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Pain Management Before, During, and After Labour

Childbirth is a peak life experience for parents. Anticipating the arrival of a new baby is exciting but can also be daunting, especially when you don't know what to expect. We have all heard that childbirth is painful, but what does that really mean? In this article, we share information about various methods the birthing person can use to manage labour pain.

Pain is the nervous system's way of signalling that the body is experiencing damaging or intense stimuli. In the context of illness or injury, pain is generally thought of as a symptom. Athletes often talk about "good pain" and "bad pain". "Bad pain" is the result of overexertion or injury, but "good pain" is developmental—it's the "burn" athletes experience when building their muscles. Labour pain is more like this "good pain", but it also has some special characteristics.

What is labour pain?

First—and this can't be said often enough—every person is different, and every birth is unique. When a pregnant person goes into labour, their physical, mental, and emotional circumstances contribute to the experience and the meaning of the experience. More about that later. What all childbirth experiences have in common, however, is the body's goal of getting the child out of its mother's body and into the world as a separate being.


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When it's time for the baby to be born, the birthing person's uterus begins to contract rhythmically and repeatedly. The contractions gradually increase in frequency and intensity as the baby moves lower into the pelvis and the cervix at the base of the uterus effaces and dilates (thins and opens). When the cervix is fully dilated at 10 cm, the powerful contractions of the uterus—the strongest muscle in the body—push the baby's head—the largest, firmest part—through the cervix, vaginal canal, and vulva and out into the world. Once the head is out, the rest of the body follows easily.

The average circumference of a new-born baby’s head is about 35cm, but at this stage the skull is soft and pliable—it consists of five plates held together by sutures made of a fibrous material that allows the plates to shift and overlap during labour. MRI scans have revealed that before and soon after labour the baby’s skull is rounded but during the intense pressure of uterine contractions the head compresses and elongates as it moves through the birth canal. Many new-borns have a conical shape to their heads when they are born but in just a few minutes the baby’s head returns to its prelabour shape.

The labour pain comes from the contractions of the uterus and the pressure of the baby moving through the birth canal on the surrounding tissues. The basic feeling is similar to menstrual cramping in the lower abdomen but can become quite intense as the contractions squeeze and stretch muscles, nerves, and ligaments. Words commonly used to describe labour pain include cramping, aching, throbbing, pressing, and shooting.

The physiology of the birthing person and the position of the baby also contribute to the experience. Other common descriptions include:

  • Lower back pain during contractions or continuous back pain.
  • Pain throughout the belly, hips, buttocks, and thighs, or some combination of these.
  • Pain that moves from front to back, back to front, or down the thighs.
  • Pain in just one area or several areas at once.

Labour pain is like the pain of athletic exertion in that it signals your body is working hard and well, but it is different in that contractions come in a predictable pattern, last for a short time (up to about a minute), and you can rest between contractions. They almost always start mild and then grow longer, stronger, and closer together, giving you time to adapt to the process. And you can't choose to stop giving birth, but the labour pains will end as soon as your baby is born. Then your body will be flooded with a rush of oxytocin and endorphins, and one of the most intense experiences of your life will soon be a faint memory.

For a first birth, the average labour lasts 12–24 hours, a second birth typically goes faster, about 8–10 hours. Although some women have laboured for several days before giving birth, others go through the process very quickly, in just an hour or two, and some women experience high-risk pregnancies and need specialist help to deliver their babies.

The birthing person's experience of labour pain does not come from the body alone. It is also influenced by societal expectations and media representations, by their belief in their ability to cope, by their previous experiences of pain, and by the birth setting—who is present, how well the others communicate (verbally and non-verbally) with the person in labour, the philosophy and practices of the birthing facility, the quality of care provided, and the comfort and safety of the environment.

How can I prepare myself?

As a mother or birthing person, there are several things you can do to prepare.

Learn about childbirth and attend birthing classes. These days you can learn about every aspect of pregnancy, childbirth, and postpartum care online. Knowledge is power, but it's also easy to get overwhelmed. Birthing classes are an excellent experiential way of finding out what to expect and how else you can prepare.

Go to your ante-natal visits. By the end of the first trimester, most expectant mothers will have begun seeing a specialist who will track their baby's development throughout pregnancy. This person, usually an OB/GYN, can be a great resource for individual questions and should be able to point you to authoritative books, classes, and websites that can help you further. They will monitor your body to ensure everything is on track and suggest vitamins and supplements you can take to ensure your baby has all the necessary nutrients.

Write a birth plan. The birth plan has become very popular in recent decades as something a mother can do to advocate for her own needs and desires during the birthing experience. However, calling it a "plan" makes it seem like you can learn everything there is to know and then make clear choices about how you want things to go. This isn't really how it happens. Being informed is great, as is being aware of your priorities, but childbirth is organic and won't necessarily follow an imagined ideal scenario. Once you go into active labour, you will be completely involved in the experience and need to rely on others to support you in making it a positive experience. This is what the birth plan can help with.

Think through the most critical pieces, such as where you want to give birth and what equipment you would like to have there (a birthing stool or ball, a bar to hold on to, a tub, etc…), who you would like to attend (medical personnel, partner, friends, family), what kinds of actions translate as emotional support for you (what are your love languages?) what your approach to pain relief will be, and what else is important to you. Remember, doctors, midwives, and nurses will certainly do what they can for you, but their primary focus will be making good medical decisions, which is not the same as ensuring you have a positive experience. If you can work with a doula (or your partner or a trusted friend), they can support you in creating a fulfilling birth experience. This doesn't mean everything happens as planned, it means that you are treated kindly, and your strength and agency are respected, supported, and encouraged as you give birth.


Be active. Being moderately active in the run-up to childbirth will help your body prepare for the task ahead. If you have a regular exercise routine, keep it up as long as your OB/GYN agrees. However, be prepared to modify your routine as your baby develops, your joints relax, and your centre of gravity changes. If you aren't very active, use the months ahead to energise. Simply walking is a great way to prepare your body for childbirth. These days there is plenty of advice about exercising safely throughout pregnancy to improve core strength and hip flexibility and activate your pelvic floor. Dancing, swimming, yoga, Pilates, strength training, and low-impact aerobics are all great choices. Women of all shapes and sizes have successfully given birth to babies of all shapes and sizes, so this is the time to fill your heart with gratitude and make the most of what you have.

Tone and strengthen your pelvic floor. A pelvic floor is a group of interconnected muscles and ligaments that span the base of the pelvis. These muscles support your abdominal organs, while three of them—the bladder, the bowel, and the uterus—have openings in the pelvic floor, which we call the urethra, the anus, and the vagina. During labour, a great deal of pressure is exerted on this area. Kegel exercises can help tone and strengthen this area, giving you more power to push and making it easier for your body to recover after the baby is born.

We have an article on how to do Kegel exercises correctly.

Remember, moderation is key. If your pelvic muscles are quite weak, don't worry. You can make noticeable improvements in 4–6 weeks and significant changes in three months or so. And don't overdo it. Professional athletes with a very well-trained core can have difficulty relaxing their muscles sufficiently during labour.

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Do perineal massage. The perineum is the soft, stretchy tissue between the vulva and the anus. To prepare these tissues for childbirth, you or your partner can gently massage and stretch them. This is especially effective after a shower or bath when they are already warm and relaxed. Sit or lay down in a comfortable position that supports your pelvis. Imagine your vagina is a clock with 12 at the top and 6 at the bottom, closest to the anus. Apply a little oil (such as coconut, olive, almond) to your fingers and gently massage the tissues surrounding your vulva from 3 o’clock to 9 o’clock. Then insert one or two thumbs into the vagina up to the first knuckle and gently sweep them around the edges from 3 o’clock to 9 o’clock, stretching the tissues slightly. Use enough pressure to cause the tissues to tingle slightly, sweeping for up to 60 seconds. Then relax. Perform this stretching sweep five times. If you feel any tightness or resistance, gently work that area some more. Breathe into your belly through the stretch and think about relaxing the pelvic floor in preparation for birth. That’s it. A little extra preparation can go a long way toward helping your body adapt to the moment.

Nine out of ten women experience some vaginal tearing while giving birth. Small tears are hardly felt and generally heal well on their own. If there is a risk of a deeper tear, the doctor or midwife will perform an episiotomy. This clean incision is stitched up afterward, which heals much quicker than a ragged tear. However, some women deliver babies with their perineum intact. In addition to doing Kegels and practicing labour positions, starting perineal massage 3–4 times/week at about 34 weeks can significantly reduce the chance of moderate to severe tears, especially when combined with controlled delivery, a warm compress on the perineum (or water birth), and manual counter-pressure to support the tissues.

Pain management during labour


Typically, the first birth can last from 12 to 24 hours or even longer. The second birth is usually quicker, around 8 to 10 hours. This time includes labour and active birth.

It's up to the birthing person to decide on their approach to pain management during labour and childbirth. There is a range of preferences, from giving birth naturally with no medication to feeling as little as possible and everything in between. People can sometimes express strong judgements about pain management during labour. Those are their opinions. What is important to your experience is your own preference, what your doctor/midwife/doula can and will do to support you, and how much room there is to make choices as things develop.

Be aware that birthing facilities differ. When you are deciding where you want your baby to be born, find out what pain management options are available to you and if the philosophy of care is largely in line with yours.

Create a safe and supportive setting. If you are planning a home birth, you can create the environment yourself, but even at a hospital or birthing centre, you can ask to adjust the lighting and the temperature, put on music/nature sounds/white noise or ask for silence, and bring some things from home that give you joy and comfort. Sometimes it's possible to use an aromatherapy diffuser or at least have some scented items to help with nausea or enhance comfort.

In early labour, you can prepare your body by staying hydrated and eating foods that are easy to digest and will give you energy. Complex carbohydrates provide slow-release energy for the duration, while foods like fruit juice or honey will give you a quick boost. Eat a good meal early on because later you won't want to. Sleep or rest when you can.

Unmedicated pain management

Relaxation techniques — meditation, visualisation, and breathing exercises are all ways of being more present in your body and more accepting of where you are in the moment. Chant a mantra or use a meditation countdown timer, visualise waves on a beach, a flower opening, your baby moving down, or use one of the many breathing techniques that can help you feel calm and relaxed or focused breathing to relax or relieve pain in a particular area.


Alternating periods of movement and rest—dance, sway, walk up and down stairs, do hip circles, rock back and forth, lean on the couch, the bed, or the birthing ball, go down on all fours, rest on one side and the other and in asymmetrical positions. Listen to your body's cues about what is best for you and your baby.

Comforting touch—massage, pressure on the hips or lower back, acupressure points, hot/cold compresses are all things your partner and doula can do to relieve tension and pain as you move in and out of contractions.

Hydrotherapy—Water soothes and relaxes the muscles and can stimulate endorphins that relieve stress and pain. If you have a bath or shower available, use the healing properties of water. Some women choose waterbirth as a natural birth option.

Find out more in our article Is Waterbirth Right For Me?

The techniques described above are especially effective if the birthing person is supported by a partner or doula who is familiar with their coping style: Do you go into yourself when under stress or do you want to make eye contact, connect, be encouraged? Where do you manifest tension? What helps you relax? Does it help to be noisy or quiet? What helps you focus your attention—sounds, touch, visual cues?

Pharmacological pain management

If you choose to get some assistance in managing labour pain, these are some of the most common options:

Epidural or spinal block. During an epidural, small tubes are placed in the lower back to drip pain medicine into the lower body. Epidural block placement usually isn't painful, although there might be some discomfort from numbing the skin before the block. It takes around 15 minutes to work. It reduces pain significantly but allows you to control the delivery and be conscious during the birth. Some of the negatives of an epidural are the risk of blood pressure dropping, causing you to feel dizzy and lightheaded. In rare cases, it can produce a headache for the mother and slow the baby's heart rate.

Spinal block. It works similar to an epidural. But the spinal block is more often used during C-sections. It's a shot injected into your lower back. It works right away and can ease the pain for 2 hours. Pros and cons are almost the same as with the epidural block.

Systemic analgesics. Analgesics such as opioids can be used to reduce your perception of pain. They help you relax and feel more comfortable but don't provide adequate pain relief. You might also feel disoriented, dizzy, and nauseated. There's the risk that the baby might be born drowsy.

Nitrous oxide. Also known as laughing gas, nitrous oxide helps you relax and reduces pain. You control the intake of the gas and can walk after giving birth. But it can also make you feel drowsy, nauseated, and dizzy.

Local anaesthetics. Local anaesthetics are injected in a specific area, usually the vaginal area, to numb the tearing pain. You might not feel the tearing or stitching, but you would still feel contractions.

Aftercare

It takes about 6–8 weeks for your body to recover after the baby has been born. In the first few weeks, your crotch and abdomen will likely feel sore and tender, and you may feel some pain when sitting, peeing, or pooping as things continue to heal. Your doctor might suggest over-the-counter pain relievers such as ibuprofen or acetaminophen to take the edge off.

Your life will have turned upside down with a brand-new baby's needs at the centre of everything. Even so, you can best take care of others when your needs are met. Sleep when you can, eat simple nutritious food and stay hydrated. This will support healing and milk production. If friends or family offer to help with food, take them up on it as long as they aren't invading your space. Use whatever comfort measures help as your body adjusts to not being pregnant anymore—ice packs for sore places, hot/cold compresses, stretching, massage, and warm baths or showers are all little self-love luxuries you should treat yourself to as often as possible.


Now, it's time to heal. You should give yourself enough time before starting to have vaginal sex again, as vaginal tears can take around 8 weeks to heal.

Conclusion

Childbirth is exciting and can also be scary, especially for first-time moms. It's normal to feel anxious before the big day. To deal with these feelings, try to learn as much as possible about pregnancy and childbirth. Be prepared, know what birth you want and how you want to manage your pain. But also be flexible and accept this new experience.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4589939/
https://www.asahq.org/about-asa/newsroom/news-releases/2018/05/pain-of-labor-and-delivery
https://repositorio.comillas.edu/rest/bitstreams/145114/retrieve
https://www.parents.com/pregnancy/giving-birth/labor-and-delivery/understanding-labor-pain/
https://www.nhs.uk/pregnancy/labour-and-birth/what-happens/pain-relief-in-labour/
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