ObGyn Intelligence
Evidence Matters
Prepare
Evidence LibraryUnderstanding pregnancy, risk, and consentBeing heard
Evidence Library · Being heard

Being believed is not a courtesy, it changes the outcome

The strongest finding in this whole tool, and almost nobody knows it.

A study followed 112 women for a year after birth, comparing their recorded pain scores during labor with their mental health afterward.

The pain scores predicted nothing. Objectively recorded pain during labor was not associated with post-traumatic stress at any point up to twelve months.

What did predict it was how she was communicated with. Positive communication from the clinicians caring for her was associated with substantially lower odds of probable post-traumatic stress: an adjusted odds ratio of 0.29 at six months and 0.20 at twelve months. In plain terms, in this group, being communicated with well was associated with roughly 70% to 80% lower odds of trauma symptoms a year later.

0.29
Odds of trauma symptoms at 6 months with good clinician communication
112 women, adjusted
0.20
At 12 months
Same cohort
None
Association between recorded pain scores and later trauma
Same cohort
Why this matters to youIt means the thing that hurt you may not have been the pain. It may have been what happened around the pain. That is not weakness or ingratitude on your part. It is the finding.

This is a single study of modest size, in women already screening positive for psychological symptoms, so the exact numbers should not be over-read. The direction of the finding is consistent with larger work showing that a woman's own experience of her birth, rather than the medical events in it, is the strongest predictor of later trauma.

Where this comes from:
252. Kountanis JA, Kirk R, Handelzalts JE, Jester JM, Kirk R, Muzik M. The associations of subjective appraisal of birth pain and provider-patient communication with postpartum-onset PTSD. Arch Womens Ment Health. 2022;25(1):171-180.
359. Plaat F, Stanford SER, Lucas DN, Andrade J, Careless J, Russell R, et al. Prevention and management of intra-operative pain during caesarean section under neuraxial anaesthesia: a technical and interpersonal approach. Anaesthesia. 2022;77(5):588-597.

Covered in the essential classes

Continue

More from Labor

This page is educational. It supports the conversation with your own clinicians. It is not consent to any treatment, and it cannot assess you. If you are worried about a symptom now, see urgent warning signs.