Pain Management During Childbirth: What Are Your Options?
by Krisha McCoy, MS
Childbirth is often thought of as one of the most painful events that humans can experience. In reality, the degree of pain can vary widely from woman to woman, and even from pregnancy to pregnancy.
Preparing yourself for the type of pain you will experience during labor and delivery can help alleviate some of the worry and anxiety you may be feeling. Planning strategies for pain relief in advance of labor will also help ensure you are able to deal with pain when the time arrives.
The Causes of Labor and Delivery Pain
Most women begin labor around the 40th week of pregnancy. Signs associated with the beginnings of labor include uterine contractions and water breaking (amniotic fluid leaking through the vagina).
Uterine contractions are the primary cause of pain during labor. In addition, the baby’s movement out of the uterus can cause pain by stretching the vagina, and putting pressure on the cervix, bladder, and bowels.
Labor pain is often manifested as cramping in the abdomen, groin, and back. Many women complain of a tired, achy feeling throughout their entire body. Some women may also experience pain in their sides and thighs.
Managing Pain During Childbirth
While you cannot prevent pain during labor and delivery, the following strategies can prepare you for this pain, so you are better able to handle it:
Exercise During Pregnancy
Getting regular exercise during your pregnancy can strengthen your muscles and increase your endurance to prepare your body for the stress of labor. If your doctor says it is okay for you to exercise, aim to get 30 minutes of moderate cardiovascular activity, such as walking, stationary biking, or swimming, and strength training exercises on most days of the week.
Take Childbirth Classes
In childbirth classes, you will learn pain management techniques, such as visualization and stretches. The 2 most popular birthing philosophies in the United States are the Lamaze technique and the Bradley method.
In the Lamaze technique, relaxation strategies, breathing exercises, distraction, and massage are taught as ways to manage pain during childbirth. The attitude toward pain relief medications is generally neutral, encouraging women to make an informed decision about whether medications are right for them.
The Bradley method emphasizes avoiding pain medications unless absolutely necessary. Instead, women are encouraged to rely on the baby’s father, who is the birth coach, to help the mother relax and use deep-breathing techniques.
Use a Doula
A doula (pronounced doo-lah) is a nonmedical person trained to give continuous emotional support during labor to help manage pain. Some hospitals and birth centers provide doulas, and some women hire them privately. One study found that the presence of a doula during childbirth significantly reduced the rate of cesarean section deliveries and use of epidural anesthesia.
Use Other Nonmedication Strategies
Other ways of managing pain include: undergoing hypnosis, doing yoga, walking, having a massage, changing positions, taking a bath or shower, and engaging in other distractions. One study found that breathing techniques and nurse-administered massage significantly reduced the perception of pain during labor. Acupuncture may also provide some benefit.
Use Pain-relief Medications
Spinal and epidural anesthesia are commonly used to manage labor pain. In epidural anesthesia, pain medications that numb nerves are given through a catheter placed in the epidural space around the spinal cord. In spinal anesthesia, the medications are injected into the spinal fluid.
In most women, these medications almost completely relieve labor pain, but do not numb the entire body. This allows the mother to use her abdominal and leg muscle strength to push and deliver the baby when it is time. In addition, the epidural catheter can be used to give extra medications in the event a cesarean section becomes necessary. However, there are risks involved with using epidural medications. The numbing process can prolong labor. They can also increase the chance of an instrumental delivery (forceps) and maternal fever.
Pain medications can also be administered through an IV catheter or through an injection into the muscle. But since these medications can cross into the baby’s bloodstream and cause their heart rate to decrease, epidural anesthesia is often preferred.
However you choose to manage childbirth pain, be sure to discuss all of your options with your doctor well before you go into labor. Having a pain-relief plan in place will not only make labor and delivery less stressful, it will also relieve your anxiety during your pregnancy. Remember to be flexible since you will not know how childbirth pain will affect you until you are in labor.
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Last reviewed April 2017 by Michael Woods, MD, FAAP
Last Updated: 4/11/2017
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