In an evolutionary sense, memory of pain serves an important purpose. Pain indicates a threat to our safety or our life, and human survival depends on us avoiding things that are going to kill us.
Historically childbirth has been both incredibly painful and associated with a high risk of maternal death. So how come humans kept lining up to do it over and over again? It makes sense that somewhere along the line a theory was posited that, unlike other pain, women just don't remember the pain of childbirth. If they did, women might never going back there and thereby threaten the survival of the species.
The myth that women are biologically programmed to forget the pain of childbirth is also fostered by the language we use to describe the euphoria and relief of delivering a healthy baby. At the moment of holding a child for the first time, women often report that the pain of labour has all but been forgotten. It hasn't really been forgotten, but the happiness and reward colour the memory of the preceding pain. This is known as the halo effect.
Interestingly, while the science won't back up the claim that women forget entirely, it does suggest that over time, many women remember labour and birth pain as being less severe than they originally recalled. This relationship seems to hold mainly for women who reported moderate levels of pain.
At the extremes of pain, memories appear more constant. Women who reported soon after the birth that their labour pain constituted “the worst pain imaginable” were mostly sticking to that opinion when questioned one year later. Same for the women who reported their birth as “pain-free”.
Pain is only one element of the overall birth experience, and other factors that contribute to how a birth is remembered include satisfaction with care-providers, choice of pain relief, level of medical intervention, complications, outcomes for the baby, and all sorts of personal factors. These elements may play a large role in determining how pain is remembered.
When all those other aspects added up to a positive overall birth experience, women reported less pain at the time, and were more likely to lower their rating of the pain over time. When these aspects combined to produce a negative experience, women reported more pain in childbirth and did not forget the intensity of that pain up to five years later.
It seems that with time comes more opportunity to process the birth and with that more distress at the way a negative experience played out. In fact, Australian data suggest that around 3-6% of women develop post-traumatic stress symptoms after a negative birth experience.
Serious complications such as very preterm labour increase the risk for a negative recollection of birth over time. There is no opportunity for a halo effect when a newborn in distress is rushed to the intensive care unit.
A slightly depressing finding for those who plan to be on first name terms with their anaesthetist during the birth is that even when pain relief is used, it may not lessen the memory of pain overall. One study found that women who had epidural analgesia during labour remembered pain more intensely than women who didn't. This pointed to “peak pain” memories for these women prior to the epidural, indicating pain isn't evaluated on average across labour but instead particular moments stand out.
However a child is brought into the world, there are many health professionals who can talk to women about their fears and anxieties about pain or the experience as a whole. Being psychologically prepared may assist some women, particularly those having their first child or those who have had a negative experience in the past.
There are lots of options for pain control in childbirth and like everything with parenting, you need to know yourself (and your threshold for pain) and work out a plan with your care-provider that feels right for you. You may not forget the pain, but if you're lucky, the end will justify the means.
Monique Robinson receives funding from Australian Rotary Health.
