Factors that play a role on how we perceive pain during labour and birth

The physiological process of labour and birth and how a woman experiences her pain is very subjective and uniquely individual. Each woman’s understanding and perception of her pain is hers alone.

For many women the pain of labour is hard but manageable. They may have used various natural methods of pain relief, relied on their body’s own inbuilt ‘control systems’ and mental determination, as well the support from their partner or caregiver(s). Perhaps these, in combination with utilising their specific personal coping strategies, made their labour a positive experience, although admittedly painful and demanding to deal with at the time.

For other women the labour pain becomes all consuming and overwhelming. Perhaps concerns about the pain before the labour made them feel anxious, as the contractions began or the labour ended up being long or complicated, or was induced. Perhaps the labour was nothing that the woman had anticipated or expected. Or the woman had no interest in experiencing labour pain at all, seeing it as an unnecessary experience to be avoided if possible.

Some women will find the pain of their labour easier than expected. It may be that they are surprised at how well they tolerated the labour. The pain may be described as very tolerable or merely uncomfortable. Occasionally a woman will relate to her labour as being ‘virtually painless’ and in rare cases ‘orgasmic’ and pleasurable. All the latter experiences are possible, but are usually the exceptions to the ‘physiological rules’.

These factors can also be individually influenced by the woman’s past, personal experiences of other pain felt in her life, her interpretations of other women’s birth experiences and her beliefs about her ‘pain threshold’. Expectations placed upon her and those put onto her from others, can also have a bearing, as well as social attitudes and cultural beliefs.

Let’s look at:

• Society’s Attitudes
• Fears and Concerns
• Expectations

Society’s attitudes

Society’s attitudes to labour pain are quite diverse, along with the many different philosophies on how best to deal with the pain of labour. Some people view labour as a natural process that generations of women have tolerated for centuries. Part of this usually entails the view that medical forms of pain relief expose them (and their babies) to risks and side effects they would prefer to steer clear of. These women often find that sharing their choice about having their baby in a birth centre or at home for these reasons, draws a response of, “Oooh you’re brave!”

Others see labour as an unnecessary pain experience to be avoided if at all possible (one common comment heard is “Well you wouldn’t have ‘natural’ dentistry would you?”) They often see medical forms of pain relief as positive interventions, ‘wonders of modern technology’, wishing to “take anything that is available, thanks!” Sharing their views may draw the response of “Do you know the risks you are taking when you accept those things?”

Many women will view their labour pain as somewhere in between these ideas, taking a “See how I go” approach. It may be that they do not want to have medical forms of pain relief unnecessarily, but are open to accepting some or all of them under certain circumstances.

 Pregnant women (and their partners) are inundated with society’s attitudes and opinions throughout the pregnancy. Often they will receive unsolicited advice or ‘pearls of wisdom’, from friends and relatives (or even total strangers), about how their labour pain should ‘be’. This can leave the pregnant woman feeling upset, bewildered, angry, or anxious, and sometimes excited and motivated (if positive attitudes are shared).

There is also the consideration of caregivers. Professionals who care for women in labour are human beings in our society as well. When they go to work, they take with them their own beliefs and attitudes about the pain of labour and how it should be managed.

These may be influenced by:

• Their professional backgrounds and qualifications
• The attitudes of their working pears and doctors
• The methods they and the facility they work in, routinely use to manage women in labour
• The birth facility they chose to work in
• Subconsciously, their decisions can be influenced by their own birth experiences (or their partner’s) if they have had any children, and how this was managed, as well as past experiences and attitudes to their own physical pain in their lives.

Fears and Concerns

Many women anticipating their first labours will express concerns about the ‘unknown’ of what their labour could bring. They may go through phases of worrying about the numerous ‘What ifs?’ sometimes filling their minds at 3am in the morning!

Some common concerns about labour pain can include:

• Not knowing what their pain threshold is
• What if I cannot do it?
• What if it goes on forever?

For women having a subsequent baby, fears may revolve around the ‘known’ and not wanting to have a similar experience again (if the last labour was a negative experience).

What can women do with these fears and concerns (if anything)? Should they be ignored and endured as family and friends respond with “Oh you’ll be all right!”? Or should they be confronted and dealt with? Perhaps you feel the issue is out of your control, accepting your fears as something that you can do nothing about?

 Suppressing your fears is one way of handling them during the pregnancy. But it may be that they will resurface, in some way, shape or form during the labour. If they do, they can affect the way you perceive your pain and how your labour progresses.

Expectations

In regards to labour, everyone will have expectations of some sort. The woman will have expectations about her own labour pain, as will her caregiver, partner, support person, family and friends. When these expectations are unrealistic, it can place incredible pressure on how the woman should behave in labour, and the pain relief she ends up choosing to accept.

 Expectations can be hard to live up to, especially when there are no guarantees of how the labour will unfold. Women (or their partners) who have a medical or nursing background can be particularly vulnerable when trying to be ‘the model patient’ in the presence of peers.

Think about some expectations of labour pain:

• What are your expectations, or do you think you have none?
• Does your partner or support person have expectations about how you will deal with your labour pain? Do they have an investment in you accepting or declining specific forms of pain relief? Will this influence your final decisions about these?
• Do your family and friends have expectations about how you should manage the labour pain? Are these reflected from their own birth experiences (or that of their partner’s or friends’)?
• Do you have cultural or spiritual expectations? Do you feel pressure to adhere to your beliefs and wonder if you will be able to achieve what is expected of you?
• Does your caregiver have expectations about how you should manage your labour pain? Do you think when it comes to ‘decision time’ that they will support your choice to accept or decline medical or natural pain relief?
• Does your chosen place of birth have expectations of how you should manage your labour pain? Will they be flexible if you decide to accept or decline various methods to manage your own pain?