Managing pain during childbirth

When women have contractions during labor, their womb contracts (tightens). As a result, the cervix gradually opens and then the baby is slowly pushed out of the womb and vagina. So contractions are a sign that labor is progressing. Because of this, many women say labor pain is different to other kinds of pain. It has a “positive purpose” and they know that it will be over relatively soon − and then they’ll be able to hold their baby in their arms.

What’s more, different women experience labor pain quite differently: Some say it’s only mild and feels more like tightening or pressure, while others say their contractions are extremely painful and distressing.

Contractions come in waves. This means that every contraction is followed by a break where you can gather strength to face the next contraction.

Having good support is the main thing that helps in labor. Many women say it’s a great help to have someone there to encourage you and make it as comfortable as possible, perhaps by massaging your back or bringing you heat packs. People like your partner, a close friend or a midwife can provide this kind of support.

Reliable support makes a real difference. It not only helps women get through labor: Research has shown that continuous support can shorten labor a little and also reduce the need for pain-relief medication in many cases. A lack of understanding and support can lead to stress and fear. This can cause your muscles to tense up, which makes the pain worse.

As a support person, you can do the following to help:

• Make sure that the pregnant woman is not left alone (unless she would like to have some time alone): Knowing that you’re there to help take care of things can make a great difference to her.
• Remain attentive and flexible, and focus on her needs. But also be willing to leave her alone if that's what she would prefer.
• Encourage her and reassure her that she’s doing a good job.
• Try to make things as comfortable as possible for her: All of the “little” niceties – like being kept warm or receiving a gentle massage – mean a lot and can really help make things easier.
• Help her keep track of what's going on. That includes encouraging her to ask questions. Or she might prefer it if you ask the midwife or doctor for her instead.

Midwives are well-trained and very experienced in finding the best way for women to cope with labor pain. They can react quickly to the changing situations and needs in labor, and explain what the options are.

Sometimes women feel they shouldn’t bother the busy staff at the hospital or birthing center with a lot of questions. But having your questions answered is a critical part of the support needed in labor, too.

Moving around and frequently changing positions can help to cope with labor pain. You can try things like standing, sitting, squatting, lying down, walking around and moving your hips in a circle – and find out what makes you feel more comfortable at that moment.

If, for instance, the baby's head is pressing deeply against your back, changing position can relieve the pain. And if the baby moves further along or changes position, you can respond by changing your position too.

Walking and moving around might make the birthing process easier, or even speed it up. Making a conscious effort to breathe calmly, and especially to breathe out slowly during contractions, can help too.

We have already mentioned moving around, changing positions and breathing. There are also other ways to relieve labor pain without medication. They are usually less effective than medication, though.

Research suggests that the following things can help:

• Relaxation techniques and yoga: Techniques like progressive muscle relaxation, or certain breathing exercises and movements taken from yoga, can distract you from the pain, relax your muscles, and help you breathe more calmly. Listening to music sometimes helps too.
• Bathing: Relaxing in a warm bathtub, shower or hot tub can help reduce the need for pain-relief medication.
• Cold or heat packs: This can particularly help relieve back pain in labor.
• Massages: Having a back or foot massage can relax and soothe your muscles. Your partner or other support person can learn some gentle massage techniques before the birth.
• Exercise ball: During pregnancy, many women use an exercise ball to strengthen their back and pelvic floor muscles. Research suggests that doing exercises with the ball during labor can help relieve labor pain too.
• Aromatherapy: The scent of essential oils can possibly help women to relax and feel less pain in labor. The oil can either be inhaled in the air, massaged into your skin, or added to a warm bath.
• Transcutaneous electrical nerve stimulation (TENS): In TENS, electrodes that send out weak electrical signals are taped to your skin. This makes the skin feel a little tingly, and may have a pain-relieving effect too. You can adjust the intensity and frequency of the electric signals yourself.
• Acupuncture and acupressure: In acupuncture, thin needles are inserted into the skin at specific points on your body. Because the needles stay in the skin, they can make it harder to move about during the birth. In acupressure, the practitioner uses their fingertips to apply gentle or stronger pressure to specific points on your body. Both of these approaches might help reduce labor pain – but there’s a lack of good research in this area.

There is no scientific evidence that other treatments help here, including hypnosis, biofeedback and homeopathy.

If women would like to relieve their labor pain with medication, they have various options.

The most effective medication is a type of regional anesthetic known as an epidural, which stops pain signals traveling up the spinal cord to the brain. This only numbs the lower part of your body, so you’re still awake and aware of what’s going on around you. Epidurals are the most commonly used form of medication-based pain relief in childbirth.

Pain-relief medication such as opioids can be injected into muscle tissue or “dripped” into the bloodstream using an infusion (a drip). This affects the woman’s whole body, not just the lower part. Opioids aren’t as effective as epidurals are, and they can cause side effects such as breathing problems. Although laughing gas (“gas and air”) is still commonly used in some other countries, it is rarely used in Germany nowadays. Sedatives are hardly used either.

Many women and couples realize afterwards that talking about the pain-relief options before the birth helped them feel better prepared – but that the actual birth was then very different to what they had expected.

Trying to imagine exactly what the birth will be like can make it harder to be flexible if things don’t go as you expected. It might seem surprising, but labor pain and pain management often end up being far less of an issue than originally thought. Many women are very satisfied with their labor and care, even if they were in a lot of pain.

Some women worry about whether other people think they’re coping well or “doing everything right” during labor. But there’s no need to worry about what others think when you’re giving birth: The only thing that matters is what works best for you and your baby. For instance, it’s totally okay to scream or wail while giving birth. The midwives and doctors have seen it all before and won't be surprised. The main thing is that you feel as good as possible, and that you deliver a healthy baby.