Except for the three nurses hurdled up in a corner behind a counter, the hospital lobby was pretty much empty when I walked in. I had received a call 10 minutes prior informing me that my wife had safely delivered a healthy baby girl. As I approached them they took turns to congratulate me and tell me what a strong woman my wife was.
“She didn’t scream,” said one of them.
“Not even once”, added another.
“And when you see her, you wouldn’t expect that she’d be this strong,” chipped in another nurse. And thus they carried on chattering away about how amazed they were that my wife, who was slight of build and young too, could go through the excruciating pain of childbirth quietly without even a trace of a suppressed scream. This was roughly three years ago when we had our first child.
My wife is Fulani and like virtually all Fulani women (and women from a few other tribes in the North apart from Kanuri of course), she was able to accomplish the spectacular feat of making what most women around the world describe as “the worst pain imaginable”, seem not that much painful after all. In this post I plan to explain how they do it. How they manage to keep their cool and act like ladies in a situation where ladies from other cultures go berserk.
This post was originally meant to be an email that I was going to send to an old friend of mine who claims I’m her only Fulani friend. She had called earlier in order to verify some information she had stumbled upon on a discussion thread on “Nairaland” about how Northern women manage to remain silent (not scream) during childbirth.
During the course of the discussion several references were made about Fulani women and hence her call to me. Of course I confirmed it because it was in fact true. And she, who herself had undergone the process of childbirth once, found it difficult to believe. She wanted to know if there were some charms that they used (traditional painkillers she called them) or whether it was voodoo. I told her matter-of-factly that no such things happen – that they just walk in, have their babies, and walk out. It was that simple. At the end of our conversation, she said to me that she didn’t see how anybody could feel the pain that she felt when having her baby and not scream.
Obviously she didn’t believe me and I was tempted to dismiss her as just another lazy woman. But when I visited the said thread (on Nairaland), I was surprised to discover how there were many like her trying to unravel “the secret”, that Northern women have, to pain management. Some of the discussants on the thread were doctors who had seen Fulani women birth babies with absolute calmness, some were women who had shared wards with Northern women and couldn’t believe their eyes, some just heard it and were finding it absolutely incredible. Some explanations were offered too. A few had some substance in them but most were way off the mark.
I started to give it serious though
I too and before long the possibility of women from different cultures experiencing different levels of pain began to cross my mind. It was a crazy idea, I know, but I said ‘what da heck, it was worth checking out’. And thanks to the internet, I was able to find out that the experience of pain can actually be manipulated psychologically without the use of drugs. In fact there was an entire field of psychology that was dedicated to the study of pain.
I, being male, decided to start my research by trying to find out what the pain of labour was actually like. I discovered that sometime in the 1940s, some doctors from Cornell University tried to create a unit of measurement for the intensity of pain which they called “dol”. Through a series of experiments which by today’s standards would seem quite unconventional, they were able to create a scale from 0 to 21 for pain intensity and were able to arrive at the figure of 10.5dol as the maximum pain that humans can possibly feel. According to their research, for any intensity greater than that, the increase would not be discernible. They did more experiments on women in labour in order to determine the intensity of the pain women go through and their results indicate that the intensity varies in the different stages of labour but when it reaches its peak at about the time the child crowns, it’s as high as 10.5dol i.e. the worst pain imaginable. And even though over the ensuing decades many researches have been done to technically discredit any claims to an objective measure of pain (including the very brilliant paper by Elizabeth Ludington and Franklin Dexter of the University of Iowa), the fact that labour pain is considered one of the most intense kinds of pain by most women has remained true.
The significance of this is that my friend was actually right when she said she didn’t see how a woman in labour would not scream because it was the normal thing to do and that there was more to the Fulani woman’s stoic-ness. Again, I tried to find out. Interestingly, as I’ve already stated, there was an entire field in psychology that concerned itself with the study of pain and thus there was no scarcity of resources to consult. I was able to find quite a bit of interesting stuff but by far the most remarkable was this paper “the Psychology of Pain” by Dr. Jon Streltzer of the Psychiatry Department of the University of Hawaii and some other very informative papers from the British Journal of Anaesthesia.
To start with, the perception of pain involves far more than mere sensation. It depends on influences coming from sources that could range from the limbic system of the brain right down to ethno-cultural influences. The ones that can help us unravel the Fulani woman’s unusually high pain threshold, are the ones I would highlight here:
Beliefs and Expectations: A person’s expectation of how much pain they can cope with influences the amount of pain they actually feel. People who go into a painful procedure (chemotherapy, labour,…) with a very strong belief in their ability to handle the pain end up feeling much less pain than those who have a tendency to ‘‘catastrophize’’. Put simply, to catastrophize is to habitually and almost immediately, appraise a situation as extremely catastrophic. Sullivan, Bishop, and Pivik in their paper “The pain catastrophizing scale: development and validation” presented findings that indicate that catastrophizers reported significantly more negative pain‐related thoughts, more distress and higher pain intensity compared with non‐catastrophizers.
In Fulani culture, daughters are raised to not only believe in their ability to cope with the pain of labor but that to scream or cry or lose control is absolutely beneath them. Mothers teach their daughters that the first childbirth is crucial, if she handles it very well (without screaming and going wild), subsequent experiences will be handled very well too and vice versa. I have overheard a few times Fulani women discussing (I think “gossiping” should be the operative word here) with utter disdain about some woman or the other who’ve had the embarrassing misfortune of screaming her head off during labor. You hear them say things like “I wish I wasn’t there. It was so embarrassing. She was screaming and crying as if she was ‘debbo kado’” “Debbo kado” means a non Fulani woman. So for them, screaming would make one less of a Fulani (and that’s supposed to be bad) and less of a woman too (and that’s worse).
Learned Pain: Psychologists believe that pain can be a learned response, rather than a purely physical problem. People can learn to feel different amounts of pain just by viewing other people. Dr. George R. Hansen of the Department of Emergency Medicine, Sierra Vista Regional Medical Center, and Dr. Jon Streltzer of the University of Hawaii report about a certain experiment that was conducted on two groups of people. The first group were made to watch people demonstrating high pain tolerance, and it turned out that they too required 3.48 times greater stimulus before they rated something as painful, compared with the second group who observed people who showed poor pain tolerance. Nonaversive shock, usually described as ‘‘tingling,’’ was applied to them too and was rated as painful by only 3% of those in the first group, compared with 77% of those in the second group.
Fulani women are like the people in that first group. They grow up around people with very high pain tolerance. They grow up seeing their mothers, aunts, big sisters, and inlaws going through labour as if it was just some boring and mildly irritating routine. So as they grow to maturity, so does their pain threshold.
Obesity: Obesity is also known to be a problem in chronic pain. A review of patients at a rehabilitation clinic found that among those who suffered the most pain, 78% were grossly overweight. This automatically puts Fulani women, being naturally slim, at a physiological advantage for high pain tolerance.
There are many other factors that affect the perception of pain like; personality type, age, gender, the context (for instance injuries sustained in a war situation are generally less painful than they ordinarily would’ve been), etc. but these factors do not have any specific significance in unraveling why Fulani women handle labour pain better than others. There are many studies though, that are currently ongoing on the effects of culture and ethnicity on the perception of pain.
To conclude, I will paste a comment from the Nairaland thread that started this all. I must warn you though that the quote is about women of a particular tribe and my inclusion of the quotation is not in any way meant to denigrate but simply because I found it very humorous. And even though the quote is about Yoruba women, it could well have been about Kanuri women.
- “Our Yoruba women are something else when it comes to childbirth…they would scream…then scatter their hair…then when the baby is coming out they would want to sit up…sitting on the baby’s head in the process…then the doctors and midwives are shouting..’Lie down and push. You will kill your baby o’…then she’ll respond (crying with her hands on her head) ‘ha I cannot bear this pain o…ye mummy o…’ then at this point her husband would cut in to console her and only God knows the insults husbands have endured from Yoruba women in labour”