Rayner in “Midwifery Today.”
Pain in Childbirth,
Can
it be controlled Naturally?
Summary
by Jodilyn Owen
In Midwifery Today article,
In “Pain During Childbirth, Can it be controlled Naturally?”
Rayner Garner, the author, poses the
question of whether pain during childbirth can be controlled without the use of medication. The often
observed occurrence of the mother whose labor stalls upon arrival to the hospital or of the birthing professionals into her
space is the catalyst for this question
The article addresses some of the many aspects that
affect pain in childbirth from the cultural, physiological, and emotional perspectives. Insight
is offered into how, by understanding the physiological source of pain, lack of cultural support for
the laboring woman, and importance of her emotional state, providers can attempt to educate parents and enact behaviors that
will not stimulate painful responses in the laboring mother.
When a laboring mother experiences
stress, her body responds by releasing chemicals and hormones into her blood stream. It is the
release of adrenaline that creates the “fight or flight” response which results in the blood flowing away from
the uterus and out into the arms and legs. Since the uterus requires a high volume of blood to effectively contract,
contractions become weak or stop altogether. The uterus is made up of three layers of muscles. The outer layer
contracts to push the baby down, and the inner layer is composed of circular muscles and contracts to close the outlet which leads to the birth canal. It is the middle layer that contracts to squeeze the blood out of the uterine
walls and then relax to let them vessels fill again. Without adequate blood supply to these muscle
layers, contractions are no longer effective. The physiological challenge of how to reduce the amounts of adrenaline
and stress hormones then comes into question.
In cultures that view birth as a normal
expected life event, the process is quiet and rapid. There is no interruption of the birthing process
by the introduction of such stress-inducing actions as having to change location for delivery, having strangers touch or talk
to you, or providers actively medically managing the labor and delivery with protocols and procedures. Communities rally
around the laboring woman and offer her guidance and support before and after labor. Our culture does not offer these
indulgences of support with privacy, love and care with quiet and stress-free birthing. Thus we are faced with the cultural
challenge of creating environmental support for the laboring women.
The primary emotional
need to avoid the introduction of adrenaline into the system is the feeling of safety. Encompassed in this feeling are
feelings of love and comfort, free demand acceptance. These feelings must be maintained and boosted throughout labor
to avoid the “fight or flight” response. It is the loss of the perception of safety that is the first domino
in that short chain to the stalling of labor. And this introduces the dual challenges of how to provide an emotionally supportive
environment and what to do if that ideal emotional state is broken.
The resolution to the issues that arise from these three perspectives lies in addressing
the “fight or flight” response directly. The author states that it can be prevented
by having the mother “birth herself”. That is to say without the company of people
she is not already intimately comfortable with. He suggests that providers use a monitoring system to watch the progress
of labor from another room and only enter when absolutely necessary. The birthing room should be kept dark and quiet.
Knowing this ideal difficult to achieve in most births, and knowing that the fight or flight
response will most likely develop at some point for most women, the author proposes that the laboring mother emote and physically
express herself. Garner suggests having her beat on a large pillow or mattress while making deep guttural sounds.
This activity serves to release the harmful build-up of adrenaline. Prevention of the state where the layers of the uterus
are working against each other will greatly relieve the pain that is associated with contractions.
Allowing the inner muscles to contract at the right time will prevent the outer and middle muscle layers from pushing against
them. Preventing this state of “fight or flight” can be accomplished by having the mother labor and deliver
where she feels safe. These is the key to a properly functioning uterus and a great reduction of pain during childbirth
without the use of medications.
