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Summary of the Midwifery Today Article:  “Pain During Childbirth, Can it be controlled Naturally?” by Rayner
Garner
Summary by Jodilyn Owen

In the Midwifery Today article, “Pain During Childbirth, Can it be controlled Naturally?” by Rayner Garner, the author
poses the question of whether pain during childbirth can be controlled without the use of medication. The often
observed occurrence of the mother whose labor stalls upon arrival to the hospital or of the birthing professionals into
her space is the catalyst for this question

The article addresses some of the many aspects that affect pain in childbirth from the cultural, physiological, and
emotional perspectives.  Insight is offered into how, by understanding the physiological source of pain, lack of cultural
support for the laboring woman, and importance of her emotional state, providers can attempt to educate parents and
enact behaviors that will not stimulate painful responses in the laboring mother.

When a laboring mother experiences stress, her body responds by releasing chemicals and hormones into her blood
stream.  It is the release of adrenaline that creates the “fight or flight” response which results in the blood flowing away
from the uterus and out into the arms and legs.  Since the uterus requires a high volume of blood to effectively contract,
contractions become weak or stop altogether.  The uterus is made up of three layers of muscles.  The outer layer
contracts to push the baby down, and the inner layer is composed of circular muscles and contracts to close the outlet
which leads to the birth canal.  It is the middle layer that contracts to squeeze the blood out of the uterine walls and then
relax to let them vessels fill again.  Without adequate blood supply to these muscle layers, contractions are no longer
effective.  The physiological challenge of how to reduce the amounts of adrenaline and stress hormones then comes
into question.  

In cultures that view birth as a normal expected life event, the process is quiet and rapid.  There is no interruption of the
birthing process by the introduction of such stress-inducing actions as having to change location for delivery, having
strangers touch or talk to you, or providers actively medically managing the labor and delivery with protocols and
procedures.  Communities rally around the laboring woman and offer her guidance and support before and after labor.  
Our culture does not offer these indulgences of support with privacy, love and care with quiet and stress-free birthing.  
Thus we are faced with the cultural challenge of creating environmental support for the laboring women.

The primary emotional need to avoid the introduction of adrenaline into the system is the feeling of safety.  
Encompassed in this feeling are feelings of love and comfort, freedom and acceptance.  These feelings must be
maintained and boosted throughout labor to avoid the “fight or flight” response.  It is the loss of the perception of safety
that is the first domino in that short chain to the stalling of labor.  And this introduces the dual challenges of how to
provide an emotionally supportive environment and what to do if that ideal emotional state is broken.  

The resolution to the issues that arise from these three perspectives lies in addressing the “fight or flight” response
directly.  The author states that it can be prevented by having the mother “birth herself”.  That is to say without the
company of people she is not already intimately comfortable with.  He suggests that providers use a monitoring system
to watch the progress of labor from another room and only enter when absolutely necessary.  The birthing room should
be kept dark and quiet.  

Knowing this ideal difficult to achieve in most births, and knowing that the fight or flight response will most likely develop
at some point for most women, the author proposes that the laboring mother emote and physically express herself.  
Garner suggests having her beat on a large pillow or mattress while making deep guttural sounds.  This activity serves
to release the harmful build-up of adrenaline.
Prevention of the state where the layers of the uterus are working against each other will greatly relieve the pain that is
associated with contractions.  Allowing the inner muscles to contract at the right time will prevent the outer and middle
muscle layers from pushing against them.  Preventing this state of “fight or flight” can be accomplished by having the
mother labor and deliver where she feels safe.  These is the key to a properly functioning uterus and a great reduction
of pain during childbirth without the use of medications.