18 March 2008

Being realistic about labor pain

ScienceDaily (Mar. 17, 2008) — A pain-free and drug-free labour may be many expectant mothers' dream but a review in the open access journal BMC Medicine reveals that reality hits hard. Most women's labour experiences differ markedly from their expectations. They are often ill-prepared for what might happen and consequently may be disappointed when the birth does not "go to plan".

The study's authors conclude that antenatal programmes should "get real". "People involved in antenatal care should listen to women's hopes for labour whilst also preparing them for what might actually happen during labour," said Joanne Lally of Newcastle University, who led the investigation. "Plans for a labour free of pain relief need to be complemented by preparing women for the possibility that they might need pain relief. Education can help to fill the gap between expectation and experience and thus ensure women are realistically prepared for their birthing experience."

The research team from Newcastle University studied published literature on women's expectations and experience of pain and pain relief in labour. They found that a gap exists between expectations and experience in four key areas: the level and type of pain, access to pain relief, the level of participation in and control over decision--making, and the level of control during labour.

Most of the literature reviewed showed that women underestimate the intensity of the pain they will experience and sometimes hold an unrealistic ideal for a drug-free labour. Indeed, in one study, more than half of the women interviewed who said they would not use pain relief actually did use it.

"Our analysis highlights the importance of antenatal education. It can empower women to have realistic expectations and make informed decisions," notes the author.

"If women can be better educated they can express their preferences but also be aware that things may not always go to plan. They can then be prepared for different eventualities and so make more realistic decisions and have a better experience."

Birth plans or other decision aids can assist women when making decisions about pain relief in labour, but evidence suggests these are not widely used. Recent guidelines published by the National Institute for Clinical Excellence (NICE) call for more research into how health professionals can effectively support pregnant women in making informed decisions about labour.

Journal reference: More in hope than expectation: Women's experience and expectations of pain relief in labour: A review. Joanne E Lally, Madeleine J Murtagh, Sheila Macphail and Richard G Thomson. BMC Medicine (in press)

Adapted from materials provided by BioMed Central, via EurekAlert!, a service of AAAS.


1 comment:

Anonymous said...

I read that women experience pain differently. This is an odd statement. Each labor is different as not one child is exactly the same. Personally I do not believe pain differs. The nerve endings fire and the signals ascend to be interpreted. The faster and more intense the stimulus, the more pain produced. this is an area where the baby can be affected, so the woman's pain control is not the major concern. They merely wish to take the edge off things and avoid anything that passes to the fetus. So yes there is lot's of pain and no-one intends to control most of it. Be honest and tell them this. One thing, if something hurts tissue is damaged. If the pain response is too high, there may be a problem. A fatigued or stressed mother will not be able to muster as much control to tolerate high pain levels. Heavens with contractions some women develop muscle spasms, and if you compare to an athlete that is running hard and long, this indicates electrolyte shifts and changes in chemistry. Anoxia or changes like this are not healthy or good for the person. Anyway for pain, there is not reason to muster conversation, it hurts, it will not be fully controlled if the interventions are not fully discussed prior to the labor. End of story.