Pain acceptance and personal control in pain relief in two maternity care models: a cross-national comparison of Belgium and the Netherlands

Abstract

BackgroundA cross-national comparison of Belgian and Dutch childbearing women allows us to gain insight into the relative importance of pain acceptance and personal control in pain relief in 2 maternity care models. Although Belgium and the Netherlands are neighbouring countries sharing the same language, political system and geography, they are characterised by a different organisation of health care, particularly in maternity care. In Belgium the medical risks of childbirth are emphasised but neutralised by a strong belief in the merits of the medical model. Labour pain is perceived as a needless inconvenience easily resolved by means of pain medication. In the Netherlands the midwifery model of care defines childbirth as a normal physiological process and family event. Labour pain is perceived as an ally in the birth process.MethodsWomen were invited to participate in the study by independent midwives and obstetricians during antenatal visits in 2004-2005. Two questionnaires were filled out by 611 women, one at 30 weeks of pregnancy and one within the first 2 weeks after childbirth either at home or in a hospital. However, only women having a hospital birth without obstetric intervention (N = 327) were included in this analysis. A logistic regression analysis has been performed.ResultsLabour pain acceptance and personal control in pain relief render pain medication use during labour less likely, especially if they occur together. Apart from this general result, we also find large country differences. Dutch women with a normal hospital birth are six times less likely to use pain medication during labour, compared to their Belgian counterparts. This country difference cannot be explained by labour pain acceptance, since - in contrast to our working hypothesis - Dutch and Belgian women giving birth in a hospital setting are characterised by a similar labour pain acceptance. Our findings suggest that personal control in pain relief can partially explain the country differences in coping with labour pain. For Dutch women we find that the use of pain medication is lowest if women experience control over the reception of pain medication and have a positive attitude towards labour pain. In Belgium however, not personal control over the use of pain relief predicts the use of pain medication, but negative attitudes towards labour.ConclusionsApart from individual level determinants, such as length of labour or pain acceptance, our findings suggest that the maternity care context is of major importance in the study of the management of labour pain. The pain medication use in Belgian hospital maternity care is high and is very sensitive to negative attitudes towards labour pain. In the Netherlands, on the contrary, pain medication use is already low. This can partially be explained by a low degree of personal control in pain relief, especially when co-occurring with positive pain attitudes.

Pregnant Women's Fear of Childbirth in Midwife- and Obstetrician-Led Care in Belgium and the Netherlands: Test of the Medicalization Hypothesis

“…This finding was in line with the earlier finding that Dutch and Belgian women giving birth in a hospital setting had a similar labor pain acceptance (Christiaens, Verhaeghe, & Bracke, 2010), and hence contradicts the existence of a specific Dutch pain-culture. Dutch women showed a greater acceptance of labor pain compared to Americans in Senden's study (1988).…”

“…Women are unsure which team member will provide care at each antenatal consult and at the moment of birth but have usually met each of them at least once before delivery. Referrals from home to hospital during pregnancy or labor likewise often reduce the continuity of care (Christiaens, Gouwy, & Bracke, 2007).…”

Labor Pain: Perception of the Parturient and Midwife Evaluation

“…The subject is controversial, because on the one hand actual results contribute to some studies [19], deny those who observe greater pain in nulliparous [7,8] or otherwise in multiparous [6]. There are physical reasons for the nulliparous has more pain in the 1 st phase of the labor as dilation and fetal descent, for greater capacity of the uterine fibers takes place in early process.…”

“…Show some authors that the level of pain is labeled as much more painful than expected. In nulliparous women the expectation of pain prior to birth, is often underestimated [5] and the highest pain both observed in multiparous [6] and in nulliparous [7,8]. Also despite the prenatal class frequency, recall the pain is referred to the extremes, both bearable as excruciating [6,8].…”

Women’s Attachment as a Predictor of Pain During Labour and Post-Delivery: a Prospective Observational Study

“…45 A history of menstrual back pain was associated with higher post-delivery pain scores. This finding, which was only significant in post-delivery pain, was expected to occur throughout labour, 11 given the biochemical mediation of prostaglandins in both the manifestations of dysmenorrhoea and uterine contractility.…”