Pain Perception at Birth Depending on the Personality of the Parturient Woman

Medical Interferences

PAIN PERCEPTION AT BIRTH DEPENDING ON THE PERSONALITY OF THE PARTURIENT WOMAN

Ioana PĂVĂLEANU1, Maria ROMAN2, Dumitru GAFIŢANU3, Cristina DOBRE2, Letiţia Doina DUCEAC4, Maricica PĂVĂLEANU4

1PhD student, „Gr. T. Popa” University of Medicine and Pharmacy, Iaşi, Romania 2Univ. Assist., PhD Student, „Apollonia” University of Iaşi, Romania 3Univ. Assist., „Gr. T. Popa” University of Medicine and Pharmacy, Iaşi, Romania 4Assoc. Prof. PhD, „Apollonia” University of Iaşi, Romania Corresponding author: Ioana Păvăleanu;e-mail:[email protected]

Abstract drug during labor. The term of natural birth, introduced in 1930, by the obstetrician Grantly Pain at birth is a symptom of special concern for the parturient woman, for her relatives and medical staff. In DickRead, refers to a vaginal birth involving no quite a number of cases, it has been observed that the invasive intervention or the administration of intensity of pain differs considerably from one woman to synthesis substances from the part of the medical another, a possible motivation being, among others, the psychological dependence and education and also the type staff [1]. The Cesarean operation is known as of personality of the patient. The present study – developed early as the Antiquity, being mentioned in many between July-September 2016 at the “Cuza Voda” and ancient cultures (in Greece, Egypt, India, The “Elena Doamna” Maternity Hospitals of Iaşi - will analyze Roman Empire, etc.). Mention should be made the intensity of pain at birth as a function of the type of personality of the woman. The group under investigation of the fact that the Cesarean intervention was was represented by 104 women in childbed hospitalized in done exclusively to the dying or already died the two maternities. The instrument employed was the Big women with the only scope of saving the baby, Five inventory, which permits to evaluate the individual personality and the scale of pain. Data was collected from no information being available on Cesarean the women in childbed 3-4 days after the delivery, when the interventions on living women. patients were also informed on the investigation under As known from immemorial times, birth development and gave their consent to be part of the study, represented a central moment for both the woman, filling in the questionnaires on paper. The results obtained showed that the type of personality influences pain at birth. the family and the whole macrosocial millieu, The more shy and inhibited by the presence of the others a reflecting the attitude of a society for its own future. woman is, the higher will be the score of her pain caused by If, in pre-Christian civilizations, birth has been birth. Utilisation of psychoprophylaxy and hypnorelaxation viewed as a natural phenomenon, in the techniques adds to the confidence in the obstetrical team, while increasing the confidence in patient’s own capacity of Christian-Jewish ones it is a mystical-cultural controlling the birth, and implicitly reducing the number concept according to which the woman has to of Caesarean operations on demand. experience the purifying suffering, the catharsis Keywords: birth, pain, parturient woman, type of personality. of the ”painful birth”, thus becoming, in the eyes of her family, of the society and in her own eyes, a ”saint”, respected by all the others. 1. INTRODUCTION Some examples related to the history of the attempts made at relieving pain at birth should Prior to the industrial revolution, women be remembered: in 1591, a Scotish midwife was used to deliver their children at home, with no burnt at the stake for having administered opium medical intervention, being assisted only by during childbirth; in 1853, queen Victoria midwives. The birth process acquired a medical received chloroform during child birth. In the character only later on, coinciding with the 20th century, several attempts have been made introduction of chloroform, by the obstetrician at developing techniques for painless birth. Thus, James Young Simpson, applied as an anaesthesic in 1933, Grantly Dick Read stated that pain at

International Journal of Medical Dentistry 9 Ioana PĂVĂLEANU, Maria ROMAN, Dumitru GAFIŢANU, Carmen DOBRE, Letiţia Doina DUCEAC, Maricica PĂVĂLEANU birth is based on preconceived ideas, on cultural represents a vicious circle, caused by anxiety, patterns, fear and negative attitudes, the stress, spasms, pain. therapeutical consequence of his observations The fear of ”childbirth pains” was transmitted being “Prepared childbirth tehniques”, namely, from mothers to daughters along almost 2,000 years, esentially: ”information, relaxation, respiration” with unexpected consistency and tenacity. Ignorance [2]. In the years ‚50, the concept of and a general lack of information generate serious psychoprophylaxy is issued, as a consequence of problems to young women, for whom the expulsion the reflexotherapy of Pavlov developed in the of their child appears as an ordeal. This explains Soviet Union, its main supporter in France being why the pain felt in the first moments and mainly Ferdinand Lamaze [3]. The English obstetrician during expulsion are considered as ”excruciating”, Dick Read, who published ”Childbirth without highly acute, corresponding to the mental fear” (1944), showed that a normal birth should representation plotted below. be painless, pain occurring only in pathological Fig. 1 systematizes the mechanism of pain at situations. As a matter of fact, painful birth birth [4]:

Fig. 1. The mechanism of pain during childbirth

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For each person in part, there exists a limit hav ever assisted a child delievery. In most of the of pain supportability, a different threshold. cases, the only information they acquire about The myometer is intensely and repetitively birth is by means of TV images, reflecting the contracting during birth, these contractions unbearable pain suffered by the parturient being the main source of pain during labor. The woman. This explains why, nowadays, numerous intensity of contractions, the size and position future mothers prefer, from the very beginning, of the child, along with the speed at which the a Caesarean operation. labor occurs are factors influencing the intensity An active management of labor, involving a of pain [5]. most precise definition of some important Generally, pain is difficult to define, especially parameters (time, dilatation, fetal descent), birth pain, as it differs from one woman to apart from the high risk of iathrogeny, will be another. Some women have a quick delivery, registered in only 45% of the parturient women, others suffer a long and complicated labor. who do not consider the usual values of such International studies show that 20% of the parameters as abnormal. parturient women felt almost no pain, 30% had The modern holistic, psychosomatic, tolerable pain and 50% - extremely difficult to obstetrical attitude opposes the above-mentioned support pain. Also observed was the fact that conception, by a personalized attitude, full of some women supported pain better than others. understanding, according to which the parturient It is certain that each woman experiences the appears as an active member of the obstetrical pain at birth in her own way. Some are suffering team, a privileged partner of the common action, unbearable pain, never to be forgotten, others whose main objective is to give birth to a healthy feel only a few painful contractions. baby, a joyful, happy and expected event. As a matter of fact, it is the combination of At worldwide level, two categories of their life experience and their genetic inheritance psychomatic ”management” of childbirth are that determines the threshold of pain or the now manifesting. The former refers to the capacity to resist it. The social support (or its complex preparation along the whole period of absence), fear, anxiety, as well as the positive or pregnancy; it includes information, the task of negative stories women come to hear about the convincing the pregnant woman that both the labor may contribute to the manner in which pregnancy and the delievery are deeply positive they face pain. physiological pnenomena, as well as a large The socio-family, cultural and religious variety of techniques (starting from the millieu of the future mothers has also a special gymnastics of respiration up to autogenous importance, influencing their attitude on traning, etc.), capable of distracting her from childbirth. A detrimental socio-cultural feeling the painful uterine contractions [3]. environment, generalized violence (physical, The latter category includes the techniques of sexual, of language, psychological, etc.) will only hypnorelaxation during childbirth, with obvious intensify the retractile attitude of a parturient advantages as to their efficiency (shorter labor, woman. Nowadays, there exist in the world minimum medication, fewer obstetrical communities in which the little girls are prepared manoeuvres), as well as from the viewpoint of to face natural childbirth. In South Africa, in the time they require (assuming no prolongued Kung tribes, young girls are encouraged to attend preparation during pregnancy). Hypnorelaxation other women during the delievery and to defy techniques are based on the suggestion according any fear. The mothers to become are educated to to which all moments of the delievery should be face pain with courage; also, the young mothers viewed as painless, due to a modified state of are told that their manner of thinking during mind, muscular relaxation, silence, half-dark and their pregnancy will influence the labor and the confidence in the obstetrical team, and especially birth process. in one’s own capacity of facing the birth, Contrary to this, in civilized societies, little considered as an experiment, as a measure of her girls are never informed on the event of birth, on ability to adopt a deeply feminine and positive its meaning, and it is hardly probable that they attitude [6]. The pregnant woman should be

International Journal of Medical Dentistry 11 Ioana PĂVĂLEANU, Maria ROMAN, Dumitru GAFIŢANU, Carmen DOBRE, Letiţia Doina DUCEAC, Maricica PĂVĂLEANU taught that any woman ”knows how to give Factors of the Big Five©plus Inventory according birth to her child” . to which individual personality may be evaluated: The psychic component influences most of all both the perception of the pergnant woman on 1. Extraversion 4. Awareness birth and the decisions to be taken. The emotional 1.1 Affectivity 4.1 Personal efficiency side is closely related to it as, both before and 1.2 Sociability 4.2 Order/Planning during the pregnancy, a periodical emotional 1.3 Assertiveness 4.3 Moral rigidity hygiene is necessary. A correct understanding of 1.4 Activism 4.4 Ambition one’s emotional structure, followed by application 1.5 Excitability 4.5 Perseverance of some exercises for releasing the repressed 1.6 Cheerfulness 4.6 Cautiousness emotions and regaining of one’s feminity may be an essential support in reaching emotional 2. Agreeable attitude 5. Open attitude equilibrium. Fear and unrest disppear when the 2.1 Trust 5.1 Imagination woman is informed on what is she to face and how 2.2 Morality 5.2 Artistic interest to manage certain negative situations/thoughts. 2.3 Altruism 5.3 Emotionality 2.4 Cooperation 5.4 Adventurous 2. MATERIALS AND METHODS 2.5 Modesty spirit 2.6 Compassion 5.5 Intelect 5.6 Liberalism The present study, analyzing the intensity of 3. Nevrotic attitude pain at birth according to the type of personality 3.1 Anxiety of the parturient woman, was developed between 3.2 Anger July-September 2016, at the ”Cuza Vodă” and 3.3 Depression ”Elena Doamna” Maternity Hospitals of Iaşi. 3.4 Timidity Hypothesis of the study: The type of personality 3.5 Exaggeration influences the intensity of pain at birth . 3.6 Vulnerability Variables of the study: pain at birth, features of personality (extroversion, kindness, scrupulousness, neurosis and an open attitude 2. Nowadays, the scale of numerical evaluation to new experiences). of pain, developed by Richardson et al., is the Investigated batch: 104 women in childbed most largely employed instrument. Patients from the ”Cuza Vodă” and ”Elena Doamna” evaluate the pain they feel with a scale from 0 to Maternities of Iaşi. 10, where 0 means ”no pain”, while 10 stands for Psychological instruments employed in the maximum pain. The numbers employed with analysis of the above-mentioned parameters: this scale (0-10) are arranged in increasing order, thus indicating a gradual increase of pain 1. The Big Five©plus Inventory: the structure of intensity. personality represents a standardized sample for Data collecting: 3-4 days after the delivery, the evaluating one’s personality, built up according women were provided information on the to the Big Five pattern (a perspective proposed research project, gave their consent for by Goldberg, 1999), capable of offering a complete participating to the study and filled in the personality profile, a full screening of one’s questionnaires on paper. individual personality, both versus the 5 meta- factors (extraversion, kindness, nevrosis, scrupulousness and openess) and especially 3. RESULTS AND DISCUSSION versus the 30 factors (sides) [7]. The 240 items of the questionnaire are formulated as assertions Out of the total number of 104 women under with two variants of response (imposed selection), analysis, 28 (26.9%) women at childbed reported thus permitting diminution of the tendency mark 10 for pain at birth, 21 (20.2%) of them - displayed when confronted with a really mark 9, 19 (18.3%) - mark 8, 19 (18.3%) - mark 7, important psychological evaluation. 5 (4.8%) - mark 6, 6 of them (5.8%) - mark 5, 2

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(1.9%) - mark 4, 3 (2.9%) - mark 3 and 1 of them Based on the number of children, the following (1%) - mark 2 for pain at birth. (Table 1, Figs. 2-3) distribution was established: women with 1 child Table 1. Pain score at birth - 42 (40.4%) cases, with 2 children - 37 (35.6%) cases, with 3 children - 13 (12.5%) cases, 4 children Valid Cumulative - 4 (3.8%) cases, 5 children - 4 (3.8%) cases, 6 Valid Frequency Percent Percent Percent children - 1 (1%) case, 8 children - 2 (1.9%) cases 2 1 .5 1.0 1.0 and 9 children - 1 (1%) case. (Table 2) 3 3 1.6 2.9 3.8 Table 2. Distribution according to the number of 4 2 1.1 1.9 5.8 children 5 6 3.3 5.8 11.5 Valid Cumulative 6 5 2.7 4.8 16.3 Valid Frequency Percent Percent Percent 7 19 10.4 18.3 34.6 1 42 23.1 40.4 40.4 8 19 10.4 18.3 52.9 2 37 20.3 35.6 76.0 9 21 11.5 20.2 73.1 3 13 7.1 12.5 88.5 10 28 15.4 26.9 100.0 4 4 2.2 3.8 92.3 Total 104 57.1 100.0 5 4 2.2 3.8 96.2 6 1 .5 1.0 97.1 8 2 1.1 1.9 99.0 9 1 .5 1.0 100.0 Total 104 57.1 100.0

Fig. 2. Distribution of pain score at birth

Fig. 4. Distribution of the number of children

To analyze the relation between the factors of personality and pain at birth, the Pearson-type correlation analysis was applied. Appendix 1 lists the significant correlations between the Fig. 3. Report of pain score at birth factors of personality (according to the Big Five

International Journal of Medical Dentistry 13 Ioana PĂVĂLEANU, Maria ROMAN, Dumitru GAFIŢANU, Carmen DOBRE, Letiţia Doina DUCEAC, Maricica PĂVĂLEANU pattern) and pain at birth, as described by women They define themselves as persons with multiple 3-4 days after the delievery. and difficult to define inner worries. A negative correlation does exist between Therefore, the hypothesis according to which emotionality and pain at birth (r = -.247, p < .05), the type of personality influences the intensity of pain which means that, the more aware a woman is at birth is confirmed. As a result, the application of her own emotions, and more open to expressing of psychoprophylaxy and hypnorelaxation them, the lower will be the score of pain she techniques might increase the confidence in the records during the delievery. The shyer, the obstetrical team in one’s own capacity of more inhibited a woman appears in front of the managing the action of birth and, implicitly, others, the higher will be the score of pain she reduce the number of Caesarian operations on will register (r = .213, p < .05). request.

IFEmotionality -.247* References IFShyness .213* 1. Enkin, M, Kierse MJNC, Neilson J, Crowther C, Duley L, Hodnett E, Hofmeyr J. A guide to effective care in pregnancy and childbirth. New York: Oxford One may assert that shy women, facing University Press;2000. difficulties in expressing their emotions, will 2. Grantly DR. Childbirth without Fear: The Principles receive a higher mark (8,9,10) for pain at birth. and Practice of Natural Childbirth. London:Pinter & Martin;2004. 4. CONCLUSIONS 3. Goetzl LM; ACOG Committee on Practice Bulletins- Obstetrics. ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician- Analysis of the obtained results permits Gynecologists Number 36, July 2002. Obstetric drawing of the psychological profile of the analgesia and anesthesia. Obstet Gynecol. women with high marks for pain at birth (8,9,10); 2002;100(1):177-91. they are extremely sensitive to the opinion of the 4. Munteanu I. Tratat de obstetrică. Bucureşti:Romanian Academy Publishing House;2006. others about them, always fearing of being 5. Feinstein NF, Sprague A, Trépanier MJ. Fetal heart rejected or ridiculized. They feel embarassed in rate auscultation. Washington, DC: Association of public, considering that the others always Women’s Health, Obstetric and Neonatal Nurses evaluate and judge them, and having a rather (AWHONN);2000. negative opinion about themselves. Equally, 6. Munteanu I, Ripman E, Hrubaru N. Maternal Fetal they can hardly become aware of and express Risk in Gestosis. Roma: CIC, Edizzioni their emotions and sentiments. They rarely Internazionali;1996. 7. Constantin T. Inventarul de personalitate Big analyze their emotions, but, when they do this, Five©plus. Manualul probei. Iaşi: Alexandru Ioan they do not succeed in fully understanding them. Cuza University Publishing House;2006.

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