I have framed the birth puzzle in terms of pain avoidance, but in fact, for the longest time I wasn’t quite sure whether labor was actually painful. As a child I asked my mother about it many times, and got a rather hard-to-follow story about a frantic rush to the hospital and the feeling of a powerful vacuum cleaner sucking me out of her body. "Yes, but did it hurt?” I would ask over and over again, but I never got a plain answer.

In the movies, women scream their way through childbirth, but is that just a cliche? Following natural childbirth, my friend Susan spoke of an amazing experience. "Did it hurt?” I asked. She steadfastly refused to say that it did, though she let on that the experience was a challenge. On the other hand, a close friend called from Atlanta, still traumatized the day after her first child was born. After fourteen hours of fruitless labor, Jenny had needed to be "induced” with the drug Pitocin, and she eventually had an epidural. The tale of the lead-up to pain relief so consumed her twenty-four hours later that she was still talking much more about the ordeal than about her baby.

After a few months of pregnancy, I was still open to the possibility of natural childbirth, but my ob-gyn set me straight. I would have to have an epidural to be ready just in case anything went wrong. If the delivery became problematic, the epidural would allow for a quick C-section. Many obstetricians insist on Caesarean deliveries for twins, so I was grateful I was at least going to attempt a traditional birth.

At twenty-seven weeks (two months early) I went into premature labor and was ordered to check in to the hospital—for good. Two weeks later, my contractions started up again and I spent the morning in Labor and Delivery receiving a cocktail of powerful labor-i nhibiting drugs to stop the process. My doctor kept making trips between my room and the adjacent one where someone was giving birth. Unfortunately, she forgot to close the two doors in between.

The woman in the next room was an Orthodox Jew and this was Saturday, the Sabbath. Earlier she had thought her baby was on the way, so she and her husband had come to the hospital on foot, because of Sabbath rules. Unfortunately they had come too soon and had been sent home. When the woman returned to the hospital, she took a taxi, but her husband didn’t have a medical problem himself, so he had had to walk to the rabbi’s house to ask if he could take a taxi as well. Unfortunately, the husband hadn’t made it to the hospital on time. So there was special stress involved in this birth.

I have never heard a more harrowing sound than this woman’s screams. It was the howling of an animal, the scream of someone being cut in two with a saw. In my childbirth class, which I attended only once before my incarceration, I had been introduced to the technique of imaging. Each woman was given a laminated photograph of a beach or a mountain scene. We were taught about relaxation and breathing. Could this woman’s ordeal have been alleviated by a present and attentive husband, a photograph, and deep breathing? I would think not, and my doctor was skeptical too.

So yes, natural childbirth can be very painful. What does it tell us that people choose to go through it? That they don’t anticipate the pain that awaits them? That they have made a rational calculation that they will enjoy the greatest balance of pleasure over pain even if they pass up pain medication? That people are irrational? Or that things matter to people besides pain and pleasure?

The woman in the next room was giving birth to her sixth child, so I don’t think she opted for natural childbirth out of ignorance. Nor—to be clear—is there any religious mandate for Orthodox Jews to avoid pain medication. Do those who choose natural birth think the pleasures of unmedicated birth will exceed the pain, making them pleasure maximizers after all? This could be their thought, but I doubt it. Rather, they appear to attach value to things other than pain and pleasure. They put up with pain because they must, to secure something they regard as tremendously important. But what?

No, I wasn't pondering such questions at the time of my early labor; I was too agitated due to the drugs I had been given, and too preoccupied with whether I was going to deliver two extremely premature babies. And I was starting to be flat-out terrified of giving birth down the road—hopefully a long way down the road. But later on I thought some more about the pain question. Why would anyone put up with more pain, if they could have less?

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