Pain management in labour and childbirth: Going back to basics

Pain is defined as ‘an unpleasant sensation caused by noxious stimulation of the sensory nerve endings’ or ‘as a state in which an individual experiences and reports the presence of severe discomfort or an uncomfortable sensation (Mosby, 2009). During labour, pain is due to the interaction of a multitude of physiological and psychological factors. Physiologically, there is a multifaceted feedback loop between hormones, endorphins and the pain receptors, which stimulate on-going oxytocin production (Sprawson, 2017). This mechanism initiates uterine contractions and cervical dilatation, and allows the fetus to enter the pelvis, causing distension and stretching of the pelvic floor and vagina. This results in the sensation of pain. How the labouring woman then perceives this unwanted feature of childbirth depends on how she processes it (Sprawson, 2017). Several factors will influence this: the woman's personality, her expectations, her cultural and social background, her previous experience(s), how tired she is and if she has pre-existing fears and anxiety about labour and birth (McCormack, 2009). The World Health Organization (WHO) also states that environment of care, effective communication, continuity of carer, and personalised and woman-centred care are also important aspects to consider when providing respectful maternity care and addressing pain management (WHO, 2018).