How Caregivers Manage Pain and Distress in Second‐Stage Labor

Abstract

Innovative care interactions are needed when helping a woman who exhibits severe pain or distress during the second stage of labor. We describe how caregivers and laboring women interacted during second-stage labor, with particular attention to how caregivers managed pain and distress. We used observational methods to perform a microanalysis of behaviors from video-recorded data. Pain occurred during labor contractions, and distress (an emotional response to pain) manifested primarily between contractions. Four patterns of women's behavior were identified: 1) no pain or distress, 2) low-level pain and/or distress, 3) focused working, and 4) severe pain and/or distress. Successful care was identified as enabling the woman to maintain herself in any state other than severe pain and/or distress. Particular modes of speech used by the caregiver enabled the attainment of successful care when the woman was not in severe pain or distress. When severe pain or distress existed, innovative caregiving transitioned the woman to another state. Successful intervention strategies included 1) giving innovative directions and 2) "talking down." Ordinary modes of "birth talk" can be used when severe pain or distress is not manifested and when the primary care problem is to assist women with bearing down. Innovative care interactions are needed when faced with severe pain or distress. Managing labor pain is an ongoing focus of clinicians who provide care to women in labor. In addition to pain, women might also experience distress, an emotional response to the labor experience. Whether from choice or necessity, caregivers for laboring women need nonpharmacologic interventions and interpersonal skills that can help women endure labor and give birth. Labor is hard work, and even in precipitous labors most women require assistance. Care given to a laboring woman consists of employing comforting strategies that help her cope with the pain of uterine contractions. The purpose of these comfort strategies is to help the woman find needed resilience during labor. Most cultures have mechanisms for providing this kind of support. In this article, we identify patterns of behavior used by laboring women and describe successful and unsuccessful strategies used by caregivers to help these women deal with pain and distress during the second stage of labor.

The Role of Maternity Care Providers in Promoting Shared Decision Making Regarding Birthing Positions During the Second Stage of Labor

“…1,33,34 We included communication patterns previously described during the second stage of labor related to the types of pushing that women may use and the maternity care provider role in encouraging that pushing approach. 36,37 The analytic framework generated from the literature included the following categories: listening to women, encouragement, information, offering choices, and style of support ( Table 1). The transcripts were considered the primary data sources, and we analyzed them using this framework with a deductive process.…”

“…Sense of control has been described as involvement in the birth process; influence over procedures, decisions, or information; being offered choices; and participation in decision making . We included communication patterns previously described during the second stage of labor related to the types of pushing that women may use and the maternity care provider role in encouraging that pushing approach …”

The Effect of Holistic Birth Support Strategies on Coping With Labor Pain, Birth Satisfaction, and Fear of Childbirth: A Randomized, Triple-Blind, Controlled Trial

“…Zero points indicate adequate coping and ten points not coping at all. Evaluating these components helps midwives decide what supportive birth strategies to use (Adams & Bianchi, 2008; Bergstrom et al, 2010; Bianchi & Adams, 2009; Roberts et al, 2010). The Turkish validity and reliability study of the scale was carried out by Akbaş et al (2021).…”

Teaching Labor Support: An Interprofessional Simulation

“…Labor support is generally understood to be the continuous presence of a caregiver who is able to provide psychosocial, emotional, and nonpharmacologic physical support, as well as facilitate communication and give anticipatory guidance in the intrapartum setting . The benefits of labor support are well documented and include the promotion of physiologic birth, decreased maternal psychological distress, and increased maternal satisfaction . Continuous labor support was recently included in the 13 Pearls of Midwifery, which outline evidence‐based practices that are part of midwifery care of women in the intrapartum setting .…”