Overestimation and underestimation of labor pain

Objective: To define factors affecting the ability of the medical staff to estimate the level of pain during labor. Methods: The study population consisted of 255 consecutive women. All parturients were asked to rate their pain level, using a visual analog scale. At the same time, the caregivers estimated the degree of pain as was exhibited by the parturients, using the same scale. Patients whose pain level was either overestimated or underestimated were compared to patients whose pain was correctly estimated. Results: In about half of the women (50.6%) enrolled in our study the level of pain was estimated correctly by the caregivers, while similar proportions of women had their pain level overestimated (24.3%) and underestimated (25.1%) by the caregivers. While the majority (54.5%) of patients who were in their second or third deliveries were equally estimated by the personnel with regard to their pain intensity levels, most of the grandmultiparous women had their labor pain underestimated by the medical staff. (57.1%, P<0.001). None of the caregivers had more than five children. Although the mostly secular medical staff could properly estimate the pain levels of most secular patients (52.3%), the labor pain of 44% of the religious parturients was underestimated (P=0.003). The ability to estimate properly the patients' suffering was found to be unaffected by age, family status, educational level, presence of companion during labor and participation in childbirth preparation course. Conclusion: The wider the cultural gap between the caregiver and the patient, the less accurate was the interpretation of patient's pain. Copyright (C) 2000 Elsevier Science Ireland Ltd.