How a trained doula assess labor pain

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This is a section from my unit on pain during labor.

Assessing Pain

Fears about pain before labor can help be allayed by discussing the birth plan and showing them ways that they can help work with their contractions as well as telling them what you plan to do as a part of their care team to help them while they are working through contractions.

After your first meeting to establish a plan, subsequent meetings can be planned to help provide information on techniques which might be beneficial to utilize during labor.

Always listen to how the woman is describing her experience. This can help you know whether or not a certain action taken is helping a woman to cope or not. During labor, though, it can be hard to know if a woman needs more help or not. Often signs that we associate with distress are actually coping mechanisms that help them through labor. Things like moaning, rocking, clenching and unclenching the hands all can be normal coping mechanisms that actually work to increase endorphins and a woman’s ability to work through the contractions.

Tension anywhere, though, is not a good coping mechanism and is indicative of pain, either emotional or physical. Signs of tension include lines or burrows on the face, clenched muscles that won’t allow movement, or tight muscles in between contractions. Any of these signs indicate that something should be done to relieve that tension.

Emotions arising from pain, surface easier when a woman is in labor. It is important to acknowledge feelings of hopelessness, anger, or fear. It is quite normal for a woman to feel these emotions and to cycle through them during labor, but it is not beneficial for them to experience them for extended periods of time. If a woman is not working through these emotions on her own, then other methods of coping with pain need to be explored.

Crying or yelling can sometimes be a coping mechanism and sometimes not. If a woman is doing these things, look for other signs of decreased coping. Assess the woman’s tension and emotionally status if these are things that she is doing during labor. Also look at how she acts or behaves in between contractions.

You should always ask if something you are doing is helpful or not. At some point in labor, most women will even stop talking or have a very difficult time answering questions. Once a woman is at this point, it is best to just do what you think may help, but pay attention to subtle cues, like pulling away from you or a slight not of the head. It is very important to be constantly watching for these subtle cues throughout labor, but particularly when the laboring woman is needing to turn inward and not worrying about answering question.  Experience and training will help you as a doula to come to recognize this subtle moments.

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