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Description of the Variability in Physical Pain Patterns During Labor and Their Relationships with Fetal Position, Pain Severity, Epidural Use, and Delivery Mode:A Mixed Methods Study
Abstract Number: T-21
Abstract Type: Original Research
Introduction: Little published information is currently available related to the nature of physical pain patterns during childbirth or their relationship with birth outcomes. This 2 phase mixed methods study explored and described these relationships during Labor Pain Questionnaire (LPQ) development.
Methods: Following REB approval, healthy, native English-speaking women of mixed parity with term gestations were recruited. Sampling was purposeful and by maximum variation. Phase 1 included 25 women with(n=15) and without(n=10) pain relief delivering by all modes. Phase 2(n=14) explored/described pain associated with fetal malposition and/or pain refractory to epidural analgesia(PREA). Following completion of a survey, women were interviewed using a Pictorial Pain Mapping Tool (PPMT) during which they drew their pain in pictures at 4 time points over labor and delivery and mapped words from a list (or generated new words) to describe their pain. Interviews were conducted during labor and/or postpartum. Details related to pain relief, obstetrical management and delivery were recorded. Qualitative analysis of pain pictures and Number of Words Chosen (NWC) were grouped by parity, delivery mode, epidural use and evidence of fetal malposition or PREA.
Results: Primiparas used > NWC and distress words to describe pain than multiparas. Pain pictures in women with au naturale SVDs, regardless of parity, demonstrated consistent patterns of uterine(UC) and rectal pain over time without the additional forms of pain described by other women (eg back pain, hip pain, electric shocks, neck, shoulder and/or inter-scapular pain). Primiparas with SVDs who used epidurals typically described back pain in addition to UC pain as a prominent early feature of early labor prior to epidural receipt. Women delivered by mid-forceps or c-section and those with fetal malposition received epidural analgesia and described very high levels of breakthrough pain despite frequent, heavy top ups using otherwise normally functioning epidural catheters. Women with persistent occiput posterior (OP) or occiput transverse (OT) fetal head positions described fairly typical patterns of physical pain (OP mid back, OT-hip, Figure 1) in addition to interscapular, shoulder and/or neck pain. This pain was relieved by rotation of the fetal head to occiput anterior or caesarean delivery and worsened by re-rotation of the fetal head and in some women, by injection of epidural solutions. This pain disappeared completely after delivery.
Discussion: Understanding the nature and variability of women’s pain experiences, including physical pain patterns, provides important insights into fetal position as a contributor to pain and epidural use. Findings suggest that pain patterns may be prognostic for delivery mode in some women. Findings also provide a framework within which research findings using the Labor Pain Questionnaire may be interpreted and applied to clinical care.