Question of the day (QOTD) 2/23/12

If someone gave you good advice on how to prepare for labor and birth, what would it be?

The subjectivity of pain

I had to just bite my tongue recently. Having a conversation with one of the docs, and he just goes on and on and on about how all women should get epidurals ~ so it "relaxes" their pelvic floors. Women "tense up from the pain" and it "makes the baby not come down."

Seriously?

Ok, he did mention that he had a kidney stone before, so he knew what pain was like.

Seriously? You're related a kidney stone to childbirth?

I quietly told him that childbirth pain is different. Women don't always need "rescued" from the pain. Some women do very well with the pain, and can find their "happy place" to cope with contractions. And lo and behold, they are able to relax their pelvic floor muscles enough to give birth successfully.

I also told him something that may have floored him: that I personally did not find labor all that painful. No, I'm not some masochist. Yes, I do experience severe pain. But pain from contractions? I personally found it very tolerable. BUT - I am also able to put myself into a light hypnotic state. I do this with childbirth and dental work.

Now, before anyone jumps at me on this topic: pain is very subjective. In other words, what I feel is mild/moderate/tolerable pain, someone else may feel it as severe. My coping ability of pain may be different than the next person.

Pain that I do NOT cope well with: surgical pain. It's a deeper, much more visceral pain that is continuous. Give me drugs. Lots of them.

Childbirth pain, to me, is an intermittent annoyance. Yeah, it hurts, to a degree. But I can cope well with it, and get into my "happy place" state of mind. Contraction pain has a definite beginning, peak, and end point.

My gut-wrenching IBS pain that comes out of nowhere? Kill me now please. I have prayed for death from that pain.

So back to contractions, pain, and coping. It's all about you, the individual woman. It's about what your response is to pain and how you are able to cope (or not able to cope). Do you go into childbirth with a positive attitude, well prepared for the rigors ahead? Do you have continuous support during your labor, telling you that you are doing beautifully?

I admit, at one point in labor with my 3rd child, I thought to myself "some drugs would be nice right now", but knowing that I was about 8 or 9 cm, it was too late in labor for medication. So, I just accepted it for what it was - labor. Deal with it, I said to myself. And I did.

Kindly share your thoughts on labor and pain/coping. Share your own personal births if you wish.

Labor coping scale

I have a research interest in how pain is quantitatively measured in the labor and delivery setting. As some of you may know, we are required under the Joint Commission to ask laboring women about their pain, using a pain scale. You know, that lovely pain scale from 0 to 10?

That one ^

I hate it. Of course you're going to have pain - it's labor! It's expected!

Some problems with using a numerical pain scale in labor and delivery, is that women might be left wondering: if I give my pain a low number, does that mean the pain is going to get worse? (More than likely, yes. But once again, it's "labor". And it's normal.)

Or, a woman might think that if she gives a high number in early labor, it means she'll get pain medication or an epidural sooner. (Not necessarily.)

How about the lovely Joint Commission, who says we need to offer pain medication (different types) depending on the severity of the pain on the pain scale? (Once again, I must declare: pain in labor is NORMAL! It doesn't mean it automatically needs medication to "fix it"!)

So, I've brought this topic up at work. Because, as you can tell, I hate using the 0-10 pain scale in labor and delivery.

What about a coping scale? -- I posed this question at our practice group meeting. I know, no one really seemed too interested in the topic, but hey, I am interested in it. So, off to research coping scales.

Interestingly enough, I did find one research article that goes about the creation and utilization of a coping with labor algorithm. Very close to what I was looking for. In an article in the Journal for Midwifery and Women's Health, I found such a concept of a coping algorithm for labor and delivery.

"The Coping With Labor Algorithm: An Alternate Pain Assessment Tool for the Laboring Woman" by Leissa Roberts, Brenda Gulliver, Janet Fisher and Kristin Cloyes. This article contains two fantastic algorithms to determine how well (or not) a woman is coping during her labor progress. (The actual article is here. However, if you aren't a subscriber, you can't access the full article. Luckily, I can access it via my school library!)

But what I really wanted to find was a numeric scale, or something I can introduce to the unit to quantify how the woman is coping with labor. Enter Penny Simkin's chart:

Thank you Penny Simkin!

What are the 3 Rs, you might ask? According to Penny, they are:

The ability to Relax during and/or between contractions,
The use of Rhythm characterizes their coping style, and
The use of Rituals, or Rhythmic activities with each contraction.


I so, so, SO like this coping score system MUCH better than the "can you rate your pain for me, on a scale of zero to ten, with zero being no pain, and ten being the worst pain in your life?"

Quantifying the very subjective nature of pain while in labor is so different for each woman. Using the coping scale with how each woman is coping with the contractions actually shows how well (or not) she is managing the "pain" of her labor. Then again, I hate the use of the word "pain" when it comes to labor. Yes, it is painful. However, to bring up the word "pain" can actually make it MORE painful for some women.

Once again, I go back to the "duh" mentality of the fact that it's labor, of course it is painful. Must we remind women of this pain by asking her, repeatedly, to rate her level of pain? Quite simply: NO.