From MIDWIFERY MATTERS, Issue No.115
Lesley Price
I was recently at a meeting next to a surgical ward when the discussion was interrupted by the distressed cries of a man's voice. There were concerned looks from all while we listened to someone obviously in great pain and discomfort. A few minutes later the cries subsided and we all relaxed and voiced relief that the man had been attended to and his distress and pain resolved. From my nurse training I knew that the principles of excellent nursing were maintaining dignity, respect and pain relief, a principle I had always adhered to in my nursing career. The incident reminded me of a woman I had cared for a few weeks previously and how the meeting would have coped if they had been next to the room of the woman I supported in labour. The meeting would have been abandoned, I am quite sure of that!
A few months ago I was caring for a young woman in labour whom I shall call Mary. This was her second pregnancy; Mary had previously had an epidural and a forceps delivery. I had met Mary in the antenatal period and I knew she was very anxious regarding her forthcoming labour and birth.
Mary wanted to mobilise and was stamping around the room and 'vocalising' very loudly. This had continued for several hours. At the height of a contraction Mary pleaded for help and support and someone to do do something. She frequently stated she was dying of the pain and no one, but no one was helping her! In between contractions she chatted, drank juice and reported how walking around and stamping her feet and shouting was really helping! In between contractions she talked in a very, very quiet voice as she sipped juice and sucked sweets.
The baby was in a posterior position and as the labour continued, Mary vocalised louder and louder, stamped around the room and used the shower, different positions, all fours, kneeling, standing, lying on her side, climbing on the bed, off the bed and so on and so on. Entonox was declined, injections declined, but a heat pad and massage gave a little relief.
Mary did not want an epidural as she had felt the last one had not worked very well. The labour went on for several hours and if I could have changed anything, it would have been to ask Mary to shout just as loud in between contractions that she was okay and did not want an epidural!
Eventually a midwife came into the room to ask if I wanted the anaethetist. Mary agreed she did. The anaethetist was summoned. When the midiwfe left the room, Mary informed me that she did not want an epidural and needed to push. Mary had a natural birth of lovely boy and was very proud of herself.
The delivery suite is in the middle of a general hospital and her frequent cries must have been very, very distressing and alarming for all who could hear, especially to patients, relatives and staff. I reflected later, wondering whether I should I have somehow 'insisted' on pain relief; should I have asked Mary to stop shouting? Should I have insisted that Mary take some pain relief and explained that her cries were harrowing to all within a twenty mile radius? But then whose needs would I be addressing? Mine. The staff's. Everybody else's. I considered producing a leaflet to be given out with a warning that women in labour find vocalising, for example, shouting a way of coping with pain, and that we do provide a vast range of pain relief readily available and an excellent epidural service 24 hours a day, and one-to-one midwifery support in labour.
I visited Mary at home postnatally, and saw her at six weeks and at three months in the local health centre. On each occasion I asked Mary whether she felt that she should have had pain relief. Her answer was, 'No' each time. Usually when I see a woman weeks after the birth, my questions are: "How is motherhood, how is the baby?" With Mary, however, owing to her magnificent vocalising, I needed reassurance that I had supported her and when caring for another woman if the same scenario should happen I will perhaps pin a notice to the door:
"Effective coping strategy in use. Do Not Disturb!"
This article was originally published in Midwifery Matters ISSUE 115, Winter 2007, p8
AH updated 30 January 2009