The word kṛcchreṇa means “with great difficulty.” When the child comes out of the abdomen through the narrow passage, due to pressure there the breathing system completely stops, and due to agony the child loses his memory. Sometimes the trouble is so severe that the child comes out dead or almost dead. One can imagine what the pangs of birth are like. The child remains for ten months in that horrible condition within the abdomen, and at the end of ten months he is forcibly pushed out. In Bhagavad-gītā the Lord points out that a person who is serious about advancement in spiritual consciousness should always consider the four pangs of birth, death, disease and old age. The materialist advances in many ways, but he is unable to stop these four principles of suffering inherent in material existence.