The point of labor pain
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Réka Morvay
Nov 11, 2009, 11:06:20 AM11/11/09
to budapestmoms
Hi everyone,
During the last labor class, someone posed the very good and
thought-provoking question of what the point of labor pain was. The
question stumped me at the time, so I decided to look into it.
Having studied evolutionary biology, my general assumption is that if
a trait manages to propagate itself down billions of years so
universally, it must have function, and one that translates into a
higher chance of survival for the offspring of the individuals
carrying that trait. Labor pain has such a point, but expert opinion
is divided on whether this point is still a valid one, whether bearing
it still serves any purpose now that we have the technology to take it
away.
Here's the article I wrote about the point of labor pain:
http://www.budapest-doula.com/labor-pain.html
I'd be interested in what you think, whether after reading the
article, what your opinion is on whether labor pain still has a valid
point today.
Réka
--
http://www.rekamorvay.com/
http://szuleselmeny.wordpress.com/
http://tejmentes.blogspot.com/
During the last labor class, someone posed the very good and
thought-provoking question of what the point of labor pain was. The
question stumped me at the time, so I decided to look into it.
Having studied evolutionary biology, my general assumption is that if
a trait manages to propagate itself down billions of years so
universally, it must have function, and one that translates into a
higher chance of survival for the offspring of the individuals
carrying that trait. Labor pain has such a point, but expert opinion
is divided on whether this point is still a valid one, whether bearing
it still serves any purpose now that we have the technology to take it
away.
Here's the article I wrote about the point of labor pain:
http://www.budapest-doula.com/labor-pain.html
I'd be interested in what you think, whether after reading the
article, what your opinion is on whether labor pain still has a valid
point today.
Réka
--
http://www.rekamorvay.com/
http://szuleselmeny.wordpress.com/
http://tejmentes.blogspot.com/
Elissa Helms
Nov 11, 2009, 1:22:42 PM11/11/09
to budape...@googlegroups.com
Hi Reka and everyone,
I studied some evolutionary biology, too, though anthropology. And
while the explanation of labor pain forcing women to seek a safe place
and support seems plausible and so, I suppose, does the other one
about bonding because you're so relieved it's over, the way we learned
about the logic of evolution is that not everything is "meant" to have
certain effects (there is no grand plan, so evolution can't be
"clever" even though lots of its outcomes seem totally ingenious).
Instead, certain things persist because they were not detrimental to
the reproductive success of individuals and so they passed those
traits on to the next generation. In other words, things that have
lost their function but don't kill you before you can reproduce or
make you sterile or unacceptable to the opposite sex will persist even
though they might also cause problems - like your appendix for
example. I thought about this during my pregnancy - we can also ask
what the "purpose" is of things like heartburn or bleeding gums. these
seem to be side effects that we can link to the processes in the body
during pregnancy but that don't have any purpose or positive functions
- they are just annoying but not enough to interfere with a successful
pregnancy, i.e. with reproductive success. so might labor pain not be
something like this? and then people thought up all sorts of cultural
reasons for women to endure and to try it again (e.g., punishment for
Eve's wickedness!) or maybe it's a combination of both.
I didn't go too far in this field (I'm a cultural anthropologist) so I
may be missing something. but there are my thoughts on the matter for
what they're worth!
Elissa
> --
>
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>
>
>
I studied some evolutionary biology, too, though anthropology. And
while the explanation of labor pain forcing women to seek a safe place
and support seems plausible and so, I suppose, does the other one
about bonding because you're so relieved it's over, the way we learned
about the logic of evolution is that not everything is "meant" to have
certain effects (there is no grand plan, so evolution can't be
"clever" even though lots of its outcomes seem totally ingenious).
Instead, certain things persist because they were not detrimental to
the reproductive success of individuals and so they passed those
traits on to the next generation. In other words, things that have
lost their function but don't kill you before you can reproduce or
make you sterile or unacceptable to the opposite sex will persist even
though they might also cause problems - like your appendix for
example. I thought about this during my pregnancy - we can also ask
what the "purpose" is of things like heartburn or bleeding gums. these
seem to be side effects that we can link to the processes in the body
during pregnancy but that don't have any purpose or positive functions
- they are just annoying but not enough to interfere with a successful
pregnancy, i.e. with reproductive success. so might labor pain not be
something like this? and then people thought up all sorts of cultural
reasons for women to endure and to try it again (e.g., punishment for
Eve's wickedness!) or maybe it's a combination of both.
I didn't go too far in this field (I'm a cultural anthropologist) so I
may be missing something. but there are my thoughts on the matter for
what they're worth!
Elissa
>
> You received this message because you are subscribed to the Google Groups "Parenting in Hungary" group.
> To post to this group, send email to budape...@googlegroups.com.
> For more options, visit this group at http://groups.google.com/group/budapestmoms?hl=.
>
>
>
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Judit Kuszkó-Kalovits
Nov 12, 2009, 11:09:11 AM11/12/09
to budape...@googlegroups.com
honestly, i was expecting something more* for enduring the pain but there had been nothing... maybe i did something wrong :)))))
judit
*like an ice-cream from the doctor, a head massage from my husband or an instant smile on the first day from the baby - preferably at the same time. lol
On Thu, Nov 12, 2009 at 1:51 PM, jugoslava <yug...@gmail.com> wrote:
I don't know much about actual anthropological reasons for labour
pain, but I always found irritating how throughout history both period
and labour pain were translated through cultural and religious dogma
into a punishment a woman was to endure for becoming/being sexually
active ...
Could it be a that biological mechanism for triggering the hormones
needed to deliver the baby was responsible?
I never recieved any pain medication, but somehow I fail to see how
the pain enhanced my childbirth experience in any way lol, and I
doubt it would have made any difference if I knew that there was a
meaningful purpose to it :)))
--
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To post to this group, send email to budape...@googlegroups.com.
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Réka Morvay
Nov 12, 2009, 11:17:28 AM11/12/09
to budape...@googlegroups.com
Hi Elissa,
You're right to pick on my pithy statement "evolution is clever that
way." I certainly did not mean to imply that evolution was a thinking
entity. However, very often intrinsic rewards are built into behaviors
that are adaptive, and MOST behaviors/traits that are universal across
a species do tend to be adaptive, otherwise at the very least it would
be less frequent, if that behavior/trait did not somehow affect
reproductive success.
You're absolutely right that evolution doesn't have a "purpose" or a
"point" as such, since it is a random process that simply favors
traits that serve to propagate THEMSELVES down the line (a la Dawkins'
"selfish gene" concept). So if a trait makes it more likely that more
of your offspring (bearing the same trait) will survive to reproduce,
then that trait gets passed down the line. And you're also right that
some traits that get propagated are leftovers or side effects, and
that if the trait doesn't kill you before you get to reproduce, it
will get passed down. However, for the majority of traits you can
assume that it serves some evolutionary purpose, or at least did in
the past, otherwise, as I said above, it wouldn't be nearly universal,
as is labor pain.
So let's approach it from the other side: Our hypothesis is that labor
pain is adaptive, and that the benefit of it is that a, women seek
help and b, it helps bonding. Can we test these in any other way? For
example, can we look at what happens when women do not seek support
when giving birth? And what happens when you take labor pain away?
The answer to the first question can be answered by the neonatal and
maternal mortality rates born in unassisted childbirth. The numbers
there are pretty bad; neonatal mortality rate is almost triple and
maternal mortality rate is almost 100 times worse.
(http://www.cdc.gov/mmwr/preview/mmwrhtml/00000345.htm) So any trait
that makes mothers seek assistance during childbirth is going to be
beneficial.
There have been a number of studies that show that epidurals change
mother-infant interaction and affect bonding. Here's a token one:
http://www.jstor.org/pss/1129216 It is unclear whether the bonding
issue comes from a lack of pain or from the effects of the drugs used,
or from the baby's changed behavior due to the effects of the
medications used. That would be a question worth exploring.
Réka
You're right to pick on my pithy statement "evolution is clever that
way." I certainly did not mean to imply that evolution was a thinking
entity. However, very often intrinsic rewards are built into behaviors
that are adaptive, and MOST behaviors/traits that are universal across
a species do tend to be adaptive, otherwise at the very least it would
be less frequent, if that behavior/trait did not somehow affect
reproductive success.
You're absolutely right that evolution doesn't have a "purpose" or a
"point" as such, since it is a random process that simply favors
traits that serve to propagate THEMSELVES down the line (a la Dawkins'
"selfish gene" concept). So if a trait makes it more likely that more
of your offspring (bearing the same trait) will survive to reproduce,
then that trait gets passed down the line. And you're also right that
some traits that get propagated are leftovers or side effects, and
that if the trait doesn't kill you before you get to reproduce, it
will get passed down. However, for the majority of traits you can
assume that it serves some evolutionary purpose, or at least did in
the past, otherwise, as I said above, it wouldn't be nearly universal,
as is labor pain.
So let's approach it from the other side: Our hypothesis is that labor
pain is adaptive, and that the benefit of it is that a, women seek
help and b, it helps bonding. Can we test these in any other way? For
example, can we look at what happens when women do not seek support
when giving birth? And what happens when you take labor pain away?
The answer to the first question can be answered by the neonatal and
maternal mortality rates born in unassisted childbirth. The numbers
there are pretty bad; neonatal mortality rate is almost triple and
maternal mortality rate is almost 100 times worse.
(http://www.cdc.gov/mmwr/preview/mmwrhtml/00000345.htm) So any trait
that makes mothers seek assistance during childbirth is going to be
beneficial.
There have been a number of studies that show that epidurals change
mother-infant interaction and affect bonding. Here's a token one:
http://www.jstor.org/pss/1129216 It is unclear whether the bonding
issue comes from a lack of pain or from the effects of the drugs used,
or from the baby's changed behavior due to the effects of the
medications used. That would be a question worth exploring.
Réka
Message has been deleted
Réka Morvay
Nov 13, 2009, 12:04:19 AM11/13/09
to budape...@googlegroups.com
Jugoslava:
On Fri, Nov 13, 2009 at 12:29 AM, jugoslava <yug...@gmail.com> wrote:
> lol you got me crawling the web over this and the opinions on whether
> the pain is an archaic evolutionary treat, a simple muscle-nerve math
> or a necessary maternal mechanism are quite fiercely contradicting lol
Indeed! :)
> ""When you think about it, there is no instance in which pain is not
> designed to protect against damage. At the level of the skin, pain
> tells us what is safe to touch and what is dangerous. At the level of
> bone, the pain of a broken bone is so great that it forces immobility,
> and that probably helps the bone to heal properly. The pain of disease
> makes people search for ways to diminish the pain, and perhaps improve
> survival from the specific problem. So, at the most basic level, there
> is no reason to believe that the pain of labor is beneficial in and of
> itself. Unless labor pain is different from all other types of pain of
> human existence, labor pain exists to warn....painful labor was
> evolutionarily advantageous for humans because human childbirth is
> quite dangerous, and women who have assistance are more likely to
> survive. If that's the case, childbirth pain is like the appendix.
> It's outlived its evolutionary usefulness and now serves no purpose."
This bit I recognize from Dr. Amy Tuteur, who is a very outspoken
anti-homebirth, anti-natural birth advocate.
> "There is evidence to suggest that babies born to moms who have
> epidurals have more problems integrating. This is due to the
> protective effect maternal pain has on the infant. To keep it simple,
> mom has pain, she produces endorphins. These endorphins travel to
> baby, to protect baby from the enormously painful journey he must
> take. Think of the enormous pressure on babies cranial bones, soft
> tissues, skeletal and muscular systems. If mom gets an epidural, she
> feels great, but the baby endures the full brunt of labor. What mom
> would choose to expose her baby to that if she truly understood what
> was at risk? I think you are being naive, and frankly, a little
> dishonest. There are risks associated with epidurals. A drop in mom's
> blood pressure due to an epidural leads to decreased blood flow to
> baby. This can be protected against in some, but not in all, cases and
> often varies greatly based on the skill of the anesthesiologist. Then
> you add to that the over 90% rate of pitocin augmentation which
> decreases baby's blood flow due to increased contraction intensity and
> frequency and you have the recipe for the astronomical rate of c-
> sections in USA as a result of fetal intolerance to labor. That's not
> even taking into consideration the unnatural position of delivery that
> is thrust upon women in hospitals. The pelvic inlet is at it's
> narrowest on your back, but most convenient for practitioners."
Hmm, this is an argument I hadn't come across before, that baby needs
mom's endorphins to endure labor pain, and quite frankly, I'm not sure
how we'd test it. Usually, the argument is that the drugs used in the
epidural DO cross the placenta and affect the baby's motor behavior,
so it would stand to reason that IF these painkilling drugs are
already crossing the placenta and affecting the baby, they would also
confer pain relief to the baby. But again, we have no way to test
this, at least not on humans. But that makes me wonder whether there
have been animal studies...
Réka
>
> ....
>> mother-infant interaction and affect bonding. Here's a token one:http://www.jstor.org/pss/1129216It is unclear whether the bonding
>> >> For more options, visit this group athttp://groups.google.com/group/budapestmoms?hl=.
On Fri, Nov 13, 2009 at 12:29 AM, jugoslava <yug...@gmail.com> wrote:
> lol you got me crawling the web over this and the opinions on whether
> the pain is an archaic evolutionary treat, a simple muscle-nerve math
> or a necessary maternal mechanism are quite fiercely contradicting lol
Indeed! :)
> ""When you think about it, there is no instance in which pain is not
> designed to protect against damage. At the level of the skin, pain
> tells us what is safe to touch and what is dangerous. At the level of
> bone, the pain of a broken bone is so great that it forces immobility,
> and that probably helps the bone to heal properly. The pain of disease
> makes people search for ways to diminish the pain, and perhaps improve
> survival from the specific problem. So, at the most basic level, there
> is no reason to believe that the pain of labor is beneficial in and of
> itself. Unless labor pain is different from all other types of pain of
> human existence, labor pain exists to warn....painful labor was
> evolutionarily advantageous for humans because human childbirth is
> quite dangerous, and women who have assistance are more likely to
> survive. If that's the case, childbirth pain is like the appendix.
> It's outlived its evolutionary usefulness and now serves no purpose."
This bit I recognize from Dr. Amy Tuteur, who is a very outspoken
anti-homebirth, anti-natural birth advocate.
> "There is evidence to suggest that babies born to moms who have
> epidurals have more problems integrating. This is due to the
> protective effect maternal pain has on the infant. To keep it simple,
> mom has pain, she produces endorphins. These endorphins travel to
> baby, to protect baby from the enormously painful journey he must
> take. Think of the enormous pressure on babies cranial bones, soft
> tissues, skeletal and muscular systems. If mom gets an epidural, she
> feels great, but the baby endures the full brunt of labor. What mom
> would choose to expose her baby to that if she truly understood what
> was at risk? I think you are being naive, and frankly, a little
> dishonest. There are risks associated with epidurals. A drop in mom's
> blood pressure due to an epidural leads to decreased blood flow to
> baby. This can be protected against in some, but not in all, cases and
> often varies greatly based on the skill of the anesthesiologist. Then
> you add to that the over 90% rate of pitocin augmentation which
> decreases baby's blood flow due to increased contraction intensity and
> frequency and you have the recipe for the astronomical rate of c-
> sections in USA as a result of fetal intolerance to labor. That's not
> even taking into consideration the unnatural position of delivery that
> is thrust upon women in hospitals. The pelvic inlet is at it's
> narrowest on your back, but most convenient for practitioners."
Hmm, this is an argument I hadn't come across before, that baby needs
mom's endorphins to endure labor pain, and quite frankly, I'm not sure
how we'd test it. Usually, the argument is that the drugs used in the
epidural DO cross the placenta and affect the baby's motor behavior,
so it would stand to reason that IF these painkilling drugs are
already crossing the placenta and affecting the baby, they would also
confer pain relief to the baby. But again, we have no way to test
this, at least not on humans. But that makes me wonder whether there
have been animal studies...
Réka
>
> ....
>>
>> > --
>>
>> > You received this message because you are subscribed to the Google Groups "Parenting in Hungary" group.
>> > To post to this group, send email to budape...@googlegroups.com.
>> > For more options, visit this group athttp://groups.google.com/group/budapestmoms?hl=.
>>
>> --http://www.rekamorvay.com/http://szuleselmeny.wordpress.com/http://tejmentes.blogspot.com/
>> > --
>>
>> > You received this message because you are subscribed to the Google Groups "Parenting in Hungary" group.
>> > To post to this group, send email to budape...@googlegroups.com.
>> > For more options, visit this group athttp://groups.google.com/group/budapestmoms?hl=.
>>
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Réka Morvay
Nov 13, 2009, 3:38:20 AM11/13/09
to budape...@googlegroups.com
On Fri, Nov 13, 2009 at 7:49 AM, jugoslava <yug...@gmail.com> wrote:
> Yeah that woman (Dr. Amy Tuteur) is quite obnoxiously narrow-minded lol, most of her
> argumentation does end up being the childish "it's not true" backed up
> by a medical degree :)
See, it wasn't that obvious to me. A lot of people say the same thing
about her, and it IS obvious that she's obnoxious and condescending to
those who do not agree with her, but she does cite some facts and
studies that are very interesting. I've learned a lot from reading her
blogs (and somehow, for a mother of 4 who is also an obstetrician, she
seems to have a LOT of time to write for blogs... she's got 3-4 of her
own, and then contributes to a number of others.) At any rate, reading
the comments on her blogs has been very educational for me.
Here's the most recent one, about the safety of homebirth attended by
a midwife. The comments are rather lengthy, and often technical,
debating statistical detail and criticizing research design, but they
also offer a lot of new insight and information.
http://www.sciencebasedmedicine.org/?p=2392
The take-home message for ME, after poring through the back and forth
about safety numbers, seems to be that in areas where home birthing is
regulated (so there are clear rules about who falls into a low risk
category, and under what circumstances you MUST transfer to a hospital
or risk losing your license), and you are attended by a licensed
midwife (of either the nurse-midwife or the certified professional
midwife variety), AND the cooperation between the hospital staff and
the home birth community is good (thus ensuring seamless and quick
transfers), then the risk of giving birth at home equals the risk for
giving birth at a hospital in terms of neonatal death. However, when
one or more of those conditions are not met (e.g. there are no clear
rules about who can birth at home and when to transfer, when the
midwife's training is questionable, when there are obstacles to
hospital transfer) then birthing at home is becomes more dangerous
than birthing in a hospital.
It is worth noting, however, that while the baby's risk is lowered in
a situation like that, the mother's risk of death and complications
increases, due to the many unnecessary interventions used liberally
and routinely in hospitals. (See one of TimMills' comments in the
above blog post for the actual breakdown of numbers.)
Obviously, this type of debate hits close to home for me, because I
attend home births as a doula, and I have seriously considered the
idea of becoming a home birth midwife.The only way I can conscienably
do that is if I'm satisfied that what I'm doing isn't putting the
women I'm attending at higher risk.
Of course, then there is always the question of IF a woman understands
her potentially higher risk at home, and she is still willing to take
that risk, is an attendant (doula or midwife) wrong to assist her?
Even using Dr. Amy's unfriendly numbers, the risk of the baby dying in
a home birth situation (with a midwife of uncertain qualifications, no
clear rules about transfer, and unfavorable transfer conditions) is 1
in 1000, so 0.1%. With a good attendant, clear rules, and good
transfer conditions, this risk is reduced to 0.23 deaths per 1000,
which is 0.023%. Low-risk women in hospital, attended by a midwife,
the risk of neonatal death is 0.37 per thousand, 0.037%. Should I
conclude home birth is safer under certain circumstances than being in
a hospital? Would that sway anybody to give birth at home?
Just to put those numbers into perspective, your chance of dying in a
car crash over the course of your lifetime is 1 in 42, or 2.4%. Your
chance of winning at roulette is 3%. Your chance of being murdered is
1 in 140, so 0.7%.
You are seven times more likely to be murdered than for your baby to
die in a home birth, even a "dangerous" home birth.
What do you guys think?
Réka
> Yeah that woman (Dr. Amy Tuteur) is quite obnoxiously narrow-minded lol, most of her
> argumentation does end up being the childish "it's not true" backed up
> by a medical degree :)
See, it wasn't that obvious to me. A lot of people say the same thing
about her, and it IS obvious that she's obnoxious and condescending to
those who do not agree with her, but she does cite some facts and
studies that are very interesting. I've learned a lot from reading her
blogs (and somehow, for a mother of 4 who is also an obstetrician, she
seems to have a LOT of time to write for blogs... she's got 3-4 of her
own, and then contributes to a number of others.) At any rate, reading
the comments on her blogs has been very educational for me.
Here's the most recent one, about the safety of homebirth attended by
a midwife. The comments are rather lengthy, and often technical,
debating statistical detail and criticizing research design, but they
also offer a lot of new insight and information.
http://www.sciencebasedmedicine.org/?p=2392
The take-home message for ME, after poring through the back and forth
about safety numbers, seems to be that in areas where home birthing is
regulated (so there are clear rules about who falls into a low risk
category, and under what circumstances you MUST transfer to a hospital
or risk losing your license), and you are attended by a licensed
midwife (of either the nurse-midwife or the certified professional
midwife variety), AND the cooperation between the hospital staff and
the home birth community is good (thus ensuring seamless and quick
transfers), then the risk of giving birth at home equals the risk for
giving birth at a hospital in terms of neonatal death. However, when
one or more of those conditions are not met (e.g. there are no clear
rules about who can birth at home and when to transfer, when the
midwife's training is questionable, when there are obstacles to
hospital transfer) then birthing at home is becomes more dangerous
than birthing in a hospital.
It is worth noting, however, that while the baby's risk is lowered in
a situation like that, the mother's risk of death and complications
increases, due to the many unnecessary interventions used liberally
and routinely in hospitals. (See one of TimMills' comments in the
above blog post for the actual breakdown of numbers.)
Obviously, this type of debate hits close to home for me, because I
attend home births as a doula, and I have seriously considered the
idea of becoming a home birth midwife.The only way I can conscienably
do that is if I'm satisfied that what I'm doing isn't putting the
women I'm attending at higher risk.
Of course, then there is always the question of IF a woman understands
her potentially higher risk at home, and she is still willing to take
that risk, is an attendant (doula or midwife) wrong to assist her?
Even using Dr. Amy's unfriendly numbers, the risk of the baby dying in
a home birth situation (with a midwife of uncertain qualifications, no
clear rules about transfer, and unfavorable transfer conditions) is 1
in 1000, so 0.1%. With a good attendant, clear rules, and good
transfer conditions, this risk is reduced to 0.23 deaths per 1000,
which is 0.023%. Low-risk women in hospital, attended by a midwife,
the risk of neonatal death is 0.37 per thousand, 0.037%. Should I
conclude home birth is safer under certain circumstances than being in
a hospital? Would that sway anybody to give birth at home?
Just to put those numbers into perspective, your chance of dying in a
car crash over the course of your lifetime is 1 in 42, or 2.4%. Your
chance of winning at roulette is 3%. Your chance of being murdered is
1 in 140, so 0.7%.
You are seven times more likely to be murdered than for your baby to
die in a home birth, even a "dangerous" home birth.
What do you guys think?
Réka
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