Thursday, September 25, 2008

Understanding pain

There is something unimaginable about the pain that another person experiences. It's never easy to witness. My response is to want to do something that will end the pain.

But surely, I am a midwife, I should be used to the intense pain of labour. I tell women to work with their pain; to accept and use it. I know both the mental haze of narcotic drugs, and the total differentness and mental alertness of spontaneous unmedicated birth for myself, and for many of the women I have been with, and the latter is the winner without a doubt. I haven't personally experienced the numbness of regional anaesthesia (such as epidurals and spinals), but I cannot imagine anyone would choose that over the physical achievement and mental exhilaration of normal birth.

Yesterday I was at the home of a mother who was looking forward to the birth of her second child. She was strong and well, and had prepared beautifully, and was now in labour. Her husband gave unconditional personal support, and her sisters and whole family all had their support roles. The bedroom was quiet and almost dark; she spent time on the exercise ball, and resting as the hours lengthened. The birth pool was set up in the bathroom, and soft candle light made the space all the more special as an intimate place to welcome the precious newcomer. Labour had begun in the morning - a lovely clear sunny day in Melbourne. As the afternoon sun set, and the sounds of labour became more regular and stronger, I expected that undefinable change to occur, as a woman surrenders to the enormous power within her body, and her baby is brought forth.

But that didn't happen. The sounds became more distressed. We waited. I withdrew for a while, not wanting the mother to feel pressured. She told me today she wondered if I didn't believe she was really in a lot of pain. I did, and I was concerned about what I was hearing and feeling. I was intuitively sensing what we refer to as 'failure to progress', although intellectually that didn't make sense. It doesn't usually happen with a second labour, when the first baby was born at term, vaginally.

The minutes passed into hours, and the mother became more tired, and vomited. I checked internally for progress. Cervix about 5cm dilated; bulging forewaters; and a very high head that could be easily pushed away. I was careful not to rupture the membranes. The only advice I could give was that we should go to hospital. I hoped we would see progress of this baby, and my intuition would be proved wrong.

It was about six hours later that this family welcomed their new baby, with the help of the midwifery and obstetrics and anaesthetics and paediatric teams at the Women's. The hoped-for progress did not eventuate, and gradually the little one became more distressed. A caesarean birth was the best birth possible, and I was grateful.

I called this post 'Understanding pain'. My understanding of pain in labour includes the belief that there is a pain that is OK, and there is another pain that is intolerable. The distinction between the two is not easy to make, either by the labouring woman or by others. I think a midwife develops an intuition, but I am always ready to question my intuition. The labouring woman is the only person who can say, "this is OK" or "this is not OK". Many women have said, in effect, "this is not OK", in transition, and then gone through the paroxysm of pain, into the wonder of new life and love. But when "this is not OK" continues, without relief, the message is a different one.

By reflecting on an experience such as this one, I am reminded that I must hear what the woman is telling me, whether it fits with my perceived knowledge base or not. I must approach the decision points carefully, with clear thinking and without fear.

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