title: [Pain in obstetrics].
abstract: In this article the authors start by going over the anatomical and neuro-physiological pathways of transmission of painful nerve impulses from the periphery to the centres. Pain is a "sensation" which is integrated in both a psychological and an emotional context. Psycho-physiological studies show that the cortex of the brain therefore plays a basic role in this integration and this allows us to consider the psycho-prophylaxis of delivery. Certain failures of psychoprophylaxis demonstrate the role of cultural factors and of factors that are specific to the subject of the pain of labour. The latter are dominated by anxiety, wich is at the same time due to the circumstances of the labour and of the individual patient. The latter stem from several sources: fear of death, separation, guilt and castration. There is one more psychological element that seems to be equally important and that is, morbid narcissism. The obstetrician should fight against the patient's anxieties which will thwart his work and disturb the onward progress of the labour. He will usually succeed but not always by the pathways that he thinks he is taking.
mesh_terms: D001007:Anxiety; D003213:Conditioning, Psychological; D003466:Cultural Characteristics; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D009424:Nervous System Physiological Phenomena; D010146:Pain; D011247:Pregnancy; D011603:Psychophysiology
vernacular_title: La douleur en obstétrique