Pain During Labor and Delivery

Pain during labor is caused by contractions of the muscles of the uterus

and by pressure on the cervix. This pain can be felt as strong cramping in the
abdomen, groin, and back, as well as an achy feeling. Some women experience
pain in their sides or thighs as well.
Other causes of pain during labor include pressure on the bladder and bowels by
the baby's head and the stretching of the birth canal and vagina.
Pain during labor is different for every woman. It varies widely from woman to
woman and even from pregnancy to pregnancy. Women experience labor pain
differently — for some, it resembles menstrual cramps; for others, severe
pressure; and for others, extremely strong waves that feel like diarrheal cramps.
It's often not the pain of each contraction on its own that women find the hardest,
but the fact that the contractions keep coming — and that as labor progresses,
there is less and less time between contractions to relax.
Preparing Yourself
To help with pain during labor, here are some things you can start doing before
or during your pregnancy:
Regular and reasonable exercise (that your doctor says is OK) can help
strengthen your muscles and prepare your body for the stress of labor. Exercise
also can increase your endurance, which will come in handy if you have a long
labor. The important thing to remember with any exercise is not to overdo it —
and this is especially true if you're pregnant. Talk to your doctor about what he or
she considers to be a safe exercise plan for you.
If you and your partner attend childbirth classes, you'll learn different techniques
for handling pain, from visualization to stretches designed to strengthen the
muscles that support your uterus. The two most common childbirth philosophies
in the United States are the Lamaze technique and the Bradley method.
The Lamaze technique is the most widely used method in the United States.
The Lamaze philosophy teaches that birth is a normal, natural, and healthy
process and that women should be empowered to approach it with confidence.
Lamaze classes educate women about the ways they can decrease their
perception of pain, such as through relaxation techniques, breathing exercises,
distraction, or massage by a supportive coach. Lamaze takes a neutral position
toward pain medicine, encouraging women to make an informed decision about
whether it's right for them.
The Bradley method (also called Husband-Coached Birth) emphasizes a
natural approach to birth and the active participation of the baby's father as birth
coach. A major goal of this method is the avoidance of medicines unless
necessary. The Bradley method also focuses on good nutrition and exercise
during pregnancy and relaxation and deep-breathing techniques as a method of
coping with labor. Although the Bradley method advocates a medicine-free birth
experience, the classes do discuss unexpected complications or situations, like
emergency cesarean sections.
Medicine-free ways to handle pain during labor include:
 hypnosis
 yoga
 meditation
 walking
 massage or counterpressure
 changing position
 taking a bath or shower
 listening to music
 distracting yourself by counting or performing an activity that keeps your
mind otherwise occupied
Pain Medicines
A variety of pain medicines can be used during labor and delivery, depending on
the situation. Many women rely on such medicines, and it can be a huge relief
when pain is quickly eased, and energy can be focused on getting through the
contractions. Talk to your health care provider about the risks and benefits of
each type of medicine.
Analgesics. Analgesics ease pain, but don't numb it completely. They don’t
affect sensation or muscle movement. They can be given many ways. If they are
given intravenously (through an IV into a vein) or through a shot into a muscle,
they can affect the whole body. These medicines can cause side effects in the
mother, including drowsiness and nausea. They also can have effects on the
baby.
Regional anesthesia. This is what most women think of when they consider
pain medicine during labor. By blocking the feeling from specific regions of the
body, these methods can be used for pain relief in both vaginal and cesarean
section deliveries.

Epidurals, a form of local

anesthesia, relieve most of
the pain from the entire body
below the belly button,
including the vaginal walls,
during labor and delivery. An
epidural involves medicine
given by an anesthesiologist
through a thin, tube-like
catheter that's inserted in the
woman's lower back. The
amount of medicine can be increased or decreased according to a woman's
needs. Very little medicine reaches the baby, so usually there are no effects on
the baby from this method of pain relief.
Epidurals do have some drawbacks — they can cause a woman's blood pressure
to drop and can make it difficult to pee. They can also cause itching, nausea, and
headaches in the mother. The risks to the baby are minimal, but include
problems caused by low blood pressure in the mother.
Tranquilizers. These drugs don't relieve pain, but they may help to calm and
relax women who are very anxious. Sometimes they are used along with
analgesics. These drugs can have effects on both the mother and baby and are
not often used. They also can make it difficult for women to remember the details
of the birth. Discuss the risks of tranquilizers with your doctor.
Natural Childbirth
Some women choose to give birth using no medicine at all, relying instead on
relaxation techniques and controlled breathing for pain. If you'd like to experience
childbirth without pain medicine, discuss this with your health care provider.
Things to Consider
Here are some things to think about when considering pain control during labor:
 Medicines can relieve much of your pain, but probably won't relieve all of it.
 Labor may hurt more than you expected. Some women who had said they
want no pain medicine whatsoever to end up changing their minds when
they're in labor.
 Some medicines can affect your baby, making the baby drowsy or causing
changes in the heart rate.
Talking to Your Health Care Provider
You'll want to review your pain control options with the person who'll be
delivering your baby. Find out what's available, how effective they're likely to be,
and when it's best not to use some medicines.
If you want to use pain-control methods other than medicine, make sure your
health care provider and the hospital staff know. You might want to also consider
writing a birth plan that makes your preferences clear.
Remember, many women make decisions about pain relief that they abandon —
often for very good reason — at the last minute. Your ability to endure the pain of
childbirth has nothing to do with your worth as a mother. By preparing and
educating yourself, you can be ready to decide what pain management works
best for you.

Hypnosis
Self-hypnosis, using visualization and breathing techniques to induce a state of
deep relaxation and banish fear, is an increasingly popular way to deal with
labor.

How It Works
"Hypnobirthing" is based on the "fear-tension-pain" syndrome of childbirth first
described by the English obstetrician Grantly Dick-Read (see Birth ideologies),
who believed that fear prevents the release of the "feel-good hormones,"
endorphins and enkephalins. He theorized that when fear is eliminated, most
women can give birth naturally.

With Hypnobirthing, you're fully aware of what's happening around you, but
may feel as though you're daydreaming or drifting off to sleep. You and your
birth partner can attend Hypnobirthing classes anytime during pregnancy to
learn the techniques before labor.

The most important thing to do is to relax and worry less about the process.
Childbirth is something that's been going on for eons and will continue to occur
long after your childbearing years are over.

Your mind and your body are totally connected, and if you are worried and
anxious when it is time to give birth, you will make your body tense and your
contractions will be that much more painful. You can talk to your body and
telling it to use its natural pain relievers to ease your process.

Water
Many women find being in warm water during labor very soothing and an
excellent way to cope with labor pain. The warmth of the water relaxes muscles,
and being in water aids buoyancy, which can help relieve the pressure on your
pelvis.

This natural method has become more and more available for women and
many hospitals and birth centers provide bathtubs.
Whether or not you can deliver your baby in the water will depend on the
hospital's policy and whether there are any doctors or midwives trained in
water births. You can also purchase or rent a birthing pool.

Relaxation and Breathing Techniques

If you're relaxed, it will be easier to stay calm and in tune with your body.

There are various techniques you can use to help you relax during labor.
These techniques include focusing on your breathing, listening to music and
listening to a meditation CD.

Learning how to breathe slowly and steadily in labor helps you focus and stay
calm. Usually, your breathing responds to how you're feeling and may increase
slightly during a contraction, or you may hold your breath, which can make you
feel light-headed. If that happens, you need to focus and steady your
breathing.

Homeopathy
This is based on the principle of treating like with like. Talk to your doctor
before using any homeopathic products during pregnancy or labor, since
homeopathy is an area of complementary and alternative medicine that's
associated with much debate and scientific controversy.

If your doctor gives you the okay, a certified homeopath can prescribe
remedies based on your individual needs. There is a lack of scientific evidence
on the effectiveness of homeopathy, although many women find the remedies
helpful.

Your nurse will remind you to breathe slowly and steadily. Breathing in for five
and out for seven slows your breathing down, helps you relax and stops you
from panicking.

Acupuncture
Acupuncture uses fine
needles placed at
specific points on the
body to reduce pain by
stimulating the
production of
endorphins.

How It Works
Acupuncture is a
traditional form of
Chinese medicine that
believes there are
channels within the body through which energy, or "chi" runs. Blockages can
occur in these channels, and so by inserting needles at certain points, energy
is unblocked, relieving pain and restoring balance to the body.

Many women find acupuncture helpful to treat mild pregnancy symptoms, and
some women use this therapy during labor.

Side-Effects
Acupuncture has no harmful side effects for the mother or baby and in labor,
needles will usually be inserted in points that do not restrict your movement, for
example in the ear.

If you want to have acupuncture during labor, you will need to look for an
acupuncturist who specializes in this area and arrange to have him or her with
you during labor.

Aromatherapy
Aromatherapy (essential) oils are derived from plants and used for their
therapeutic properties. The use of these oils in childbirth can stimulate, refresh
and soothe you and, to some extent, your partner.

There is some evidence that oils like lavender reduce anxiety in labor, which in
turn helps you cope with pain. Hot and cold compresses with essential oils can
be soothing and massaging diluted essential oils (in a carrier oil) into the skin is
therapeutic, too.

Many experts, however, recommend against aromatherapy during pregnancy

and labor because some scents may be hazardous to pregnant women. The
effects of most plant oils on pregnant women is unknown.

Reflexology
Reflexology involves massaging reflex zones on your feet that correspond with
different parts of your body to improve your blood circulation and relax any
tension you may be feeling. Because many women naturally want to be active
and move around during their labor, it may be more helpful in between early
contractions.

When it comes to pain management during labor, the choice is entirely yours. If
you're interested in natural childbirth, but you're not sure what's best for you,
talk to your doctor. She may have suggestions and insights that will help you
make the best choice for you and your baby.

Express your fears

Are you worried about pain, needles, medicines, or losing control? Speak with
a knowledgeable and trusted friend, childbirth educator, or doula. Voicing your
concerns can bring relief as well as allow you to learn more about practical
solutions to your concerns. Stating your preferences in a birth plan can also
help calm fears.
Practice rhythmic breathing

Breathing techniques can help you manage contractions. Breathe fully in a

slow rhythm during contractions. Release tension with each exhalation and try
moaning. Also try taking quick breaths, about one every 2 to 3 seconds (20 to
30 per minute). If you lose your rhythm, your partner can help you regain it with
eye contact, rhythmic hand or head movements, or by talking you through
contractions.

Take a warm shower or bath

A warm shower can soothe you, especially if you can sit on a stool and direct a
handheld showerhead onto your abdomen or back. Bathing in warm water may relax
you—and it may even speed up labor.

Seek relief with warm or cool compresses

Place a warm pack on your lower abdomen, groin, lower back, or shoulders during
labor. Fill a long sock with uncooked rice and heat it in the microwave for about one
minute, then place it on your abdomen (make sure it's not too hot). If it gets cold, reheat
it in the microwave.

A cold pack or latex glove filled with ice chips can help soothe painful areas—but avoid
using it on the abdomen. Cool cloths relieve a sweaty face, chest, or neck.

Indulge in gentle touch or massage

Touch conveys reassurance, caring and understanding—whether it's someone holding
your hand, stroking your cheek or hair, or patting your hand or shoulder. Have your
partner or doula massage you with light or firm strokes using oil or lotion to help soothe
you.
You could also place three tennis balls in a tube sock and have your partner roll them
up and down your back to relieve back pain. Or have him rub your back with the heels
of his hands.