Clinical trials in Los Angeles plan to explore how virtual reality can be used to deal with acute pain through coaching and distraction. Photograph: Tracey Nearmy/AAP |
Clinical trials are using a VR headset to help manage pain during labor
rin
Martucci had been enjoying the beach vista and gazing at a flock of birds
overhead when something shook her view. The voice of Ralph Anderson, her
gynecologist, broke through the sound of the waterfall next to her.
“We’re
ready to push!” he said, gently taking Martucci’s virtual reality headset off
and bringing her back to a hospital room at Orange Regional Medical Center in
Middletown, New York. Martucci, 40, looked around at her husband and mother,
their voices swirling excitedly around her: “She’s crowning! She’s ready!”
“I was
like, ‘Wait, what are you doing?’. I thought I needed the goggles to push!,”
Martucci says. She had been so engrossed in her virtual beachside hideaway, she
hadn’t realised that her baby’s head was starting to show. It was time to take
off the goggles.
Martucci
is believed to be the first woman to use virtual reality (VR) for pain
management during labor. With more women moving away from scheduled C-sections
– which accounted for 32% of US births in 2015 – VR might offer another
drug-free pain option during birth.
“I was
on a beach, and there was a fire going,” Martucci recalls. “Wherever you moved,
the scene moved with you. If I looked up, I saw the galaxy and the sun setting.
On the right, there was a waterfall and a lot of movement with birds,” Martucci
says. From time to time, a woman with an English accent peppered Martucci’s
virtual world with guidance.
“You
wanted to listen to her,” she says. “I remember her focusing on the breathing
and your body tensing and relaxing, and tensing and relaxing. She kept saying
‘Focus on the birds,’” says Martucci. “It was really very calming. She would
teach me how to breathe and be really in touch with your body.”
‘It made me feel I’m OK here’
Martucci
had declined an epidural earlier in the day when she started to think her labor
contractions were becoming too painful to manage on her own, but she was open
to Anderson’s suggestion to try a pre-programmed VR headset.
If I looked up, I saw the galaxy and the sun setting. Wherever you moved, the scene moved with you - Erin Martucci
While
Martucci wore the device, Anderson monitored her contractions remotely and
check on her in between seeing other patients. “You could tell she was having
pain the whole time, but she was breathing through all of it,” Anderson says.
Near the end of the two hours, Anderson saw Martucci was reacting more to her
contractions, and her pain had intensified. She let out some guttural sounds
and writhed a bit. He sensed that it was time to check whether she was ready to
push.
“Obviously,
I know I was going through some of the contractions, and eventually I knew my
body was telling me I’m ready, but I never anticipated that I wore the machine
for that long. It definitely calmed me down and helped me breathe and really
focus on getting through the labor,” Martucci says. “There was something about
it that made me feel, ‘I’m OK here.’”
Within
minutes of taking off the device, Martucci gave birth to her second child, a
girl.
Erin Martucci and her daughter. Photograph: Mary Bratton |
Getting
women on board with virtual reality
Anderson’s medical practice wants to improve patient safety by
reducing the use of opiate and narcotic pain medications and anesthesia, and is
exploring alternative pain treatments during labor, including jacuzzi baths and
nitrous oxide, or laughing gas.
Since the summer, Anderson, who is also the chairperson
of the robotic surgery steering committee at Orange Regional Medical Center,
has been using a Samsung Gear VR headset to help calm his patients before and
during minor procedures, such as biopsies of the cervix.
He had only offered it to a small number of women during
early-stage, passive labor, and wasn’t sure his patients would be open to using
it during late-stage, active labor when contractions are at their strongest and
most women want to focus on their breathing. During active labor, women are
prone to ask for epidurals, where pain relief is injected into the spine.
Martucci seemed open to managing her pain without medication, so
was a good candidate for the headset. “The patient has to be a little bit
motivated and not someone who is going to be that scared of the pain,” Anderson
says. “You have to put the device on at the right time, because if that pain is
that intense, you’re not going to catch up.”
Later that day, Anderson offered the device to another woman who
was going into labor with her fourth child, and who chose VR to distract
herself during an uncomfortable pelvic exam and induction. She gave birth
shortly after removing the headset. “She was so interested, and was writing
down the details, wanting to know where she could get her own.” says Anderson.
VR for pain
The company that created the virtual environment and supplied
the headset Anderson uses, AppliedVR, has partnered with Cedars-Sinai
Medical Center in Los Angeles for clinical studies. The trials will explore
using VR to manage acute pain, mainly through coaching and distraction. Other
hospitals, including Boston Children’s Hospital and UCLA, also have planned
trials with AppliedVR.
People try out Samsung Gear VR headsets, the kind used by gynecologist Ralph Anderson, at a technology conference. Photograph: Albert Gea/Reuters |
Using
VR in this way is still rare, but there is some evidence that this technique of
being immersed in an different sensorial environment can temporarily relieve
pain. According to a report in the Psychology of Consciousness medical
journal in September 2015, adults using VR while experiencing pain reported an
average 82% reduction compared to those who do not. The researchers found that
adults benefited more than children, though it remains unclear how virtual
reality could alter chronic, persistent pain.
Some
hospitals and doctors have begun to use VR to train surgeons before they
operate on real patients, while others are exploring how to use it to aid
diagnosis, allowing multiple, complex 3D scans to be examined in a virtual
environment.
Adults using VR while experiencing pain reported an average 82% reduction compared to those who do not
In the
limited VR trials for childbirth, Anderson found that AppliedVR’s technology
can help women take their mind off the pain, but also keeps their eyes open and
engaged – rather than closing their eyes and clenching their firsts. Prenatal
professionals encourage women to concentrate on a focal point to keep them
relaxed and concentrated on their breathing.
Natural
birthing proponents point to the increasing medicalization of birth since the
Victorian era, and to discussion of birth that focuses on pain and fear. Using
VR during labour could encourage women to give birth naturally and without
drugs, but might also mean that they aren’t fully present during one of the
most important moments of their lives.
“I can imagine that for some women, looking at
the sky or at the birds or flowers can be more relaxing than focusing on the
body,” says Beatrijs Smulders, a Dutch midwife and author of Safe Birth. “But
from my experience, any distraction from focusing on your body inhibits the
birth.” She has attended to more than 4,000 births in her 40-year career in the
Netherlands, a country known to promote home and natural births and with a
C-section rate of 7.7%, according to a 2015
study.
Too
much stimulation during labor can stimulate cortisol, the stress hormone, which
inhibits the other hormones the body needs to quickly and successfully push the
labor along, including oxytocin, endorphins, and prolactin. Smulders recommends
laboring women seek darker, quieter spaces and give full attention to their
bodies.
Women
are capable of internalizing the pain, Smulder says, and using it to make the
body respond to labor. “It’s the body that does the work. You have to go down
into your body and leave all the activities in your brain alone.”
But
for Martucci, using virtual reality felt like a simple and powerful way to deal
with the intensity and discomfort of her labor.
“Having
that voice take me through the breathing and being in touch with your body and
that focal point helped so much more,” says Martucci, who recounts her birth
story at every opportunity. “I thought it was great. And we have this healthy,
beautiful baby girl.”