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Journey to Confidence: Women's Experiences of Pain in Labour and Relational Continuity of Care


  • Nicky Leap RM, MSc, DMid,

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    • Nicky Leap, RM, MSc, DMid, is a Professor of Midwifery in the Centre for Midwifery, Child and Family Health at the University of Technology, Sydney, Australia, and a Visiting Senior Research Fellow at King's College London, London, UK.

  • Jane Sandall RM, RN, PhD,

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    • Jane Sandall, RM, RN, PhD, is a Professor of Social Science and Women's Health, and Programme Director (Innovations) NHIR, Kings Patient Safety and Service Quality Research Centre, Health and Social Care Division, King's College London, London, UK.

  • Sara Buckland RM, RN,

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    • Sara Buckland, RM, RN, is a research assistant in the Centre of Midwifery, Child and Family Health, University of Technology, Sydney, Austalia.

  • Ulli Huber PhD

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    • Ulli Huber, PhD, is a research associate at King's College London, London, UK.

Centre for Midwifery, Child and Family Health, University of Technology, Sydney, P.O. Box 123, Broadway, NSW, 2007, Australia. E-mail:


Introduction: An evaluation carried out at King's College Hospital Foundation National Health Service Trust in London identified that women who received continuity of carer from the Albany Midwifery Practice were significantly less likely to use pharmacological pain relief when comparisons were made with eight other midwifery group practices and the local maternity service as a whole. This study was designed to explore women's views of this phenomenon.

Methods: We conducted a thematic analysis of semistructured, audiotaped, in-depth interviews with 10 women who reflected on their experiences of preparation and support for pain in labour and midwifery continuity of carer with Albany midwives, using a qualitative descriptive methodological approach.

Results: Women reflected positively on how, throughout pregnancy and labour, their midwives promoted a sense of their ability to cope with the challenge of labour pain. This building of confidence was enabled through a relationship of trust that developed with their midwives and the value of hearing other women's stories during antenatal groups. These experiences enhanced women's ability to overcome fears and self-doubt about coping with pain and led to feelings of pride, elation, and empowerment after birth.

Discussion: Women valued being encouraged and supported to labour without using pharmacological pain relief by midwives with whom they developed a trusting relationship throughout pregnancy. Features of midwifery approaches to pain in labour and relational continuity of care have important implications for promoting normal birth and a positive experience of pregnancy, labour, and birth for women.

J Midwifery Womens Health 2010;55:234–242 c̊ 2010 by the American College of Nurse-Midwives.