Topic area
My articulation of a theory of Pain Dynamics and their impact on birth outcome has been shaped by insights into the psychological challenge of physical achievement, which I gained as a physical education and outdoor adventure teacher. These insights into pain dynamics in birthing have been further shaped during 40 years as a birth educator, doula and birth counsellor.
Theoretical perspective
Pain Dynamics describe the interplay between a birthing woman, her caregivers and support team when she experiences a 'crisis of confidence' (not to be confused with transition) in labour. Crises of confidence in birthing are akin to the experience of 'hitting a pain barrier' in other high intensity physical activities involving functional physiological pain. In labour, crises of confidence often lead to the use of medical pain relief with consequent disturbance of the physiological birth process.
Underpinning theories/philosophies
Physiological pain and its connection to birth hormones
[Buckley, S. (2015) Hormonal Physiology of Chidbearing: Evidence and Implications for Women, Babies and Maternity Care. www.ChildbirthConnection.org ]
Midwives attitudes to labour pain
[Leap, N. & Hunter, B. (2016) Supporting Women for Labour and Birth. UK Routledge]
Impact of ‘birth territory’ on the experience of pain in labour.
[Fahy, K. et al. (2008) Birth Territory and Midwifery Guardianship. UK: Elsevier]
Continuous support in labour
[Alfirevic, Z. et al. (2009) A Cochrane Pocketbook of Pregnancy and Childbirth. UK John Wiley and Sons]
Birthing woman’s Pain Type (avoidant, status quo, wait and see, aspirational but naïve, embracing pain) and Crises of Confidence
[Dempsey, R. (2013) Birth with Confidence: savvy choices for normal birth. Australia Boat House Press]
Argument to be made
Normal physiological birth is supported by understanding pain dynamics; normalizing predictable 'crises of confidence' and planning specific 'working with pain' strategies to manage them.
Discussion
To develop strategies for practical application of this theory of pain dynamics during - midwives' conversations with pregnant women, in birth education settings and in the birth space.
In small groups/with partners -
discuss - midwife's personal attitude to pain in labour; identify client groups predominant pain type; strategies for 'working with pain'.
role play - pain dynamics conversation with pregnant / birthing women from each identified pain type
Share key insights with full group
Conclusion
Understanding Pain Dynamics, including awareness of a woman's pain type as a likely positive match to her birth aspirations, offers midwives a framework for realistic discussions with pregnant/birthing women about the impact of pain dynamics on birth outcome. Understanding these impacts may encourage women to reflect on the implications of their pain type and so make wise choices regarding place of birth, continuity models and appropriate support for 'working with pain', thereby increasing their potential for normal physiological birth.
Social and cultural precursors and consequences of optimal childbirth , Emotional and spiritual aspects of labour and birthing , Educational aspects
