WASHINGTON, DC — Patients’ experience of pain during birth and ob/gyn procedures is nuanced and can, in some cases, relate to a perceived loss of control, experts said during a presentation at the American College of Obstetricians and Gynecologists (ACOG) 2026 Annual Meeting. Improved communication with patients and offering choices regarding pain control can enhance these encounters.

Historically, women’s pain has been interpreted through a psychological lens, said Holly Berkley, MD, a comprehensive ob/gyn at the US Naval Hospital in Naples, Italy. That bias still shows up today, she said, with women’s pain being reported as less severe. The perception that pain is undertreated in gyn procedures but potentially overtreated during delivery and ob procedures is highlighted on social media, she said.

However, when there is “an authentic, real clinical interaction, patients report less pain than when there is not,” said Lt. Cmdr. Allison Eubanks, MD, an ob/gyn at Walter Reed National Military Medical Center in Bethesda, Maryland. “Improving communication can improve how the patient actually experiences pain,” she said.

Eubanks and Berkley outlined six principles that ob/gyns and their colleagues can use to help improve patient satisfaction and address pain perception, anxiety, and procedural distress:

Screen for anxiety: Anxiety is one of the strongest predictors of procedural pain, Berkley said. Use a one-question screen: “On a scale of 0-10, how anxious are you about this today?”

“This isn’t just nice — it’s clinically useful,” she said. Implementing this early in patient pathways, such as during counseling for contraception, will help streamline evidence-based interventions to deal with high anxiety scores, Berkley said. “We screen for depression, we screen for intimate partner violence. Why are we not screening for procedural anxiety?”

Implement standardized preprocedural counseling: “If a patient has high anxiety, we shouldn’t just note it. We should change the plan,” Berkley said. Studies indicate that structured, standardized preprocedural counseling, particularly with audiovisual tools, reduces anxiety more than routine counseling alone, she said.

Tailor support for high-risk patients, she advised: “If we wait until the day of the procedure, we’ve already missed the most meaningful window to change the experience.”

Use therapeutic language: Healthcare providers typically say things like “It’s just a pinch” or “This will be over in a second,” which can increase distrust and unintentionally amplify negative outcomes, Eubanks said. More effective language sets expectations while giving patients a sense of control. Use statements such as, “You may feel cramping for 15 seconds. If you need me to pause, say stop.” Navigate the procedure calmly, she advised.

Employ medical trauma prevention: Ask a simple question after deliveries and other procedures: “How was that for you?” That extra 5 seconds can prevent long-term distress, Berkley said. “The trauma literature shows that being heard and having the experience acknowledged reduces long-term distress,” she said. “Just asking the question has benefit and reduces that culture of silence.”

If a patient replies that something was painful, overwhelming, or not what they expected, that’s not just feedback but a clinical signal, she said. Validate the response, explain what happened, and adjust the plan going forward if needed. Also document the information so it carries forward to the next provider or procedure.

Standardize procedural pain protocols: When one provider offers a cervical block and another doesn’t, that variability drives inequity and confusion, Eubanks said. All pain options should be discussed with every patient, every time, she said. Comprehensive pain management counseling includes offering patients the option to undergo gynecological procedures under intravenous sedation or under monitored or general anesthesia when and where available, she said.

Standardized protocols also should be used for pain during cesarean, Berkley said. A tiered plan from the International Journal of Obstetric Anesthesiologists suggests using counseling during prenatal care, early replacement of nonfunctioning epidurals, and bundled care interventions. 

Utilize shared decision-making for labor pain management and support: Shared decision-making improves the childbirth experience, Eubanks said, noting that expectation shapes pain and education can act like “a little bit of analgesia.” Structure your counseling: What does the patient know? What are their preferences? Discuss their options clearly and completely, then make decisions together. There are numerous evidence-based labor support techniques from aromatherapy to massage. Guide your patients to research what is right for them. And incorporate patient education materials from sources like the Society of Obstetric Anesthesia and Perinatology, Berkley said.

In addition, there are several system-level factors that influence pain treatment, Eubanks noted. These include racial disparities in analgesia use, where minority patients report more pain and are receiving less treatment; differences in neuraxial access; patients reporting dismissal of pain concerns; and structural barriers of short-term visits.

“Addressing the pain gap requires both individual practice and systemic changes,” she said. “Pain in ob/gyn is rarely systematized, and that’s the gap. The goal here is not to eliminate pain, it’s to eliminate preventable suffering, and that’s only going to happen when we make this consistent.”

Additional principles mentioned were the addition of racial equity safeguards to ensure timely access to neuraxial analgesia; providing training reforms such as training women’s healthcare providers in cervical blocks; and working to enact policy reforms like protocol standards.

Eubanks and Berkley also presented 30- and 60-day plans for practices. In 30 days, practitioners can audit their current IUD insertion protocol, standardize offering cervical blocks, develop an anxiety screening question, and update their counseling script. In 60 days, they can implement a hysteroscopy pathway, train staff on the use of therapeutic language, review epidural utilization by race, and develop a patient education video.

The presentation “was really insightful,” said Ania Tyrawa, a third-year medical student at Chicago Medical School, Chicago, who was in the audience. “Especially the [wording] and giving us an outline of good ways to speak to patients, even before starting to do that myself, I think that’s very helpful.”

Heading into clinical rotations as a fourth-year student, Tyrawa said the talk gave her a plan of how she can talk with patients about pain.

Eubanks, Berkley, and Tyrawa reported having no relevant financial disclosures.

Karen Blum is a freelance medical/science writer in the Baltimore area.