Birth Pains - It Gets Better With Time

Terri here: good article

11 Dec 2008

New research to be published in BJOG: An International Journal of Obstetrics and Gynaecology illustrates how women's memories of labour pain decline over time. However, for some women, their recollection of pain does not seem to diminish and for a minority, their memory of pain increases with time.

2,428 Swedish women were recruited from antenatal clinics across Sweden and took part in the original study in 1999 which looked at women's memories of labour pain two months and a year after birth (elective caesarean sections were not studied). A 5-year follow up on the same cohort of 1,383 woman was later conducted.

The aim was to study women's recollections of labour pain over time in association with the use of epidural analgesia and to evaluate overall childbirth experience.

In all three occasions, the women filled in questionnaires and were asked to rate their experiences of the intensity of labour pain and their memories of the childbirth. Other data such as the mode of delivery and methods of pain relief were noted. Five years after they gave birth, 49% of women remembered birth as less painful than when they rated it two months after the birth, 35% rated it the same, and 16% rated it as more painful.

Researchers found that women who reported labour as a positive experience two months after birth had the lowest pain scores. When asked again after a year and then again after five years, their memory of the intensity of pain during childbirth declined. For women who said that their childbirth experience was negative or very negative, on average, their assessment of labour pain did not change after five years (Around 60% of women reported positive experiences and less than 10% had negative experiences).

Researchers also note that women who had epidural analgesia remembered pain as more intense than women who did not have epidurals. It may have been that they had chosen an epidural because the pain was more intense in the first place, or it may have been that pain relief afforded by the epidural made the preceding labour, by contrast, seemed even more painful. However, their perception of how painful labour had been also declined with time

Previous studies have stressed the importance of the attitude and behaviour of caregivers in determining whether a woman has a satisfying experience during her childbirth. This study reveals how the memory of pain is influenced by a woman's overall satisfaction with her labour experience. The researchers suggest that healthcare professionals should take into account the woman's overall experience when assessing whether a woman needs further support postnatally.

Professor Ulla Waldenström from the Department of Woman and Child Health at the Karolinska Institute in Sweden, who undertook the study said, "A commonly held view is that women forget the intensity of labour pain. The present study, which measured women's memory of labour pain up to five years after the birth, provides evidence that in modern obstetric care, this is true for about 50 percent of women.

"The findings also show that there is great individual variation, and that a woman's long-term memory of pain is associated with her satisfaction with childbirth overall. The more positive the experience, the more women forget how painful labour was. For a small group of women with a negative birth experience, long-term memory of labour pain was as vivid as five years earlier.

"Women who had epidural analgesia remembered more pain, suggesting that women remember pain as they experienced it when requesting the epidural, that is, the 'peak' pain. They don't seem to make a comprehensive assessment including the relatively pain-free period after having received the epidural."

Professor Philip Steer, BJOG editor-in-chief said, "This research shows that labour pain is an acceptable experience for many women. Others prefer to have pain relief. It is important for us to appreciate that the overall experience of childbirth (for example, how well supported women feel) has a major influence on women's memory of how painful it was giving birth.

"My advice is for women to discuss the range of options regarding caring labour with their doctors and midwives. Some women (perhaps 3% to 5%) have an underlying deep-seated fear of childbirth and may require counselling to help them cope."

Notes

BJOG: An International Journal of Obstetrics and Gynaecology is owned by the Royal College of Obstetricians and Gynaecologists (RCOG) but is editorially independent and published monthly by Wiley-Blackwell. The journal features original, peer-reviewed, high-quality medical research in all areas of obstetrics and gynaecology worldwide. Please quote 'BJOG' or 'BJOG: An International Journal of Obstetrics and Gynaecology' when referring to the journal.

Reference

A longitudinal study of women's memory of labour pain-from 2 months to 5 years after the birth.
Waldenstro¨m U, Schytt E.
BJOG 2008; DOI: 10.1111/j.1471-0528.2008.02020.x.