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Pain Relief

A Surprising Concept about Pain Relief


Adapted from BIRTH DAY by Mark Sloan, MD


Outside the U.S. and Canada we find a more expanded set of pain relief options, both pharmacologic and nonpharmacologic, yet an even greater difference in philosophical approaches. Here the goal of hospital labor pain management is the complete obliteration of pain; in Europe and elsewhere (where most uncomplicated vaginal deliveries are attended by midwives), the objective is “good enough” pain relief.


“Good enough” pain relief is a concept not commonly expressed in the U.S. In our drive to eliminate pain, we overlook a critical fact: pain relief is not the most important factor in determining most women’s overall satisfaction with childbirth. Pain relief consistently ranks fourth in postpartum satisfaction surveys here and abroad, behind the quality of the relationship with her doctor or midwife, the support she receives from caregivers, and her involvement in making decisions regarding her care during labor.  In other words, a completely painfree birth can still be an unsatisfying one, and a painful labor can be a fundamentally positive, fulfilling experience. In focusing too much on pain relief, we forget that it’s the simple human aspects of childbirth that actually make all the difference.


Continuous labor support is nothing new. Prior to the 20th century medicalization of birth, which drove nonmedical persons from the labor room, women were attended not only by midwives or doctors but by supportive, experienced, female companions as well. The companion was usually a friend or family member who focused on the laboring woman’s immediate needs: fetching cool drinks, fluffing pillows, holding her hand, etc. It is a simple concept - someone staying with the woman throughout labor and usually for some time after birth - and it is strikingly effective. The benefits of continuous labor support extend well beyond the issue of pain relief.


In conclusion it seems that the best advice to a woman preparing for childbirth may be this: 1) learn and educate oneself as to the options available at this point in time, all pharmacologic and nonpharmacologic modalities, and choose what makes sense to her, 2) visit the options for birthing places and choose the one that feels most comfortable; likewise choose a practitioner with whom she feels a satisfying relationship, 3) be flexible about plans and expectations, and 4) gather the people she loves around her.   

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