Thursday, June 21, 2012

Why minimizing childbirth pain and improving birth experience matters

One of the things that made my experience particularly traumatic, to me, was the degree of pain that I had experienced.  I had some pharmaceutical pain management techniques offered to me, specifically, Fentanyl and Nitrous oxide gas – but I still recall being in more pain than I had ever been in my life up to that point and in more pain than I ever care to be again in my life.  I had given some thought to the management of pain that I could expect after a caesarean delivery and how to mitigate and cope with that pain – in fact I had some fairly realistic idea of what I could expect having had an open gall bladder surgery 13 years prior to my first pregnancy.  Needless to say, though such strategies are useless for coping with the circumstance that I was facing.  I had not given any thought as to how I would manage the pain of labour and delivery, because, I had not planned on ever having to manage the pain of labour and vaginal delivery.


There is some evidence that suggests that the circumstance I was in, being unprepared and completely lacking control over it, likely made it much more painful than it might have been otherwise (see:  Tinti, C. Schmidt S., & Businaro N, (2011) “Pain and emotions reported after childbirth and recalled 6 months later: the role of controllability,” Journal of Psychosomatic Obstetrics and Gynaecology, Vol. 32 (2), pp. 98-103).  This suggests that adequately preparing women for what they are likely to experience and providing them with some degree of control over it might mitigate their experience of childbirth pain.


I also have little reason to believe that the memory of the pain I experienced is likely to fade over time.  I know that now, nearly 2 years after the event, I still remember it as being extremely painful and distressing.  One longitudinal study has found that the memory of labour pain among those with negative birth experiences tends to remain negative over time – with little change even 5 years after birth (see: Waldenstr√∂m, U., & Schytt, E., (2009) “A longitudinal study of women’s memory of labour pain – from 2 months to 5 years after the birth,”BJOG: An International Journal of Obstetrics and Gynaecology, Vol. 116 Issue 4, pp. 577 to 583).  This suggests that efforts to mitigate the experience of pain among childbearing women and efforts to mitigate the risk of negative birth experiences are worth it as pain in birth is not something that women generally forget about, particularly when their experience has been negative.


Further, there is some evidence that severe, unrelieved pain may contribute to the development of Post-traumatic Stress Disorder (PTSD) as a result of childbirth (see: Reynolds, J.L. (1997) “Post-traumatic stress disorder after childbirth: the phenomenon of traumatic birth,” Canadian Medical Association Journal, Vol. 156 (6), pp. 831-835 and Denis, A., Parant, O. & Callahan S. (2011) “Post-traumatic stress disorder related to birth: a prospective longitudinal study in a French Population,” Journal of Reproductive and Infant Psychology, Vol. 29, No. 2, pp. 125-135) .  There is also some evidence that unexpected events may also contribute to PTSD after childbirth (see: Leeds, L. & Hargreaves, I. (2008) “The psychological consequences of childbirth,” Journal of Reproductive and Infant Psychology, Vol. 26, No. 2, p.p.108-122).  While I am working with a psychologist, I have not been officially diagnosed with post-natal PTSD, however, if it looks like a duck, walks like a duck and sounds like a duck – it is in all likelihood a duck or at the very least a duck-variant and no amount of “putting up a good external show” is going to fix it.  This evidence also suggests that the provision of quality maternity care services might prevent serious psychological morbidity.

Given this evidence – it appears that:

*minimizing unexpected events during childbirth,

*improving childbirth education to accurately portray the realities of childbirth,

* improving the information given to women about their realistic options for pain relief in labour,

* improving access to a broader range of pain relief options in hospitals that serve women during labour and delivery,

* improving facilities that serve childbearing women during labour and delivery – particularly with a view to improving access to pain management techniques, and improving the physical environment of these facilities;

*and, improving the ability of women to exercise personal autonomy during labour and delivery by respecting an informed decision making process whenever practical -

Would likely result in a much higher quality of care and would likely mitigate the risk of adverse psychological and physical outcomes for mothers and their babies.  What is particularly shocking is that none of these suggestions have anything to do with decreasing the rate of caesareans or increasing the numbers of women who attempt to VBAC – both of which seem to be the only measures of quality maternity care that the BC government seems to care about at this time.

1 comment:

  1. I've just found your blog and wanted to say "thank you." I am in the U.S. and seeking a maternal request cesarean. I have found very little information on the topic, including on how to pay for the procedure in our health system, but plenty of criticism for those who are interested. Good luck and thanks again.