The Pain Coping Scale: Penny Simkin’s new tweek to an old tool

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Once again, Penny Simkin has created a practical and useful  tool for use in the labor room. The Pain Coping Scale evaluates not just pain, as pain is normal in the birth process. The Pain Coping Scale provides a tool of how well a client is coping with her pain. Penny’s series of a two-part blog post ran on Science & Sensibility, the Lamaze International research blog (references below). As a doula, I can relate to the how difficult it is to watch our client’s at the height of labor and wonder, “Are we doing enough to help?” In my experience many hospital care providers are poorly prepared to differentiate between pain and suffering and are not trained to recognize warning signs of birth trauma should it occur.

Primary to this discussion is realizing that pain in labor is normal and distinct from suffering. Reading Penny’s entire post is a good introduction to or reminder of this concept. Pain can occur without suffering and suffering occurs without pain. 18% of new mothers report having a traumatic birth experience in a national study (Declercq, Sakala, Corry, & Applebaum, 2008). 9% of those women had ample symptoms to be diagnosed as PTSD.  Prevention of suffering in labor should be a topic for every doula and childbirth series.

Most useful to doulas and childbirth educators is a section entitled “Practical Suggestions to Prevent Posttraumatic Stress Disorder After Childbirth”. Checklists are provided for before, during, and after labor to identify issues or fears related to childbirth.  The concept of using a code word to prevent suffering is now well introduced in the vocabulary of most doulas and educators.

New to some educators may be the Pain Coping Scale. This is a modified Pain Scale that appears above. Coping well because no pain is evident is rated as a 0 at the smiley left end and not coping with pain is rated as a 10 at the desperate looking face on the  left.

Women in labor may rate their pain as high but if they are coping well, she may not be suffering. Those who rate their pain as high and their coping as low  deserve the attention of the doula, staff,  everyone.  She is suffering and it’s time to increase all the support available to prevent feelings of despair and abandonment.

Thank you, yet again, Penny, for an effective tool in preventing suffering in birth. Our client’s deserve all our best support!


Part 1:

Part 2:





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