The intensity of labor pain is different for every woman & varies from birth to birth. You have a bunch of effective options to consider for managing labor pain. Pain is often the most “feared” part of childbirth.
It doesn’t have to be.
Many moms consistently share their super effective pain management. Even without drugs.
We’ve been led to believe birth is off the charts horrendously painful without an epidural or “no big deal I can pop this baby out & not feel anything with an epidural”. That’s completely misleading. Because the reality is most of us experience all the in-between scenarios.
Like… the women who’ve prepared for an unmedicated birth & don’t have much pain, or the women who decide to get epidurals but still have pain & all the other combinations. Many birthing classes don’t talk about “specific types” of pain management (watch one mom teach you how to have less pain here), because they assume that you’ll have your epidural & be done with it. They don’t bother arming you with tools to cope, just in case you need them (epidural doesn’t work, don’t have time to get it, etc.).
All your options should be presented to you on a silver platter. Then YOU choose what YOU want, should you want it & should you need it. It’s all part of being prepared…right? Labor can take unexpected turns. Having talked with 100′s of moms & providers who’ve been involved with tens of 1000′s of births, it’s clear…moms who know their options do better in labor, have less pain, on & on & on.
So what are my options?
- Nitrous Oxide (or laughing gas). Some hospitals are starting to use nitrous oxide during labor as an alternative to narcotics or epidural analgesia. It provides a good amount of relief for some women without the needles, or heavy duty meds that the other options offer. One of the benefits is that it moves quickly through your system. No studies or observations have seen any adverse effects for the baby. Ask if your hospital provides nitrous oxide (it may be available). Evidence here from the Journal of Midwifery & Women’s Health.
- Narcotics. Also called Opiods, are depressant drugs which can be administered through IV, by a needle (into the muscle) or inhaled. Unlike their epidural (listen to an interview with an Ob/Gyn who teaches you all about Epidurals here) counterpart, they do not interfere with labor or your ability to push (you can still feel your lower half).
- Epidural/Spinal Analgesia. The most common form of medication pain relief. Epidurals are administered via IV through a catheter into the spine. Usually the analgesia is local, meaning you’re still conscious. The other kind is General, which means you’re knocked out (unconscious) & is used mainly for emergencies when there’s no time to get the epidural going.
- Comfort measures – continuous labor & birth support, birth positions (we talk about these below) & your environment. The evidence will surprise you- according to multiple studies, this might be THE most important factor for a better birth.
- Mental strategies- more info below.
- Sterile water injection. For back labor, sterile water is injected via a needle just under the skin in your lower back. It’s an effective way to relieve lower back pain during labor without any side effects for you or the baby.
I’m getting an epidural, why do I need to learn how to cope with pain?
Such a great question. Thanks for asking!
As your uterus begins contracting in early labor, the pain and discomfort you feel could range from minimally uncomfortable to very uncomfortable. During this part of labor, you’ll not be at the hospital. You’ll (most likely) be in the comfort of your own home.
Early labor progresses and leads into active labor (when you’re 4 to 5 cm dilated- meaning your cervix opens up so baby can get out)-things really intensify for women at this point. Usually mamas need to focus & breathe through their contractions and not joke around, or multi-task (cooking or paying bills or whatever they were doing before).
You may or may not be at the hospital yet. And even if you are, the anesthesiologist may not be able to immediately give you your epidural (they’re busy with other labors too). From early labor until the time you get your epidural could be hours past what you expected, for whatever reason. And some women say their epidural didn’t kick in much at all.
Every woman’s body & labor is different. So it’s a good thing to know how to cope with pain regardless of what you’re planning. All providers & all mamas say the same thing- “Be flexible because plans usually change in some way”.
What can I do to cope with labor pain?
The evidence shows Continuous Labor & Birth support as having THE biggest influence over THE most important “parts” of birth (meaning less pain, faster labor, needing fewer episiotomies & overall birth experience satisfaction). This can be your spouse, best friends, family members, or a doula who you’ve hired. This is a really important first step.
Check out this study of over 15,000 women researched from the US Cochrane Center at the Johns Hopkins Bloomberg School of Public Health.
Let’s get comfy- (before the hospital & at the hospital)
- Create an environment that is soothing for you in your home. This may involve dimming the lights, candles, your favorite music, having your favorite oils to smell (aromatherapy), your favorite body pillow etc. No, this isn’t just a “feel good” thing. By relaxing your mind & body, you’re body works more efficiently to bring baby out (contractions, etc.). Evidence shows this time & time again. Do you like spas? Then you’ll like this setup too.
- Tender touch. Having your spouse massage your neck, legs, arms, back, scalp is awesome for some women and really helps them relax. It’s a great (non-verbal) way for your birth support to help you “relax” without saying it out loud. If they notice you’re clenching your fists or tightening your shoulders, a simple touch to that area is a great reminder to release that tension & relax. Counter-pressure is another thing that feels fabulous for some women. Simply having them apply pressure to your lower back could lessen the pain you feel.
- Changing positions. You’ll know what feels good and what doesn’t when you’re in labor. Leaning over the bed, sitting on a birthing ball, getting on all fours, squatting, leaning on a birthing ball, rocking in a rocking chair, swaying from side to side with your spouse, hopping in a warm bath, taking a warm shower (and anything else you can come up with) are all great options. Different labor & birth positions relieve pain. These sound “weird” to a lot of mamas, that’s ’cause we’ve been told lying on your back, in bed, is how you give birth.
Just think about it for a minute. It makes no sense. The muscles your incredible body needs to use can’t effectively be used, which means greater pain. That’s why ALL the evidence goes against lying on your back during a normal labor and birth.
Example…when you strain your hamstring you naturally want to move around a little bit- putting pressure on it, walking a little bit & working it out, which helps the pain go away by increasing blood flow & oxygen directly to the muscle. Same thing happens here, except the we’re increasing blood flow & oxygen to your muscular uterus, which gives more oxygen to your baby.
But there’s another component that’s just as significant…your mind.
Let’s Get Mental
While your body knows exactly how to birth your baby, your mind often gets in the way. By getting in the way of labor, your mind can very easily slow labor down or even stop it completely. It happens all the time.
There is a huge mind-body connection in birth that’s mostly glossed over. That’s absurd. Do athletes gloss over their mind-body connection? Any demanding life event (work presentation, sporting event, pre-wedding jitters) requires mental practice for the mind-body connection. (By the way, check out our interview with Dr. Stuart Fischbein on “how to be fearless in pregnancy and birth“)
Mental Coping Strategies
Visualization- imagining the smooth trip your baby is taking through the birth canal, the pelvis and out into the world increases the likelihood of it happening.
Or by transporting yourself to an entirely different place, like a place that makes you super happy can be really effective in helping you relax (a resort in the mountains, your favorite beach, etc.). Try different things & see what works. Professional athletes, speakers, (you name it) pay big $$$ for this stuff, because it’s proven. It works.
Get verbal- it may be helpful to sing, groan, moan or otherwise express yourself vocally during labor. Just letting go helps you relax in the moment instead of fighting it. Sort of like “screaming” at the top of your lungs when you’re pissed or just letting it out when you need a good cry. It just has a way of helping. Do ya know that feeling?
Set short goals – things like “I’ll make it through the next contraction” or “I’ll make it until my nurse, midwife, doctor comes in next”. Having short goals that are easily attainable gives women a sense of satisfaction and “oh yeah I can do this”. Those mini-victories start adding up & you gain confidence as you keep truckin’ closer to birth! Next thing ya know…booyah…big victory…birth!
Mantras- just a fancy name for a phrase or word that you repeat to yourself (either out loud or quietly). It can be anything. For example: “I am strong. I can do this.” Repetition helps women get into a rhythm which helps lessen pain. Athletes use these all the time. Why? It’s proven. It works.
Breathing- each woman needs to breathe in her own way. For some it might be long, slow breaths, for others it may be faster breaths or a combination of the two. If you’ve taken yoga or Pilates this will come very naturally to you. Research shows that increased oxygen to the brain helps you relax, lessens pain and also provides more oxygen to baby. A win-win. We haven’t talked to a mama yet who didn’t find Yoga (or Pilates) super beneficial for pregnancy & birth.
Stay positive – instead of focusing on “I’m only dilated to a 4?” …think “I am one-step closer to meeting my baby! Yeah! I can do this!”. We’ve all heard it before, “your body follows your mind.” This alone can keep you out of the fear -pain cycle.
Relaxation- this can go hand in hand with visualization. As you’re working through contractions, start at the top of your head and work your way down to your feet, consciously relaxing each and every muscle (you may have a CD or MP3 of someone leading a guided relaxation which can be helpful…big time). Even releasing the tension in your eyebrows or mouth can help!
Reward- obviously your baby is a huge reward at the end of labor, but it may be helpful to have something else that’s tangible like- your favorite meal, a handbag that you’ve wanted, a beverage that you’ve been craving, etc. (well… hello there big tall sexy glass of Cabernet…I’ve been missin’ you! )
Focusing on an external reward directs your thoughts to those pleasant, desirable things and away from pain. Just like “that trip to Hawaii at the end of next month” helps you deal with “that boss”. Know what I’m sayin’? Give it a try!
We talked with Dr. Michelle Collins, certified nurse midwife at Vanderbilt University & she shared from her experience of catching 4000+ babies into the world that pain usually does not define a woman’s birth satisfaction. She said many women who’ve felt some pain often rank their birth satisfaction higher than women who felt nothing.
Evidence shows the most important factors affecting birth satisfaction are “personal expectations, the amount of support from caregivers, the quality of the caregiver-patient relationship, and involvement in decision making”. Many moms liked the intensity and bond created with baby. It’s kinda like the people who love to run marathons, or do triathlons, or extreme sports. Pushing our comfort zone and challenging ourselves is internally very rewarding…and instead of getting a piddly ribbon or medal at the end, we get a beautiful baby! Talk about a sweet reward at the finish!
Check out the Evidence here about “Pain & Women’s Satisfaction with the Experience of Childbirth” published in the American Journal of Obstetrics & Gynecology.
Being familiar with a wide variety of ways to deal with pain is ‘super importante’ as you prepare for labor. Practicing beforehand is also super important. You’re wayyyy more likely to remember them, use them & have less pain in the heat of the moment because of taking just a little time to practice.
Remember: coping with pain starts with great birth support, i.e., people who are supporting your preferences, decisions, are there for you emotionally & physically and who are encouraging and positive. That includes your provider.
You might be in the zone and they may selfishly waltz in acting like “mehhh, just another labor,” and be super distracting to you. This happens all the time. No one talks about it. This is your birth. You hired your provider (even if it’s the provider on call).
Suggestion- send one of your birth support to chat with your provider (doctor, midwife and nurse) to make clear your desires for the kind of bed manners YOU WANT for your birth. They are there to serve you and your baby! It’s all about you mama. You Can Do This!
(written by Sarah. She has two kids: a strong willed and dare we say “spunky” 4-year-old (aka boo bear, buster, mr. monkey) and a drooling, teething, not-so-sleepy 11-month-old (aka smalls, cooey). And she’s married to Steve (aka shmookie). They live in the great state of Michigan.)