Working with pain in labour

‘Working with pain’ beliefs and practices The ‘working with pain’ approach to the care and support of women during labour was developed as part of a masters degree.1 As a result of an extensive literature search on pain, drawing on multi-disciplinary discourses and undertaking semi-structured interviews with midwives, it was found that attitudes to pain in labour could be separated into two paradigms, that of ‘working with pain' and that of 'pain relief'. The ‘working with pain’ paradigm includes the belief that there are longterm benefits to promoting normal birth in terms of women’s experiences and lives, and that pain plays an important role in the physiology of this process. At the beginning of labour, pain allows a woman to realise that she is about to give birth: to find a place of safety and gather people around her who will support her. As labour continues, the pain triggers a cascade of neurohormones that control the process; the pain changes and shows that labour is progressing as it should. The pain of labour marks the enormous change that is occurring in a woman’s life – her transition to motherhood; the complex interplay of hormones and chemical changes helps her prepare to welcome her baby. Her joy at becoming a mother can be heightened by the contrast with the pain of labour, together with a sense of achievement and triumph at the completion of a huge and challenging task. When labour is progressing normally – that is when contractions are normal and the baby is well positioned – it seems that, with support and encouragement, women are able to cope with the pain they experience.1-4 This is due to the production of the body’s natural painrelieving opiates, endorphins.5-7 Where midwives and birth supporters are using the working with pain approach, they try to create an environment which encourages the production of endorphins and to avoid creating the circumstances that inhibit their production. In contrast, if a woman experiencing normal labour is offered pharmacological pain relief, she will find it irresistible, as labour involves both pain and uncertainty, which can be emotionally demanding and exhausting. The use of pharmacological pain relief not only affects a woman’s perception of labour, it increases the use of other medical interventions, reducing the chances of having a normal birth.8 In some circumstances, the pain can be described as ‘abnormal pain’ according to the working with pain approach, for example where the baby is poorly positioned or labour has been accelerated with drugs. Women experiencing abnormal pain are likely to have a genuine need for pharmacological pain relief. In contrast, the ‘pain relief’ paradigm is characterised by the belief that no women need suffer the pain of labour and it is a kindness to alleviate it by a variety of pharmacological methods of pain relief. Women are offered a ‘pain relief menu’ including the pros and cons of each method to enable them to make an ‘informed choice’. Women may also receive the implied message that it is not possible to get through labour without resorting to pain relief. Many health professionals also promote the use of pain relief because they feel disturbed by the noise and behaviour of women labouring naturally.