{"title":"我感到疼痛,而不是压力:对剖宫产疼痛的个人和方法反思。","authors":"Rachel Somerstein","doi":"10.1016/j.ajog.2025.06.036","DOIUrl":null,"url":null,"abstract":"<p><p>Cesarean delivery is one of the most common operations in the world, and a growing number of cesarean deliveries are performed in the United States each year. Despite the operation's relative safety, pain during cesarean delivery is common, ranging from 1.2% of births to more than a third of births depending on the institution, how pain during cesarean delivery is measured, and the type of analgesia used. The intensity of pain during a cesarean delivery varies as well, and evidence suggests that its frequency may be underreported. Yet, intraoperative pain poses serious risks for mothers' wellbeing, particularly because it can trigger childbirth-related posttraumatic stress disorder, which, in turn, hurts mothers psychologically and physiologically and impairs their capacity to bond with their babies. Despite how common pain during cesarean delivery is and in spite of its consequences, there is a lack of widespread agreement on how to prevent or to treat intraoperative pain and few examples of patient-narrated experiences of it. In this Special Article, I sought to contribute my own experience with intraoperative pain during a cesarean delivery, the development of childbirth-related posttraumatic stress disorder, and the use of Eye Movement Desensitization and Reprocessing for treatment. I also reviewed the evolution of the literature on pain during cesarean delivery from surrogate markers of pain to studies that focused on patients' reports of pain during cesarean delivery, a methodological shift that will expand the identification and treatment of intraoperative pain. I introduce geographer Nancy Hiemstra's notion of periscoping, a method used to identify problems or voices that may be hidden from view and propose that such methods, although useful, may miss capturing such subjective experiences as pain. I then propose that the recent focus on patient-reported pain is emblematic of a paradigm shift in maternal care to devote greater attention to women's pain. The implications of this paradigm shift might include not only addressing intraoperative pain but also present clinicians and researchers with an opportunity to focus on other common but similarly overlooked aspects of cesarean birth that may benefit from patient-centered inquiry and methodological approaches. These include the difficulties of postpartum recovery and the limitations that cesarean deliveries can place on family size. I close by highlighting the gap between cesarean delivery as a routine procedure and patients' experiences of it-an opportunity for clinicians to recognize and address, through prenatal and postpartum education, the short- and long-term major and minor consequences of cesarean birth.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.4000,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"I feel pain, not pressure: a personal and methodological reflection on pain during cesarean delivery.\",\"authors\":\"Rachel Somerstein\",\"doi\":\"10.1016/j.ajog.2025.06.036\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Cesarean delivery is one of the most common operations in the world, and a growing number of cesarean deliveries are performed in the United States each year. Despite the operation's relative safety, pain during cesarean delivery is common, ranging from 1.2% of births to more than a third of births depending on the institution, how pain during cesarean delivery is measured, and the type of analgesia used. The intensity of pain during a cesarean delivery varies as well, and evidence suggests that its frequency may be underreported. Yet, intraoperative pain poses serious risks for mothers' wellbeing, particularly because it can trigger childbirth-related posttraumatic stress disorder, which, in turn, hurts mothers psychologically and physiologically and impairs their capacity to bond with their babies. Despite how common pain during cesarean delivery is and in spite of its consequences, there is a lack of widespread agreement on how to prevent or to treat intraoperative pain and few examples of patient-narrated experiences of it. In this Special Article, I sought to contribute my own experience with intraoperative pain during a cesarean delivery, the development of childbirth-related posttraumatic stress disorder, and the use of Eye Movement Desensitization and Reprocessing for treatment. I also reviewed the evolution of the literature on pain during cesarean delivery from surrogate markers of pain to studies that focused on patients' reports of pain during cesarean delivery, a methodological shift that will expand the identification and treatment of intraoperative pain. I introduce geographer Nancy Hiemstra's notion of periscoping, a method used to identify problems or voices that may be hidden from view and propose that such methods, although useful, may miss capturing such subjective experiences as pain. I then propose that the recent focus on patient-reported pain is emblematic of a paradigm shift in maternal care to devote greater attention to women's pain. The implications of this paradigm shift might include not only addressing intraoperative pain but also present clinicians and researchers with an opportunity to focus on other common but similarly overlooked aspects of cesarean birth that may benefit from patient-centered inquiry and methodological approaches. These include the difficulties of postpartum recovery and the limitations that cesarean deliveries can place on family size. I close by highlighting the gap between cesarean delivery as a routine procedure and patients' experiences of it-an opportunity for clinicians to recognize and address, through prenatal and postpartum education, the short- and long-term major and minor consequences of cesarean birth.</p>\",\"PeriodicalId\":7574,\"journal\":{\"name\":\"American journal of obstetrics and gynecology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":8.4000,\"publicationDate\":\"2025-08-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American journal of obstetrics and gynecology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.ajog.2025.06.036\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of obstetrics and gynecology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ajog.2025.06.036","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
I feel pain, not pressure: a personal and methodological reflection on pain during cesarean delivery.
Cesarean delivery is one of the most common operations in the world, and a growing number of cesarean deliveries are performed in the United States each year. Despite the operation's relative safety, pain during cesarean delivery is common, ranging from 1.2% of births to more than a third of births depending on the institution, how pain during cesarean delivery is measured, and the type of analgesia used. The intensity of pain during a cesarean delivery varies as well, and evidence suggests that its frequency may be underreported. Yet, intraoperative pain poses serious risks for mothers' wellbeing, particularly because it can trigger childbirth-related posttraumatic stress disorder, which, in turn, hurts mothers psychologically and physiologically and impairs their capacity to bond with their babies. Despite how common pain during cesarean delivery is and in spite of its consequences, there is a lack of widespread agreement on how to prevent or to treat intraoperative pain and few examples of patient-narrated experiences of it. In this Special Article, I sought to contribute my own experience with intraoperative pain during a cesarean delivery, the development of childbirth-related posttraumatic stress disorder, and the use of Eye Movement Desensitization and Reprocessing for treatment. I also reviewed the evolution of the literature on pain during cesarean delivery from surrogate markers of pain to studies that focused on patients' reports of pain during cesarean delivery, a methodological shift that will expand the identification and treatment of intraoperative pain. I introduce geographer Nancy Hiemstra's notion of periscoping, a method used to identify problems or voices that may be hidden from view and propose that such methods, although useful, may miss capturing such subjective experiences as pain. I then propose that the recent focus on patient-reported pain is emblematic of a paradigm shift in maternal care to devote greater attention to women's pain. The implications of this paradigm shift might include not only addressing intraoperative pain but also present clinicians and researchers with an opportunity to focus on other common but similarly overlooked aspects of cesarean birth that may benefit from patient-centered inquiry and methodological approaches. These include the difficulties of postpartum recovery and the limitations that cesarean deliveries can place on family size. I close by highlighting the gap between cesarean delivery as a routine procedure and patients' experiences of it-an opportunity for clinicians to recognize and address, through prenatal and postpartum education, the short- and long-term major and minor consequences of cesarean birth.
期刊介绍:
The American Journal of Obstetrics and Gynecology, known as "The Gray Journal," covers the entire spectrum of Obstetrics and Gynecology. It aims to publish original research (clinical and translational), reviews, opinions, video clips, podcasts, and interviews that contribute to understanding health and disease and have the potential to impact the practice of women's healthcare.
Focus Areas:
Diagnosis, Treatment, Prediction, and Prevention: The journal focuses on research related to the diagnosis, treatment, prediction, and prevention of obstetrical and gynecological disorders.
Biology of Reproduction: AJOG publishes work on the biology of reproduction, including studies on reproductive physiology and mechanisms of obstetrical and gynecological diseases.
Content Types:
Original Research: Clinical and translational research articles.
Reviews: Comprehensive reviews providing insights into various aspects of obstetrics and gynecology.
Opinions: Perspectives and opinions on important topics in the field.
Multimedia Content: Video clips, podcasts, and interviews.
Peer Review Process:
All submissions undergo a rigorous peer review process to ensure quality and relevance to the field of obstetrics and gynecology.