Labor Pain: an in Depth Pregnancy Topic

---

For many pregnant women, concerns about labor pain are second only to concerns about their baby's welfare. Decisions you make about pain relief measures can have a profound effect on:

• your experience and memories of labor;
• procedures, medications, or restrictions that may become necessary for you or your baby; and
• your and your baby's well-being after the birth.

For these reasons, you will want to explore your labor pain relief options well in advance and make informed choices based on the best and latest research. This website can help you do that.

How does labor pain differ from other types of pain?

Labor pain differs from other kinds of pain in ways that make coping easier. Labor pain:

• is not a symptom of injury or illness: When pain signals that something is wrong, anxiety can increase painful sensations. Labor pain, however, is simply a sign that your body is working hard and well.
• is self-limiting: Labor rarely takes more than 24 hours.
• is rhythmic: Contractions last no longer than a minute or so and come in a regular pattern with one to several (usually) pain-free minutes in between them. This means you can predict and prepare for each contraction and rest between them.
• intensifies gradually over time: Contractions almost always start off mild and gradually grow longer, stronger, and closer together, thus allowing you time to adapt.

What is labor pain like?

The experience of labor pain varies markedly from woman to woman. It can also vary for the same woman in different parts of the labor and from one labor to another.

Nearly all women experience lower abdominal pain during contractions. Many also experience low back pain, either with contractions or, less often, continuously. Women may also feel pain throughout the belly; in the hips, buttocks, or thighs; or in some combination of these locations. Pain may radiate from front to back, back to front, or down the thighs. It may be felt in several areas at once or just in one specific place. Words women use to describe their pain include: cramping, sharp, aching, throbbing, pressing, and shooting. Pain intensity varies widely and generally increases as labor progresses.

The sources and sensations of pain are different in the dilation and pushing phases of labor, and your experience may differ substantially as well. The pushing phase may be less painful.

Some women reporting intense labor pain prefer not to describe their pain in negative terms. This suggests that the sensation and interpretation of pain may be distinct from each other. There are various reasons why this may be so.

What factors affect my experience of labor pain?

Labor pain is widely viewed as being nothing more than the perception of unpleasant sensation. The reality, however, is much more complex. Your experience of labor pain depends on many factors, including:

• your belief in your ability to cope: Confidence in one's ability to cope with the pain strongly influences how much pain women report experiencing in labor. Overall, more confident women report less pain.
• societal expectations and beliefs about labor pain: A woman's experience of labor pain and what she thinks is necessary to remedy it are influenced by popular and cultural beliefs, including images in the media.
• your labor environment: Elements affecting how much pain you experience include:
  • who is with you
  • their verbal and nonverbal communication with you
  • the quality of support you receive
  • the philosophy of care and the practices of medical staff
  • the familiarity and comfort of your surroundings, including noise, lighting, and temperature.
• your previous experience with pain: If labor is not your first painful experience, you are less likely to feel overwhelmed and more likely to have developed coping skills. These experiences can reduce fear and pain.

Does labor pain relief make for a satisfying birth experience?

True or false: "If you have total or nearly total relief from labor pain, you will be very satisfied with your childbirth experience?" Many women and maternity caregivers may answer "true." However, women's labor pain experiences are often quite different from other experiences of physical pain. Labor pain need not involve suffering, and it can bring a sense of satisfaction and accomplishment.

When a woman feels she is successfully meeting a challenge and that she is the center of loving attention, she may experience a sense of exhilaration and zest even while in great pain. If she feels helpless and unable to cope or that people are not treating her with respect, she will suffer regardless of her pain level.

Labor pain and labor pain relief play at best a minor role in satisfaction ratings, except when expectations go unmet. Women are most likely to feel satisfied with their births when they feel a sense of accomplishment and personal control and when they have a good relationship with caregivers. A good relationship includes such elements as being treated with kindness and respect, getting good information, and being given the opportunity to participate in decisions about care. (The page on Best Evidence: Labor Pain provides support for this important information.)

What factors affect my choice of labor pain relief options?

Your choice of labor pain relief options is limited by where you decide to have your baby:

• type of birth setting:
  • If you choose to have your baby in a hospital, as opposed to a birth center or at home, you will have access to pain medication, but may have very limited help with drug-free methods. Most women who give birth in U.S. hospitals use one or more types of pain medication.
  • If you choose to have your baby outside of the hospital, a much wider array of comfort measures and non-drug techniques are likely to be available, but epidural analgesia is never an option and injected narcotics (also called opioids) are usually not available.
• hospital practice patterns: You are much more likely to have epidural analgesia if you have your baby in a hospital where epidurals are the norm than in one where they are not.
• hospital size: Epidural has become the leading method of labor pain relief in hospitals handling a large number of births. By contrast, narcotics are more common than epidurals in hospitals where fewer women give birth. (View Trends in Pharmacologic Relief in the U.S.)

What explains this variation in available labor pain relief options?

There are several factors which affect your options:

• caregiver beliefs:
  • The staff in larger hospitals that train residents and serve women at higher risk are more likely to take a high-tech approach to birth, including preference for epidural analgesia.
  • Hospital caregivers in general are more likely to believe that labor pain is best managed by medication of some kind.
  • Out-of-hospital caregivers tend to view pregnancy and birth as normal events that rarely require medical intervention, including pain relief drugs.
• staffing and equipment: Large hospitals usually have anesthesiologists available at all times, which tends to promote epidural use. Many smaller hospitals don't, making narcotics, which can be administered by nurses, the order of the day. The administration, monitoring, and possible complications of an epidural cannot be handled outside of the hospital. Some birth centers offer narcotics, but most out-of-hospital practitioners regard the need for pain medication as reason for hospital transfer.
• economics: Hospitals with around-the-clock anesthesiology services have an incentive to spread the cost of these services over many procedures and may encourage epidurals. Staff time is an economic factor as well. Once epidurals become the norm, support for other labor pain relief options often falls off because it is most efficient to have a similar routine for all. Unmedicated women also require a different set of skills and need more time-intensive nursing attention.
• women's preferences: In many U.S. birth settings, women appear to be given limited information about labor pain relief options and to have limited choice among various options. Nonetheless, many who use hospitals prefer pain medications, and many who use out-of-hospital settings prefer drug-free methods.