The Joint Commission requires hospitals to ask patients to rate their pain at regular intervals.  Most use a smiley-face pain scale like this:

Since I’ve long thought asking this of laboring women to be unhelpful at best and the cause of additional pain at worst, I’ve begun suggesting to clients that they consider using the pain scale suggested here.  (Her scale goes from 0 = “Haha!  I’m not wearing any pants!” to 10 = “You hurt my feelings and now I’m crying!”. Still not very useful, but at least it’s funny. )

More than once I’ve had a laboring woman look to me to provide an answer when the nurse asks her to rate her pain.  Often, it seems the look is conveying the question, “How much worse is this going to get exactly?” Then the nurse might describe ‘10’ as “the worst pain you’ve ever experienced; like having your arms ripped off”.  Unfortunately, (or rather, fortunately) most of us have never had our arms ripped off.  This just further confuses things for the woman.  Now she’s wondering, “Just how close does labor pain get to having your arms ripped off?”.  Another unhelpful description a (male) OB gave a first-time mother was that ‘10’ was like “when the baby is crowning, without an epidural”.  This is particularly damaging to the woman’s confidence since, no matter where she is in labor, she now has it in her head that the worst is yet to come.

The answer to the pain question, according to blogger/nurse At Your Cervix, is “Not Applicable”.  The pain of labor should not be compared to other types of pain because it is NOT THE SAME KIND OF PAIN.  Unlike having your arms ripped off, much of the pain of labor is caused by the body doing what it’s supposed to do.  Now, here’s where Penny Simkin, the grande dame of doulas, comes to the rescue with a pain scale that is made just for labor.  It looks like this:

The genius here is that the focus is not on the intensity of the pain, but rather on how well the woman is coping with the pain.  It’s also important to note that not every woman will even get to the end of the coping scale: I’ve seen women not get below a 5.  Likewise, it is quite common for women to get all the way to 0 (can’t do it) a few times during labor, just to get back on top of the contractions and go back down to a 5.  More than once, I’ve seen a woman reach 9 centimeters, then have a break in her labor that allows her to take a much-needed nap, making her rating around 7 or 8.

If you are pregnant, know that the pain of labor doesn’t necessarily follow a straight line up to ‘10’.  Most often, the contractions will get more intense, and your body will produce more endorphins to allow you to cope.  Or you might get past transition and have a “rest and be thankful” nap before pushing.  Or maybe you will truly get to the end of your rope, then you will feel that urge to push and it will feel fantastic.  In any event, definitely ignore the pain scale.