Theories of Pain Management in Childbirth
There are two main theories for managing the pain of childbirth. Most comfort measures used during labor accomplish the goal of either one or both theories. Understanding why the comfort measures work may help you make good decisions about which technique to use.
Fear Tension Pain Cycle According to the Fear Tension Pain theory of pain management, the fear (or stress) a woman experiences during labor causes her body to react in ways that increase the pain. The originator of this theory, Dr. Dick-Read, hypothesized labor was not inherently painful. He believed the pain in labor was largely due to the fear of labor prevalent in the culture. He taught the birth canal could be obstructed by this fear. As the labor becomes dysfunctional, the pain increases and the mother's fear of what is happening increases and so increases the tension she feels and increases the pain which then cycles back to increase her fear.
We know the stress hormones released by the body (catecholamine) can interfere with labor by decreasing blood flow to the uterus and placenta, decreasing the uterine contractions, and decrease oxygen to the baby. According to the Fear Tension Pain theory of childbirth, the pain of labor can be lessened by stopping the cycle at any point. To stop the cycle at the fear point, experts recommend preparing for labor through education, birth planning and mental/emotional work.
The education should consist of what to realistically expect from labor, including common variations of normal. It should also include ways to overcome the most common challenges. If a woman is able to participate in a labor before the birth of her own child, it can help remove much of her fear of the unknowns of labor. When this is not possible, video of normal birth can help the mother prepare for what labor with actually be.
The birth planning should include positive health measures such as nutrition and exercise to keep the mother in the best condition possible. The expectant mother should also explore the options available to her in labor at various birth places and with various caregivers. This will help the mother choose the attendant and birth setting most comfortable for her.
The mental and emotional work necessary to overcome the fear of labor requires the mother and her partner to honestly confront the fears, hurts and other negative emotions that affect their relationship and will affect the labor. Many mothers find it difficult to say out loud the fears they hold in their hearts such as, "What if I'm not a good mother?" "What if my partner leaves me?" "What if I need to have a cesarean?" But for most, just speaking the words to another person relieves much of the pressure the fears cause.
Avoiding tension in labor is generally accomplished through a variety of relaxation techniques. Some, such as the progressive relaxation, keep the mother's mind relaxed and prevent fear. Others like massage help to keep the mother's body tension free to avoid excessive pain and discomfort. Relaxation techniques must be practiced before labor to be effective during labor.
Gate Control Theory According to the Gate Control Theory, you can block a painful stimulus (close the gate) and thereby reduce or prevent pain. This theory draws from the presence of two different types of never fibers. The large nerve fibers transfer pressure, non-damaging heat and cold and send signals quickly. The small nerve fibers transfer pain, light touch and extreme heat and cold and send signals more slowly. The idea is to activate the long nerve fibers so they prevent the slower moving small nerve fibers from sending pain signals.
Comfort measures based on this theory can be used at any time without practice and include ice packs, warm cloths, pressure and the labor tub or shower. The drawback to these techniques is the tendency for the nerves to habituate (get used to) the sensation in about 15 to 20 minutes. When this happens, either change the place you are working on (move the ice pack) or choose a different activity to do for a while.