Thursday, October 22, 2009

Found in the medical school library: Labor pain scale

I spent part of this fall feverishly reading through the obstetrics section of the library at our local medical school to try to make some sense of our multiple IVF failures and five consecutive miscarriages. I didn't come up with great answers for our situation, but I did come across this little pain scale. As soon as I saw it, I knew that I just had to share it with you.

Because this, ladies and gentlemen, is a visual analog of how much it freakin' hurts to have a baby, found in an obstetrics textbook (btw, primipara means first baby and multipara means you've already had a child):

Now, as you know, Will and I would do practically anything, including amputate digits, if we could successfully conceive a child who could live.

But I have to say, it amused me to no end (and ok, I'll be honest, it slightly terrified me, too) to see that should we actually ever succeed at this venture, it may come close to feeling like I'm amputating a digit to have our little loved one join us in the world. Thankfully, it looks to hurt a little less if we get some training ahead of time (not surprisingly, it looks like fear increases pain). And of course, this is without an epidural...

From where I'm sitting now, terrible labor pain seems like a pretty damn good problem to have, ya know? But yowza!

Those of you who have been there, done that, does this pain scale reflect your experience?

It was worth it, right?


(hello? anyone?)


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  1. Obviously wouldn't know on the full-term labor thing, but when i miscarried the first time, with about 13 weeks of placenta to expel, I did, actually, pass out from the pain. And I've never done that before- not when I had to wait 24 hours to have the shattered bones in my arm surgically pieced back together - not EVER.

    I totally believe it, but that's still one scary graphic.

  2. I've had two babies, and didn't think labor and delivery was that bad.

    The first I had HELLP so I was on mag sulfate, which was horrible, and Pitocin, which most people think is horrible. I was tied to the bed with IV's and a catheter and the BP cuff from hell, which sucked, but I think the mag made me unaware how much it hurt. I did get some Nubain around 7cm, which was nice for taking the edge off things. Overall, I'd call it a 6 on a scale of 10.

    The second was completely unmedicated and almost entirely at home (so no mag or stupid BP cuff that goes off at the peak of every contraction!). He was really really low and I told my husband that it wasn't pain so much as pressure. I have described that as a constant 7, with the contractions getting up to 9.

    But both labors only took about 6 hours and really, you can do anything for 6 hours, especially knowing that it will end and you'll have the baby as a reward.

    I've never had a digit amputated, though, so I don't know how that feels!

  3. Oh! This post is so timely. Was on the phone with my idiot sister (who is an RN, albeit an unemployed one) last night. She felt compelled to tell me about her friend, a visiting nurse, who had a patient who was paralyzed by an epidural. When I pointed out that this is very rare, she insisted that it's more common than I think. Bull! A friend who is a critical care nurse conjectured that there is likely more to the story.

    10 weeks of self inflicted PIO shots were enough pain. I have nothing to prove. I want the freaking epidural! I certainly want the option. MY OB has said I will get it when I ask for it.

    But, yeah, that scale is scary. Had to look up what causalgia is. Apparently it's the same as reflex sympathetic dystrophy, which when I heard about it several years ago, scared the crap out of me.

  4. Standing on your side of the fence, looking at neighbours who are writing in about their experience.

  5. Don't know, will find out in a couple of weeks and am absolutely terrified. Agree that it is a great problem to have and am grateful to be here but also now very very frightened (am such a wuss). The pitying looks and the "it'll all be worth it" comments I am getting from strangers these days are not helping. I'm going with the "everything will be fine if I have an epidural" perspective. Naivety is my specialty these days.

  6. I delivered our 1st baby 6 years ago in small NorCal 'hippy' hospital w/no epidural and no drugs. Labor stalled at 8 cm, had pitocin. Delivered our son after 36 hours of labor.
    Did it hurt? Hell, yes!
    Do you forget it? Of course!
    Was it worth it? Absolutely!!!

    Also experienced a natural miscarriage at 9 weeks, which, compared to labor, wasn't even on the pain scale.

    I'm pregnant again after IVF and hope to do it again, naturally. It's not for everyone, and I may not get through it a second time, but I'm going to give it my best shot because the easy recovery and avoidance of any potential complications was worth it to me. Definitely.

  7. I unintentionally amputated part of a digit once, and it was akin to the throbbing chilled/numb sensation that you get when you pinch your finger in a car door. So, if labor will hurt even less than that, COUNT ME IN!

    I'll have more to say on the subject in about 5 months (knock on wood, fingers crossed, salt over the shoulder, don't step on a crack).

  8. I wouldn't be crazy enough to have an epidural free birth...but my friend had a 9 + lb baby naturally with no pain relief. She said she's glad she did it and that it's over...but that she would never do it again. That's about all I got for ya!

  9. After 2 miscarriages, I swore that when I got pregnant and carried to term (which, thankfully, I eventually did), I would never complain about labor. And I never will. I went through 20 hours of pitocin-induced contractions with no epidural, and I loved every single minute of it. The pain is manageable . . .you know it will eventually end. (which mine did, once I only got to 5 cm after all that time and ended up having a c-section)

  10. I don't know about pain from going into labor naturally but I half cut my finger off (thankfully not all the way) and I had pain from 4 minute long contractions all in my lower back and I have to say the finger incident hurt less by far. A man must have come up with that scale!

  11. I just have to say, it annoys me to hear an unmedicated birth referred to as a "natural birth." An epidural is pain relief. It doesn't make childbirth "unnatural." I think this is sort of like the annoyance parents of twins feel when anyone asks if their twins are "natural." IMO, there is either vaginal birth or cesarean birth. Natural/unnatural sound like judgment to me.

  12. Funny, they didn't pull out this scale in my childbirth class last week.....

    The scale's interesting in that it seems to indicate that the concept of "productive" pain doesn't count for much. In other words, lots of moms (including mine, who's endured both natural childbirth and an accidental amputation) have told me that since you're able to focus on a positive product/outcome, it's easier to put the pain in context then if, for instance, you're dealing with pain relating to disease.

    Anyway, just a thought. I'm going for the epidural!

  13. Wow, that's a scary chart for sure. Thanks for stopping by my blog...I actually read yours pretty often, I've just never left a comment. You and Will are very strong people and I really hope you get your happy ending soon.

  14. Well....after years of trying to concieve, thousands of shots in the stomach and the bootie...2 miscarriages and 2 IVF's....I told my Dr. I was done and that we would be delivering this baby by c-section. I had long ago abandoned my earth mother desire to push a baby out of my whoo haa....I just wanted the baby and the delivery method just needed to be safe and easy! My Dr. nodded and smiled at me for months as I tried to tell him how to do his job, but then my precious baby gave his mother the best gift of all and was in a beautiful frank breech position so my OB had no choice but to go in after him. I had not a single cramp, contraction or twinge....his position kept him out of my pelvis so I never even got the pressure. (But don't think I love being pregnant either...I had a slew of other really painful issues such as tail bone and back pain that put me out of work early). I felt a tiny little prick of the spinal the day he was born and a bit of discomfort for a few days after and then all was fine....and my whoo haa is unharmed and in her original condition! For was the ideal situation.....10 years ago...I would have gone to all the classes, done all the breathing and suffered through God knows what to push that baby out myself...I think it just depends on your own personal perspective at the time!

  15. I have to disagree if you are well prepare and you are having a normal childbirth experience without complications. I have had natural childbirth without drugs, except for pitocin and magnesium sufate and I did well. Of course I was prepared, having done the Bradley method and Lamaze. I am a labor and nurse, now retired due to Ehlers-Danlos Sydrome which causes daily chronic pain. I think that each woman experiences labor differently, I have known some very strong women who have been brought low by labor pains.
    I have also seen many women labor without only due to their own desire to to so or due to not needing any pain relief, I think that preparation really is the key and that fear plays a huge part and that that is where the Bradley method and Lamaze come in as they are all about using the brain to keep the body from a state of panic during labor and that increases pain. It is very interesting reading.
    I have delivered a stillborn child, with pitocin, had a two day induction with pit and mag and then had a a 2 uncomplicated spontaneous vaginal deliveries.
    My last baby was what is called "sunny side up" which means that he was face up so he was almost 3 weeks late and I stalled at 8 cm after pitocin and back labor. My doctor finally stuck his hand inside and turned him, causing him to deliver that moment in the labor bed. The nurses were not amused, nor was my husband who had to act as assistant and hand the doc the precip tray kept in every room. Oh and those last two babies weighed 9 pounds even.
    I guess my point is that while my childbirth experience would tell you that I have a strong pain tolerance, my need for daily pain medication now would not. So perhaps it is difficult to judge how one will do. I use to tell women that I labored and their family and visitors that the only ones who got to make the decisions about laboring and pain relief was the one who was doing it and whatever she wanted was what we did. No judgments, only support. (This especially applied to certain communities where the husband would tell us that the wife did not need pain medication, Oh Hell No!)

  16. oh... I meant I was induced rather than going into a natural labor. I didn't mean to be unclear.

  17. Ouch! Well, I'll never experience childbirth, and hopefully won't experience amputation, so I'll never know. But it'd put gall stones somewhere high up on that chart!

  18. I have never had a finger cut off, so I can't say for SURE. My labors were fairly fast and (while painful) manageable. Though I will say that the one moment I was most glad to be numb was when the doc was sewing up my laceration post-delivery.

    Pain is also subjective. Some people have a higher threshold than others. I think childbirth is a worthwhile (and manageable ) pain.

  19. Yeah... labor hurts. I've been there twice and the pain just radiates all over you belly and back. I had a natural birth both times... it hurts but you can get through it because you know after you push out your baby it'll be gone!

  20. I don't know.

    I am prone to passing out from some pain, in some circumstances, but have also been told in others (an abscess that developed after an appendectomy) that I have a high pain threshold. At that point I realized that having a high pain threshold doesn't mean what we often think it does ... that you can withstand a lot of pain. It means that you literally don't feel it (or don't feel as acute pain what others think would feel acute). I wasn't being tough, I just didn't hurt much.

    I labored for about 32 hours without pain relief, some of those on pitocin. It hurt, but it was a different sort of hurt from others I've experienced. As someone said, purposeful. I never got past 4 cm dilated and ended up having a c-section so cannot speak to the later stages of labor. I do wonder if retrospect whether an epidural might have helped labor progress, but of course I'll never know.

    Clear as mud, eh?

  21. I've been through labor at full-term (induced) with my first child and a c-section at 26 weeks with my twins (who, unfortunately, did not survive)

    And I can tell you that having a child hurts a lot less than losing a child.

  22. That is an interesting chart! I really don't have a high tolerance for pain, so I'm quite doubtful of my ability to give birth with no pain relief. I wish there was some option in between a quite painful unmedicated birth and an epidural where you are confined to the bed and not able to move around.

  23. And by that I mean (just in case it wasn't clear), that my guess would be that what you've already been through is likely a lot more painful than even the most horrific labor and delivery imaginable.

    Physical pain hurts. But, at least from my admittedly skewed vantage point, emotional pain really, really, really hurts.

  24. I think the problem here is that every labour is different--I remember once listening to a friend describe each of her four births--apparently the third was the one that took the pain to a level she hadn't previously dreamed of.

    In my case, having gone through IVF, I had an odd determination to birth the child naturally even if I couldn't conceive naturally (logically, I agree that medication doesn't make a birth un-natural, but I was feeling a societal stigma from the IVF and was accordingly irrational). I was prudent enough to ensure that an epidural would be available any time I wanted one (my doctor said the baby's head could be out, and she'd still let me have one).

    What actually happened was that I got lucky. Firstly, my body was weird, so that while I was discovered to be dilated to 7cm at 37.5 weeks, I was not having regular contractions and I was not in any pain. My waters were broken, and my son was born four hours later. I had about three hours of gradually increasing pain while dilating to 10cm. I haven't had a finger amputated, but I had severe OHSS and at its worst, my labour was on a par with that--except I knew that this was the final bit of having my baby, that it would all be over in a matter of hours not days, and that the epidural was waiting for me anytime I wanted it--nobody offers you an epidural for OHSS.

    When I started pushing, the pain stopped altogether. My son must have been in the absolute perfect position for nerve-blocking. I did require a last-minute episiotomy, so for the actual birth, my genital region was completely numb, but it had been pretty far stretched before that point and I hadn't felt anything.

    Immediately after the birth I felt absolutely fantastic. Afterglow central.

    So basically, I would recommend that people take labour as it comes. If you're lucky, you might not get pushed past your limits anyway. Just make sure you know when the epidural is and isn't available to you. I also thoroughly recommend childbirthing classes for both you and your partner.

  25. When I miscarried at 11 weeks, the pain was insanely intolerable. I didn't have enough sense to even go to the hospital because I had a moron doctor who said just take some tylenol and it will be over soon after it starts (said after they discovered I had a vanishing twin and then second sac had no fetal pole).

    When I delivered my twins 13 months later, I had a c-section and it was more psychological-ness (emergency c-section, preemie twins, constant need to puke on the OR table). The actual pain was only for about 48 hours afterward in the incision area. I was driving on the 6th day.

  26. Yowzer...that is some chart. One of my IRL friends had advised me, after her c- section with twins, to schedule a c-section because "it was like going in for a pedi"

    I don't buy it - but (assuming we will be lucky enough to make it) I am hoping to have a vaginal birth - still up in the air on pain relief.

  27. 2 L&Ds - 1st was 31 hours, most of it mild labor. The pain got bad before we went to the hospital - imagine your organs twisting inside out over and over - so then I had an epidural, and thank heavens because it took so long I would have been completely exhausted had I not had a few hours of sleep in the middle of it. Second one 8 hours, pain was pretty tolerable until after the water broke, then I was all, EPIDURAL PLEASE! Never had a "natural" childbirth but both my friends who did said it wasn't so bad - but both of them had them that way because their total labor time was less than 3 hours and there was no time to get an epidural.

  28. I think every labor is different, and every patients pain tolerance is different as well... You'll be fine! and YOU WILL GET THERE. :)
    It makes me laugh the discussion about "nautral" vs "unnatural" birth and reminds me of a discussion w/ my employers disability company.
    The girl who called to discuss my short term leave was not smart at all. It went like this:
    Girl: "did you have a natural birth?"
    Me: "Why does that matter with my short term leave?!" a
    Girl: "well a natural birth gets you 6 weeks paid time off, and a not-natural one gets you 8. I just need to know if it was natural or not."
    Me: "By 'natural' are you asking if I had pain medication??"
    Girl: "No. How did the baby come out? Was it 'natural' or 'not'?"
    Me: "You mean, did this baby come out of my VAGINA?"
    Girl: *pause* "yes... that's natural"
    Me: "Bwah-ha-ha-ha-ha....

  29. bring on the drugs! yay for epidurals!

  30. Nah... my dad says it's "just uncomfortable" ;-)

    Having been through a few unmedicated labors, my experience was that when I felt I couldn't take it anymore I was very close to giving birth. In fact, that was how I know I didn't have time to get an epidural with my last.

    It hurts. The only thing I had that was worse was the hysterosalpingogram.

  31. you wait this long for a live baby - you take no chances with natural birth. C-section all the way.

  32. I never made it past 6cm dilated because baby's heart rate kept dropping too much, but up until that point I'd had toothaches that hurt more. Honestly. I'm also a natural redhead and "they" say redheads have a lower pain tolerance, but I don't know. Maybe the Lamaze training helped? I've also had my fingertip cut off, and broken bones. The toothache was, by far, the most painful of all my pain experience.

    ...and as someone else said about the hysterosalpingogram... fuck yea that hurt a lot! My labor wasn't as bad as that either.

  33. I've never given birth but, working in OB, I can tell you that it's evidently no picnic. lol Sometimes I can hear the mom screaming from post partum! Then, there are other times where they handle it just fine, with great dignity and grace. I think a lot of it depends on your pain threshold?

    Happy ICLW!

  34. It does hurt, unbelievably so, BUT you literally forget it the very second you see your baby, or hear that cry for the first time...The pain can not adequately be described, but neither can your heart swelling!! You will get to experience that, I SO believe it!!!

  35. So Mo, now that you've been there, done that, what do *you* think of this pain scale?

    So very happy that Magpie is safely in your arms!


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