ABSTRACT
This poignant quota tion about a woman’s ex peri ence of birth in a birth centre captures the paradox inherent in childbirth pain – the agony and the ecstasy. It leads us into the heart of the conundrum re gard ing pain and the con tempor ary ex peri ence of childbirth, at least in the Western world. Though pain is intrinsic to labour, in most other con texts of our lives it is seen as negat ive and treatable by a variety of pharmacological agents. A whole sub-specialism of anaesthetics has evolved in maternity care to devise increasingly soph istic ated and techno lo gical solutions to labour pain. From this per spect ive, the de velopment is part of a medicalisation of childbirth that has been ongoing over the past 200 years or so. The availabil ity of epidural anaesthesia, argu ably the most successful of these techno lo gical advances, and its increasing uptake, poses a question that would have been unthinkable 200 years ago – how can women do labour without one? With rates for primigravid women at 70 per cent in some units, it does seem a reason able question to ask and yet, for the midwife, the question highlights how far the maternity ser vices and soci ety’s expectations have shifted from an anthropological understanding of childbirth towards the biomedical para digm. Yet, research has consistently shown that dissatis fac tion with birth is seldom related to the in tens ity of pain (Hodnett 2002). In fact, a body of research shows the oppos ite – that coping with labour pain is associated with feelings of self-esteem (Callister et al. 2003, Niven and MurphyBlack 2000) and self-growth (Aldrich and Eccleston 2000). In this chapter I will revisit the debate around pain and labour raised in the first edition, during the course of which I will, once again, draw on Leap and Anderson’s (2008) seminal writing on models of labour pain. I will then examine the evid ence base of a whole spectrum of sup portive meas ures and inter ven tions, from psychological methods to phys ical therapies, from sensory aids to com plement ary therapies and from birth envir on ment issues to pharmacological agents.
