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.