It is already known that caregivers’ attitude and behavior is important in determining whether a woman has a satisfying experience of childbirth. But our knowledge about memory of labor pain is still limited. Is satisfaction with labor linked to memories of the pain?
Professor Ulla Waldenstrom and colleagues at the Karolinska Institute in Sweden explain that the memory of labor pain usually reduces over time, but for some women it increases. The team set out to investigate the memory of labor pain after two months, one year, and five years, and whether it is linked to the pain relief used and the woman’s feelings about her experience.
They examined figures on 1,383 women who gave birth in Swedish hospitals in 1999. Five years on, the women completed questionnaires on their memories of the birth. Pain was rated on a seven-point rating scale (1 = no pain at all, to 7 = worst imaginable pain).
After five years, nearly half (49 percent) of the women remembered birth as less painful than when they rated it two months after the birth. Just over a third (35 percent) rated it the same, but 16 percent rated it as more painful.
Results appear in BJOG: An International Journal of Obstetrics and Gynaecology.
The authors say that evaluation of childbirth was indeed associated with recollection of labor pain after two months. Women who reported labor as a positive experience after two months also had the lowest pain scores after one year and five years. Women who rated their childbirth as negative or very negative were more likely to rate their pain the same, but women who had epidurals remembered pain as more intense. This may be because the pain was more intense in the first place, say the experts, or it may be that the women primarily remembered the pain just before the epidural was given.
They write, “There was significant individual variation in recollection of labor pain. In the small group of women who are dissatisfied with childbirth, memory of pain seems to play an important role many years after the event.” The experts say this challenges the view that labor pain has little influence on subsequent satisfaction with childbirth. Labor pain and long-term memory of pain involve different memory systems, they suggest.
Professor Waldenstrom concluded, “Around 60 percent of the women reported positive experiences and less than ten percent had negative experiences. A commonly-held view is that women forget the intensity of labor pain. The present study, which measured women’s memory of labor pain up to five years after the birth, provides evidence that in modern obstetric care, this is true for about 50 percent of women.
“But the findings show that there is great individual variation, and that a woman’s long-term memory of pain is associated with her satisfaction with childbirth overall. The more positive the experience, the more women forget how painful labor was. For a small group of women with a negative birth experience, long-term memory of labor pain was as vivid as five years earlier.”
She recommends that health care professionals take the woman’s overall experience into account when assessing the need for further postnatal support. The woman’s recollection of labor pain may also help guide the content of postnatal support in order to avoid long-term effects on well-being.
Professor Philip Steer, journal editor, commented, “This research shows that labor pain is an acceptable experience for many women. It is important for us to appreciate that the overall experience of childbirth (for example, how well-supported women feel) has a major influence on women’s memory of how painful it was giving birth.
“My advice is for women to discuss the range of options regarding caring labor with their doctors and midwives. Some women (perhaps three to five percent) have an underlying deep-seated fear of childbirth and may require counseling to help them cope.”
Earlier findings have shown that women who remember childbirth as a negative experience have fewer subsequent children, and a longer gap between children, than women who have a positive overall experience. Fortunately, this study implies that there are more women who forget the extent of their labor pain than those who do not, and that the process of forgetting continues many years after the birth.
As the researchers state, “These findings suggest that for most women, labor pain is a manageable life experience.”
Waldenstrom, U. and Schytt, E. A longitudinal study of women’s memory of labour pain: from 2 months to 5 years after the birth. BJOG: An International Journal of Obstetrics and Gynaecology, 2008.