Personal control in pain relief during labour.

Personal control is a central feature of women's involvement in their childbirth experiences. To achieve this control tacit rules and guidelines are applied to define how women and the professionals who care for them should behave. This study investigated the extent to which women exercised control in pain relief during the first stage of labour by comparing (a) the rules which they held prior to childbirth (2-3 cm cervical dilatation) with those which they afterwards felt applied to their labour and (b) the rules held by the women before and after childbirth with those held by the midwives. In a quantitative study using a repeated measures design, a questionnaire was administered to 35 midwives and to 100 women prior to and within 24 hours following their delivery. Consistency of the women's scores before and after childbirth, indicated by few statistically significant differences, tended to confirm their rules on control of pain relief. Some of the rules were held even more strongly following childbirth. A surprising finding was the even stronger agreement by midwives with some of the rules. There was a definite trend for many of the rules held by the women prior to childbirth to increase following birth towards those of the midwives. This could be the result of the experience of childbirth per se but the possibility that it was contributed to by the influence of the midwives cannot be ruled out and warrants further research. An interesting hierarchy in the rules for compliance with professional care has been highlighted.

Memory for labor pain: a review of the literature.

BACKGROUND: Women's ability and accuracy in recalling labor pain are widely debated, even though clinicians commonly use such retrospective information in their practice. The objectives of this paper are to review the literature to establish if labor pain is forgotten, if recall is accurate, factors that affect the accuracy of recall, and consequences of recall. METHODS: An electronic search of Medscape, Psychlit, Bath Information and Data Services, and CINAHL between 1990 and 1999 was undertaken using the key words "labor" and "labour," "pain," and "memory." Each key word produced thousands of hits, but the combination of all three was surprisingly unsuccessful. This review, therefore, used a manual and print search and a detailed knowledge of work in this and related fields. RESULTS: The literature was relatively limited, and many studies demonstrated methodological problems. Inductive and deductive analysis suggested that women do not completely forget labor pain, and recall is often vivid but not always entirely accurate. CONCLUSIONS: Memories of labor pain can evoke intense negative reactions in a few women, but are more likely to give rise to positive consequences related to coping, self-efficacy, and self-esteem.

Differences in midwives' approaches to pain relief in labour.

OBJECTIVE: To examine the influence of midwives' approaches on the care given to women for pain relief during labour. DESIGN: Non-participant observation was used to collect data on midwives' behaviours during interactions with women in labour. SETTING: A large teaching hospital in Northern Ireland. PARTICIPANTS: Observations focused on interactions that were related to pain relief and involved 11 midwives caring for 15 women throughout the first stage of labour. KEY FINDINGS: Midwives' approaches to pain relief differed; at one extreme the midwife acted as 'a cold professional' whilst at the other extreme she was observed to be 'a disorganised carer'. In the middle of these two extremes was the 'warm professional'; her approach had a positive influence on the women's experience of labour pain. IMPLICATION FOR RESEARCH: Further research is needed to develop a profile of the factors that 'make' for a warm professional. The information gained could be used to teach midwives the skills of being 'a warm professional', in particular, the value of effective communication for sensitive care such as pain relief in labour.

Systems of midwifery care in use in Scotland.

A survey was undertaken to identify the different systems of midwifery care in use in hospital and community settings in Scotland. The 53 units which responded provided 90% of the maternity care in Scotland. Of the 53 units, the 28 integrated units undertook 83% of Scottish births and were more likely than the non-integrated units to have implemented systems designed to reduce fragmentation of care. Nearly a fifth of units had five different systems of care in operation. More than half the units had at least one of the following systems of care in operation or under planning: individualised care plans; 'patient allocation'; DOMINO schemes; nursing/midwifery process or model; and team midwifery. The most frequently used system was planning individualised care (88% of the units). 'Patient allocation', nursing/midwifery process or model and the DOMINO scheme were in over 60% of the units. The least used system was team midwifery, which was in operation in 21% of the units and being planned for a further 30%. The use of the different systems in combination within a number of units demonstrates that approaches to the objective of continuity of care are complex. There is a need for further research into continuity of care as this is a commonly cited advantage of all five systems of care.