Working with expectant families in Bangkok, as a birth doula, HypnoBirthing Childbirth Educator and BAMBI volunteer, I hear a lot about pain and suffering. When discussing birth preferences with my doula clients, I always ask the partner for their views as we discuss their plan. Often, the husband/birth partner will hold their hands up in an ‘I surrender’ fashion and tell me “Whatever she wants, it’s up to her. I won’t be the one suffering.” And it doesn’t just stop with the parents, I find can be doctors equally fixated on the pain and suffering of birth. On one occasion, a laboring client who was coping very well was told by her doctor “If you want the epidural, you could get it in a few hours, but why suffer until then? Just get it now.” Another time my client’s doctor pulled me aside “Khun Fran, let her get the epidural. Don’t make her suffer!” I smiled politely and affirmed that if my client asked for the epidural, I would certainly let staff know so that they could call the anaesthesiologist to attend. As a side note, neither making clients suffer, nor telling them what to do are within the scope of practice of the birth doula!

And as much as I disagree with the disempowering use of language and the assumption that birth is always inevitably so painful that chemical pain relief is required to prevent suffering, I understand why some doctors offer it and even see it as the best way to go. Let’s consider their frame of reference for a moment; As medical professionals, doctors are trained to detect pathology and to treat the symptoms of their patients, pain being one of them. Aside from that, being in the presence of another’s pain drives the majority of people to feel uncomfortable, and how handy it is to have a simple solution to just ‘fix it’. But here’s the thing; the sensations of birth are part of a normal, physiological process. Yes, those sensations can include pain, but it’s not pathological, it’s purposeful. With each surge of your body, baby comes once step closer. So, with the right mindset and support, even if there is pain, does suffering have to be inevitable? Let’s take a look…

While the terms ‘pain’ and ‘suffering’ are often used interchangeably (which goes some way to explain the fear of labour that many women have) I would argue that the two are separate entities. The origins of pain are physical and can be described as an unpleasant sensory experience that is associated with actual or potential tissue damage (Merskey, 1979). On the other hand, suffering describes a negative emotional reaction and includes factors such as: perceived threat to body and/or psyche, helplessness and loss of control, distress and an inability to cope with the distressing situation (Lowe, 2002). So, although the terms are used in place of one another, it’s perfectly possible to experience pain without suffering and vice versa. For example, can you recall a time that you experienced pain but felt able to cope with it? Without feeling fearful, helpless, or out of control, the pain was not accompanied by suffering. By introducing enough positive factors, such as knowledge about what is happening to you, support and reassurance, distraction, feelings of security etc, it can help prevent a painful experience being interpreted as suffering (Lowe, 2002). On the flip side, have you ever felt anxiety so acute or a shame so deep that you wanted the ground to open up and swallow you whole? Although these feelings don’t come with real or possible physical damage, they certainly cause suffering. And so, we can deduce that not all suffering is caused by pain at all. Instead it is as a result of negative factors, such as those we looked at earlier, such as perceived threat to body and/or psyche, helplessness and loss of control, distress etc that allows pain to be transformed into suffering.

If we are supported by care providers who truly believe that labour pain equals suffering, what messages do we receive from those who very often we are looking to for guidance during a vulnerable time? If drugs are the only thing on offer, rather than the myriad of other methods of comfort and support, the message loud and clear is “YOU ARE NOT STRONG ENOUGH TO DO THIS ON YOUR OWN. I DO NOT BELIEVE THAT YOU CAN DO THIS”. To clarify, I am not demonizing anaesthesia; it can sometimes be the catalyst needed for a successful vaginal birth. But, as a lone tool for supporting a laboring woman, I think it’s poor indeed. It reminds me of an expression, if your only tool is a hammer then every problem looks like a nail”. Instead, women might seek care providers who could offer them the support, guidance and comfort necessary to help them navigate a challenging but empowering experience. Instead of being told “don’t suffer…” supportive care providers will uplift you by telling you “You are strong! You can do it!”.

Beck (2004) asserts that “birth trauma is in the eye of the beholder”, so a woman’s perception of her birth and how she was treated during her labour, will define whether she views it as traumatic, or not. And with some studies indicating that as many as 1 in 3 mothers report symptoms of Post-Traumatic Stress Disorder (PTSD) after childbirth (Creedy et al., 2000) it makes sense to choose a care provider wisely. Someone who understands that there is more than one way to support a laboring mother, someone who will raise us up with their words and actions instead of undermining us, someone who doesn’t believe that a laboring woman needs to be saved from a normal, physiological event and someone who knows that all pain is not suffering.

 

 

 

Beck, C Birth Trauma: In the Eye of the Beholder Nursing Research 53(1):28-35 Jan/Feb 2004

Lowe N. K. (2002). The nature of labor pain. American Journal of Obstetrics and Gynecology, 186(5 Suppl.), S16–S24

Merskey H. (1979). Pain terms: A list with definitions and notes on usage. Recommended by the International Association for the Study of Pain (IASP) Subcommittee on Taxonomy. Pain, 6(3), p.250