Thursday, July 5, 2012

Pain in the Neonate

It was once a common thought among some (often more western) cultures that children didn't feel pain before the age of 3, or if they "felt" the pain, they didn't remember it so it didn't matter anyway.

This belief has persisted throughout many, many generations and our current medical model of care often manages to ignore the important fact that unborn and newborn babies DO feel pain. As for "remembering", we may not be able to recollect the things that happened to us in our infancy, but that doesn't mean they aren't a part of our unconscious thoughts, foundational behaviors, and cellular memory.

An article from Science Daily addresses recent research about painful procedures being performed on newborns in ICU's (this article is addressing research conducted in Paris, but our procedures are very similar), particularly how many procedures newborns undergo and that some of these are performed without any pain medication.

It is important to know, and the article addresses this, that these painful procedures are occurring at a time in development when pain is generally unexpected and newborn (as well as unborn) babies are more sensitive to pain than older children and adults. This just seems like common sense to me, but for those who do not naturally protect the young, we need lots of research to try and prove these "theories" and make a very crucial change in the medical system.

Kangaroo Care
As for the research, 430 neonates were observed and their average gestational age was 33 weeks, average ICU stay was 8.4 days. Painful and stressful procedures were measured as well as pain medication/relief.

The results are upsetting... the average number of procedures for each neonate during their ICU stay was 141, the average per neonate/per day was 16; of these, 70% of procedures were considered painful (such as nasal and tracheal aspiration, heel stick, adhesive removal) and 30% were considered stressful.

I'm not sure I see the need to separate the two (painful and stressful) for a neonate, I feel as though pain is stress inducing and stress can heighten receptivity to pain.

80% of these procedures were performed without pre-procedural analgesia ... however, the researchers noticed that when parents were present, or the procedure was being performed during day-time hours, more pain medication was used.  

How sad. I believe there are more effective and efficient ways to receive even better results for the health of the baby. For example, better record keeping and use of blood samples could decrease the overuse of heel sticks and we already know that kangaroo care and breastmilk are excellent supplements to almost any therapy. 

Some babies in the ICU are experiencing hundreds of painful and stress inducing procedures during their "treatment", I am certain these babies would be stronger and healthier if there were treated with respect and nurtured.

Now that we have the technology to treat conditions that result from prematurity, low-birth weight and other issues, we need to consider our ethical responsibilities to those we treat. We must keep in mind that the future of our humanity (and ourselves) is in the hands of the tiny babies we are treating and they will likely give back to us (and the world) as we have treated them... let's give them love!

As a professional, I would like to bring attention to this issue and to support a hasty change in the manner that procedures are conducted on neonates with very little to no pain medication.

This includes interventions that occur during labor, birth, and postpartum because many of these can increase stress and pain in the baby as well. Interventions such as pitocin, forceps delivery, fetal scalp monitor, removal from the mother after birth, suctioning, circumcision, etc.

A change can be made, but it is parents and birth professionals that need to advocate to make it happen!

Happy Advocating!
~Wisdom and Birth

JAMA and Archives Journals (2008, July 4). Newborns in ICUs often undergo painful procedures, most without pain medication.Retrieved from


  1. I read this post today, and then just now I read this info about Florida's proposed Amendment 6:

    and so this line made me think of your topic again: "In March, the Florida House passed a bill requiring doctors to describe fetal pain to women before performing an abortion past 20 weeks."

    Not that I support this, but it has to do with what you were getting at, with unborn babies feeling pain.

  2. Such a tricky issue because we need to acknowledge that babies feel pain and sensations in utero and they are learning about the world around them through the experiences they have, but as usual there are always extremists that will use this knowledge against women... such as "requiring that women be told a fetus feels pain during an abortion". Why aren't doctors required to tell parents this before completing a number of interventions that cause pain!?!?