If you're like most women, the pain of labor and delivery is
one of the things that worry you about
having a baby
. This is certainly understandable, because labor is painful for
It's possible to have labor with relatively little pain, but
it's wise to prepare yourself by planning some strategies for
coping with pain. Alleviating your anxiety about pain is one of the
best ways to ensure that you'll be able to deal with it when
the time comes.
Pain During Labor and Delivery
Pain during labor is caused primarily by uterine muscle
contractions and somewhat by pressure on the cervix. This pain
manifests itself as cramping in the abdomen, groin, and back, as
well as a tired, achy feeling all over. 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.
Although labor is often thought of as one of the more painful
events in human experience, it ranges 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. In addition,
are more likely to give their pain a higher rating than women
who've had babies before.
The intensity of labor pain isn't always the determining
factor that drives women to seek pain management - often it's
the repetitive nature and length of time the pain persists with
Preparing for Pain
To reduce pain during labor, here are some things you can start
doing before or during your pregnancy:
Regular and reasonable
(unless your health care provider recommends against it) can help
strengthen your muscles and prepare your body for the stress of
labor. Exercise can also 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 health care provider about
what he or she considers to be a safe regimen, given your
prepregnancy fitness level and the history of your pregnancy.
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 approach takes a neutral position toward
pain medication, 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
medications unless absolutely 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 medication-free
birth experience, the classes do prepare parents for unexpected
complications or situations, like emergency cesarean sections.
Other ways to handle pain during labor include:
- massage or counterpressure
- changing position
- taking a bath or shower
- distracting yourself by counting or performing an activity
that keeps your mind otherwise occupied
A variety of pain medications could potentially be used during
labor and delivery, depending on the situation. Talk to your health
care provider about the risks and benefits of each.
Pain medications, including the drugs like morphine
and meperidine, can be given intravenously or through a shot
that's readministered as needed. Either way, these medications
act systemically - meaning they affect the whole body. These
medicines don't usually slow down labor or interfere with
contractions, but can cause side effects in the mother, including
drowsiness and nausea. Analgesics may be administered well into
labor but several hours before the expected birth.
If pain medications are given systemically, the baby's also
going to get those medications. The effect on the baby depends on
how much and how close to delivery the drug is given to the mother
- some babies show signs of sleepiness immediately after birth. And
some women find that the drowsiness and nausea they experience with
systemic analgesics makes them less helpful than regional
anesthesia. Talk to your health care provider about the risks and
benefits of taking analgesics systemically.
These drugs don't relieve pain, but they may help to calm and
relax seriously anxious women. Sometimes they are used in
conjunction with analgesics. These drugs can have significant
effects on both the mother and baby, and should be used cautiously.
Women's reactions to these drugs vary - some feel a loss of
control that is unnerving, whereas others do not. These drugs can
sometimes make it difficult for women to remember the details of
the birth. You should discuss the risks of taking tranquilizers
first with your health care provider.
This is what most women think of when they consider pain medication
during labor. Nerve blocks deaden the sensation in specific regions
of the body and can be used in both vaginal and cesarean section
Epidurals, a form of local anesthesia, provide continuous pain
relief to the entire body below the belly button, including the
vaginal walls, during the entire process of labor. An epidural
involves medication given by an anesthesiologist through a thin,
tube-like catheter that's inserted in the woman's lower
back (in the same location where a spinal tap would be performed).
The amount of medication can be regulated according to a
woman's needs. Some medication does reach the baby, but
it's much less than what the baby would get intravenously or
under general anesthesia (which sedates the baby as well as the
mother and is almost exclusively reserved for emergency surgical
births). Epidurals are usually given once a woman is in active
Epidurals do have some drawbacks - they may make it more
difficult for the woman to push the baby out, and they can cause
her blood pressure to drop. They can also cause itching, nausea,
and headaches in the mother. The risks to the baby are minimal, but
include possible distress caused by the mother's lowered blood
Some women choose to give birth using no medication at all,
relying instead on relaxation techniques and controlled breathing
for pain. If you'd like to experience childbirth without pain
medication, make your wishes known to your health care
Things to Consider
Here are some things to think about when considering pain
control during labor:
- Medications can relieve much of your pain, but probably
won't relieve all of it.
- Labor often hurts more than you anticipated. Some women who
have previously said they want no pain medicine whatsoever end up
changing their minds once they're actually in labor.
- Pain medications can affect your labor - your blood pressure
may drop, your labor may slow down or speed up, you may become
nauseous, and you may feel a sense of lack of control.
- Pain medications can affect your baby, the baby may be drowsy
or have changes in the heart rate.
- If you end up needing a cesarean section, you'll be given
regional or general anesthesia for the birth. General anesthesia
is given in emergencies when a life-threatening condition
has developed in the pregnant woman or baby.
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 pain
control methods are available, how effective they're likely to
be, and when it's best not to use certain medications.
If you want to use pain-control methods other than medication,
make sure your health care provider and the hospital staff know.
You might want to also consider writing a
that makes your preferences clear.
Remember, too, that many women make decisions about pain relief
during labor that they abandon - often for very good reason - at
the last minute. Try not to confuse your ability to endure the pain
of childbirth with your worth as a mother. Your best bet is to
educate yourself about all of your options for pain relief to make
a choice about what's best for you and then to be flexible
about that decision.
Larissa Hirsch, MD
Date reviewed: February 2008
Originally reviewed by:
Serdar H. Ural, MD
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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