Pain in Childbirth by Victoria Stumpf, ICCE, Doula
PAIN: Webster’s Dictionary defines pain as “physical or mental suffering”. Normally, pain is a message from your body to do something–remove your hand from the flame, pull your foot off the object you have stepped on, etc. Ordinarily, it is a stimulus telling us that something is wrong. Pain in labor (childbirth), however, is an exception. It is the one time that pain is not the symptom of a problem and when muscular tension is a negative response rather than a helpful one.
Some examples of the various reasons for pain during childbirth:
1) IF THE UTERUS IS SHORT OF OXYGEN, this may cause more cramping or pain. Any muscle aches when insufficiently oxygenated. In labor, this may happen when there is not enough time between contractions for the uterus to receive plenty of oxygen to replenish the uterine muscle. You can correct this by: a) breathing slowly and fully between contractions, b) beginning and ending every contraction with a deep cleansing breath, and c) breathing in an easy, relaxed manner during contractions.
2) IF THE CERVIX IS SLOW TO OPEN. The baby’s head presses through the cervix as if a tight sweater were being pulled over it. The cervix is very flexible and will open up more and more, but this takes time and most women find the stretching uncomfortable or painful.
3) IF THE BABY IS IN A POSTERIOR POSITION. Labor with the baby in an occiput-posterior position (the back of the baby presses into the mom’s lower spine) can cause back pain. It can be very painful and tiring because it may take a long time for the baby to turn to the proper anterior position. Use the class manual for reminders of the techniques for coping with back labor or back pain, and try any of the following: a) change positions frequently–walking, hands and knees leaning over a birth ball, kneeling or sitting while leaning forward with support, sitting on a birth ball, to name just a few positions, b) pelvic rocking–standing, all-fours position, or passive with the partner doing it for you, c) stand or sit in the shower and direct hot water on her lower back, d) sit in a Jacuzzi bath, if one is available, e) alternate between hot and cold packs on her lower back as demonstrated in class, f) try the Double Hip Squeeze technique, the Lunge maneuver, the Dangle position, or Squatting for longer periods of time, g) apply a firm counterpressure on her lower back, h) utilize massage techniques such as those demonstrated in class, and i) use any massage tools such as a tennis ball or “Mr. Happy” wooden spider from Bath and Body Works that give her some back pain relief.
4) THE PHYSICAL SENSATION OF THE BABY’S ROTATION AND DESCENT THROUGH HER PELVIS. The hormones of pregnancy have a lubricating and softening effect on muscle, tissue, ligaments and joints, which helps during the birth. However, some babies are large and it take time for them to squeeze through their mother’s pelvis. Some techniques to remember: squatting, pelvic rocking, and changing positions frequently. Remind her to keep her bladder empty so that it doesn’t impair the baby’s descent. Use gravity whenever possible, and avoid laying in a prone position for long periods of time. Remember to alternate between rest and activity. Above all…..have patience…..the baby will create the labor he/she needs to be born.
5) PRESSURE ON THE URETHRA AND BLADDER. The pressure of the baby’s presenting part (usually the head) on her bladder can be quite painful. It is important to keep her bladder as empty as possible. She should urinate at least twice an hour-more if she is on an IV- to make sure that a full bladder is not contributing to the pain she is feeling.
How she feels EMOTIONALLY about what is happening in her body is just as important as what is occuring physiologically. Negative feelings can intrude and make the labor seem more painful. Some examples:
***If she is not prepared for the sensations of labor or is demanding a great deal of herself, she may create a struggle to keep control of a labor that she feels is *out* of control.
***If she is sure that labor will be extremely painful, she may get into such a state of tension very early in labor that even the slightest touch will hurt.
***If a labor is very long (twenty hours or more) and she is suffering from lack of sleep, she may feel sensations strongly. Labor demands energy and stamina. Lack of sleep can make her feel more emotional. She may feel very vulnerable. She needs plenty of love and comfort to sustain her. She needs reassurance and positive affirmations.
***If she is in an environment or with people whom she does not like or trust, her feelings can intrude on the birth process. She may feel pressured to perform according to a set time schedule or she may feel controlled by medical interventions or hospital personnel making decisions as to what she should or should not be doing. Her uneasiness may make her unable to relax or use comfort techniques taught in class, causing her to feel out of control and in more pain.
***If she has not allowed herself to believe that some parts of her labor may be extremely painful, she may feel overwhelmed or unable to cope. It is not unusual for a woman in labor to think, “something must be wrong-this sensation is too powerful!” Remind her that her body knows what to do…her body sets the pace and rhythmn of labor. Encourage her verbally, and try to help her stay on top of each contraction, while staying relaxed in between the contractions.
***If she has not learned and PRACTICED ways of handling pain by herself as well as with her partner, she is then left at the receiving end of very strong sensations that she may feel ill-equipped to handle. Solution: Practice the techniques learned in class and read the manual and hand-outs in the final few weeks of her pregnancy.
OTHER FACTORS INFLUENCING PAIN PERCEPTION:
1) FEAR AND ANXIETY: Fear that pain may be overwhelming, or worries about her threshold of pain tolerance can build up in the final weeks or months of pregnancy. In labor, fear and anxiety can trigger the release of excessive stress hormones (epinephrine and norepinephrine), which can sometimes lengthen her time spent in labor.
2) CULTURAL INFLUENCES: Attitudes and ideas presented from family members, friends, peer groups, television and movies regarding pain during childbirth can influence her perception of pain and cause her to doubt her tolerance for dealing with pain. Reading up on birth stories in childbirth books and magazines can give her an honest perception of how birth is different for every woman, and demonstrate the idea that each woman copes with pain in different ways. The library or local bookstores provide an endless resource of childbirth books. Our class manual and handouts are also a good resource to help her feel more knowledgable about all aspects of birth.
3) THE DEGREE OF PAIN tolerated bears a direct relation to the *rate of increase of pain*, rather than the *level of pain reached*. Rapid labors, induction or augmentation of labor by artificial means are examples of situations that may affect her ability to cope with pain. In each of these situations, her partner and Doula (if she has one) can step up the comfort measures (see below) to help her cope.
4) HOW WELL-RESTED SHE IS WHEN SHE BEGINS HER LABOR affects how well she is able to cope. It is important that she stay as well-rested as possible in the final few weeks of pregnancy, since you never know when labor will begin.
FACTORS WHICH DECREASE PAIN PERCEPTION/ COMFORT MEASURES FOR LABOR:
*Support Person(s)/ Partner with her throughout labor
*Hire a Doula as a second Support Person
*Medical Personnel (Doctor, Midwife, Nurse) that are supportive of her wishes and encouraging her to do what she wants or needs to do to stay comfortable
*Physical and Emotional support, Verbal Encouragement
*Confidence, belief in her body’s ability to give birth
*Frequent Urination (at least 2x each hour)
*Relaxation and Breathing Techniques
*Back Rubs, Massage
*Jacuzzi (if one is available)
*Pelvic Rocking (Standing, Hands and Knees, Passive w/Partner)
*Alternate between rest and activity
*Heat or Cold Packs (Alternate)
*Cool cloth on face, neck
*Gymnastik Ball to sit on or lean over
*Pregnant woman well-hydrated (ice chips, clear fluids) and nourished
(Copyright: Victoria Stumpf, ICCE, Doula- 1996)