Had a client who's very afraid of pain?

HennyPenne · 12-31-2006, 04:24 AM

I was at a birth yesterday and everything went well. the only thing that concerned me is the woman has a very real fear of pain. not just from the delivery (vaginal pain) but from any labour or cramping or back discomfort. my first thought was perhaps it was sexual or physical abuse, but if it was then her husband was a pretty unlikely to person to have caused it. (he was very very sweet and she very much desired his touch. she seemed very comfortable around him and over all it looked to be a healthy relationship.)

she was having back pain and as it turned out baby was OP (and I wont toot my own horn, but I suspected this waaaay before doctor mentioned it!). anyhow she ended up getting stadol at like 1cm and Epi at 2-3cm. and she was pushing that button every single time she felt a twinge. finally I started realizing there was a problem and I had to start conversation about how many woman still feel pressure and discomfort near the pushing/delivery stage as I was getting very concerned she was going to freak when she felt something. and she had a dozen questions about how much discomfort? and how exactly it will feel? and after the delivery she started to feel the contractions with the birthing of the placenta and she was askng for the epidural again... totally overwhelmed by it.

what do you do when a woman is that scared of pain? I mean I would have seriously thought it was innocence - the innocence of truely not understanding labour and birth, but she had a great child birth class that a friend of mine teaches. and i would have thought perhaps she is young and innocent but she is in her early 30's.

I honestly wasn't sure how to respond. I'm used to people desiring the least amount of pain control they can tollerate. and granted some woman who either aren't well prepard mentally, or who are just plain scared will end up "giving in" to pain relief.... but no one has ever walked in and asked for a epi right away.... well I mean none of my clients thus far.

and just as I side note I sympathize with being "innocent". with my first kid I was terrified. I never took a class but I did read every book out there (which I think may be worse depending on the books!) and I walked in scared half to death! but even I tried ot hold off on the epi til I felt I needed it - like 5cm? and i had a 20 hr labour. But... I also didn't know what a doula was and I was 19.

1stimestar · 12-31-2006, 05:32 AM

We can never know what makes some women so scared of the pain of childbirth. Perhaps past abuse perhaps not. Maybe she grew up hearing her mother tell her what a terrible birth she put her through and your client didn't want to do that to her baby. I had a client with that issue. I'm glad you were there for her where she was at. I'm sure you were a great comfort.

tlcdoula · 12-31-2006, 09:21 AM

Who knows why she is so afraid - only she truly does and then even she might not understand. Having ones first child can be a frightening experiences - she doesn't know what to expect and since she is in a hospital she is putting all her trust into a bunch of strangers!

My suggestion is to just meet her where she is at - like you did. Do not expect her to go unmedicated, because the might be too difficult for her to do. Like you did explain the feelings and sensations that she might still feel even with the epidural, and if that is still hard for her to handle there is always the option of cranking the epidural up very, very high so she feels nothing (for some women that might be what they need).

Just being there and being accepting can make a world of difference!!!

doula Michele · 12-31-2006, 10:06 AM

Yes, we meet women where they are at. Who knows why she has a low pain tolerence. Maybe she does not even know. Everyone is so different.
I agree that being there and explaining everything letting her know its normal. and supporting her choices is the best that you could do!

HennyPenne · 12-31-2006, 02:57 PM

Quote:

Originally Posted by tlcdoula

Like you did explain the feelings and sensations that she might still feel even with the epidural, and if that is still hard for her to handle there is always the option of cranking the epidural up very, very high so she feels nothing (for some women that might be what they need).

Believe me I wasn't about to try to talk her out of an Epidural! but she was NOT wanting a c section...and when her epi was cranked up to the point she couldn't feel anything she also wasn't able to feel how to push. and b/c her baby was OP she needed to really push when she got to pushing stage or she would end up with a C. so it was kinda a hard place.

I understand all the reasons you all say about why women are afraid of pain. I mean the same things went thru my head during her birth. but I guess I just needed to run it by some trusted doulas to get more insight. you know how it is.

it's kinda weird that she had a lot of odds aginst her and she was still able to have a vaginal birth. Induction from nothing (and I mean nothing - no dialation, no effacement... nada), she had an OP baby, she was terrified of pain (which s often slows everything down), and she couldn't feel a darn thing but her epi started to wear down just when she needed to push. she doesn't know how lucky she got not ending up with a C! I was very pleased for her.

b'earth angel · 12-31-2006, 05:31 PM

Let me say that I think that you did a great job with helping prepare this lady for the eventual pain she would go through. Sometimes people are scared of pain because of life traumas or even something a loved one experienced, especially from childhood. Although sometimes the client doesn't know why they are scared of the pain. I do ask in the prenatal interview if they have any life traumas that they would like to share with me, something that might influence the labor and birth. And it's not always sexual in nature. Some do, some don't. But it does help me to know just in case! KWIM?

Thanks for sharing w/us!

mothermedoula · 12-31-2006, 08:42 PM

Quote:

Originally Posted by HennyPenne

I was at a birth yesterday and everything went well. the only thing that concerned me is the woman has a very real fear of pain. not just from the delivery (vaginal pain) but from any labour or cramping or back discomfort. my first thought was perhaps it was sexual or physical abuse, but if it was then her husband was a pretty unlikely to person to have caused it. (he was very very sweet and she very much desired his touch. she seemed very comfortable around him and over all it looked to be a healthy relationship.)

she was having back pain and as it turned out baby was OP (and I wont toot my own horn, but I suspected this waaaay before doctor mentioned it!). anyhow she ended up getting stadol at like 1cm and Epi at 2-3cm. and she was pushing that button every single time she felt a twinge. finally I started realizing there was a problem and I had to start conversation about how many woman still feel pressure and discomfort near the pushing/delivery stage as I was getting very concerned she was going to freak when she felt something. and she had a dozen questions about how much discomfort? and how exactly it will feel? and after the delivery she started to feel the contractions with the birthing of the placenta and she was askng for the epidural again... totally overwhelmed by it.

what do you do when a woman is that scared of pain? I mean I would have seriously thought it was innocence - the innocence of truely not understanding labour and birth, but she had a great child birth class that a friend of mine teaches. and i would have thought perhaps she is young and innocent but she is in her early 30's.

I honestly wasn't sure how to respond. I'm used to people desiring the least amount of pain control they can tollerate. and granted some woman who either aren't well prepard mentally, or who are just plain scared will end up "giving in" to pain relief.... but no one has ever walked in and asked for a epi right away.... well I mean none of my clients thus far.

and just as I side note I sympathize with being "innocent". with my first kid I was terrified. I never took a class but I did read every book out there (which I think may be worse depending on the books!) and I walked in scared half to death! but even I tried ot hold off on the epi til I felt I needed it - like 5cm? and i had a 20 hr labour. But... I also didn't know what a doula was and I was 19.

She's the only one who would know what was going on in her mind. Did you ask her the classic, "what were you thinking about during that contraction?"

I also love penny Simkin's ideas in The Labor Progress Handbook. She says to try to reframe the pain into something more gentle. Like telling a women who's pushing and afraid of tearing that her birth canal is like the inside of her cheek, soft and stretchy.

I'm sure you were great support for her!

HennyPenne · 01-01-2007, 07:24 PM

Quote:

Originally Posted by mothermedoula

She's the only one who would know what was going on in her mind. Did you ask her the classic, "what were you thinking about during that contraction?"

I also love penny Simkin's ideas in The Labor Progress Handbook. She says to try to reframe the pain into something more gentle. Like telling a women who's pushing and afraid of tearing that her birth canal is like the inside of her cheek, soft and stretchy.

I'm sure you were great support for her!

I work for a program so I don' get to meet the woman before the go itno labour which sucks for this reason as I often know nothing about them unless they offer it up during the labour. oddly it usually just works out fine but at times like this it can be a pain.

I did ask her what was going thru her head (b/c i find "what are you thinking about" always get the answer "nothing"!) but she was so closed up o perhaps unaware she was even thinking of anything. sometimes she would just say "I would like ice" when I ask her what is going thru her head.

I've read the LPhandbook but I never noticed the cheek remark! I really like that! I tried to describe it like a blooming flower that that was way to far fetched for her. she needed something more tangable to relate to and the cheek idea would have probably worked great! I will have to remember that!

thanks for all your great feedback ladies! =)