If you're like most women, the pain of labor and delivery is one of the things that worry you about having a baby. This is certainly understandable, because labor is painful for most women.
It's possible to have labor with relatively little pain, but it's wise to prepare yourself by planning some strategies for coping with pain. Alleviating your anxiety about pain is one of the best ways to ensure that you'll be able to deal with it when the time comes.
Pain During Labor and Delivery
Pain during labor is caused primarily by uterine muscle contractions and somewhat by pressure on the cervix. This pain manifests itself as cramping in the abdomen, groin, and back, as well as a tired, achy feeling all over. Some women experience pain in their sides or thighs as well.
Other causes of pain during labor include pressure on the bladder and bowels by the baby's head and the stretching of the birth canal and vagina.
Although labor is often thought of as one of the more painful events in human experience, it ranges widely from woman to woman and even from pregnancy to pregnancy. Women experience labor pain differently — for some, it resembles menstrual cramps; for others, severe pressure; and for others, extremely strong waves that feel like diarrheal cramps. In addition, first-time mothers are more likely to give their pain a higher rating than women who've had babies before.
The intensity of labor pain isn't always the determining factor that drives women to seek pain management — often it's the repetitive nature and length of time the pain persists with each contraction.
Preparing for Pain
To reduce pain during labor, here are some things you can start doing before or during your pregnancy:
Regular and reasonable exercise (unless your health care provider recommends against it) can help strengthen your muscles and prepare your body for the stress of labor. Exercise can also increase your endurance, which will come in handy if you have a long labor. The important thing to remember with any exercise is not to overdo it — and this is especially true if you're pregnant. Talk to your health care provider about what he or she considers to be a safe regimen, given your prepregnancy fitness level and the history of your pregnancy.
If you and your partner attend childbirth classes, you'll learn different techniques for handling pain, from visualization to stretches designed to strengthen the muscles that support your uterus. The two most common childbirth philosophies in the United States are the Lamaze technique and the Bradley method.
The Lamaze technique is the most widely used method in the United States. The Lamaze philosophy teaches that birth is a normal, natural, and healthy process and that women should be empowered to approach it with confidence. Lamaze classes educate women about the ways they can decrease their perception of pain, such as through relaxation techniques, breathing exercises, distraction, or massage by a supportive coach. Lamaze approach takes a neutral position toward pain medication, encouraging women to make an informed decision about whether it's right for them.
The Bradley method (also called Husband-Coached Birth) emphasizes a natural approach to birth and the active participation of the baby's father as birth coach. A major goal of this method is the avoidance of medications unless absolutely necessary. The Bradley method also focuses on good nutrition and exercise during pregnancy and relaxation and deep-breathing techniques as a method of coping with labor. Although the Bradley method advocates a medication-free birth experience, the classes do prepare parents for unexpected complications or situations, like emergency cesarean sections.
Other ways to handle pain during labor include:
- hypnosis
- yoga
- meditation
- walking
- massage or counterpressure
- changing position
- taking a bath or shower
- distracting yourself by counting or performing an activity that keeps your mind otherwise occupied
Pain Medications
A variety of pain medications could potentially be used during labor and delivery, depending on the situation. Talk to your health care provider about the risks and benefits of each.
Analgesics. Pain medications, including the drugs like morphine and meperidine, can be given intravenously or through a shot that's readministered as needed. Either way, these medications act systemically — meaning they affect the whole body. These medicines don't usually slow down labor or interfere with contractions, but can cause side effects in the mother, including drowsiness and nausea. Analgesics may be administered well into labor but several hours before the expected birth.
If pain medications are given systemically, the baby's also going to get those medications. The effect on the baby depends on how much and how close to delivery the drug is given to the mother — some babies show signs of sleepiness immediately after birth. And some women find that the drowsiness and nausea they experience with systemic analgesics makes them less helpful than regional anesthesia. Talk to your health care provider about the risks and benefits of taking analgesics systemically.
Tranquilizers. These drugs don't relieve pain, but they may help to calm and relax seriously anxious women. Sometimes they are used in conjunction with analgesics. These drugs can have significant effects on both the mother and baby, and should be used cautiously. Women's reactions to these drugs vary — some feel a loss of control that is unnerving, whereas others do not. These drugs can sometimes make it difficult for women to remember the details of the birth. You should discuss the risks of taking tranquilizers first with your health care provider.
Regional anesthesia. This is what most women think of when they consider pain medication during labor. Nerve blocks deaden the sensation in specific regions of the body and can be used in both vaginal and cesarean section deliveries.
Epidurals, a form of local anesthesia, provide continuous pain relief to the entire body below the belly button, including the vaginal walls, during the entire process of labor. An epidural involves medication given by an anesthesiologist through a thin, tube-like catheter that's inserted in the woman's lower back (in the same location where a spinal tap would be performed). The amount of medication can be regulated according to a woman's needs. Some medication does reach the baby, but it's much less than what the baby would get intravenously or under general anesthesia (which sedates the baby as well as the mother and is almost exclusively reserved for emergency surgical births). Epidurals are usually given once a woman is in active labor.
Epidurals do have some drawbacks — they may make it more difficult for the woman to push the baby out, and they can cause her blood pressure to drop. They can also cause itching, nausea, and headaches in the mother. The risks to the baby are minimal, but include possible distress caused by the mother's lowered blood pressure.
Natural Childbirth
Some women choose to give birth using no medication at all, relying instead on relaxation techniques and controlled breathing for pain. If you'd like to experience childbirth without pain medication, make your wishes known to your health care provider.
Things to Consider
Here are some things to think about when considering pain control during labor:
- Medications can relieve much of your pain, but probably won't relieve all of it.
- Labor often hurts more than you anticipated. Some women who have previously said they want no pain medicine whatsoever end up changing their minds once they're actually in labor.
- Pain medications can affect your labor — your blood pressure may drop, your labor may slow down or speed up, you may become nauseous, and you may feel a sense of lack of control.
- Pain medications can affect your baby, the baby may be drowsy or have changes in the heart rate.
- If you end up needing a cesarean section, you'll be given regional or general anesthesia for the birth. General anesthesia is given in emergencies when a life-threatening condition has developed in the pregnant woman or baby.
Talking to Your Health Care Provider
You'll want to review your pain control options with the person who'll be delivering your baby. Find out what pain control methods are available, how effective they're likely to be, and when it's best not to use certain medications.
If you want to use pain-control methods other than medication, make sure your health care provider and the hospital staff know. You might want to also consider writing a birth plan that makes your preferences clear.
Remember, too, that many women make decisions about pain relief during labor that they abandon — often for very good reason — at the last minute. Try not to confuse your ability to endure the pain of childbirth with your worth as a mother. Your best bet is to educate yourself about all of your options for pain relief to make a choice about what's best for you and then to be flexible about that decision.
Reviewed by: Larissa Hirsch, MD
Date reviewed: February 2008
Originally reviewed by: Serdar H. Ural, MD
