The Birth Pleasure Study

Pleasure as experienced in birth has not been the focus of rigorous qualitative or quantitative investigation. The Birth Pleasure Study was designed to address this gap as the first-ever mixed methods study of pleasure as experienced in the birth process. This research centered the lived experiences of birthing people. Through mixed methods, nuances of sensation and factors that supported and hindered pleasurable birth experiences were explored, as well as the impacts these experiences had on birthing people, their sexuality, and their wellbeing. Throughout, a critical and intersectional feminist lens and a biopsychosociocultural framework was applied.

First, I conducted 23 in-depth qualitative interviews with participants over 18 years of age who reported having experienced birth pleasure. Participants hailed from a variety of racial and cultural backgrounds, socioeconomic statuses, genders, and sexual identities. Participants were located across the United States and two participants were abroad, in Israel and England. I performed preliminary analyses and developed a coding structure for content and thematic analyses, for which I used NVivo software. Pleasure and pain experiences interacted dynamically in birth, in what I call a Birth Pleasure-Pain Spectra. I use the plural “spectra” because, based on these data, I do not locate birth pleasure and pain on either side of a single spectrum. Rather, I see birth pain and pleasure as two overlapping, dynamically related, and multifaceted spectra.

A typology of pleasure emerged from the interviews that included emotional, mental, spiritual, physical, and sexual aspects. Some participants also reported pain-free birth experiences without the use of analgesia. Maternal age, birth setting, and parity, and the degree of medicalization and de-medicalization of the birthing persons’ approach to birth, all patterned their experiences of pain and pleasure. Generally, births in hospitals were less likely to be pleasurable across the typology of pleasure and less likely to be pain-free. Pleasurable and pain-free birth occurred in all birth settings, across parity (primiparas and multiparas) and all demographic factors such as race, class, and gender identity. Sociocultural aspects, such as race and gender identity, seemed to call forth different strategies for creating a protective relational space around the birthing person. These efforts were intensified for those facing intersecting oppressive pressures of racism, sexism, classism, cisheteronormativity, and more. Birth pleasure experiences had varied impacts on sexuality postpartum: for some, enhancing sexual well-being, and for others having little to no impact in the face of other postpartum issues such as perinatal injuries or relationship changes.

The preliminary analysis of qualitative data formed the conceptual foundation for the quantitative phase of the study. I designed a survey instrument based on the qualitative findings, which was then pilot tested with willing interview participants and refined with their feedback. The result was The Birth Experience Survey, an exploratory, non-probabilistic, convenience sample online survey. Any consenting person over 18 who had ever given birth was welcome to participate. In all, 1781 people responded to the survey, of which 779 (49%) had experienced birth pleasure. Those affirmative respondents briefly described their experiences, resulting in 578 individual experiential accounts, which I also analyzed using NVivo. In sum, 406 (70%) reported emotional pleasure, followed by 360 (62%) mental, 116 (20%) physical, 35 (6%) spiritual, and 23 (4%) sexual pleasure. Eighteen respondents reported pain-free births without the use of analgesic medications (3%). Quantitative survey data addressing experiences of birth pleasure were analyzed in SPSS for descriptive statistics and crosstabulations. In terms of birth setting, 70.7% of pleasurable births took place in the hospital, followed by 20% at home, and 9.1% in birth centers. The most common types of pleasure experienced were emotional (98.9%), followed by mental (91.8%), spiritual (76.9%), physical (61.3%), and least common, sexual pleasure (14.5%). Overall, the most types of pleasure and most intensely rated experiences of pleasure were reported by those who gave birth at home. Across all pleasure types, birth pleasure was “not experienced” most frequently in hospital settings as compared to other settings.

Synthesized from these mixed methods data, I constructed the pleasure-forward birth model, with applications for biological, psychological, and sociocultural understandings of birth. Based on the findings of this study, I conclude this dissertation with recommendations for birthing people, birth care professionals, researchers, and birth justice advocates and activists.