A qualitative interview study into experiences of management of labor pain among women in midwife-led care in the Netherlands

Abstract

Introduction: Many pregnant women are concerned about the pain they will experience in labor and how to deal with this. This study’s objective was to explore women’s postpartum perception and view of how they dealt with labor pain.

Methods: Semistructured postpartum interviews were analyzed using the constant comparison method. Using purposive sampling, we selected 17 women from five midwifery practices across the Netherlands, from August 2009 to September 2010.

Results: Women reported that control over decision making during labor (about dealing with pain) helped them to deal with labor pain, as did continuous midwife support at home and in hospital, and effective childbirth preparation. Some of these women implicitly or explicitly indicated that midwives should know which method of pain management they need during labor and arrange this in good time.

Discussion: It may be difficult for midwives to discriminate between women who need continuous support through labor without pain medication and those who genuinely desire pain medication at a certain point in labor, and who will be dissatisfied postpartum if this need is unrecognized and unfulfilled.

Keywords:

• Childbirth
• coping
• labor pain
• midwifery
• women’s health

Acknowledgements

We thank all the midwifery practices for recruiting women for our interviews. We also thank all the women who gave us their time and were prepared to share their intimate labor experiences with us.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Current knowledge on the subject

• When women's antenatal approach toward labor pain does not work out as planned, some women feel lost, not in control and tend to catastrophize labor pain.

• The cognitive coping strategies instilled in women as part of their childbirth preparation help them to manage with labor pain.

• Most women want to wait and see until labor before they decide about the use of pain medication during labor.

What this study adds?

• Some women change their approach early in labor from “Pro Pain Relief” to “Pragmatic Natural” (wait and see). This change may be prompted by their midwife.

• Women may be so focused on natural birth without pain medication that they fail to take the variability of the birth process into account.

• Some women expect midwives to know which method of pain management they need during labor and to ensure this is arranged in a timely manner.