Pain in labor and childbirth is one of the primary reasons why women have feelings of anticipation, dread, and fear concerning childbirth. In our culture, and in many others, childbirth is known as the worst pain that anyone has experienced or could endure.
When I was pregnant with my first child, I read books and googled everything I could about childbirth and various women’s experiences. I wanted to know how much pain I would be in.
We’re presented with images of women in labor in the media, and I knew that it would probably be much different, but I didn’t expect how different.
(Seriously, your birth won’t be anything like you’ve seen on TV or the movies!)
So I’ve compiled everything you need to know about pain during childbirth. Here’s what’s in this article:
- What causes pain in labor?
- Two types of pain
- Pressure, Ring of Fire & Tearing
- Measuring Pain
- Improve Your Chances at a Less Painful Childbirth
- Left Occiput Anterior is the Optimal Position
- Exercises for Optimal Position
- Cultural Expectations, Tension, and Lizard Brain
- Preventing Ring of Fire and Tearing
- Prevent Inductions
- Labor Positions
- Pain Management in Labor
- Type of Pain Management
- Cesarean Section
- NEXT POST: Read stories from real Women about their labor pain
What Causes Pain in Labor and Childbirth?
Pain during labor is caused by contractions of the uterus. (You probably already knew that one.) But did you know that it is also caused by pressure on the cervix and pelvic floor as well? Many things can contribute to the severity of pain in labor and childbirth, including:
- induction and medications like pitocin
- strength of your contractions and how far you are into labor
- baby’s positioning
- speed of your labor
- position you’re laboring in
- cultural expectations and psychology
- pain tolerance level
Things that do NOT influence pain during labor:
- mother’s fitness level (working out during pregnancy may help with swelling, aches, and pains brought on by pregnancy, but will not help you experience less pain in labor)
- mother’s diet
- having a small baby (even premature births are painful)
Much of what you hear may or may not decrease pain in labor is anecdotal. It worked for one woman, so it must work for me, right?! Unfortunately no. Many women swear that red raspberry leaf tea (good for MANY things) helped them decrease their pain (there is no evidence for this). Or that being fit helped them deliver more easily (many unfit women have reasonable births while other fit women have extremely painful births!).
But the good news is that there are many things that you can do to help decrease your potential pain in childbirth!
Two Types of Pain
Did you know there are actually different types of pain? It makes sense, though I had never really thought of it before. In labor and childbirth, you experience two clinical types of pain, visceral and somatic.
The visceral pain is described as the pressure of the uterine contraction, which happens in Stage 1 (early and active labor, and transition).
Contractions are similar to what your uterus does during your period. When you get cramps, it’s from your uterus gentle squeezing out your uterine lining. When you have contractions, your body is… more forcefully squeezing out your baby. And the uterus is one of the strongest muscles in the body.
Pressure, Ring of Fire, & Tearing
Somatic pain is the stretching and potential tearing of the tissue as the baby exits the birth canal. Mothers experience this type of pain in Stage 2 of labor as the baby is born.
If you’ve taken birth classes, you’ve probably heard about the ring of fire. The ring of fire is the stretching pain when the baby’s head is crowning. The perineum (the flesh between the vagina and anus) stretches (and sometimes tears). Often, this is described as the most painful part of birth.
Your care provider may convince you that you need an episiotomy (a cut to open the vagina further), but research has proven this to be unnecessary and oftentimes risky. Tearing naturally can be painful, but women often tear worse with an episiotomy.
There was an image circulating around a while back about the human body being able to withstand 45 “dels” of pain, while childbirth is typically 57.
This is a hoax, folks.
There was a start to quantify measurements of pain back in the 40s, but it never took off because it was too complicated and their methods were… a little sadistic. (Read the article… they would burn the hands of women in labor.) But the unit they came up with was the “dol” and it is measured by a “dolorimeter”.
In any case, the standard description of pain is still just a 0-10 scale. I like the color coded numerical scale (#11) from the Pain Doctor.
- 0= No pain
- 1= minimal
- 2= mild
- 3= uncomfortable
- 4= moderate
- 5= distracting
- 6= distressing
- 7= unmanageable
- 8= intense
- 9= severe
- 10= unable to move
Improve Your Chances at a Less Painful Childbirth
First of all, there are women that experience very little pain in childbirth, there are women who can barely withstand the pain of labor and childbirth, and there are women who have orgasms during childbirth because it was so pleasurable (WHAT?!).
The range of pain felt is extremely wide, and you can’t know where your pain will be on the spectrum until you experience it.
I experienced absolute extreme pain in my unmedicated birth, level 10, no doubt. Perhaps I have a very low pain tolerance… which would make sense because I’m highly sensitive to feelings, hot, cold, and even nagging little aches and pains. I am hyper-aware of my body, and I feel that if you have an acute awareness of your body, you might experience higher levels of pain as well.
You can’t control your pain tolerance level. But there are things that you can do to increase your chances at a less painful birth. One of the most influential steps you can take is to make sure that baby is in the right position.
(For this section, Spinning Babies is the website you want to head to… they have all the information you could ever want on positioning your baby. But I will summarize and highlight some main points.)
Left Occiput Anterior is the Optimal Position
In LOA (Left Occiput Anterior) the baby has his back to the mother’s left side and faces her spine. This is the absolute best position for birth because it allows the baby to tuck his chin and pass through the pelvic bone easily.
In many other positions, the baby could have his head tipped back, or could be pressing against the spine, which could cause back labor. Back labor is described as being much more painful than labor in which baby is in LOA. You can feel intense pressure and pain even between contractions (eek.)
Exercises for Optimal Position
There are so many little things that you can do to put baby in a good position, stretch out your pelvis (to make sure baby has enough space), and even relieve your own aches late in pregnancy.
Check out this video. I watched this many times when pregnant with both boys, and she does a great job of explaining how it all works.
Remember, positioning baby works for pain during labor because the best position can make sure you don’t have worse pain during labor by potentially preventing back labor, and even shortening the amount of time labor takes. But it won’t prevent pain entirely.
Cultural Expectations, Tension, and Lizard Brain
Not every culture has the the same expectations of pain in childbirth. This our thoughts have a direct effect on how much pain we will be in.
You may think this one is a little hippy-trippy, but the science behind it is true.
Programs like Hypno-babies and Blissborn help to break down the stigmas of birth, your fears and expectations, and allow you to relax during the process.
The science is this: if you have fear or cultural stigmas around birth, you will be tense. Tension causes you and your baby to be in fight or flight, and can cause other symptoms, like sub-par birthing position.
If you treat the fear and learn to relax through the use of self-hypnosis, you can get into your “lizard brain“. Your lizard brain is where the most instinctual processes of our brain happen, birth included. With relaxation, you can reach a place where you are preventing further pain caused by being in your feeling or thinking brains and experiencing fear.
Preventing the Ring of Fire & Tearing
Perineal massage can help tremendously with making sure your vaginal opening is stretched and flexible enough to provide room for baby’s head. Perineal massage is exactly what it sounds like. You can find plenty of resources online to help you get started. Here are two:
- Redbook– Anecdotal evidence
- American Pregnancy Association– description, instructions, and even pictures
Another way to minimize your potential pain during labor is to avoid the use of pitocin. Some women claim that it was not terrible or did not change their contractions at all. But most women agree that pitocin made their contractions stronger and that they did not get a break in between.
There are times when an induction is the best choice for your baby. (If the baby is in distress, or the mother is in distress, for instance.) But it doesn’t have to be your only option if you fear going past your due date.
A few ways to get labor started on its own include:
- nipple stimulation
- membrane sweep
- red raspberry leaf tea (anecdotal evidence)
- eating dates
- eating pineapple
- bouncing on a birth ball
Women did not start giving birth on their backs until men entered the birth room. Literally, for decades, midwives were present at births and it was common for women to give birth in a leaning position, squatting position, sitting position, or on all fours. When doctors decided that they needed a clearer picture, they would make women birth on their backs (also called the supine position).
You can reduce not only pain, but additional complications by laboring and birthing in a squatting position. Sad news, if you are hooked up to an IV at a hospital, you will not be able to birth in this position. There are other positions to birth in that are better than on your back, including a side-lying position with one leg supported.
Here is a fantastic article about the dangers of giving birth on your back.
Pain Management In Labor and Childbirth
When we think of pain management during childbirth, we think of the gold standard of all pain meds: the epidural. But there are many others.
Natural Methods (non-medication)
Some ways to manage pain in labor and childbirth if you plan on giving birth without medication:
Self-hypnosis, breathing, visualization. Use these resources:
Massage and pressure (especially on the back and hips):
Heat (hot shower, bed buddy):
Nitrous oxide, or laughing gas, can be inhaled to take the edge off. With the severity of contractions, it’s less a pain manager and more in the business of helping you stay in your lizard brain. For many women, nitrous oxide helps ease anxiety more than pain.
(Oh, and it’s not the same thing you get at the dentist’s office!)
These are pain meds that are delivered into an IV. Again, these can help make pain milder, but won’t take away the pain completely. Some women can’t even tell a difference!
A pudendal is the use of lidocaine or another local anesthetic to block pain to the vagina and rectum area.
This is nice for women in labor because then you can’t feel your contractions. But it comes with a host of potential side effects, including:
- back pain
- bleeding from puncture site
- bleeding difficulties
- drop in blood pressure
- increased risk of tearing
- potential increased chance of c-section needed
- working only on one side
- slowing labor down
- increased need for additional interventions
- potential drowsiness of baby
- potential decreased chance of successful breastfeeding
- loss of bladder control
- nerve damage
For many women, these side effects are not worth the risk. But in most cases, the use of epidural is safe.
For many women, the idea of scheduling a c-section is a way to bypass the pain of labor and childbirth altogether.
You may have an epidural, a spinal, or potentially general anesthesia (if it is an emergency).
C-Sections may require more pain management for a longer time postpartum. A c-section is, after all, major surgery.
Pain experienced in labor and birth is not a predictor of maternal satisfaction! That’s great news, because even if it truly is the most painful thing you ever experience, it won’t make you hate your birth experience!
Read on to the next post about Women’s experiences with Pain and Childbirth!