Labor Pain Basics
How is labor pain different 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 pain. But labor pain is simply a sign that your body is working hard and well.
- Only lasts a certain amount of time: Labor rarely takes more than 24 hours.
- Is predictable: Contractions usually last only a minute and come in a regular pattern, with a few (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. This gives you time to adapt.
What is labor pain like?
It’s different for each woman, and it can be different for each labor. However, women often experience:
- Lower abdominal pain during contractions.
- Low back pain, either with contractions or, less often, continuously.
- Pain throughout the belly, in the hips, buttocks or thighs, or in some combination of these locations.
- Pain that moves from front to back, back to front or down the thighs.
- Pain that is 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. Some women experience relatively little discomfort, even without pain medications.
The sources and sensations of pain are different in the dilation and pushing phases of labor. Your experience may differ as well before and while you are pushing. 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 pain women feel in labor and what it means to them are separate things.
What affects labor pain?
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 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 with labor pain and what she thinks is necessary to remedy it are influenced by popular and cultural beliefs. This includes images in the media, which can sensationalize labor pain as routinely extreme.
- Your labor environment, such as:
- 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 the health care team in your birth setting.
- The familiarity and comfort of your surroundings, including noise, lighting and temperature.
- Your previous experiences 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.
How can I relieve labor pain?
It’s important to understand your options and their pros and cons before making your plan for coping with labor pain. Even if you’re set on a specific labor pain relief option or expect to follow the advice of a friend, relative or care provider, it is a good idea to learn the pros and cons of all your options. This way, you can create a plan that suits your own values and preferences and can be adapted in real time to meet the demands of your labor. Keep in mind that you can use many strategies, at one time or one after another.
To start, good labor support — especially as provided by a doula — is the foundation of coping with labor, regardless of other pain relief choices you make. You can read more about labor support here.
Even if your first preference is pain medication, you can still benefit greatly by using comfort measures and mental strategies:
- In early labor when you are still at home.
- In combination with labor pain medication to increase its effectiveness (a dose of pain medication strong enough to remove all sensation would leave you unable to move or push).
- While waiting to get epidural analgesia and experience the effects of the procedure (anesthesiologists aren't always readily available, and there is a delay from decision to relief).
- In circumstances where pain medication isn't advisable or there isn't time.
- When an epidural doesn't work (occasionally, an epidural provides only partial anesthesia, or it doesn't take at all).
- To delay or limit medication use, which may reduce adverse effects.
The main types of options for help with labor pain are:
- Non-drug options:
- Comfort measures: These include things you can do for yourself, others can do for you, or that can be done to the environment to increase your comfort. Examples include tubs or showers, applying hot or cold objects, massage, or use of a birth ball.
- Mental strategies: Examples include relaxation, hypnosis or music.
- Drug options:
- Nitrous oxide: This is an anesthetic gas (also known as "laughing gas") that is inhaled. Using a hand-held mask according to her need and contraction pattern, the woman controls use of this drug, experiences immediate effects, and can easily stop using it. This is an important method of labor pain relief in many other countries. Nitrous oxide is making a comeback and is available in more and more settings in the United States.
- Narcotics: This class of depressant drugs (also known as opioids) is given through an intravenous (IV) drip, by injection into a muscle or through a nasal spray. Narcotics are especially used in smaller U.S. hospitals.
- Epidural or spinal analgesia: One or more medications (often including narcotics) are injected into the spinal canal to numb a specific area of the body. Epidural has become the most common method for labor pain relief in the United States.
Many women I know got an epidural. How could using an epidural affect my birthing experience?
Childbirth with an epidural requires additional technology and procedures to monitor you and your baby and prevent or treat the side effects of this method. The following are standard or very commonly used along with epidurals:
- Electronic fetal monitoring (EFM).
- Pitocin ("pit" or synthetic oxytocin), a drug to intensify contractions (helps counteract epidural’s slowing of labor).
- Intravenous (IV) fluids (helps counteract epidural’s lowering of blood pressure)
- Frequent blood pressure monitoring.
- Drugs for low blood pressure.
- Bladder catheter (due to loss of lower body sensation and less ability to move)
- Medication to combat itching from narcotic drugs.
The following are more likely when epidural analgesia is used:
- “Assisted” vaginal birth (with help from vacuum extraction or forceps).
- Maternal fever, leading to more newborn testing right after birth to understand whether this is a sign of infection, and sometimes just-in-case treatment with antibiotics.
- Decision to shift to cesarean birth because the baby is not handling labor well.
Since each of these interventions has its own risks and side effects, getting an epidural can lead a woman down an unexpected path with more risks and unplanned effects (we call this the Cascade of Intervention; read more about it here). As you can see, the trade-off for the generally good pain relief epidurals bring can be a big impact on the experience of labor.
How will I know what my options are?
A few factors can affect what options for pain relief you will have on hand, such as:
- 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. However, you might not have access to or 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, you’ll probably have access to a much wider array of comfort measures and non-drug techniques. That being said, an epidural is never an option and injected narcotics (also called opioids) are rarely available in a freestanding birth center or at home. Some birth centers have nitrous oxide.
- 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 U.S. hospitals. It may not always be available, especially in smaller hospitals. In that case, narcotics would likely be offered.
It’s critical that you ask about your pain relief options when you are choosing your place of birth.
Why do the options for pain relief differ so much?
A few things affect which pain relief options will be available to you when you give birth:
- Care provider beliefs. Care providers in larger hospitals that train residents and serve women at higher risk are more likely to take a high-tech approach to birth and may prefer using an epidural.
- Hospital care providers in general are more likely to believe that labor pain is best managed by medication of some kind.
- Out-of-hospital care providers tend to view pregnancy and birth as normal events that infrequently require medical intervention, including pain relief drugs. Instead, they tend to offer a variety of comfort measures.
- Available staff. Large hospitals usually have anesthesia services available at all times, which often make them more likely to use epidurals. Since smaller hospitals don't usually have anesthesia services available through the night and on weekends, they are more likely to use narcotics.
- Equipment. Giving, monitoring and responding to possible complications of an epidural cannot be handled outside of the hospital.
- Economics. Hospitals with around-the-clock anesthesia 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. Additionally, women who don’t use medications require a different set of skills and may need more attention from nursing staff.
- Women's preferences. Many women who use hospitals seek pain medications, and many who use out-of-hospital settings seek drug-free methods. However, in many U.S. birth settings, women aren’t given enough information about labor pain relief options and/or have limited options.