Human behaviors are influenced by the complex interaction of nature and nurture. These interactions are also known as biological factors (nature) and social-environmental factors (nurture). A study done by Matisyohu Weisenbrg and Zahava Caspi studied the effects of sociocultural family of origin and educational level on the verbal and nonverbal pain exhibited during childbirth. They also incorporated measuring coping styles and extroversion. The findings of this study emphasized the clinical importance of considering social ethnocultural groupings to create relevance under certain circumstances. While most women rate pain of giving birth as high, external factors such as education, coping methods, and ethnocultural grouping can skew or change results. In summary, the biggest advantage from the completion of this experiment is that the results of analyzing pain perception in sociocultural group of origins with education levels, can then portray an importance in determining pain perception and behavior. While also combining this with coping styles and levels of extroversion, the results could lead to an instructional intervention for preparing women for childbirth.
In this study, the comparison was between women from Middle-Eastern origins and Western origins; the Middle-Eastern group consisted of women from Asia, North Africa, or one of the other Eastern countries. The Western group consisted of women from Europe, the United States, or other English-speaking countries. The Middle-Eastern group consisted of 53 women, while the Western group consisted of 30 women. They also incorporated education levels; if the women had less than 12 years of schooling, they were categorized into a low education group. If the woman has more than 12 years of schooling, they were categorized into a high education group. Among the Western group of women 20 were of the higher education group, and 18 women in the Middle-Eastern group. While in the Western group 10 women were in the lower education group, and in the Middle-Eastern group 35 women were in the lower education group.
The study in total had 83 women between the ages of 19 and 38. Within the groups it was described that the Western group was significantly older than those in the Middle-Eastern group. With the group as the whole, 17 out of the 83 women reported they were having their first child, 66 out of the 83 women reported they had given birth at least once, and 20 of the 83 women reported this would be their fourth or higher birth.
Weisenberg and Caspi hypothesized that women of a Middle-Eastern background would score higher on extroversion which would translate into higher scores to be associated with greater expressions of pain. Also, it would be expected that the coping styles of women from a Middle-Eastern origin would more likely engage in using denial or emotion reducing strategies to cope instead of using an active, more direct style of coping. This hypothesis came from the fact that group norms are shown to have strong influence on a response to pain. A study done by Buss and Portnoy demonstrated that the stronger the association one has with their group correlates with an increase of willingness to tolerate pain (Weisenberg & Caspi, 13). From this Weisenberg proposed theoretically that cultural differences are based on modeling, this led to the anticipation that the intimacy of childbirth would lead to an increase of family origin effectiveness on the mother giving birth (Weisenberg & Caspi, 13-14).
The four dependent variables (pain ratings, pain behavior, extroversion, and coping) resulted in significant differences obtained for cultural and educational grouping. Overall, each cultural group, had mean pain ratings that were high. Weisenberg and Caspi examined pain ratings by using the Mann-Whitney nonparametric test. Using this research method, the results demonstrated a significant gap in cultural difference with the Middle-Eastern group ranking higher than the Western group. Also, from this method the results portrayed that women from low education levels yielded higher averages of pain ratings than the higher level. The researchers then divided it by individual cultural groups, also using the Mann-Whitney nonparametric test. For Western women, the rankings of pain had little to no difference for the low and high education groups. For Middle-Eastern women, a significant difference was obtained when the low was compared with the high education groups, resulting in higher rankings of pain (Weisenberg & Caspi, 16).
Pain behaviors were also analyzed by using the Mann-Whitney nonparametric test. The average ranking of pain behavior was higher for Middle-Eastern women than those in the Western group. Comparably, the results also indicated that the women from the low education group compared with the high education grouped yielded a significantly higher pain behavior rank. When looking at the cultural groups individually, there was no significant difference between the Western groups of education levels. On the other side of the spectrum, the Middle-Eastern group of women had a significant difference when the low education level was compared with the high education group– higher ratings on the pain behavior for the lower levels. Also, when compared culturally just for education levels, Middle-Eastern and Western high education groups did not significantly differ, while the low education groups did; the Middle-Eastern group obtaining the higher rating (Weisenberg & Caspi, 16).
In terms of extroversion, no significant differences were found with cultural or educational groups, there was also no difference obtained for pain ratings or pain behavior (Weisenberg & Caspi, 16).
When analyzing coping styles, they used the Miller Behavioral Style Scale (MBSS). There were also no significant differences obtained with cultural groups, however there were significant differences with education. Higher monitor scores were obtained for the high education levels, rather than the low. Using the MBSS, and dividing it at the median, resulted in a significant difference between the high and low education groups obtained for the ratings of pain, but did not correlate with pain behavior (Weisenberg & Caspi, 16-17).
Weisenberg and Caspi also looked at the participation in a preparation course for childbirth. More Western women, than Middle-Eastern women participated in a preparation course. Likewise, more women in the high education group than the low education group participated in a course. While course participation did not have any significant difference on pain ratings, it did have effect on pain behavior scores. They were significantly less for women who participated in a preparation course, rather than those who did not participate in a preparation course (Weisenberg & Caspi, 17).
To summarize, there was a correlational analysis indicated by a significant moderate correlation between the pain ratings and pain behavior. Pain ratings yielded a low, but significant, negative relationship with MBSS monitor score. There also were no other significant relationships obtained that directly affected the study. From this study as well, they have hypothesized that childbirth is more subjected to familial influence because of its intimacy. From this hypothesized statement, the strongest influence of family origin on pain ratings as well as pain behavior was found in the low education group. The high education groups did not suffer from family influence. They concluded, educational influences can change the original contribution of family origin on pain (Weisenberg & Caspi, 17). As stated before, with the results done from this study as well as the incorporation of other studies and research we can create proactive methods for the instructional intervention for preparing women for childbirth.