Pain in Childbirth – Part 1

father in delivery room
Biological Purpose of Pain

The human body responds to pain with either the response to flee, or the response to stand and fight. Some responses are automatic, such as the immediate withdrawal of the hand when burned accidently. External pains can be avoided.

But, what is known as visceral (ves-er-al) pain cannot be escaped. These are ones from the internal organs, and the uterus is an internal organ. This is in the case of normal and natural function, not a diseased state.

Extreme hunger or excessive thirst are due to physiological imbalance. These can be painful, but satiated by eating and drinking.

How Pain is Felt

On the body surface and on the outside of various organs are nerve endings. These were heightened during man’s primitive days, as sensors when man was attacked by creatures with tooth and claw. Certain exterior areas are very sensitive such as the neck, under the arms, abdomen, and chest.

The internal organs also have receptors, but only register with pain mechanisms when the external area is severely injured. The interesting thing is “the intestines and uterus can be burnt, cauterized, handled and moved without any sensation of discomfort to the patient,…(34)”. But if either has been torn or stretched the receptors respond with pain. The question we have to ask is why only during birth is the sensation of pain felt…a normal function.

The nerves send the information to the part of the brain called the thalamus. Here the intensity of the pain is interpreted. Then they are sent to the outer cortex of the brain to be balanced and qualified. The response to the messages from the Thalamus would be dependent upon the magnitude of the message by the Thalamus. The strongest response is fear, which brings about the most motor responses.

The thing to emphasize here is that this response is recognized in the normal and uncomplicated labor. The degree of neuro-response mechanism is determined by the state of the particular woman who has the pain. One may get a sense of total agony, and feel she is in great discomfort. While another woman may sense that it is not intense agonizing pain. It depends on the mental state of the person.

For the woman in birth the first time, the pain sensation will cause tension. This tension sets the stage for a flight reaction, that causes the uterine muscles that are circumventing the lower portion of the uterus to tighten. The longitudinal muscles are then constricted.
It is the longitudinal muscles that work to assist the fetus to be expelled at birth. The circulatory muscular portion of the uterus causes the longitudinal muscles to struggle in the effort to dilate the cervix. They work in opposition rendering the lower portion of the uterus and outlet resistant to dilation. The two opposite reactions in the muscular structure is then interpreted by the brain as pain.

Therefore, the fear OF pain produces ACTUAL pain.

We are so conditioned to believe that childbirth must be painful. Even Hollywood’s depiction is of childbirth as a painful ordeal, showing women screaming in agony.
It does not have to be this way…

Pain in any other part of the body at any other time is an indicator or “alarm” that something is not right. In labor it is also…an indicator that you need to RELAX.

Pain in labor releases a hormone that inhibits labor.

The Vocabulary of Pain

 

father in delivery room

The following information was written in order to understand pain in childbirth. This is a preliminary to understanding what your body senses when in labor.

Pain Threshold

The definition is “the point in which an individual first perceives the presence of pain”. This could be when ice or heat no longer is affective for blocking and / or reducing pain.
Each person has their own threshold. It is thought that threshold remains the same throughout ones life. But, Childbirth educators have found that the threshold is quite flexible. It is found that when comfort measures are used that effectively reduce pain or make it easier to bear, and the woman is distracted from her comfort measures, then the comfort measures no longer are useful. It will take a stronger stimulus to then break through the pain. Nothing had changed in the strength of the pain itself, “rather, her distraction reduced her pain threshold so that less pain was necessary in order for her to notice it (162)”.

Intensity
Intensity is defined as “the quantitative measure of how strong or severe the pain is (Ibid.)”. The usual measurement is a scale of 0 to 10. O being no pain, and 10 meaning that the pain is out of control.

Character
Character is a qualitative measure, using verbal or pictorial descriptors and analogies. Pain character may be described as burning, aching, tearing, or sharp like a knife. Character is the most important aspect to consider when managing pain.

Duration
Concerning when pain is first noted, and how long it lasts, and whether it is a steady pain or sporatic. It is particularly significant in that smaller diameter nerve fibers may, after repetitive signals become more responsive to pain signals. Many management strategies that are not pharmaceutical focus on the larger nerve fibers, which respond well.

Location
It is where the pain is perceived in the body. Depending on the location, the distress level may rise and start to interfere with eating, breathing, sleep, concentration, or the ability to otherwise function normally. If she is unable to concentrate due to location or any other aspect of the pain, she will be less able to use the pain management strategies she has learned.

Sensation Threshold
It is the point where the stimulus was first perceived. When reached, it is when the client first is aware of itching, cold, pressure, pain, or any other sensation. Of these, pain is the most important in that it could signify potential or actual tearing. Other sensations that may later become concerning may eventually grow strong enough to be perceived as pain.

Pain Tolerance
Defined as the greatest severity of painful stimulation an individual is able or is willing to tolerate. “Encouraged Tolerance” is the highest level of pain a person will tolerate when encouraged to try to tolerate more”. It serves a purpose, but not for women in labor as it may lower the tolerance to pain. It actually would translate to suffering rather than just pain.

Categories of Pain

Cutaneous
Occurs at the dermal level, and is sharp, localized, and generally tonic. An example would be the prick of the needle when given an injection.

Visceral
Occurring at the organ level, could be sharp or dull. There is less localization and could either be tonic or episodic. Examples: uterine contractions, severe constipation, and intestinal gas.

Somatic
It occurs at the soft tissue level. It is dull, aching, not localized and usually tonic.

Nerve Compression
The pain results from pressure on one or more nerves. It may be localized, or be referred pain to one or more regions of the body.

Stress, Part 3

Stress

stress

Stress and Pregnancy

This is a huge transitional period for the family unit, and usually characterized as stressful. Due to new roles to learn, adjustments within the family unit, communication patterns are re-established. These shifts may trigger biologic changes, hormonal function shifts, and immune system vulnerability.

The whole family unit is thrown off it equilibrium due to restructure of family roles, adjustments to family goals, physical and emotional changes that pregnancy may bring. This is the case for the average and normal situation and pregnancy. What about other circumstances or high risk pregnancy?

If the pregnancy is from an already stressful situation such as a rape or domestic violence has occurred, the stressor of pregnancy brings additional problems. Decisions need to be made to assist the mother, if other children are involved, their safety attended to.

In high risk pregnancy situation, stress is further aggravated if hospitalization is required. “High risk” is a label given to those whom the health of the baby or mother to be is threatened.

The pregnant mother’s ability to adjust and or adapt to the situation may be in jeopardy by the excessive level of stress. The mother must understand the causative factors in being labeled high risk and accept the situation in order to have a good outcome. As well as the pregnant mother, all other family members need to assess, accept, and readjust to this prognosis.

Unfortunately, pregnancy on the reservation is almost always considered high risk. This is due to poverty, gang activity, teenage pregnancy, alcohol consumption and drug abuse.

Only YOU can change this! Change the additional stressors in your life, and then you can change the outcome of your pregnancy and delivery!

Stress, Part 2

Stress

stress

Social and Family Stress

Social stress can be an actual threat or that what is perceived as a threat. These are within ones social environment. This could be relationships at work, conflicts at school, or interactions that occur within a person’s society.

Inside the family unit certain life events can affect the family directly or indirectly. Some of the stressors could be things that are deemed “normal” such as a birth in the family.

Stressors could be caused by ambiguous facts, such as an illness of unknown cause in which the doctor states the person will die at some time. Also, there are stressors that are caused by nonambiguous facts such as the onset of a severe storm and its aftermath.

Volitional stressors are things such as divorce, things that members of the family may cause or control the end result. Chronic stressors are events that occur over an extended time, such as a handicapped family member. Acute Stressors are temporary, such the hospitalization of woman giving birth. An isolated stressor is a singular event, such as the arrest of a family member.

Family stressors can proceed a crisis within the family but not all family stress leads to a crisis. Here are four indicators that a family is in a crisis:

• Members within the family are no longer able to function with their family roles
• Family members cannot make decisions and solve problems
• They are unable to give care to each other in a way usually seen
• A shift from family to individual survival

Stress

About Stress

stress

There are two types: the type that is good, making you feel satisfaction and happiness. And there is negative, which leads to fatigue and possibly, illness.

There is no singular thing to point to as a cause of the latter. But, what is known about it is that the body makes biochemical changes when it is present.

GAS or General Adaptation Syndrome, has three stages. These stages are: alarm, resistance, and exhaustion. In the alarm stage the quick initial response is lowered blood pressure and tachycardia. This is in preparation for the fight or flight response to continued stress. The body will continue to increase its production of adrenocortico-tropic hormones. Along with this is increasing heart rate and elevation in blood pressure.

If the condition becomes prolonged, to the point where the adaptation of the body is too great, vulnerability of the body occurs…and exhaustion. The body is not designed to stay in a heightened state of arousal.

If continued, the sympathetic nervous system becomes activated with vasoconstricted blood vessels, increasing blood pressure, increasing heart rate, and the secretion of adrenaline. The immune system will then become suppressed and the increasing cortisol will cause cholesterol and other lipids in the blood to increase at the same time.

Situations or “agents” that cause stress are called STRESSORS. These may include physical things such as heat, exertion, trauma, infection, or cold. Or it may be from psychological reasons such as fear, anxiety, or disappointment. Stress may be caused by external things. Examples may include poverty, inadequate housing, and certain life events.

Factors altering stress responses are called mediators. The MEDIATORS may be genetics, developmental factors, experience, and social context. Some people appear to be more resilient and cope better with stress, while others seem to be more vulnerable.

The Vision

CHAIR STRADDLE

It has been my long-term goal, to start the work of Childbirth Education on the Rosebud Reservation, then expand the birthwork to local native women assisting families and extended family in childbirth.  This vision includes a mobile bus that would be able to reach even the most rural of communities to assist in health care for pregnant and post-partum women, and a free-standing childbirth center.  BIG dreams!

Today, I was thinking “What are the obstacles for young women who may be interested in becoming a Doula?” Well, first it would be the funding necessary to have the training as a Doula. So I set-up a scholarship funding campaign on Go Fund Me.

The campaign is designed to raise money for a minimum of 10 women. I believe that is a good start!  If you are interested in supporting my vision, here is my campaign: https://www.gofundme.com/rstdoulas