Cultural influence on the expression of labour-associated pain

Abstract

Background Every woman expresses pain differently during birth since it depends on a multitude of predictive factors. The medical care received, companionship during birth, cultural background and language barriers of the women in labour can influence on the expression of pain. This study aims to evaluate the expression of pain during birth and its associated factors in women treated in a Spanish border town. Methods The study included 246 women in labour. The expression of pain during labour was evaluated using the validated ESVADOPA scale. A descriptive analysis and association study were performed between cultural identity and dimensions of the scale. Multiple linear regression models were performed to assess the association between cultural identity, origin, language barrier, and companionship during labour. Results The women included in the study comprised 68.7% Berbers, 71.5% Muslims and 82.1% were accompanied during labour. An association between cultural identity and greater body expression of pain (p = 0.020; Cramer’s V = 0.163) in addition to its verbal expression was found during the latent phase of labour, (p = 0.028; Cramer’s V = 0.159). During the active phase of labour, cultural identity was associated with pain expression through greater body response, verbal expression, expression of the facial muscles, anxiety, inability to relax and vegetative symptoms. The different factors studied that had a predictive value were companionship (p = 0.027) during the latent phase of labour and Berber origin (p = 0.000), language barrier (p = 0.014) and companionship (p = 0.005) during the active phase of labour. The models designed predict pain expression in the latent phase by companionship and type of companionship (β = 1.483; 95%CI = 0.459–2.506, β = 0.238; 95%CI = 0.029–0. 448, respectively), and in the active phase by background, language barrier and companionship (β = 0.728; 95%CI = 0.258–1.198, β = 0.738; 95%CI = 0.150–1.326, β = 1.888; 95%CI = 0.984–2.791, respectively). Conclusion Culture, origin, language barrier and companionship during labour influences the manner in which women in labour express their pain. An understanding of this may help midwives correctly interpret the signs of pain expression and be able to offer the appropriate assistance depending on a woman's particular characteristics. There is a clear need for new models of maternity care that will take the cultural and language characteristics of women in labour into consideration.

Application of epidural analgesia in obstetric hospitals of Ukraine and its alternative

“…Крім того, під час пологів важлива соціальна підтримка. Наявність супутника, який підтримує, може значно зменшити відчуття болю у жінки та її потребу у фармакологічному знеболюванні [23,24,26] Інструментальне розродження збільшує ризик короткочасних ускладнень для дитини: синці, травми обличчя, зміщення кісток черепа, кефалогематоми (скупчення крові під шкірою голови). За даними деяких досліджень, у дітей, народжених із застосуванням акушерських щипців, у 4 рази підвищується ризик крововиливу у мозок; однак інші дослідження не виявляли суттєвої різниці між дітьми віком 5 років, народженими природно або із застосуванням щипців [2].…”

Cultural Framing and the Impact On Acute Pain and Pain Services

“…One setting, in which intracultural differences in pain expression have been studied extensively is labor pain. For example, some Muslim women might express their pain more actively by screaming and crying, than women who self-identify as Christians [ 40 ]. Religious beliefs in general can have an impact on an individual's perceptions, emotions, and behaviors and can significantly affect health, pain sensitivity and treatment outcomes [ 41 ].…”

“…However, the evidence for the association was rather weak. A language barrier was also associated with greater pain expression in two studies, demonstrating the interaction of expression and communication [ 40 , 42 ].…”

Coping Strategies during Childbirth Related to Cultural Identity: Companionship, Choice of Analgesia and Maternal Satisfaction

“…Midwives commonly treat labouring women from all over the world whose culture differs considerably from their own. Therefore, it is essential to be sensitive to the characteristics of each culture [ 13 , 14 , 15 ], as this generates a different perspective on the way women experience childbirth, and therefore to provide quality health care, the training of nurses and midwives needs to have a multicultural approach [ 16 , 17 , 18 , 19 ].…”

“…Knowing the sociocultural characteristics of women before the birth can help us to understand whether pharmacological methods are accepted to relieve pain, the preference for alternative methods to just alleviate it, the acceptance of companionship during labour or whether, in contrast, culturally they usually give birth alone [ 16 ]. Furthermore, we must be aware of the cultural acceptance of facts that can be controversial depending on the society in which the birth takes place, such as exaggerated verbalisation, no contact with the male partner during dilation or continuous praying.…”