On child birth

Double portrait, Lucian Freud, 1985-86

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An hour before the birth of our first child, the midwives had a changing of the guards, and we were assigned a new midwife. She wasn’t there long—she mostly gave Johanna some advice about breathing and told her to get up and walk around—but, Johanna says, “it was such a complete shift in my experience.”

Johanna

You could perhaps say that for most of that birth, I tried to suffer through it, while at the end she taught me techniques that gave me a deep sense of control. I noticed how much more manageable it became when I changed my practice.

Afterward, I remember thinking, “I could have done that better”—I could have done the first part better. When I notice something that can be improved like that, it is hard to resist—

Henrik

It is a mental disease you have.

Johanna

I get so much pleasure out of tweaking and improving things. I felt like giving birth again right away just to see if I could improve it.

Henrik

OK, so I would like to talk about that second birth.

For context to the readers, the second birth was that of Rebecka, in July 2021, a year after we’d moved to the island. I remember it as if you, more or less, delivered Rebecka yourself at the hospital, and you did it, I should say, without any anesthetics. There was a very primordial, animal kind of power to you that day; you were walking around, naked, with your eyes closed, rocking slowly back and forth. I mostly sat around reading a book by Valeria Luiselli and did my best to fight off a midwife you disliked.

For you, how was the second birth compared to the first?

Johanna

Well, the second one was, as you said, more or less a solo experience. I had contractions all through the night as I slept, and then I woke up at four as they were picking up in intensity. I remember it was still half-dark outside as I got up and started pacing around. It felt so good being the only one awake: complete focus.

I got my focus wrong the first time. I had only watched a single birth video before Maud was born, and that was of an influencer who gave birth to her first child… She had music on and filmed the whole thing and joked around—there was a certain mood which was, well, it was pleasant and fun, but it sort of gave me the wrong idea. I remember I felt like I was supposed to talk to you and be excited about what was about to happen, and so on. But that was not what I needed. I needed to be completely tuned into my body.

The second time, I felt very strongly that I didn’t want to scatter my attention. This was also one of the reasons I wanted to minimize talking to the midwives: it distracted me from the actual work.

Giving birth is the most painful thing I’ve ever been through. And it’s a very particular kind of pain: that you stand there waiting for the contractions. You know it’s coming, this pain that just fills you to the brim. It is coming, again and again. And you have to face the pain, you have to turn toward it, you can’t look away. If you tense up and try to crawl out of the pain, it gets much worse. You must not let yourself get scared of it. You have to relax and welcome it.

Doing this, for me, required all the focus I could muster. I couldn’t talk to others; I couldn’t do anything but turn my attention inward into my body.

I was sick during my first pregnancy, and was busy dealing with all that, so when I gave birth the first time my understanding of births was as if I had been living under a rock. I had no idea what happens in the body. I was just letting the hospital lead me along, which was, in retrospect, not a great idea. But the second time, I had prepared better and had learned about how various hormones regulate the birth process, and, most importantly, how I could help the process along by regulating which hormones flooded my system. I had the understanding that you can, to a very large extent, help the body do its work better—primarily by minimizing stress and fear and, conversely, by boosting oxytocin, which is the engine of birth.

Henrik

What do you mean when you say oxytocin is the engine of birth?

Johanna

Oxytocin helps orchestrate the contractions. As it builds up in the body and the uterus becomes increasingly receptive, the contractions become stronger and stronger. But some of the hormones related to stress and fear inhibit oxytocin. So if you experience stress or fear, your contractions will often grow weaker and less coordinated, slowing the labor, sometimes stalling it.

The bleeding I experienced after I gave birth to Maud was, I suspect, connected to this. Oxytocin also regulates the expulsion of the placenta and helps the uterus contract and close up the wound, but after Maud was born she stopped breathing and turned blue, and the midwife ran out with her, and you ran out too—I didn’t know what was happening, or if she was going to make it—so I got very, very stressed. Hence, my oxytocin levels collapsed and I couldn’t close up the wound and stop bleeding. It is interesting how feelings have real consequences like this.

Henrik

How do you boost oxytocin?

Johanna

Generally by feeling safe. All things cozy; warmth, keeping the light down, and so on. This was another reason I wanted to minimize my interaction with the midwives: when I’m around people I don’t know well, I can’t help but put on a more polite mask, and the feeling that gives me is not cozy. I wanted to be in a cocoon that felt extremely safe and calm, I wanted to be completely relaxed.

I remember when we first got to the hospital, I had decided to take a bath (because warm water is good for oxytocin). But you remember what happened in the bath… We didn’t have a shower at the time, since we were renovating, and I guess I hadn’t been to the sea much that summer since we didn’t have a car and I was too dizzy to get around… To quote Marcus Aurelius’ description of his bath water, it was “oil, sweat, filth, dirty water, all kinds of loathsome stuff”. It was as if the water peeled off an inch of my skin. It looked disgusting! I got really stressed thinking the midwife would walk in on me. What would they think? Seeing everything that was floating in the water. I realised I needed to get up immediately, to get rid of the stress.

Later, when the midwife came in and wanted to chit-chat about all sorts of things unrelated to the birth, I asked her to leave the room. That sort of thing does not come easily to me, but I had prepared myself mentally to be ready to do things that were uncomfortable to me, in order to protect my cocoon without getting stressed.

It made a really big difference being so disciplined about making it feel good for myself. Another thing that was much better the second time—I learned this from the good midwife—was that I stood up the whole time. When I stood up, I could more easily follow the body compared to when I lay stiffly in bed. It is rough having contractions while lying down. But when I stood and rocked back and forth, it was like an anesthetic, the movement itself. I stood up the whole time during the second birth. Except when we were in the car and the last ten minutes.

Henrik

One thing I want to pick up on here is that it is really cool with the newer generations of mothers who have access to so much more information, who’ve watched a bunch of videos of births beforehand, who can read blogs and ask questions to LLMs, and who understand what’s happening on a much deeper level. You are not as dependent on the midwives and authorities anymore; there is a sense of empowerment and control.

Johanna

When my best friend, Rebecka (who our youngest is named after), gave birth to her second child the other day, it went really fast, as you know, so she didn’t have time to go to the hospital and ended up giving birth with her boyfriend in the bathroom at home. She was so cool. When the baby’s head had come out, her boyfriend saw that the umbilical cord was wrapped around the baby’s neck. He told Rebecka and sounded a bit scared. But she said—and felt—that it’s nothing to worry about, you can just slip it off afterwards. She’d seen it in a bunch of birth films she watched beforehand, and also seen midwives who removed umbilical cords while just the head was sticking out, or once the baby was fully out. Of course it does happen that a baby is badly tangled up. So it’s not that you should brush it off. But I just thought it was cool that she’d seen it on video so many times, that she knew that the usual thing is that you can just slip it off. If you don’t know that, I assume it’s easy to get scared because it sounds very brutal, having the umbilical cord wrapped around the neck.

Doing your own research gives a sense of control, which is calming.

Henrik

It was a bit hard for the midwives to read the situation, though, because you were so self-reliant. You seemed too calm and collected.

Johanna

I knew I was progressing quite rapidly, but they didn’t understand that because they weren’t trying to gather that kind of information—how I was experiencing it, how it was changing for me. They just went by how many centimeters I had dilated. An hour before I gave birth, they thought I had stalled. But it was obvious to me that I hadn’t. I could feel the head moving down.

The earlier contractions had been very manageable. As long as I was up, moving about, and stayed focused on what was happening in my body, relaxing and breathing calmly, they were fine. But the later contractions… They really tested me. Now I got to see if I had the mental strength to handle it. I had to lean fully into technique and continuously do what felt right in my body. I had these affirmations that I repeated to myself. That “this pain is helping the baby out,” and to “welcome the pain”: “it is a good pain, it is not a pain to be afraid of.”

The head was moving down fast. I knew that I was about to give birth. But I couldn’t talk. I was standing by the sink in the toilet. And I couldn’t figure out how to tell you she was coming. I was just so deep inside myself. I remember thinking, “I have to pull myself together so I can tell Henrik I’m about to give birth.” A minute earlier, the midwife had been talking about giving me a contraction-stimulating IV drip—she wasn’t even on the right tennis court. And now, she’d gone out because she thought I wasn’t ready.

Henrik

As context for the readers, you somehow managed to communicate that you wanted me to lead you to the bed. Though I didn’t know you were about to give birth. Sitting across from the bed was this very young medical student who was in there to observe. It was the first birth she’d ever seen, and I remember thinking she was getting quite a demonstration. You were like an animal. I was pressing on your back to relieve the pain, so I didn’t see much… but I heard the medical student jump up from her chair and run out of the room—she’d suddenly seen the top of Rebecka’s head.

Johanna

I had heard that Gudrun Schyman (the former leader of the Swedish Left Party, a colorful woman, to say the least) had said she thought it was a great experience when the pushing contractions started because then she could do something productive, then she could use the pain and the contractions for something. That was my experience too, that it was a kind of liberation, also because I understood I was close to giving birth.

But of course, it’s not like this for everyone. Our friend Jenny got scared of the pushing contractions and stalled. Again, how we feel really affects birth. They had to give her a labor-stimulating drip, and that got so intense: these uncoordinated, pulsing contractions with no rest. In the end she had to push the baby out mechanically, pure force.

But if you manage to stay completely relaxed through it all, there is this thing that can happen, which I experienced during the second birth, which is called the fetal ejection reflex, where the body just totally takes over and pushes the child out on its own. You don’t tell yourself “now, let’s push.” The body just does it all by itself; you breathe out the baby. All you need to do is breathe deeply so as not to rush it. It was an incredible experience.

Henrik

It is a little like an orgasm? That you do a bunch of work to get yourself to that state, but then you lose control—

Johanna

Well, it feels a little different.

Henrik

I get that…

Johanna

I feel like giving birth taught me a lot about how to manage myself. It made it visceral to me how important it is to shoulder the full responsibility for your problems and to gather the information you need. This is good to have in your bones in all sorts of situations.

It is always useful to deepen your understanding, to maintain a sense of control. It is always useful to train your ability to accept what happens, especially when it is not what you wished for or planned.

And also: to accept that it can be hard to accept.