Pain in labour

AIMS Journal, 2012, Vol 24 No 4

Marie J Taylor reports on Nicky Leap’s presentation – September 2012, Bristol

Professor Nicky Leap presented to a dedicated audience of birth supporters back in September 2012 at the Bristol Aquarium. She shared her research findings and wisdom regarding the approaches to pain in labour

This sell-out event, at a great venue in central Bristol, gave those who attended a deeper understanding of why pain in labour is such an important topic, and equipped us all with practical tools we could use immediately. For those interested in gaining a deeper understanding Nicky provided signposts to further investigation. This review is a reminder for those who attended and provides people who weren’t lucky enough to be there with the benefit of her sage words and advice.

The keystone to Nicky’s presentation was the interplay between four elements around the approaches taken to labour pain and their impact on a triumphant and empowering birth. Her presentation was followed up by a fun and innovative ‘speed dating’ session where birthworkers got the opportunity to meet each other and discuss video clips of postnatal interviews with women and also midwives sharing their experiences.

Nicky showed us how mother’s and caregiver’s perspective (and subsequent choices they make throughout a labour) depend on who you are and what your role is at the birth. This then impacts the pain relief methods you are likely to use, which affects expectations, which dictates your perspective and so it goes on.

The pain associated with giving birth is often regarded as something to be avoided altogether, or at the very least endured. Examine the idea of pain further and Nicky Leap suggests the experience of it is based not just on anatomy and physiology but on what’s going on in the mind and wider culture. Her presentation reminded me, as someone who supports people giving birth, about the impact and the limits that our own beliefs have on the expectations of the people who we want to experience a triumphant birth.

Nicky showed evidence that women’s level of satisfaction with their birth experience does not correlate with the pain relief they receive. In fact, as a rite of passage, the existence of pain is important as it mostly marks memories in a positive way, building self esteem because women feel proud that they have coped and been self sufficient.

Nicky talked about taking an approach that works with pain, in contrast to a menu of pain relief. In my view the power of this is so great because of the subconscious expectations that are implied by the choice of approach.

Nicky Leap’s ‘Working With Pain’ Framework
• Women CAN cope with the pain of uncomplicated labour
• Concept of normal and abnormal pain: the need for pain relief is associated with malposition/distocia
• Pain as a stimulator of endogenous opiods, minimising disturbance
• Pain gives a clue to progress

Nicky also addressed the issue of expectations of the mother and the caregivers. Many of us groaned when she highlighted research explaining the common expectations of intervention by obstetricians for their own births, but then I span off in a giddy haze when Nicky followed it up by stressing the importance of the power of persuasion and, more importantly for me, paying attention to what we can learn from fields of NLP (neuro-linguistic programming) and hypnosis (my areas of expertise) to persuade mothers to trust their ability to birth and change their expectations. The most powerful tool is what she calls the ‘Midwifery Wave’.

Midwifery Wave
It starts slowly
It builds to a peak
It starts to die down
It lasts about a minute
And then there’s a REST

If only we had a video of the entire room doing the Midwifery Wave as they set it to memory! The concept that it lasts just a minute and then there is a rest frames the undefined ‘contractions’ into a concept that is achievable for the mother because it has a time frame and also there is time to rest and gather resources.

Another practical application of this that Nicky gave was to suggest things to say that alter perception and expectation.

Things to say that shift perception and expectation
• Your body will tell you what to do
• Trust your body
• Each contraction brings you one step closer to meeting your baby
• Between each contraction you can have a rest
• The uterus is the strongest working muscle in the human body – it’s a wonderful, powerful organ
• You will find an inner strength that you didn’t know you had

Her last suggestion, ‘Many women find that. . .’, I thought was particularly powerful as it persuades the mother to ‘try on’ a different perspective to see if it feels right for her without forcing your point of view. However, we’ll never really know what its like for another person, so Nicky advises that it should be used with caution.