labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Sunday, September 16, 2007

What A Pain

Labor = Pain.

Most people would agree with that statement. There are some who have had the Labor = Ecstatic version, but seeing that is far and few between I’ll keep to the first notion.

Now, I am sure that most women realize that they will experience pain when they go into labor. I’ve discussed that some seem to be quite surprised that they have to experience pain, but I won’t go into that again. So, assuming that every woman who is due to give birth at some point in their life will have a first hand account with labor pain, I figured that it might be helpful to understand a few things about that pain.

What does labor pain come from? Well, duh, Labor Nurse, it comes from the contracting uterus and a large baby exiting your nether regions. Yup, you are right. But, it is more than that.

  • Dilation and effacement of the cervix. The opening and thinning of the cervix while a baby’s head is rammed up against it can be unpleasant.
  • Pressure of the baby within the pelvis. Imagine placing an 8 pound bowling ball in your rectum and holding it there while it is intermittently squeezed resulting in an increase in that sensation.
  • Pressure from the contracting uterus against surrounding organs. The uterus isn’t floating in its own orbit; it is smooshed against your other organs (like your bladder and intestines) and causes them to hurt, too.
  • The increase of lactic acid within the uterine muscle. Actually, the uterus is just one big muscle, and when it is exercised, so to speak, for hours and hours it will make lactic acid. It’s pretty much the same thing as an over worked bicep or quadriceps muscle if you exercise it too much.
  • And of course, the most obvious: stretching of the perineal and vaginal tissue with a descending baby. This pain has frequently been referred to as the infamous Ring Of Fire.

Another factor contributing to labor pain is your personal and cultural beliefs and experiences surrounding pain. Think back to a time in your life when you had some serious pain. How did you react to that? Did you find anything that helped you cope with it? How did that change your view of any future anticipated pain? I’ve personally found that women who have had bad experiences with pain in their past that they were unable to cope with for whatever reason have a really hard time when labor kicked in. On the other hand, women who approached previous pain with a mindset that they can deal with it one way or another have an easier time getting through contractions. I’m not saying that if you merely winced when your arm got chopped off that you can whistle through contractions; what I mean is that those who have been able to successfully tackle and mentally cope with whatever pain they’ve experienced seem to be able to accept and get through labor without losing their minds. And when I say “tackle and mentally cope”, this means that the person found something to help them. What that something was can vary considerably, and it actually doesn’t really matter. It was that they found something that was important.

Women who have a hard time coping through labor can actually make their pain worse by merely being afraid of it. Pain is heightened by fear and tension. And this turns into a self feeding cycle. You have pain, you tense up, you become afraid of what your feeling, which further increases tension, which increases the level of pain experienced…. you get the idea.

There are a few other things I think are important to address regarding pain. Since most give birth in a hospital, there are some annoying things that have to be done. First is that nurses must document pain levels. This is a standard in any area of nursing set forth by our hospital’s lovely accrediting body (JCAHO). So we have to ask what your pain level is on a scale of 1-10. If we are solely looking at how this works for documentation purposes, providing a number helps anyone looking at the chart see the progression and/or relief of pain. But it’s very annoying to ask a woman who is clearly experiencing a lot of pain, “What number would you give this pain?” Like she cares to answer. I think I’d probably answer something like, “Who the fuck cares? It hurts!” but unfortunately we need that damn number.

The other thing is that many people get caught up in what the monitor is telling us. I can’t tell you how frustrating it is to see family members staring at the monitor during a contraction and hear them say, “But honey, that one only registered a 35 on the monitor!” when she is moaning and writhing in pain. Unless the woman has an internal uterine contraction monitoring device, that monitor isn’t telling anyone shit about the pain level. Only the woman can tell us that. So stop looking at the monitor (I wish we didn’t have to use them… it would solve so many problems).

Lastly, think about the traditional definition of pain. Pain is typically defined as suffering caused by injury or illness. Labor does not signify injury or illness. It’s a normal, natural physiological process. But our society seems to forget this and equates this normal pain with pathological pain that must be treated and fixed. And so many times women jump into the whole pain, tension, fear cycle because their mind is telling them that their pain is abnormal and something must be wrong. But there isn't.


Joyce said...

As far as labor pain goes, yes mine was painful but I remember my mother (who never shared much in the way of female stuff - she was of that generation) that you forget all about the pain once you hold the baby. I found that to be true. It was painful while you were going through it, but it became a distant memory once you held your baby. There was something wonderful waiting at the end of all that pain.

Labor Nurse said...

Ya know, I rarely hear the whole "you forget the pain once you hold your baby" line. Actually, many women who weren't anticipating much pain, or the intensity of it, seem to be a bit traumatized in the days following it. When I work postpartum, many of those women have a need to discuss their experience to help them get over what they endured.

But clearly women must forget some aspect of their pain because they keep having babies!

Christina said...

Had I not had a second child, I would have never experienced labor. The first was a scheduled c-section because she was breech.

Labor was intense, and while I had planned for a natural birth, I decided I needed an epidural after 14 hours of 2-3 minute apart contractions lasting over a minute. I knew it would be painful, and I'm pretty tolerant of pain, but after that long, my mental reserves were failing and I couldn't stop myself from tensing up. It didn't help to hear I was only 4cm at that point. The epidural helped relax me so I could rest up for pushing.

Oh hey, I wanted to ask your advice on something: what stethoscope do you like best? I'm in nursing school, and start clinicals next week. We have to have a stethoscope, but the school's bookstore only offers the cheap-o $10 ones and the $80 Littmann ones. Are the expensive ones worth it? Should I look elsewhere for a different one? amommystory [at]

mommymichael said...

labor and birth doesn't HAVE to be painful though. plenty of women use hypnosis for birth and feel only tightening or sensations of birthing but no pain at all. women using hypnobabies in specific for instance. 70% feel what i stated above. 15% feel some version of discomfort *but not necessarily pain* for the pushing stage, and 15% feel it for some remaining portion of labor.

I only had 9 day practice with it just due to circumstance. In actuality you need 6 weeks. However! half of my 14 hr labor *well 24 hrs if you count the braxton hicks i had all night before* was pleasant, pain free, stretching and tightening sensations. My husband commented I sound like I was having sex.
So we teach pain elimination using Hypnobabies. Help eliminate any fear, so mom doesn't tense up during birth and goes freely along with whatever it is she ends up feeling, because we understand every mom feels something different. I have friends that had NO pain using Hypnobabies, that in previous births had pain so bad they couldn't stand it.

Labor Nurse said...

Christina, I personally like the ADC brand stethoscope. I bought it in nursing school (after hating my required sprague style) over 11 years ago and still use it. They can be hard to find but if you google them I am sure you'll find a place that sells them. I don't care much for the adult Littmans, but I have a pedi Littman that is good (their neonatal size is good too). I also have a DRG brand adult stethoscope, but I'm not impressed.

mommymichael, I have no experience with hypnobabies, nor have I ever had a woman using hypnobirthing. I would love to, though, as it sounds like a great way to go.

Rinna said...

hello, bloghopped my way to your blog. it is a very enjoyable read to say the least.

thank you for this post.

prior to giving birth to my 1st baby, i was very gung-ho about having an unmedicated birth. unfortunately, i was gbs+ and my water broke without me going into labor (within the mandatory 24hrs) so i eventually had an induction. it was pretty intense and i had a few insane moments (wanting a c-section, wanting to go home) but i was able to deliver without any painkillers.

now, as we are planning our 2nd baby, even though i'd still want an "unmedicated" birth ideally (in quotes because i assume i will have abx because of gbs), i am quite terrified by it because i now know how painful labor could be.

after reading your post, i feel a little bit more empowered to go without painkillers again for as long as i can.

thank you.