I have a research interest in how pain is quantitatively measured in the labor and delivery setting. As some of you may know, we are required under the Joint Commission to ask laboring women about their pain, using a pain scale. You know, that lovely pain scale from 0 to 10?
That one ^
I hate it. Of course you're going to have pain - it's labor! It's expected!
Some problems with using a numerical pain scale in labor and delivery, is that women might be left wondering: if I give my pain a low number, does that mean the pain is going to get worse? (More than likely, yes. But once again, it's "labor". And it's normal.)
Or, a woman might think that if she gives a high number in early labor, it means she'll get pain medication or an epidural sooner. (Not necessarily.)
How about the lovely Joint Commission, who says we need to offer pain medication (different types) depending on the severity of the pain on the pain scale? (Once again, I must declare: pain in labor is NORMAL! It doesn't mean it automatically needs medication to "fix it"!)
So, I've brought this topic up at work. Because, as you can tell, I hate using the 0-10 pain scale in labor and delivery.
What about a coping scale? -- I posed this question at our practice group meeting. I know, no one really seemed too interested in the topic, but hey, I am interested in it. So, off to research coping scales.
Interestingly enough, I did find one research article that goes about the creation and utilization of a coping with labor algorithm. Very close to what I was looking for. In an article in the Journal for Midwifery and Women's Health, I found such a concept of a coping algorithm for labor and delivery.
But what I really wanted to find was a numeric scale, or something I can introduce to the unit to quantify how the woman is coping with labor. Enter Penny Simkin's chart Thank you Penny Simkin!
What are the 3 Rs, you might ask? According to Penny , they are The ability to Relax during and/or between contractions, The use of Rhythm characterizes their coping style, and The use of Rituals, or Rhythmic activities with each contraction.
I so, so, SO like this coping score system MUCH better than the "can you rate your pain for me, on a scale of zero to ten, with zero being no pain, and ten being the worst pain in your life?"
Quantifying the very subjective nature of pain while in labor is so different for each woman. Using the coping scale with how each woman is coping with the contractions actually shows how well (or not) she is managing the "pain" of her labor. Then again, I hate the use of the word "pain" when it comes to labor. Yes, it is painful. However, to bring up the word "pain" can actually make it MORE painful for some women.
Once again, I go back to the "duh" mentality of the fact that it's labor, of course it is painful. Must we remind women of this pain by asking her, repeatedly, to rate her level of pain? Quite simply: NO.