Dealing With Pain During Childbirth

Learning all you can about labor and delivery can help you manage the pain of childbirth when the time comes.

Pain During Labor and Delivery

Pain during labor is caused by contractions of the muscles of the uterus and by pressure on the cervix. This pain can be felt as strong cramping in the abdomen, groin, and back, as well as an achy feeling. 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 as the baby goes through.

Pain during labor varies widely from woman to woman and even from pregnancy to pregnancy.

It's often not the pain of each contraction on its own that women find the hardest, but the fact that the contractions keep coming — and that as labor progresses, there is less and less time between contractions to relax.

How Can I Prepare Myself for Labor?

Regular and reasonable exercise (that your doctor says is OK) can help strengthen your muscles and prepare your body for the stress of labor. Exercise also can 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 doctor about a safe exercise plan for you.

Many parents-to-be attend childbirth classes where they learn different relaxation or breathing techniques for coping with pain. They're also taught online and in books. These methods help to increase comfort levels but don't make pain disappear. Relaxation strategies and medicine-free ways to handle pain during labor include:

• rhythmic or deep breathing
• hypnosis
• yoga
• meditation
• walking
• massage or counterpressure
• applying cold or heat to painful areas
• using a birthing/exercise ball
• aromatherapy (soothing scents)
• acupuncture or acupressure
• changing position
• taking a bath or shower
• listening to music
• distracting yourself by counting or performing an activity that keeps your mind otherwise occupied

Many women in labor like to get help and support from a companion or a doula (someone who's professionally trained to give support before and during labor, as well as post-delivery).

Some women choose to give birth using only medicine-free techniques (often called "natural childbirth").

What Pain Medicines Can Be Used During Labor and Delivery?

Many women choose to use both relaxation/breathing techniques and medicine during labor and delivery. Some may start off planning to not use medicine, but change their minds as labor progresses. It can be a huge relief when pain is quickly eased and energy can be focused on getting through the contractions.

A variety of medicines can be used, depending on the situation and the facility. There are also different ways to give the same medicines. Talk to your health care provider about the risks and benefits of each type of medicine and the different ways you can get them.

Medicine given by injection into a muscle or vein: Medicines given this way are called analgesics, which means they relieve pain (although the pain may not completely go away). They don’t affect sensation, cause numbness, or affect muscle movement. The medicines most often used for women in labor are opioids, which can be given as a shot into a muscle or through an IV line. They circulate throughout the body, so they affect the whole body, not just the painful areas. This can sometimes cause unwanted side effects.

Medicine that is inhaled (breathed in), called nitrous oxide: Commonly known as laughing gas, this can be breathed in through a mask before the start of a contraction. It doesn't relieve pain as well as opioids, but helps ease anxiety so moms can cope better with the pain.

Medicine that is given by injection into the spinal region: Medicines given this way affect only the lower body. This means fewer side effects than with medicines injected into a muscle or vein.

• Epidurals (or epidural blocks): This is what most women think of when they consider pain medicine during labor. An epidural involves inserting a thin, tube-like catheter through the lower back into the area just outside the membrane covering the spinal cord (called the epidural space). The medicines given through the epidural catheter can be pain relievers, such as opioids, or numbing medicine (anesthesia). Sometimes they're given together. They work to lessen or block pain from the waist down. The amount of medicine can be increased or decreased according to a woman's needs.
• Spinals (or spinal blocks): This is a single shot of medicine directly into the fluid surrounding the spinal cord in the lower back. As with an epidural, the medicine can include pain relievers, numbing medicine, or a combination. It’s quick and easy to do, and starts working right away. But the effect goes away after a short while. This type of pain control is often used for C-sections.

Local anesthesia: This is when numbing medicine is injected into a small area of the body to prevent pain before a procedure, such as an episiotomy or the repair of a vaginal tear. Local anesthesia also can numb the vaginal area during childbirth.

General anesthesia: This anesthesia, given by mask or IV, quickly causes a person to become unconscious (or "asleep") so they don't feel any pain. For childbirth, it's usually only used for emergency situations.

Talking to Your Health Care Provider

Talk about your pain-control options with the person who'll be delivering your baby. Find out what's available, how effective they're likely to be, and when it's best not to use some medicines.

If you want to use pain-control methods other than medicine, make sure your health care provider and the hospital staff know. Consider writing a birth plan that makes your preferences clear.

Remember, many women make decisions about pain relief that they abandon — often for very good reason — when they're in labor. Enduring the pain of childbirth has nothing to do with your worth as a mother. By preparing and educating yourself, you can be ready to decide what pain management works best for you.