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Entries in Cochrane Database for childbirth (1)

Friday
Mar142008

Do NBA Downplay Pain in Childbirth?

According to researchers in England, natural birth advocates such as childbirth educators and others who educate women during the pregnancy do just that.

The journal Bio-Med Central looked at 346 published papers in a variety of journals, abstracts and databases to cull their information.

Four key themes were found in the literature:

- the level of pain
- pain relief
- involvement in decision-making
- control

They then further broke down each theme into these categories:

- expectations
- experience
- the gap between expectation and experience

The Cochrane review found that women greatly underestimated the pain they felt and many felt like failures if they accepted or requested medication.

One point I found interesting was the aspect of decision-making when choosing whether or not to have medication.

The study says, "... it is multiparous women (women with more than one child) who place emphasis on being fully informed rather than primiparous (first time moms) who are concentrating on controlling emotions rather than being involved in decision making." Besides this, women who'd had more than one baby thought it was even more important to be treated with respect and be seen as an individual.

Would this be because women who've been through labor before (I would say, specifically in the hospital) felt they'd been on a production line last time? I'm glad they pointed these thoughts out; perhaps it can illuminate gaps in the care of women in the hospital.

When looking at control issues, they focused on a study in America and found that women who birthed at home wanted more control of their labor and also wanted more control in the decision-making process. Women in the hospital wanted the safety of the medical model and thought more about safe outcomes than wanting control or even a quality birth experience. I suspect primips were more likely to feel this way than multips... it seems the studies say the same thing.

When they looked at pain issues, they didn't look at things like positioning, but they did see that women who had the most support wanted or needed more medication. One press article called it "hand holding." While they didn't specifically mention doulas, they did mention midwives and family members. I don't know if doulas are as prominent in the United Kingdom as they are here in the United States, so that might have made a difference in their not mentioning them.

I wish they'd have looked at things like a woman's positioning in labor because I suspect that had a lot to do with a woman's experience of pain. Those of us who work in birth see, over and over, that a woman's pain level is dramatically different when she is "allowed" to move around... in the hospital and at home. And if they'd have looked at natural pain relief such as aqua-therapy (birth tubs, pools and showers), I'm willing to bet women felt more in control and more relief than women in beds on monitors.

I also wonder if they took into account women who had posterior babies or women who were going along delightfully until complications arose and they were looking at possible cesareans. I know that in my own experience with women that once the idea of surgery presents itself, many women jump into the wanting an epidural camp - the pain suddenly becomes unbearable.

I wonder if they looked at the length of a woman's labor, seeing that the longer it went on, the more often she chose medication... perhaps the baby was in a funky position that wasn't aided by movement because of the monitors.

I wonder if they looked at women who had pitocin or other means of induction. How does a care provider or childbirth educator prepare a woman for the pain of pit, cytotec or even prostaglandins? Some women have very little pain with induction or augmentation, whereas other women have excruciating pain. How do we teach about the different types without scaring the bejeebers out of women?

Wonderings we probably won't get answers to.

A look at how the press reported the information can be read in the following locations:

The Independent's "Women 'are misled into thinking childbirth can be pain-free'"

The EurekAlert - "Pain free childbirth? Get real!"

The BBC News says, "Women 'unprepared for childbirth'"

The journal article can be read here.