Pain perception in Pregnancy.

So we touched on Labour experiences last time, so now we are going to expand that subject a because it is important to know a little of what your Wife or partner is going to go through psychologically, emotionally and physically over the next few months and when she is in labour…

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Sarah during Surge

Every woman will have a different experience throughout pregnancy and everyone woman will have a different experience of labour and the birth of their baby. However your Wife or partner will be influenced mentally and emotionally by the experiences of other women and by TV and movies as well. From other women your Wife or partner is more than likely to only hear about bad birthing stories. They are also likely to only hear about bad experiences of newborns. Now, while its important to know what can go wrong in childbirth, (since the more knowledge you have of the possibilities, the less likely you are to fear the unknown) getting that information from another mother, if she has only had bad experiences, is actually not helping your Wife or partner in the slightest. In fact you should ask them to not tell you about their birthing experience if it was traumatic at all (if a close friend, then you will already know their story and hopefully their experience will enrich yours in some way.

Hollywood births = plenty of over the top screaming for less than a minute and then they are presented with a perfectly clean baby who looks roughly two months old. Yes, that seems completely real. ‘One born every minute’. I cannot stress enough how important it is to not watch that program. Not you, not your Wife or partner. It is incredibly psychologically damaging to your impression of what labour can look like. I will add here a little bit about contractions (or surges). Again, they are all different in how they start, but generally, most surges last around a minute with a small window of time in between that shortens the closer to birth you get. The best way to describe them will be that they are like the worst period pain your Wife or partner has ever felt with pressure (down there) added on.

So what do I mean by programs and peoples stories of labour being damaging?

Well, your Wife or partner will Be told that it is going to be the most immeasurably difficult, painful, intense, horrendous, hideous, inside twisting, relentless, awful processes she will ever endure. Those are words I have heard women use to describe labour to each other first hand. Now, if it was that bad, surely we would have stopped doing it a long time ago?

now before any women think ‘what the fuck does he know?! It is painful!’ I’m not here to reduce what you have go through, it is absolutely no small feat to produce a child unto the world and I have no doubt that pushing a baby through your vagina is a pretty intense experience. I have watched enough birthing videos as well as being with Sarah throughout her labour. So I am not blind to the hardship labour can be, but…

Disclaimer: There may be some biological terms thrown in here and a brief introduction to how pain pathways work.

Pain is a subjective experience, everyone has different interpretations’ of pain and it you were to test a hundred people by hitting them on the arm, you will likely get different pain levels and descriptive words that will range wildly from That didn’t hurt at all’, to ‘Oh Lord! That was the worst pain ever!’. Basically this happens because over time as we are subjected to more pain stimulus through our lives (from any factor) and we learn different techniques and become much better at dealing with the pain (Gating pain) felt from our sensory nervous system (think about bumping your leg, your first action is to rub the area bumped. That is a learned response because its effect of gating pain signals reaching your brain). Not only can we gate pain from sensory nerves, we can also gate pain psychologically as well through relaxation, breathing exercises and mediation, these reduce hormone release that increase stress like cortisol and increase the release of hormones that reduce stress like oxytocin.

So! Lets have a quick lesson in the biological process of feeling pain, pain perception and methods that reduce pain. since we are here.

Pain perception is a subjective psychological mechanism that tells us when we have been hurt physically, neuropathically or in some cases, psychologically. Physical pain can be described simply as an injury sustained to the body either through acute pressure exerted to the body until tissue is damaged, or through external damage to the body’s tissue, for example cuts or grazes. It can also be from tissue damage from extreme temperatures. These types of pain are called nociceptive. Neuropathic pain is when nerves have been damaged in such a way that signals to the brain are faulty and psychological pain could be described as emotional pain such as social loss or grief. Here, we will see how the body sends messages through the nervous system and we will look at the different degrees in which different people experience pain.

 The nervous system is an intricate system of fibres that run through your entire body, from the sensory neurons all the way through to the thalamus in the brain. To give a brief breakdown of the pain pathway during noxious stimulation (something that makes you think ‘ouch!’) we will imagine a human subject at home. The subject walks through the house and without looking steps on a plug. As most of us know, this may be one of the most painful moments a human must endure (I think Lego is worse?). Damage is immediate to surrounding tissue which causes a receptor potential in the sensory neurons to send signals down the nociceptive nerve fibre to the axon terminal in the spinal cord. Here the nociceptor can make synaptic connections with several other cells including transmission cells and Interneuron via releasing a neurotransmitter called glutamate. The interneuron very quickly sends a signal through the motor neuron fibres which causes our subject to remove his foot from the plug. Nociceptor sends another signal to the transmission cells via synapses in the spinal cord, from here it travels up into the brain to the thalamus. From here another signal is sent to the somatosensory cortex where the brain interprets the body’s senses.

From here the brain sends signals to the interneurons that form synapses with transmission cells which produce neurotransmitters which include enkephalin. This helps stop transmission cells from forming action potentials and in turn, reduces the pain felt by our subject. If the brain did not produce enkephalin, the pain would simply continue until the damage was healed. Our subject also has the potential of reducing the amount of pain felt and the speed in which pain subsides by rubbing his foot. Touch neurons can also release glutamate to cause spinal interneurons to release enkephalin, easing the pain felt by the pressure caused by the plug. As you can see the release of neurotransmitters to reduce pain can happen both ways either from the brain via the spinal cord or from the nociceptor.

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Sarah between surges (3 minute space between surges)

Hypnotherapy has long been used to help reduce the amount of pain felt by subjects that experience any type of pain either chronic or acute. For example, in Hypnotherapy for the Management of Chronic Pain several studies are reviewed showing a significant reduction in perceived pain by patients who received hypnotherapy, who were taught self-hypnosis or relaxation techniques. In recent years, hypnotherapy has become more fashionable for labouring women to use to allow the act of childbirth to be calmer and less painful. In a review of studies done on hypnobirthing each study showed either a significant reduction in pain during labour, more comfort during and after treatment, fewer patients that underwent hypnotherapy needing pain medication, patients having a higher tolerance for pain, labour was calmer which attributed to shorter first stage in labour and shorter labour time overall, shorter hospital stays and less surgical intervention. This is because hypnotherapy and other relaxation techniques suppress neural activity between the sensory cortex and the amygdala which processes emotional reactions. By suppressing emotional reactions to pain it reduces the fear and anxiety felt by women during childbirth. In retrospect, by starting hypnotherapy months before childbirth, it can greatly reduce the fear and anxiety attributed to childbirth further decreasing pain perception.

With emotional pain, action potentials can occur in areas of the brain such as the anterior cingulate cortex even without a physical injury. The anterior cingulate cortex sends signals to the Vagus nerve exciting it causing chest pain and nausea. We see this when people loose loved ones and grieve, when children and adults suffer socially or when a couple’s relationship breaks down. Your response to this emotional pain is the same or in extreme cases as bad as physical pain as it can cause muscle contraction, crying, vomiting, diarrhoea and headaches to name a few symptoms.

A physical injury to the male genitals can also cause the body to perceive pain in other parts of the body such as the stomach since they are both connected via the vagus nerve. Thanks to this, even if a kick the testicles does not injure and hurt the point of impact, you can still perceive the pain as if you have had a kick to the abdomen and chest.

Anxiety, which occurs in the brain as a chronic or acute ‘fight or flight’ response, can manifest pain almost anywhere on the body. Anxiety increases your awareness and you can become ‘hypersensitive’. Thanks to this, any physical pain you perceive while feeling anxious can feel much worse thanks to your heightened state.

There are many ways to increase or exacerbate pain that we feel. This can occur when we feel anxious, scared, fearful, guilt. This leads to inhibiting hormones that reduce stress like oxytocin and the increase in the amounts of hormones that add to stress like cortisol. Now in a normal everyday environment, your hormones generally sit at levels that keep you calm quite well. But during labour, if your Wife or partner is scared, nervous, stressed, fearful and anxious about what is happening to her body, she will produce more cortisol, this will have a couple of bad knock on effects, first she will focus on whatever is painful and become hypersensitive to any change around her, this will in turn increase the amount of cortisol released causing her to be even more alert to stresses around her. Secondly, cortisol production inhibits relaxin production (relaxin is the hormone her body produces that allows her muscles and ligaments to relax to allow the baby to pass though her pelvis and down the birth canal) this will of course lead to more stress and anxiety and ultimately a never ending cycle or fear and pain. This can, if left unchecked lead to very serious problems in labour, your Wife or partner may in fact not be able to give birth to your baby naturally because her level of fear is literally making her contract the muscles inside her, this can cause distress to the child and interventions may be required, which then has any number of negative effects attributed to them. On top of that, having to have some interventions may make your Wife or partner feel like a failure, as if she has not been able to do the one thing she should be able to do without help. This can lead to postnatal depression and serious psychological problems that if left unchecked….

STOP!!! I hear you say. And your right, I should. This is not a nice scenario, it sounds awful, and yet to many, many women, this is the scenario they find themselves in on their first child birth mainly because of external input, negativity and fear. We must also remember that anything can happen during childbirth. Problems can occur that where not foreseen. You cannot control everything. But you can see that pain perception is not the same for all and can be altered for everyone. It is highly subjective depending on our own personal life experience. Emotional and mental control as well as experience of pain all together dictates how our body will respond in labour. We can also see that with discipline, we can reduce the pain we perceive with mindfulness and relaxation techniques that can reduce anxiety and fear of the unknown. So as you can see, it doesn’t have to be like people tell you it’s going to be. Labour is called labour for a reason. It isn’t easy. But it can be (and to a lot of women is) described as the most amazing experience they have ever had, my Wife Sarah among them.

So how do we go from a terrible experience to an amazing experience with reduced pain without medication(unless required) or intervention in labour? Well my friends, that leads us quite nicely to courses, community and communication.

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