A study involving 21 mothers in Melbourne Australia has shown that their experience of birth pain is strongly shaped by the social environment of the birth.

Some women interpret pain as purposeful and productive and they convey the ability to cope. Some interpret the pain as threatening and respond fearfully, resorting more quickly to analgesic pain control.

This study showed that the social environment, which can change during the birth, can change a woman’s interpretation of the pain.

In the study, when the people around the labouring woman were known, trusted and calm, she had a sense of being safe and the pain was less threatening.

Having him there didn’t alleviate the pain, it just was comforting … he was like my life net … I don’t know how women would do it alone. It would be awful.

I think everyone was just really calm around me like my midwife was very calm. Every time she spoke to me she was very soothing and … there was no panic in her voice … I think I would have panicked if she was more panicky.

Caregivers’ words were also able to help her manage the pain herself.

I just kept saying that I couldn’t do it. And then Sally was like “no, you can, you can do it, you can keep doing it, you’ve been doing it, come on”, you know? And that was good, that was good to have her, she was perfect at that time.

 You don’t care what’s happening around you as long as you know they’ll take care of you and you’ll be in good hands … and then you can just let go, you just do what you have to do and just go with the flow.

Conversely, when a woman lacked the support or presence of her preferred caregiver or support person, it had a negative effect on her description of the pain.

You’re in this most incredible pain … I wouldn’t even know what to compare it to and then they make your partner go home, which is just absurd because you need that support … you don’t want to do it alone, it’s horrible.

The presence of strangers or others whom the woman did not want present, could interfere with her focus and her description of the pain.

Because I know they really can’t help me out and it’s … it’s in fact distracting and it stresses me out. I don’t want to see anybody ‘til I have my baby because I’m really in that much pain, I don’t want to see anybody at all. Your husband is the person that you can share … but not with everyone … <

The woman can read the social environment and this affects her experience of the pain.

…having like a hundred people in the room and their faces all looked petrified. A hundred faces really stressed is pretty scary.

This corresponds to earlier research showing that women’s experiences of coping with pain during childbirth are influenced by support from trusted caregivers to whom she feels emotionally connected.

This study provides insight into the mechanism for this. Caregivers can reassure the woman that the pain is productive and purposeful. They can help her towards a ‘mindful acceptance’ state that has previously been demonstrated to allow the labouring woman to accept the pain as non-threatening and to work with it. Conversely, caregivers can communicate that something is wrong, leading to the opposite reaction, catastrophizing and helplessness.

This corresponds with recent pain science, which sees pain in relation to a response to threat. If the people around the woman convey danger, it makes sense that the woman will seek safety.

Other research has demonstrated that the neurophysiology of physical and emotional pain overlap and that emotional pain can heighten physical pain (and vice versa). It may be that the social pain of being alone or feeling vulnerable during labour contributes to the woman’s physical pain experience.

These are important insights for those managing places where women give birth – social support is important. The insights are also important for those attending the birth, be they partners, friends or professionals, because of the influence of their reactions on the woman’s experience of pain.

Whitburn LY, Jones LE, Davey M & Small R (2017), The meaning of labour pain: how the social environment and other contextual factors shape women’s experiences, BMC Pregnancy & Childbirth

Photo: Lindsey Turner. Creative Commons.