Pain is normal, and an integral part of labour and birth. But knowing this doesn't make it any easier to accept. Even to a multigravida the intense pain of labour will always come as a surprise: our memory tends to block or diminish the extent of negative experiences. And every woman will need to find ways of dealing with the pain she is experiencing.
Fortunately pain in a normal labour builds up gradually, giving the woman a chance to acclimatise to it. However, when labour is induced medically contractions can intensify suddenly and dramatically, and this may in turn necessitate some form of pharmacological pain relief (running the risk of unleashing the 'cascade of intervention').
Expectations and perceptions of pain
Whilst pain has its origin in physiological processes, our perception of pain depends in large part on interpretation and expectation. If a woman has been led to expect pain, this may make her tense with anticipation. On the other hand if she is not expecting the pain to be too bad, its intensity may take her by surprise.
Our experience of pain depends on many things, including our general sensitivity to pain ('pain threshold'). If we don't know what is happening to us, or don't believe we can cope, our perception of pain is likely to be much greater. Thinking too much about it can make it worse: if one knows one has several more hours of intense pain, this may make it seem unbearable. But if we can simply try to be 'in the moment' - perhaps using a trick like counting down the contractions ("that's one less to go!") - the pain can become easier to bear.
Natural pain relief
In times of great pain, our bodies release pain relieving endorphins. These have a similar effect to opiate drugs (drugs like heroin and morphine work by engaging the endorphin receptors in the brain). Anxiety or fear tend to block the effect of endorphins, by engaging a 'flight or fight' response which requires alertness and readiness for action (stimulated by adrenaline and cortisol). So anything that can be done to create a safe, secure environment - free from distractions and worries - is likely to activate the body's own pain relieving rresponses.
Helping with the pain
There are many things you can do to help with pain that don't involve pharmacological pain relief. In the first stage of labour, try distracting her between contractions. Simply having a conversation, or putting on some music, to 'take her mind off it' can help considerably with the pain. Other things that will help with the pain include making sure she gets adequate rest and that she is able to move about and adopt different positions according to what she finds most comfortable at any given moment. A bath can help, as can massage or placing of warm towels on of the lower back.
Throughout labour helping a woman to feel comfortable and confident will help her cope with the pain. The skill is to read her ability to 'go within herself' - her ability to distance herself from the pain - and to know when she might need additional support. A birthing partner of like mind, who really wants to be there and is 100% present with her, can make a huge difference - in the words of the old saying, 'a problem shared is a problem halved'.
Tips and tricks
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Demonstrate total commitment to her - be there! The art of presence is to connect with the woman without needing words or touch so that she senses that you are 'in tune' with her feelings. Constantly observe her behaviour and make your responses echo her needs. Like other arts, this is easier said than done and requires considerable practice to perfect.
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Give her constant reassurance - Nothing in life prepares us for the pain of labour, and it is important to keep reminding her that this is normal, that she can cope with it, and that it is helping her towards the birth of her baby.
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Bear in mind that her mood will change as the pain increases - Use your knowledge of the 'pain-gate' theory. Review the various forms of distraction that are available to her: rocking, water, massage, counting mobilisation, singing or music.
Further reading
Lundgren I, Dahlberg K (1998) Women's experience of pain in childbirth
Midwifery 14: 105-110
Moore S. Psychological support during labour. In: Henderson C, Jones K (eds) (1997)
Essential Midwifery Mobsy, London
Rajan L (1993) Perceptions of pain and pain relief in labour: the gulf between the experience and the observation
Midwifery 9: 136-145
Royal College of Midwives (2001) Brown Study Series Number 1. Midwifery Clinical Practice: the first stage of labour. Royal College of Midwives Trust, London
