April 10, 2013
By Helen Akinc

Just as perceptions of what makes a home a home or what constitutes a weekend breakfast differ across cultures, so goes the perception of pain, especially the pain of childbirth. In some cultures, particularly in parts of Asia, how a woman handles labor pains reflects upon her family’s honor—meaning that she is expected to be stoic and not complain too much lest an over-reaction bring shame upon the family. In other parts of the world, particularly in Mediterranean areas, the cultures tend to be more expressive and emotional which can be seen in a mother giving birth with clear and expressive communication of how she is feeling. In some western cultures, women want to be in total control during the birthing process. Some may see the pain management process (by epidural) as handing over control to the medical staff and are uncomfortable with that. Still others believe that pain management during labor makes the birthing process much more tolerable and allows them to experience and focus on the birth as opposed to the pain. 

What is especially interesting about some of this is that the culture expectations seem to influence the actual perception of pain. An example of this is that in parts of India, women in labor report less pain than women in labor in the United States. A key factor is that the two different cultures approach pain very differently. This can be problematic when a woman needs pain management but is culturally prevented from doing so. 

There are also very different settings for childbirth and the nature of the setting often dictates what is possible in terms of pain management. Many births take place at home and pain management is generally not possible there. In some countries, private hospitals offer pain management, whereas public hospitals do not. Some studies suggest that having family and close friends present for the birth is so supportive to the mother that this can reduce her need for medication or that a smaller amount of medication is sufficient to manage the pain. 

Religious beliefs can be important factors in both how a woman experiences pain and in how she views labor and childbirth in general. Interviews of women in various cultures in The Pain of Childbirth: Perceptions of Culturally Diverse Women;suggest that strong religious beliefs may help some women during the labor process and help her to reframe the pain with spiritual meaning. 

In a very interesting comparative study of Dutch and Belgian women’s views toward pain in labor, (Pain acceptance and personal control in pain relief in two maternity care models: a cross-national comparison of Belgium and the Netherlands[ii]) the authors write: 

Although Belgium and the Netherlands are neighbouring countries sharing the same language, political system and geography, they are characterised by a different organisation of health care, particularly in maternity care. In Belgium the medical risks of childbirth are emphasised but neutralised by a strong belief in the merits of the medical model. Labour pain is perceived as a needless inconvenience easily resolved by means of pain medication. In the Netherlands the midwifery model of care defines childbirth as a normal physiological process and family event. Labour pain is perceived as an ally in the birth process. ….

Two main findings emerge from this investigation. First of all, the care context is of major importance when studying the use of pain medication during labour. This is illustrated by the fact that the answer to our first research question – do labour pain acceptance and personal control in pain relief determine how childbearing women cope with labour pain? – is country specific. Regarding Dutch women we find that the use of pain medication is lowest if women have a positive attitude towards labour pain and experience control over the reception of pain medication. In the Netherlands Gomar and Fernandez’ [7] argument that the accessibility of, or control over, pain medication is likely to be one of the best predictors of the use of pain medication if women have negative attitudes towards labour pain, is confirmed by our findings….

Second, our investigation also indicates that the average labour pain acceptance is the same among our Belgian and Dutch respondents. ….

Despite the fact that the Belgian and Dutch women in our sample share the same pain attitudes, the use of pain medication strongly differs between the groups. More Belgian (47.8%) than Dutch respondents (14.5%) receive pharmacological pain relief. This could be an indication of an unmet need among Dutch respondents. More Dutch women might have been disappointed with their hospital birth as a consequence. This could explain the earlier finding that Dutch women giving birth at hospital report lower childbirth satisfaction compared to Belgian women with a hospital birth [45].

There are many studies exploring the topic of pain perception across various cultures. One thing is clear-women’s attitudes toward the pain of childbirth are influenced by many factors, and care-givers need to be sensitive to differences and consider the woman’s culture as well as her own personal attitudes. 

The Pain of Childbirth: Perceptions of Culturally Diverse Women

Lynn Clark Callister, RN, PhD, Inaam Khalaf, RN, PhD, Sonia Semenic, RN, PhD(c), Robin Kartchner, RN, BSN, Katri Vehvilainen-Julkunen, CNM, PhD.  Pain Manag Nurs. 2003;4(4) 

[ii] Pain acceptance and personal control in pain relief in two maternity care models: a cross-national comparison of Belgium and the Netherlands, by Wendy Christiaens*, Mieke Verhaeghe and Piet Bracke; BMC Health Services Research 2010, 10:268