If I were to do a poll about labor concerns, most people would say what they fear(ed) most about childbirth was the pain. What’s more, when most people just think of a word they associate with childbirth, the first to come to mind is pain.
(As a side note: how sad is it that joy, family, or wonder are not the first words. Instead it is pain, epidural, loss of control…)
I digress – pain and its management are very central in childbirth education models (especially in Western thought). There are many different theories of pain – all worth studying.
But the research that surprised me the most indicated that pain is not chief when it comes to satisfaction in childbirth.
Are you surprised too?
Then, of course, since its good research, it didn’t surprise me so much and it even began to make a lot of sense.
It didn’t matter so much as far as pain and its management. Women with epidurals were just as likely as women without medical pain management (drugs) to feel dissatisfied with their birth over these points – information provided, concerns recognized, and support received.
Let me break that down again – women with epidurals were dissatisfied with their birth if they felt the doctor and nurses didn’t give them enough information, didn’t address their concerns, and/or didn’t give enough support.
In fact, research seems to indicate that patients are more likely to sue if they feel they are not being communicated with and included in decision making. (see below for citation)
Can we all collectively say “Wow”?
This totally knocks the old “all that matters is a healthy baby” out of the picture. Also out the door is the idea that an epidural is the “Cadillac” of pain management.
Insurance companies, doctors, nurses, hospitals, clinics, politicians, feminists, women, and men should all be jumping all over this.
Why is it not happening?
Because this model of care in addressing all concerns, providing all information, and giving all levels of support requires a lot of time. If I were better with numbers, I’d run them to see if it confirms my suspicions – it’s cheaper to pay high malpractice premiums than it is to take fewer clients in order to spend more time with each one.
I’ve said it before, but it bears repeating – OBs (and some midwives as well as general practitioners for regular health matters) do not spend enough time counseling patients on preventative medicine and healthy lifestyle choices. How many of us were asked about our eating during our pregnancy, unless we were “gaining too much weight”? How many heard that exercise could be continued but to take it easy, without regard for our current level of fitness?
I’m getting off track – pain, however central in our minds before labor, appears to take a lower position of importance during labor.
Yes, it’s still painful.
Yes, we still want to know how to deal with it – either with coping techniques or drugs.
But for women with or without epidurals, even those with absence or pain or sensation, still have a greater need for this – information and the support it gives.
Once we recognize that and true informed consent happens, it will change everything about birthing in America.
The article that is the main focus of this: http://www.ajog.org/article/S0002-9378%2802%2970189-0/abstract Results: Four factors—personal expectations, the amount of support from caregivers, the quality of the caregiver-patient relationship, and involvement in decision making—appear to be so important that they override the influences of age, socioeconomic status, ethnicity, childbirth preparation, the physical birth environment, pain, immobility, medical interventions, and continuity of care, when women evaluate their childbirth experiences. Conclusion: The influences of pain, pain relief, and intrapartum medical interventions on subsequent satisfaction are neither as obvious, as direct, nor as powerful as the influences of the attitudes and behaviors of the caregivers.
Article concerning likelihood of lawsuit: Communication gaffes: the root cause of malpractice claims. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1201002/
Another article regarding pain management and maternal satisfaction:
Abstract – Maternal Satisfaction and Pain Control in Women Electing Natural Birth – I think this one comes to the wrong conclusion that “survey results suggest that concerns about epidurals and their effect on the baby, greater than anticipated labor pain, perceived failure of requesting an epidural, and longer duration of labor may have accounted for these findings [of being less satisfied with birth].” I think further study is needed, but that it is good to point out what the study did certainly find: “88% of women who requested an epidural for pain reported being less satisfied with their childbirth experience than those who did not, despite lower pain intensity.” http://journals.lww.com/rapm/Abstract/2001/09000/Maternal_Satisfaction_and_Pain_Control_in_Women.14.aspx
(As a side note: how sad is it that joy, family, or wonder are not the first words. Instead it is pain, epidural, loss of control…)
I digress – pain and its management are very central in childbirth education models (especially in Western thought). There are many different theories of pain – all worth studying.
But the research that surprised me the most indicated that pain is not chief when it comes to satisfaction in childbirth.
Are you surprised too?
Then, of course, since its good research, it didn’t surprise me so much and it even began to make a lot of sense.
It didn’t matter so much as far as pain and its management. Women with epidurals were just as likely as women without medical pain management (drugs) to feel dissatisfied with their birth over these points – information provided, concerns recognized, and support received.
Let me break that down again – women with epidurals were dissatisfied with their birth if they felt the doctor and nurses didn’t give them enough information, didn’t address their concerns, and/or didn’t give enough support.
In fact, research seems to indicate that patients are more likely to sue if they feel they are not being communicated with and included in decision making. (see below for citation)
Can we all collectively say “Wow”?
This totally knocks the old “all that matters is a healthy baby” out of the picture. Also out the door is the idea that an epidural is the “Cadillac” of pain management.
Insurance companies, doctors, nurses, hospitals, clinics, politicians, feminists, women, and men should all be jumping all over this.
Why is it not happening?
Because this model of care in addressing all concerns, providing all information, and giving all levels of support requires a lot of time. If I were better with numbers, I’d run them to see if it confirms my suspicions – it’s cheaper to pay high malpractice premiums than it is to take fewer clients in order to spend more time with each one.
I’ve said it before, but it bears repeating – OBs (and some midwives as well as general practitioners for regular health matters) do not spend enough time counseling patients on preventative medicine and healthy lifestyle choices. How many of us were asked about our eating during our pregnancy, unless we were “gaining too much weight”? How many heard that exercise could be continued but to take it easy, without regard for our current level of fitness?
I’m getting off track – pain, however central in our minds before labor, appears to take a lower position of importance during labor.
Yes, it’s still painful.
Yes, we still want to know how to deal with it – either with coping techniques or drugs.
But for women with or without epidurals, even those with absence or pain or sensation, still have a greater need for this – information and the support it gives.
Once we recognize that and true informed consent happens, it will change everything about birthing in America.
The article that is the main focus of this: http://www.ajog.org/article/S0002-9378%2802%2970189-0/abstract Results: Four factors—personal expectations, the amount of support from caregivers, the quality of the caregiver-patient relationship, and involvement in decision making—appear to be so important that they override the influences of age, socioeconomic status, ethnicity, childbirth preparation, the physical birth environment, pain, immobility, medical interventions, and continuity of care, when women evaluate their childbirth experiences. Conclusion: The influences of pain, pain relief, and intrapartum medical interventions on subsequent satisfaction are neither as obvious, as direct, nor as powerful as the influences of the attitudes and behaviors of the caregivers.
Article concerning likelihood of lawsuit: Communication gaffes: the root cause of malpractice claims. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1201002/
Another article regarding pain management and maternal satisfaction:
Abstract – Maternal Satisfaction and Pain Control in Women Electing Natural Birth – I think this one comes to the wrong conclusion that “survey results suggest that concerns about epidurals and their effect on the baby, greater than anticipated labor pain, perceived failure of requesting an epidural, and longer duration of labor may have accounted for these findings [of being less satisfied with birth].” I think further study is needed, but that it is good to point out what the study did certainly find: “88% of women who requested an epidural for pain reported being less satisfied with their childbirth experience than those who did not, despite lower pain intensity.” http://journals.lww.com/rapm/Abstract/2001/09000/Maternal_Satisfaction_and_Pain_Control_in_Women.14.aspx
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