Monday, July 13, 2009

Purpose of Labour Pains

In my post on Back Pain, in response to Scott Adam's complaint that back-pain was evil, I asserted that pain has a perfectly valid function, and it is painkillers that are evil.

Pain has a perfectly valid function - it is the body's way of communicating something important to the mind. If you ignore a small child, it will misbehave louder until it gets your attention. And pain works the same way. If you completely ignore your back until it seizes up, then you shouldn't be surprised if it seizes up from time to time. That's how systems work.

In my view, it is painkillers that are evil - or rather the casual use of painkillers - because they interfere with the natural communication between the mind and the body, and the natural balance of work, rest and play.

However, although this is the general function of pain, it sometimes doesn't seem to work properly. For example, in some chronic situations such as cancer, the body sends excessive pain signals to which the only possible response appears to be some kind of signal blocking mechanism such as drugs or TENS. Alternative therapies in this category might include acupuncture and hypnosis.

Childbirth is another situation where pain-killing drugs and TENS machines are commonly used. Why should mothers suffer labour pains?

Childbirth is a natural and, if all goes well, perfectly healthy procedure; many people therefore think it is inappropriate to treat childbirth as a medical condition. And there is a common ideology of "natural" childbirth: many women adopt birth plans that aim to avoid excessive medical intervention, not just out of bravado or authenticity, but also for fear of unnecessary side-effects.

But it is one thing to oppose or refuse excessive medical intervention; quite another to assert that labour pain has a positive function, as does Dr Denis Walsh.

"Pain in labour is a purposeful, useful thing, which has quite a number of benefits, such as preparing a mother for the responsibility of nurturing a newborn baby." [Observer, 12 July 2009]

Dr Denis Walsh is an associate professor of midwifery at the University of Nottingham; he is described by the Observer as "one of the UK's leading midwives". The basis for his claim is apparently set out in an article Dr Walsh has written for the Royal College of Midwives journal Evidence-Based Midwifery. (See note below)

Evidence-based midwifery, huh? I wonder what kind of evidence can Dr Walsh produce for the purpose of labour pains? Is this perhaps the kind of hypothesis that can only be evaluated by evolutionary biologists? Labour pains have doubtless co-evolved with maternal care, many other species lacking both, but can we really conclude that labour pains are an adaptation that help to promote maternal care? I think it is more plausible to say that labour pains are a side-effect of a much more important adaptation, namely large brains.

In any case, evolutionary biology offers one possible meaning of the word "purpose" - some functional trait that has evolved or co-evolved for a reason. If that's not what Dr Walsh means, what else could he possibly mean?

Note 1: Dr Walsh has an article in the current issue of Evidence-Based Midwifery (Volume 7, Issue 2, June 2009), but this seems to be about something else and I couldn't find the word "purpose"; he had an article on the Role of the Midwife in a previous issue, but this is for subscribers only. However, I did find an interesting editorial in the current issue by one Professor Marlene Sinclair, Practice: a battlefield where the natural versus the technological, citing Elul, Habermas and Ihde.)

Note 2: I didn't know whether evolutionary biologists had ever studied labour pains as a separate phenomenon, so I tried Google and found an abstract of an article by Wulf Schiefenhövel called Perception, Expression, and Social Function of Pain: A Human Ethological View (Science in Context, 1995). I have sent an email to Professor Schiefenhövel asking for his opinion on Dr Walsh's claim.

Note 3: When I previously blogged on pain, I got a lot of comments from people trying to sell dodgy pain relief. Any such comments will be quickly deleted, so please don't bother. I am only interested in retaining comments that discuss the points in this blog.

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