all about informed choice, informed decision making & woman-centred care.