Article Review: "The Effects of Positive or Negative Words When Assessing Post-Operative Pain"
I read an interesting article yesterday with some important implications for labor and birth. It was aimed at an audience of anesthesiologists, but it raises some important questions about how laboring women frame their own experience and how they're cared for.
The authors had conducted a study to determine the effect of language when checking in with post-cesarean patients. The assessors came into the room of the recovering patients in the first day after their cesarean. To half of the patients, the assessors asked the patients, "Do you have any pain at the moment?" 63 of the 116 patients (54.3%) responded that they did. To the other group, the assessors used more positive language, asking, "How are you feeling?" and "Are you comfortable at the moment?" In this group, only 28 of the 116 women (24.1%) reported that they were in pain. And these women were recovering from a major surgery!
For the most part, this study was well-conducted, although it did have a few limitations, which were acknowledged by the authors (like the fact that study's design meant that only the patients, and not the assessors, were blinded; and the difficult-to-define spectrum of pain and comfort affected the results). However, I think it offers important food for thought in the care of laboring women.
Imagine how a similar phenomenon might happen with a woman in labor. If asked how she's feeling and if she's comfortable, the laboring woman and her friends and care providers can work to help her find optimally comfort and find a rhythm with the work her body is doing. If confronted with the question of her pain, she may pause, get out of her body's natural rhythm, and focus more on the pain she's feeling. The authors of this article point out that, during pregnancy and the postpartum period, women are increasingly susceptible to the power of suggestion. This is acutely true during labor. We need to carefully consider how our language frames the mother's birth experience.
I certainly don't want to discredit women who have felt pain during childbirth. Although I believe there are ways to manage pain and increase comfort in labor, I feel that it would be more beneficial to reframe our perception of pain in labor. As the authors of this study pointed out, pain is defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." This definition, and the common perception of pain, is that it indicates that something is wrong. Sometimes this is the meaning of pain in labor, as when the baby is malpositioned, or the mother is in an unfavorable position. This pain can alert the mother and her care providers to take action to correct this.
Often, though, the "pain" of contractions is a sign that everything is right, that the body is doing just what it needs to in order to birth this baby. For this reason, hypnobirthers have chosen to linguistically reframe many of the sensations of labor. Rather than "contractions," they refer to "waves" or "surges." These words are inspired by images of nature running its right and proper course, and help a laboring mother realize that her body, too, is doing what it naturally should. Many hypnobirthers speak of intense pressure, rather than pain, as they experience the sensation of the uterus working to open and thin the cervix.
Many women feel that hypnobirthing isn't for them. I still believe that these women benefit from linguistically reframing the sensation of labor and birth! If a mother says she's in pain, we should believe her and work with her to manage it! But if she hasn't said anything of pain, then let's not introduce the word into the vocabulary of the experience. Let's talk about optimizing comfort; let's compliment her for beautifully handling the intensity of the experience; and let's remind that her body knows what to do, and that she is doing just what she needs to be doing.
What terms or phrases have been helpful for reframing labor sensations for you?
Chooi C. S. L., Nerlekar R., Raju R., Cyna A. M. (2011). The effects of positive or negative words when
assessing postoperative pain. Anaesthesia and Intensive Care 39(1), 101-106.
One of the things that drives my linguistic study of the birth environment is that so little has been done in this area so far. In situating my contribution to the literature, I've had to go back a few decades to find relevant books. So here's this beauty: published in 1984, Birth Stories, edited by Janet Isaacs Ashford, is a collection of birth stories (bet you couldn't have guessed that!).
An interesting feature of this book, though, is that the stories collected range from 1915 to 1983, so it really gives a big picture of a variety of obstetric practices and childbirth tendencies over several decades. You may have heard of some of them: overuse of forceps due to complete unconsciousness of the mother during delivery; "Twilight Sleep;" women being left alone, without friends or family, to labor; routine shaving, enema, and episiotomy... Unfortunately, the list goes on. I'm so grateful to be mothering in an era when most of these have faded into the past. I watched many of them fade as I turned the pages of this book.
Throughout the decades, themes persist. There are women who feel there must be a better way, who seek alternative care. Some of these women find it. They deliver at home or birthing centers with the care of experienced midwives. Some are treated with respect in the hospital and voice their preferences and are listened to. Birth empowers them. Some go without care and face unfortunate consequences. Some feel that they can't find it, and end up being subject to the interventions they were hoping to avoid, even though they vocally protested. These women feel a loss of control, and birth is a severely disempowering experience. Their stories are told in this book.
After reading this book, I believe more strongly that birth is a story we must keep telling. We must tell our experiences, good and bad, and seek to make birth better and better for our birth-giving posterity.
Now to close, I have two questions for you, dear reader: 1) Would you be interested in also reading article reviews of the journal articles I'm reading about language and childbirth? and 2) Do you know of any books I'm missing out on that talk about language and birth? If so, comment below!
In September, I'll be presenting at the Evidence Based Birth Conference in Kentucky. (Can I just pause to say about how thrilled I am to be able to present at this amazing conference!?) I'll be leading a workshop about the critical role that our words play in shaping the birth environment. I can't wait to share how my passion for birth converges with my passion for linguistics and give other birth workers tools to use their language for good!
In preparation for my workshop, I'm familiarizing myself with any other texts that are relevant to this topic. It turns out that there aren't a ton of super-relevant texts, but I'm reading what I can about the overlapping spheres of language usage and childbirth. Enter Women Writing Childbirth: Modern Discourses of Motherhood by Tess Cosslett. It's an older book (published 1994) that synthesizes and analyzes literature of the 20th century that addresses the topic of childbirth. While it's well-done and thorough and has a few good themes, it's not a book I would widely recommend. If you're curious about what (mostly female) writers have written about birth in both fiction and non-fiction works and want to read one critical interpretation of those texts, it's a worthwhile read. It's certainly got its own biases (which the author acknowledges), and I disagreed--either in part of in whole--with several things Cosslett writes. However, she does uncover a few worthwhile themes in her analysis. Here are the ones that stood out to me:
Cosslett teases out these themes as she examines several works of literature, both fiction and non-fiction. This book certainly provided food for thought and insight into potential themes in the language that surrounds birth.
Stay tuned for more reviews of the birthwork/linguistics literature and a preview of my EBB workshop!
Hi, I'm Sara. I'm a childbirth educator and birth + postpartum doula serving Utah county. I'm a twin mom (plus one!), natural VBACer, and birth lover!