The meaning of labour pain: how the social environment and other contextual factors shape women's experiences.

BACKGROUND: The majority of women experience pain during labour and childbirth, however not all women experience it in the same way. In order to develop a more complete understanding of labour pain, this study aimed to examine women's experiences within the perspective of modern pain science. A more complete understanding of this phenomenon can then guide the development of interventions to enhance women's experiences and potentially reduce their need for pharmacological intervention. METHODS: A qualitative study was conducted using phenomenology as the theoretical framework. Data were collected from 21 nulliparous women, birthing at one of two large maternity services, through face-to-face interviews and written questionnaires. Data were analysed using an Interpretative Phenomenological Analysis approach. RESULTS: The data from this study suggest that a determining factor of a woman's experience of pain during labour is the meaning she ascribes to it. When women interpret the pain as productive and purposeful, it is associated with positive cognitions and emotions, and they are more likely to feel they can cope. Alternatively, when women interpret the pain as threatening, it is associated with negative cognitions and emotions and they tend to feel they need help from external methods of pain control. The social environment seems particularly important in shaping a woman's pain experience by influencing her interpretation of the context of the pain, and in doing so can change its meaning. The context and social environment are dynamic and can also change throughout labour. CONCLUSION: A determining factor in a woman's experience of pain during labour is its perceived meaning which can then influence how the woman responds to the pain. The meaning of the pain is shaped by the social environment and other contextual factors within which it is experienced. Focussed promotion of labour pain as a productive and purposeful pain and efforts to empower women to utilise their inner capacity to cope, as well as careful attention to women's cognitions and the social environment around them may improve women's experiences of labour pain and decrease their need for pain interventions.

Novel grouping of planned coping strategies for managing the intensity of labour: A survey study of Australian nulliparous women.

BACKGROUND: It is common for women to explore and plan strategies to cope during labour. These strategies are usually focused on pain control and described as either pharmacological or non-pharmacological. As labour is an individual experience, each woman should be enabled to choose strategies that best suit them, and that reflect what they feel influences their sense of capacity to cope. AIM: By exploring women's intentions and choices of strategies, this study aimed to understand how coping strategies can better reflect women's individual needs and expectations. METHODS: Fifty-six primiparous women were recruited from one tertiary hospital in Melbourne, Australia between February and May 2021. Data were collected via a survey in late pregnancy using open-ended questions. Content and thematic analyses were used to analyse responses. RESULTS: Themes related to how women frame the intensity of labour, how they strive for a relationally safe environment and a need to be prepared and knowledgeable. Strategies chosen by women could be grouped into two categories: intrinsic and extrinsic. Intrinsic strategies could be self-generated by women (such as breathing techniques and movement), while extrinsic strategies required either equipment (such as a bath) or others to administer (such as epidural analgesia). CONCLUSIONS: Women value having a range of intrinsic and extrinsic strategies that enable autonomy or require external support. This moves beyond the 'pharmacological and non-pharmacological' categorisation of strategies, and we propose that reframing strategies as intrinsic and extrinsic could have a number of benefits on women's sense of autonomy and utilisation of strategies. The findings provide a foundation for more targeted research into how women can be supported to individualise and implement these coping strategies in labour.

Women's views and experiences of a new Midwifery Group Practice model in rural Australia.

BACKGROUND: Women in rural Australia often have limited maternity care options available, and in Victoria, like many Australian states, numerous small hospitals no longer offer birthing services. AIM: To evaluate women's views and experiences of maternity care at a local rural hospital that re-established birthing services with a Midwifery Group Practice (MGP) model of maternity care. METHODS: Women who booked into the new MGP model from May 2021 to June 2022 were invited to complete an anonymous online survey and participate in an optional additional semi-structured interview to explore their views and experiences. Descriptive statistics were used for quantitative data, and open-ended survey and interview responses were analysed using a general inductive approach. FINDINGS: Sixty-seven percent (44/66) of women completed the survey and five also completed an interview. Women were highly satisfied with the care they received. They felt respected, empowered, and had a sense of agency throughout their pregnancies, labour and birth, and post-birth. They reported low levels of anxiety during labour and birth, and felt that they coped physically and emotionally better than they anticipated. They felt well supported by midwives and highly valued the continuity of care within the MGP model. CONCLUSION: Women's voices play a critical role in informing maternity care provision, particularly for those in rural communities who may have limited access to care options. The findings support and expand on existing research regarding the value of midwifery continuity of care models, and can inform other rural maternity services in introducing similar models.

Tools for assessing labour pain: a comprehensive review of research literature.

ABSTRACT: The experience of pain associated with labour is complex and challenging to assess. A range of pain measurement tools are reported in the literature. This review aimed to identify current tools used in research to assess labour pain across the past decade and to evaluate their implementation and adequacy when used in the context of labour pain. A literature search was conducted in databases MEDLINE and Cumulative Index of Nursing and Allied Health Literature, using search terms relating to labour, pain, and measurement. A total of 363 articles were selected for inclusion. Most studies (89.9%) assessed pain as a unidimensional experience, with the most common tool being the Visual Analogue Scale, followed by the Numerical Rating Scale. Where studies assessed pain as a multidimensional experience, the most common measurement tool was the McGill Pain Questionnaire. Only 4 studies that used multidimensional tools selected a tool that was capable of capturing positive affective states. Numerous variations in the implementation of scales were noted. This included 35 variations found in the wording of the upper and lower anchors of the Visual Analogue Scale, some assessment tools not allowing an option for "no pain," and instances where only sections of validated tools were used. It is clear that development of a standardised pain assessment strategy, which evaluates the multidimensions of labour pain efficiently and effectively and allows for both positive and negative experiences of pain to be reported, is needed.

Anatomy Students That are "Team-Taught" May Achieve Better Results Than Those That are "Sole-Taught".

Anatomy practical classes have traditionally been taught by a team of demonstrators (team-taught) in a large dissection room. More recently, particularly in nonmedical contexts, practical classes have been taught by one teacher (sole-taught) to smaller student groups. The aim of this study was to compare student outcomes when the same course was delivered with practical classes team-taught at one campus (metropolitan) and sole-taught at a second campus (regional) while maintaining similar staff to student ratios. This anatomy course, for physiotherapy and lower academically credentialed exercise science/physiology students, utilized blended delivery whereby most content was delivered online and practical classes comprised the main face-to-face teaching. In 2018, the metropolitan campus introduced team-teaching practical classes while the regional campus continued with sole-teaching. Student marks and engagement with online content were compared between campuses and to the previous year (2017) when both campuses had sole-taught practical classes. While final marks for the course increased overall in 2018 (P < 0.01), exercise science/physiology students at the metropolitan campus (team-taught) improved their final marks (53.5 ± 1.1%) compared to a slight decrease for the regional (sole-taught) campus (44.8 ± 1.4%) (P < 0.01). There were no differences between campuses for physiotherapy students in 2018. Student engagement with online content did not contribute to the improvement in marks for exercise science/physiology students. Introduction of a team-teaching format improved student marks, particularly for the lower academically credentialed students. Team-teaching should be considered as the preferred format for anatomy practical classes, particularly in courses involving students with diverse academic credentials.

The nature of labour pain: An updated review of the literature.

BACKGROUND: The pain experience associated with labour is complex. Literature indicates psychosocial and environmental determinants of labour pain, and yet methods to support women usually target physiological attributes via pharmacological interventions. AIM: To provide an update of our understanding of labour pain based on modern pain science. The review aims to help explain why women can experience labour pain so differently - why some cope well, whilst others experience great suffering. This understanding is pertinent to providing optimal support to women in labour. METHOD: A literature search was conducted in databases Medline, Cumulative Index to Nursing and Allied Health Literature and PsycINFO, using search terms labor/labour, childbirth, pain, experience and perception. Thirty-one papers were selected for inclusion. FINDINGS: Labour pain is a highly individual experience. It is a challenging, emotional and meaningful pain and is very different from other types of pain. Key determinants and influences of labour pain were identified and grouped into cognitive, social and environmental factors. CONCLUSION: If a woman can sustain the belief that her pain is purposeful (i.e. her body working to birth her baby), if she interprets her pain as productive (i.e. taking her through a process to a desired goal) and the birthing environment is safe and supportive, it would be expected she would experience the pain as a non-threatening, transformative life event. Changing the conceptualisation of labour pain to a purposeful and productive pain may be one step to improving women's experiences of it, and reducing their need for pain interventions.

The relationship between student engagement with online content and achievement in a blended learning anatomy course.

Blended learning has become increasingly common in higher education. Recent findings suggest that blended learning achieves better student outcomes than traditional face-to-face teaching in gross anatomy courses. While face-to-face content is perceived as important to learning there is less evidence for the significance of online content in improving student outcomes. Students enrolled in a second-year anatomy course from the physiotherapy (PT), exercise physiology (EP), and exercise science (ES) programs across two campuses were included (n = 500). A structural equation model was used to evaluate the relationship of prior student ability (represented by grade in prerequisite anatomy course) and final course grade and whether the relationship was mediated by program, campus or engagement with the online elements of the learning management system (LMS; proportion of documents and video segments viewed and number of interactions with discussion forums). PT students obtained higher grades and were more likely to engage with online course materials than EP and ES students. Prerequisite grade made a direct contribution to course final grade (P < 0.001) but was also mediated by engagement with LMS videos and discussion forums (P < 0.001). Student learning outcomes in a blended anatomy course can be predicted the by level of engagement with online content. Anat Sci Educ 11: 471-477. © 2017 American Association of Anatomists.

Impact of introduction of blended learning in gross anatomy on student outcomes.

Blended learning has become increasingly common, in a variety of disciplines, to take advantage of new technology and potentially increase the efficiency and flexibility of delivery. This study aimed to describe blended delivery of a gross anatomy course and to evaluate the effectiveness of the delivery in terms of student outcomes. A gross anatomy course for second-year physiotherapy students across two campuses was delivered in traditional face-to-face teaching mode in 2013 (n = 150 students), some online content was introduced in 2014 (n = 160) and the subject was fully blended in 2015 (n = 151). The final 'blend' consisted of one lecture per week with most content delivered using online video resources (prepared by staff using a structured peer-reviewed process) and retention of face-to-face practical classes. Outcomes evaluated included student grades, student engagement with content through online discussion forums and student feedback using both quantitative and qualitative analysis. Grades were higher in 2014 and 2015 than in 2013 (P < 0.01). There were no differences in student engagement with online discussion forums. Student feedback identified some negative comments and lower levels of intellectual stimulation (P < 0.05) with the initial introduction of online content in 2014. The fully blended version in 2015 resulted in more balanced comments about online content but higher perceived workload (P < 0.05). All cohorts listed practical classes as a major factor contributing to learning. Blended learning appears to be well-suited to gross anatomy teaching on the proviso that face-to-face practical classes are maintained, but may result in higher perceived workloads. Anat Sci Educ 9: 422-430. © 2016 American Association of Anatomists.

Assessment of pain associated with childbirth: Women's perspectives, preferences and solutions.

OBJECTIVE: to develop an understanding of women's experiences of pain associated with childbirth and the assessment of labour pain. This exploratory study, informed by modern pain science, sought to explore women's retrospective reports of their pain experience during labour and to ascertain what pain assessment strategies might be acceptable in maternity care or future research. DESIGN: a qualitative study was performed using phenomenology as the theoretical framework. Data were collected from semistructured telephone interviews. Thematic analysis of transcripts was performed. SETTING: Melbourne, Australia. PARTICIPANTS: 19 women - both primiparous and multiparous - who gave birth in a large maternity hospital, either in a midwife-led birth centre or with standard hospital birth suite care were interviewed in the month following labour and birth. FINDINGS: two themes were identified in post-birth interviews that related to pain assessment. The first theme is the acceptability of pain assessment and reflects the interview structure, drawing on responses from a set question that asked what pain assessment strategies would be acceptable. The second theme emerged from women's comments about measurement accuracy, including the limitations of using a scale with a static upper limit and the changing nature of labour pain. KEY CONCLUSIONS: a woman-centred approach demands pain assessment that matches each woman's preference for mode and timing and captures the multiple dimensions of pain. Women describe the need for an expanding scale to accommodate the progressive modifications of their conception of what is extreme pain. IMPLICATIONS FOR PRACTICE: whenever a series of pain ratings is required, researchers and health professionals need to find ways to adjust for the fluctuations in pain scale interpretation.

Women's experiences of labour pain and the role of the mind: an exploratory study.

OBJECTIVE: labour pain is unique and complex. In order to develop a more sophisticated understanding of labour pain this exploratory study aimed to examine women's experiences of labour pain within the perspective of modern pain science. An improved understanding of labour pain will assist in informing and enhancing pain management approaches. DESIGN: a qualitative study was performed using phenomenology as the theoretical framework. Data were collected from telephone interviews. Thematic analysis of transcripts was performed. SETTING: Melbourne, Australia. PARTICIPANTS: a diverse sample of 19 women who gave birth in a large maternity hospital was interviewed in the month following labour. FINDINGS: the data suggest that a woman's state of mind during labour may set the stage for the cognitive and evaluative processes that construct and give meaning to her pain experience. Women's descriptions of their pain experiences suggested two states of mind. The first was characterised by the mind remaining focussed, open and accepting of the inner experience, including pain. This state tended to be accompanied by a more positive reporting of the labour experience. The second was characterised by the mind being distracted and thought processes featured pain catastrophising, self-judgment and a negative evaluation of pain. Although these two mind states appeared to be distinct, women could shift between them during labour. Women's evaluations of their pain were further influenced by their personal beliefs, desires, the context and the social environment. KEY CONCLUSIONS: women's state of mind during labour may set the stage for the cognitive and evaluative processes that construct and give meaning to their pain experience. IMPLICATIONS FOR PRACTICE: developing interventions for labour pain that promote positive evaluative processes and cultivate a state of mind focussing on the present may improve women's experiences of labour pain.

Labour pain: from the physical brain to the conscious mind.

The study of pain goes well beyond the study of anatomy and physiology. To fully understand a phenomenon such as pain, one must consider the realm in which it exists - the conscious mind. This paper aims to explore the concept of the conscious mind and its relevance to the human experience of labour pain. Understanding the interactions between the mind, brain, body, social environment and natural world on the experience of pain enables a more comprehensive conception of labour pain. Reaffirming that pain is an embodied subjective experience is important during this current era in pain science research that seems to lean towards neuroreductionism and conceptualises pain as a pathological by-product of disease. Labour pain, however, is a clear demonstration that pain is not always a signal of bodily disorder. The experience of pain is generated by the brain and is realised through the conscious mind. Thus, the study of pain - particularly complex pains such as labour pain - should focus not just on the physical body and neural processes in the brain but must aim to include, and be capable of capturing, all elements that constitute it; the mind, brain, body and the environment.