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(I thought I’d give you guys another preview of part of my online doula course.)

Defining Pain

Typically pain tells us that something is wrong in the body, but many theorists feel like labor pain is different. Some propose the idea that labor pain does not signify a disorder, but is a natural part of physiologic labor. Others feel like different pains during labor may signify the need to change positions or slow down.

Many different theories have also been presented for the cause of labor pain. Hypnobirthing sees it more as cultural construct that is related to fear and anxiety. Others have theorized that it is due to hypoxia and pressure on the structures within the pelvis.

In this course we will be teaching you that pain has physical, emotional and cognitive causes, and that it is unique to each and every person. The way women deal with it is also unique. As a doula, it will be your job to address all of these aspects in your care as well as respect the fact that women themselves are the ones that should describe their experience of pain, not the doula or the other care providers. The causes and theories of pain will be presented, while the actions a doula should take will be discussed later on in the course.

Causes of Pain

Physiologic causes

There are numerous theories related to how our physiology causes pain during contractions. One has to do with how our cells react to a depletion in oxygen. When the uterus contracts, it may constrict the blood supply and cause a decrease in oxygen. This in turn causes the release of prostaglandins, substance P, and lactic acid. All these are involved in our pain response.

The pressure and stretching of the cervix and perineum may also be described as painful. This pain is also sometimes felt in the rectum or lower back.

During the second stage of labor, pain is caused by pressure on the other organs surrounding the uterus, as well as the stretching of tissues in the vaginal wall and perineum.

Pain can also be caused by how your uterus is tilted. This causes a greater amount of pain during contractions and also decreases the blood supply which then lead to a pain response. How the uterus is tilted and what internal organs may be pushed on during labor may be affected by the position a woman is, so this may play a role in how much pain women feel.

Fatigue can also play a role in how much pain a woman feels. When a person is exhaustd, their ability to cope with pain decreases.

Genetics may also play a role in how we feel pain.

Emotional causes

Past emotional experiences also make a difference in how women percieve pain. Situations that tend to increase feelings of pain include: a previous traumatic birth, previous sexual abuse, or any other perinatal or birth losses previously experienced.

Fear also tends to increase feelings of pain, which in turn increases feelings of fear and anxiety. This is believed to happen because the area of the brain that regulates emotional reactions is also stimulated when pain is felt. It also affects our hormones, that then tighten the uterine muscles. Fear is created in many ways during childbirth. Things like hospital routines, unfamiliar environments, strange people around you, and being confined can all lead to feelings of fear or that something is wrong.

Dr. Grantly Dick-Read also theorized that pain during labor is caused by fear. He felt like fear caused the sympathetic nervous system to be stimulated. This in turn causes the circular muscles of the uterus to contract, which opposes the normal action of the uterus and results in oxygen deprivation and more pain. This theory has come to be known as the fear-tension-pain theory.

Cognitive causes

People view pain and their ability to cope with it in different ways. Some woman may see themselves as being able to cope with pain and feel like they are capable and responsible for controlling it themselves. Others are more dependent on others for help in coping with pain. This may include medication, but it also may just be more hands on care by the doula. It is important to understand what coping style a women uses to best meet her needs.

Culture plays a big role in how women respond to pain also. Culture, very often, determines what is acceptable and unacceptable ways of dealing with pain. Some cultures view labor and birth as unacceptable painful, while others view it as normal and okay. Some may see it as a test of faith, a challenge to overcome, or a punishment. It helps to understand how your client views pain in order to help her work through her labor.

Physiology of Pain

There are three processes involved when pain is transmitted to the brain. The first begins at the point of injury and includes how the pain impluse is transmitted. The second is how our brain interprets it, and the third is how the brain responds to the information given.

When an injury first happens, A-delta fibers transmit sharp and localized sensations that are also very fast. A-beta fibers transmit sensations from the skin, ans A-alpha fibers transmit sensations from the muscles. A C-fibers, on the other hand, are slow, dull, aching feelings.

These impulses are transmitted from the area of injury to the spinal column and then to then brain where the impulse is interpreted. This is not a simple process and involves previous experiences, cultural influences and our own feelings about pain.

Once a stimulus is interpreted as being painful, the body releases chemicals like endorphins, serotonin, and norepinephrine that help produce a pain-relieving effect.

Most theorists use the gate control theory of pain to describe how we feel and process pain. This theory proposes that pain can be stopped at three seperate points: 1)at the ends of the nerves, 2) Where the nerves first connect at the spinal column, 3) and where pain is interpreted in the brain.

Pain at the ends of the nerves can be reduced by increasing the amount of natural endorphins produced, which provide a pain relieving effect at the end of the nerves. Once the pain impulse reaches the spinal cord, it is transmitted to the brain, but the a gating mechanism blocks the transmission of other impulses. Thus, triggering the faster A-delta fibers before the C-delta fibers, helps to block some of the impulses that may be received. This may also explain how techniques such as imagery or or distraction help to relieve pain. It also helps explain why touch may help.


Find a birth story online, then tell what may cause pain in that situation and why(remember that pain is caused by physical/social/and cognitive processes).

Read about epidural/endorphin relationship. Read about assessment of research. Assess this article, discuss how this might impact your work as a doula and what information you can provide to your clients when they are making decisions.

Follow Rachel Leavitt:

Rachel has worked as a register nurse (BSN from University of Utah) since 2004 with a work history in Labor and Delivery, NICU and Postpartum Care. She is also the founder of New Beginnings Doula Training which she organized in 2011. When she's not busy being a mother and grandmother, she can be found reading research papers related to some aspect of childbirth.

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