Labour Pain

Labour pain is one of the most intense physical experiences many women will face, yet it serves a vital purpose – each contraction brings you closer to meeting your baby. Understanding what causes this pain and knowing your options for relief can help you feel more prepared and in control when the time comes.

Table of contents

• What Causes Labour Pain
• What Labour Pain Feels Like
• The Unique Nature of Labour Pain
• Factors That Affect Labour Pain
• Preparing for Labour Pain
• Non-Medical Pain Relief Methods
• Medical Pain Relief Options

What Causes Labour Pain

Pain during labour happens because your body is working hard to bring your baby into the world. The main source of pain comes from the contractions – the tightening and releasing of the muscles in your uterus (the womb)^[1]. These contractions put pressure on your cervix (the opening to your uterus), causing it to stretch and open^[1].

Labour pain has two distinct components. Visceral pain occurs during the early first stage and second stage of childbirth. It happens when your cervix stretches and opens, activating pain signals that travel through spinal segments T10 to L1^[7]. Somatic pain joins the visceral pain during the late first stage and throughout the second stage. This type of pain comes from stretching, pressure, and sometimes tearing of the pelvic floor, perineum, and vagina as your baby descends. These pain signals travel through spinal segments T12 to L1, and S2 to S4^[7].

Other causes of pain during labour include pressure on your bladder and bowels from the baby’s head, and the stretching of the birth canal as your baby passes through^[1].

What Labour Pain Feels Like

Labour pain feels different for everyone, and it can even feel different from one pregnancy to the next^[1]. Many women describe contractions as strong cramping in the abdomen, groin, and back, along with an achy feeling^[1]. Some women also experience pain in their sides or thighs^[1].

The sensation of a contraction is often described as a wave-like tightness that begins at the top of your uterus and moves downward^[4]. During a contraction, your uterus hardens, and at the peak, the pain can be strong enough that you cannot walk or talk^[4]. Between contractions, your uterus relaxes and becomes soft, and you may feel relief^[4].

Women use many words to describe their labour pain, including cramping, sharp, aching, throbbing, pressing, and shooting^[2]. Some describe it as very strong menstrual cramps, while others compare it to strong waves that feel more like diarrhea cramps^[10].

Often, it’s not the pain of each individual contraction that women find hardest, but rather the fact that contractions keep coming with less and less time between them to relax as labour progresses^[1].

The Unique Nature of Labour Pain

Labour pain is different from other types of pain in several important ways that can actually make it easier to cope with^[2].

First, labour pain is not a symptom of injury or illness. It is simply a sign that your body is working hard and well to deliver your baby^[2]. When pain signals that something is wrong, anxiety can increase pain, but labour pain has a positive purpose.

Second, labour pain only lasts a certain amount of time. Labour rarely takes more than 24 hours^[2].

Third, contractions are predictable. They usually last only about a minute and come in a regular pattern, with pain-free minutes in between. This means you can predict and prepare for each contraction and rest between them^[2].

Finally, labour pain intensifies gradually over time. Contractions almost always start off mild and gradually grow longer, stronger, and closer together. This gives you time to adapt^[2].

Interestingly, while labour pain ranks high on pain rating scales, its memory diminishes with time. Of women who experienced severe pain in labour, 90% found the experience satisfactory three months later^[7]. This short-term memory may be related to the positive outcome that occurs at the end of labour.

Factors That Affect Labour Pain

Your experience of labour pain depends on many factors. One of the most important is your belief in your ability to cope. Confidence in your ability to handle pain strongly influences how much pain women report experiencing. Overall, more confident women report less pain^[2].

Societal expectations and beliefs about labour pain also play a role. A woman’s experience with labour pain and what she thinks is necessary to manage it are influenced by popular and cultural beliefs, including images in the media, which can sensationalize labour pain as routinely extreme^[2].

Your labour environment matters too. Factors such as who is with you, their verbal and nonverbal communication, the quality of support you receive, the philosophy of care in your birth setting, and the familiarity and comfort of your surroundings all affect your pain experience^[2].

If labour 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^[2].

Pain scores are generally higher in women having their first baby compared to women who have given birth before, especially if there has been no antenatal education^[7]. Women having their first baby tend to experience greater pain during early labour, while women who have given birth before often experience more intense pain during the pelvic phase as a result of rapid descent of the baby^[7].

Preparing for Labour Pain

Learning all you can about labour and delivery can help you manage pain when the time comes^[1]. Knowledge about labour can make you feel more in control and less frightened about what’s going to happen^[8].

Regular and reasonable exercise during pregnancy can help strengthen your muscles and prepare your body for the stress of labour. Exercise also can increase your endurance, which will be helpful if you have a long labour^[1]. Always 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^[1]. Women who attend birthing classes are more likely to have a vaginal birth^[22]. Natural birth classes such as Bradley and hypnobirthing teach strategies to cope with labour pain and give you realistic expectations while building confidence^[22].

A doula – someone who is professionally trained to give support before, during, and after labour – can provide guidance, encouragement, and reassurance^[1]. Women who receive continuous labour support from a doula are more likely to give birth vaginally, less likely to need forceps or a cesarean section, have faster labours, and are more satisfied with their births^[22].

Writing a birth plan – a document that outlines your labour and delivery preferences – can also be helpful. Women who go into labour with a birth plan are 10% more likely to have a vaginal delivery^[22].

Non-Medical Pain Relief Methods

There are many non-medical ways to help manage labour pain. These comfort measures may ease pain directly or indirectly by soothing and relaxing you^[23].

Relaxation and breathing techniques are fundamental strategies. Rhythmic or deep breathing can help you “ride the waves” of each contraction^[1]. Breathing techniques increase oxygenation, relaxation, and body awareness^[20].

Movement and position changes can make a significant difference. Keeping active during labour helps – try walking, kneeling, rocking backwards and forwards, or changing positions frequently^[8]. Many women find sitting and swaying on a birthing ball (a large exercise ball) helpful^[1].

Touch and massage provide comfort for many women. Your partner can massage you or apply counterpressure to your lower back^[1]. However, some women prefer not to be touched during labour.

Water can be soothing. Taking a warm shower or bath, or immersion in a warm tub, may help relieve pain^[1]. Applying heat or cold to painful areas can also provide relief – try a heating pad on your groin or back, or a cool cloth to wipe your face^[23].

Creating a calm environment helps. Dim lights, peaceful surroundings, soft music, privacy, and warmth can all contribute to comfort^[23]. Listening to music or using aromatherapy (soothing scents) can provide distraction^[1].

Other techniques that some women find helpful include hypnosis, yoga, meditation, acupuncture, acupressure, and visualization^[1]. TENS (transcutaneous electrical nerve stimulation) is a technique in which nerves in the lower back are stimulated using a small hand-held device. It has no known side effects for mother or baby^[13].

One advantage of these non-medical methods is that they can be combined with each other and with medical pain relief. They don’t interfere with labour progress and often may help it along. They also help you feel a sense of accomplishment and confidence, and they won’t make you unconscious, unstable, or groggy^[23].

Medical Pain Relief Options

Many women choose to use both relaxation techniques and medicine during labour and delivery. Some may start off planning not to use medicine, but change their minds as labour progresses^[1]. It can be a huge relief when pain is quickly eased and energy can be focused on getting through the contractions.

There are two main types of medical pain relief: analgesia, which relieves pain without loss of feeling or muscle movement, and anesthesia, which relieves pain by blocking most feeling^[15].

Gas and air (also called Entonox or nitrous oxide) is a mixture of oxygen and nitrous oxide gas that you breathe in through a mask or mouthpiece^[8]. It won’t remove all the pain, but it can help reduce it and make it more bearable. The gas takes about 15 to 20 seconds to work, so you breathe it in just as a contraction begins^[8]. It may make you feel lightheaded, sick, sleepy, or unable to concentrate, but you can stop using it at any time^[8].

Opioid medications such as pethidine or diamorphine can be injected into your thigh or buttock to relieve pain and help you relax^[8]. These medications are given through an IV (intravenous line) into a vein or through your muscle. They don’t completely stop pain, but they take the edge off and help you relax between contractions^[9]. Side effects can include making you feel woozy, sick, or forgetful, and if given too close to delivery, they may affect the baby’s breathing^[8].

Epidural anesthesia is used in about 77% of deliveries in the United States and is the most common type of pain relief used during labour^[14]. An anesthesiologist inserts a needle and a tiny tube (catheter) in the lower part of your back near the spinal cord. Pain medication runs through the tube and numbs the nerves that cause pain^[1].

In most cases, an epidural gives complete or nearly complete pain relief. It numbs only the lower part of your body, usually below your belly button, and allows you to be awake and alert throughout labour. You will be able to feel pressure and push when it’s time to give birth^[14]. It takes about 15 minutes for the pain medication to work, and you can continue to receive it as needed^[14].

Epidurals are very safe. Possible side effects include a decrease in blood pressure (which may slow your baby’s heart rate), a sore back where the needle was inserted that should last no more than a few days, and rarely (in about 1% of cases) a headache if the needle pierces the covering of the spinal cord^[14]. The best evidence shows that epidurals do not slow labour or lead to more cesarean deliveries^[14].

Spinal anesthesia provides medication through a needle inserted in the lower back into the spinal canal. Relief from pain is almost immediate and lasts from one to three hours. A spinal can be used for vaginal childbirth as well as for a planned cesarean section^[14]. Sometimes epidural and spinal techniques are combined in what’s called a combined spinal epidural (CSE)^[14].

General anesthesia is the only type of pain medication that makes you lose consciousness. You will not be awake for the birth of your baby. It works quickly and is typically used only if you need an emergency cesarean section or have another urgent medical problem^[14].

It’s important to understand that the use of pain medications does not make your labour “less natural,” and it does not increase the likelihood that you will have a cesarean birth^[15]. Pain relief medications can help you better cope with labour and delivery. The medications used have no long-term effects on the baby or on a child’s later development^[15].

Remember that you don’t need to make a decision about using medication until you are actually in labour. But it is a good idea to learn about what types are available at your hospital or birthing center and think about your options before labour starts^[15]. Be flexible – you can use many strategies at one time or one after another^[2].