Midwifery



Midwifery

Gate Control Theory of Pain

The Gate Control Theory of Pain was developed by Melzack and Wall (1965), which explains the modulation of pain in spinal cord. This theory proposes the gating concept, takes place in the dorsal horn of spinal cord through which the information of pain passes to the brain (Godfrey, 2005). According to this theory pain impulses can easily pass if the gate is open and if the gate is closed no pain impulses can pass. This opening and closing of the gate depends on different factors and are related with the flow of pain information passed through synapses. When large fibre firing predominates then the pain impulses cannot pass through synapses due to the closed gate, on the other hand, when small fibre firing predominates then pain impulses can pass due to the open gate (Jacques, 1994). The sensation of pain can occur in the midbrain, with more redefined perception of pain occurring at the level of cortex. The entry of pain impulses into the pain conduction system is controlled by raphe nuclei, located in midbrain. All this pain impulses information passes through neurotransmitters, which cause the gate to open and close. It carries the sensory information like touch, pressure and temperature, which results in the suppression of transmission of pain information to the brain (Godfrey, 2005). Therefore, according to this theory the gate is closed by the activity in large diameter fibres, whereas gate is opened by the activity in small fibres. The theory also proposes that the pain intensity can be determined by the amount of activities occurring in the two distinct fibres (Jacques, 1994). Hence, the theory postulates that less pain can be felt when the activity in large fibre increases, which more pain can be perceived when there is more activity present in small fibre.

Question 1

Based on the best available evidence, what is the most important midwifery advice to give women about early labour?

Answer

Pregnancy is hard, but it is also wonderful and miraculous. Pre-pregnancy is the time when changes start in the body of women and she needs to be very careful in many areas of life. Studies have shown that mother-to-be needed advice and support in four dimensions: emotional, physical, informational, and advocacy (Iliadou, 2012). The most important advices to be given, by midwifery, for early labour are that they advice women for physical preparation of healthy birth, it contains advice related to exercises such as breathing and relaxing. Expectant mothers are advised to be preparing intellectually as well, by reading labour, birth and postpartum period before the birth. They are also advised to strengthen their self esteem by realising that birth will be a demanding task but to trust your body. Mothers-to-be are also advised to develop and strengthen the bond between themselves and their unborn child, by singing and talking to him and should also allow father to participate in the labour (Feilitzen, Radestad, Hildingsson, and Haggstrom, 2009). Advice regarding coping with pain at home is really necessary to be ...