Often one of the biggest things on a pregnant woman’s mind is the impending and fast approaching labour. Not only is this the way they finally get to meet their baby, but one of the reasons why labour takes up so much thought and anxiety is because its painful. And unfortunately, if you’ve ever been pregnant you’ll know that people often see your big pregnant belly as the perfect opportunity to share with you their experience of just how painful and traumatic their birth was. The reality is, yes labour is painful… hence the name “labour” – it’s hard work. But that doesn’t mean it needs to be something that is feared.
Today I’ll talk you through the basics of why labour is painful, how to prepare for this pain and different ways to manage pain in labour.
Why is labour painful?
Pain in labour is due to a combination of both physical and psychological factors. Physically through contractions and movement of the baby throughout the different stages of labour - pain is experienced in the woman’s uterus, cervix, vagina and perineum (the skin the stretches between the vagina and anus as baby is coming out) as well as the ligaments and joints in her pelvis.
Psychologically, there are a number of factors shown to influence a woman’s interpretation of pain. Research shows that fear can make a woman’s experience of pain in labour heightened. And that preparation for the labour and birth can actually help reduce anxiety and fear towards the birth, helping women manage or cope with the pain in labour better. (1)
So that’s great news, because that’s what MWK is all about. Educating and preparing you for what’s to come. So hopefully by listening in today, you’ll find comfort in knowledge and potentially any concerns or fears you may have may be addressed and eased slightly.
Some other factors that may play a part in the level of pain experienced throughout labour include:
- the baby’s position eg. you may have heard of women experiencing labour with a posterior baby, where their baby is lying with its back on the mothers back, which can both slow the progress of labour and also cause significant pain in the lower back.
- The environment you give birth in – Dr Sarah Buckley writes about this a lot where she describes the natural hormones of labour either being hindered or heightened depending on the environment you labour in. This is based on feelings of fear and tension. She gives the example of a cat giving birth in a dark, cosy, hidden environment eg laundry basket, inside a cupboard etc. where this nesting instinct kicks in as a way to ensure safety when in a vulnerable situation – giving birth. (2) Similarly, in human birth it is common to see that labour may slow when you leave home and get to the hospital, or when lights are bright or you feel observed and pressured for time – because the fight or flight hormones kick in.
So thinking through the environment you labour and birth in is really important so that the helpful hormones of oxytocin (which keep the uterus contracting and therefore labour progressing) and endorphins (which are the body’s natural pain relief opiates) can be released rather than fear induced fight or flight hormones. As a side note, this is not me saying all women should have a homebirth because they’re bound to be more comfortable at home. A lot of women feel safe in the hospital, knowing there are facilities and people around to help if need be. But this doesn’t mean you can’t create an environment that promotes this nesting feeling – turn down the lights, have music playing, maybe some little battery operated candles, some essential oils etc. Create the birth space that will make you feel safe, comfortable and in control.
- Support you have to manage the pain – midwives should be one on one when you’re in established labour and can provide a whole host of different ideas and supports to help you through the pain (although sometimes due to staffing issues you may not get this). Your partner or other support people, maybe a doula can all help provide the support and encouragement you need to get you through the pain.
- Mindset – understanding that labour pain = progress can set you up to welcome the pain. If you heard my birth story in Ep2 I describe getting to a point at home where my contractions were regular, every 2-3minutes, but only lasted around 30-45seconds. I was definitely in pain through the contractions but all I could think was I want these to get longer and stronger because then they’ll be more effective in opening my cervix and getting this baby out. So I found, and basically learnt from seeing so many women give birth, that if you can turn your focus from pain is bad and I can’t cope with this to this pain is actually good because my baby is going to be born, it can really help get you through.
- Pharmacological or non-pharmacological pain management methods – which I’ll go into now.
Tips to manage pain in labour:
Women will cope with labour pain better if they aren’t afraid or fearful of it and if they feel somewhat in control of the situation. So, I’ll briefly explain a range of options for pain relief that may be available to you. It is important to talk with your care provider about this as well because some birth places will not be able to offer all of these options eg. birth centre doesn’t offer epidurals. Some options will also not be recommended depending on whether you have a high-risk pregnancy or based on how far into the labour you are when requesting it. I definitely recommend having a good conversation with your care provider before labour about all your options, so that when you turn up in labour you know what to expect and have a clear idea of what options you may like to use.
Options for pain relief in labour:
Natural methods of pain relief:
- Water – helps with relaxation and produces endorphins (natural pain relief). Also reduces the pressure on muscles and pelvis which can be very helpful for long labours where you want to continue either being upright and moving – but your legs are beyond it.
- Positioning & movement - moving freely, swaying and rocking your hips will help relieve some of the pain and pressure during contractions. I’ve mentioned this is other episodes – but gravity (being upright) will also help move baby through the pelvis. For me personally, I know I could not handle lying down during my labour and even sitting through a contraction was so much more painful. Despite the fact that you’re exhausted and have often been on your feet for hours, movement can be so helpful in lessening the pain experienced.
- Massage – Massage reduces muscle tension which again is about this idea of relaxing which then releases natural endorphins. Massage or light touch (drawing lightly on your back) can also be distracting which helps your mind focus on that touch as opposed to the contraction that is happening
- Heat/ice pack – heat pack to lower back. Cold compress to face, neck, shoulders.
- Breathing techniques – being relaxed is so important in order for natural hormones which assist labour to progress, like oxytocin, as well as hormones that act as natural pain relief – endorphins. As I’ve highlighted - If you feel anxious, fearful and tense your body will react in fight or flight – adrenaline hormones, which may impact the progress of labour. So, focussing on long, slow breaths can be so helpful in relaxing your body, and then on top of that the actual process of focussing on the breathing can help with distracting from the contraction itself.
- Music – helps create a relaxing environment
Non-medical methods of pain relief in labour:
- TENS machine – portable, battery operated device which generally hangs around your neck or can clip onto clothing. The little device has wires coming out of it and sticky pads at the ends of the wires that are put on your lower back. To use the TENS there are different settings etc but it basically sends small electrical pulses onto your body – stimulating the release of endorphins. TENS machines can be adjusted to increase the strength and frequency of the electrical pulses. The one I used in labour seemed to have a constant subtle vibration and then as a contraction started, I’d press a boost button and the pulse would be stronger until I turned to boost off at the end of the contraction. It basically distracts your brain into focussing on those pulses rather than the contraction pain
- Sterile Water Injections – these are particularly helpful for women who experience intense back pain in labour (often due to posterior positioned baby). During a contraction, two midwives will inject a tiny blip of sterile water into two points on your lower back. They generally repeat this on two further spots, so you have four blips of sterile water injected just under your skin. I will warn you the injection stings like crazy, people liken it to being stung by a wasp. The sting usually lasts about 30seconds but can then take away or relieve your back pain for the next few hours. This is a great option to try as it has no harm or effect on the baby. It can also be repeated throughout labour if you’ve found it helpful but it is wearing off.
Medical methods of pain relief for labour:
This is where it’s important to take note of the potential side effects and risks that can come by using medical methods of pain relief.
- Nitrous Oxide/Gas – a mixture of nitrous and oxygen which is breathed through a mouthpiece during your contractions. As soon as you start feeling the contraction begin, you start to breathe on the mouthpiece. It’s important that you breathe long, slow and really deep breaths and in my experience you have to hear little beads rattle in the machine which helps you know you’re getting it. With gas the important thing to know is it won’t take way your pain, it generally just takes the edge off – especially at the peak (hardest/ most intense part) of your contraction. Some women also find that using the mouthpiece and concentrating on the long deep breaths helps distract from the contraction and therefore provides relief from the pain in that way. A lot of women are nervous about using gas as they are worried they may feel sick but I always say if you’re looking for a medical pain relief option to help, give gas a go! If you try it through one contraction and you don’t like it that’s fine, just a few deep breaths out and the gross, dizzy feeling will leave and you’ll be back to normal. This also means it’s a great option as it never passes through the placenta – which means it won’t affect your baby. Also something to know is that the level of oxygen to nitrous can be altered so you often start off with it a low level of nitrous and then if you are finding it helpful, not feeling sick and as labour progresses and contractions intensify, the level of nitrous can be increased by the midwife.
- Morphine – this intramuscular injection is a strong painkiller. Like gas though, it is not going to take away the pain of a contraction, just lessen its severity. Although some women don’t find it effective at all. Morphine isn’t instant and once given, usually takes about half an hour to kick in. Morphine can make women feel nauseas and also quite drowsy (so most hospitals policy is that women cannot be in the bath within, I think 4 hours of having the morphine injection). In terms of safety for baby, morphine does cross the placenta and can therefore cause your baby to also be sleepy which can cause breathing issues. Generally, this is if the injection was given quite close to the birth of the baby so if considering morphine it is best to have it in the full swing of established labour, but when expecting baby to not arrive in the next 4 or so hours.
- Epidural – this is the most invasive but also most effective pain relief option available in labour. So effective that for most women an epidural will in fact take away all pain. How it works is that an anaesthetic drug is injected by an anaesthetist into the epidural space (basically a small space near your spine). A small plastic tube is left in this space and taped to your back which continues to administer the anaesthetic top ups throughout labour. The anaesthetic generally takes 20 minutes or so to start taking effect. As mentioned, for some women it will completely take away all sensation of pain and be so strong that standing or even holding their own legs up isn’t possible. Some women will experience a lesser dose which means the sensation of pain is altered but they can still feel when they are having contractions and where pressure is applied etc. Because of the level of sensation that it blocks, an epidural can provide opportunity for a woman to rest and even sleep.
If having an epidural you will also require both a urinary catheter and an intravenous drip of fluids. The drip is because the anaesthetic can cause a drop in blood pressure and the urinary catheter is due to the fact that the sensation to wee is also numbed by the epidural (and most epidurals mean women can’t actually manage to walk to the toilet and a stuck lying in bed). You will also be required to have CTG monitoring continuously so that the baby’s condition and your contractions can be monitored more closely.
With the increase in benefits or effectiveness in relieving pain also comes an increase in risks and potential negative side effects due to the use of an epidural. Research shows that women who have epidurals will generally experience longer first and second stages of labour (if you want to know more about what they are listen to episode 9), have an increased incidence of the baby being malpositioned (making it more difficult to be born), more likely to require oxytocin infusion to ensure contractions continue and are more likely to need assistance with the birth of their baby (eg. instrumental, episiotomy, CS). And of course the epidural procedure comes with its own risks, the most common of those being that it is ineffective, or only partially effective (meaning it may only work on one side for example), hypotension (as mentioned earlier), dural puncture and headache (3) which are usually short term complications that can be easily treated, although do mean you can feel pretty rubbish over the first few days when you really want to be enjoying your newborn. More serious or permanent complications are very rare but of course will be discussed with you in labour by the anaesthetist prior to giving the epidural.
So that’s a bit of an overview of some of the natural, non-medical and medical options for pain relief in labour. I think it is important to note however that research has shown that the use of pain relief isn’t actually associated with women reporting greater satisfaction with their birth experience.
I hope some of these methods of pain relief are helpful and that you can remember them when in labour. If some of them stand out in particular and sound like they’d be useful for you, talk them through with your partner or labour support person so even if you forget in the heat of labour about all these different options, your support person is there able to suggest them.
I’d love to hear more about your birth experiences, what worked for you in terms of managing your pain – so head across to FB and IG @mumwillknow to fill me in on the hot deets.
Also, if you’re keen to do some further reading, here are some of the resources I used in making this episode:
Photo by Kirstie Perez Photography @kpphotoinc