Managing pain during childbirth

Giving birth is a physical and emotional challenge, and having good support really makes a difference. For many women, it is a relief to have someone there to encourage them and make it as comfortable as possible, perhaps by massaging their back or preparing heat packs. People like their partner, a friend or a midwife can provide this kind of support.

Reliable support makes a real difference. It not only helps women get through labor emotionally: Research has shown that continuous support can shorten labor a little and reduce the likelihood of needing pain relief.

Midwives are well-trained and experienced in finding the best way for women to cope with pain. They can react quickly during childbirth and explain what your options are. Sometimes women feel reluctant to 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. Being stressed and anxious can have effects like making your muscles tense, which doesn't make it easier to cope with pain. The traditional ways in which women have always helped themselves get through labor include:

• Getting into different positions – like sitting up instead of lying – to find the most comfortable position.
• Walking around if possible. Walking and moving around might help relieve the pain a little and make the birthing process easier, or even speed it up.
• Trying out cold or heat packs. This can relieve pain – and especially the back pain that often accompanies labor pains.
• Breathing calmly and consciously, or trying out special breathing techniques.

The position of a woman’s body is particularly important in labor. If, for instance, the baby's head is pressing too deeply against your back, changing position can usually relieve the pain and make it much easier to push. And if the baby moves or changes position, you can respond by changing your position until it feels better.

Childbirth classes teach techniques that can be used to take advantage of gravity during labor. Some people swear by particular positions or breathing techniques. Different women will find different things to be helpful – something that makes the birth easier for one woman might only help a little, or even make things less pleasant, for another.

For many women, labor pain is different from other painful experiences. This is partly because it is “pain with a positive goal” and because they know it will definitely end quite soon. Finally holding your baby in your arms at the end of it all is an enormous reward for all the effort.

There's a lot of advice out there about how to relieve pain during childbirth without using medication. But only a few of the commonly recommended measures have proven to be effective in studies. These include:

• Relaxation techniques and yoga: Studies suggest that some women feel less pain while giving birth if they do relaxation exercises. Techniques like progressive muscle relaxation, or breathing exercises and movements taken from yoga, can help distract women from the pain, relax their muscles, and help them breathe more calmly.
• Bathing: Relaxing in a warm bathtub, shower or whirlpool can help reduce the need for pain-relieving medication in some women. 
• Massages: Having a back or foot massage can relax and calm your muscles. Your partner or another person who will accompany you during the birth can learn some gentle massage techniques beforehand.
• Exercise ball: During pregnancy, many woman use an exercise ball to strengthen their back muscles and train their pelvic floor. Research suggests that doing exercises with the ball can help relieve labor pain too.

There is no scientific evidence that the following methods help:

• Acupuncture: In acupuncture, thin needles are inserted into the skin at specific points on the body to relieve pain. Because the needles stay in the skin, they can make it harder to move about during the birth. Previous research has led to contradictory results.
• Hypnosis: Hypnosis aims to help people relax and achieve an inner state of maximum concentration. When in this state, your own perception of things like pain can be influenced by what someone else tells you. Self-hypnosis is also possible, by repeating certain instructions to yourself. Previous studies on the effectiveness of hypnosis aren't reliable enough to be able to say whether it can relieve labor pain.
• Transcutaneous electrical nerve stimulation (TENS): In this approach, electrodes that send out small electrical impulses are taped to the skin, causing a mild tingling sensation. Women can adjust the intensity and frequency of the impulses themselves. The theory behind it is that these impulses override the pain signals, so that you feel less pain. Based on previous studies, there is little evidence that TENS actually influences pain sensation. There were no side effects.
• Biofeedback: This relaxation technique involves using a computer to make it possible to see or hear different signals from your body, such as your pulse or breathing rate. This way you can also see how your own body responds to pain or anxiety. The aim is to then relax your body by consciously focusing on reducing these signals. This has not been proven to be effective during childbirth.

There is also no evidence that women feel less pain when listening to calming music or sounds, or if they use aromatherapy, homeopathy or have acupressure.

Having someone there to support you during childbirth can be helpful in many ways. The following things are essential for good support:

• Make sure that the pregnant woman is not left alone (unless she would like to have some time alone): It can make a big difference if you feel that someone you are close to is there to help take care of things.
• 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, for instance by saying how well she is doing everything.
• Try to make things as comfortable as possible for her: All of the “little” niceties make a big difference and can really help make things easier – like having someone show understanding or care, being kept warm or being given a gentle massage.
• Help her keep track of what's going on: Encourage her to ask questions. Or she might want you to ask the midwife or doctor for her instead.

Childbirth can, of course, also be so overwhelming for the person accompanying the woman that they feel helpless and need some support themselves. And hospitals don't always allow partners or other people to accompany women in every stage of the birthing process. It might help to discuss this with the doctor or midwife before the birth, so that there are no surprises.

Some people might worry about dealing with seeing the woman in so much pain, or how they might react to seeing so much blood. But during the actual birth, they often find it easier than expected to focus on her, and block out other things happening at that moment.

It could also be helpful to talk to each other beforehand about what to do in an emergency. The person accompanying the pregnant woman might need to make some decisions, especially if the woman needs a Cesarean section and is given a general anesthetic. Knowing what's important to her can help make it easier to make better decisions when the time comes. By taking a childbirth class together, couples can learn about many things that could be useful when making those kinds of mutual decisions.

Many women and their partners realize afterwards that talking about the pain relief options helped them feel more ready for the birth, but that the actual birth was then very different to what they had expected.

Trying to imagine exactly what the birth will be like isn't very helpful: Doing so can make it more difficult to be flexible in unexpected and changing situations. It might seem surprising, but in the middle of labor, things like pain and pain management are often far less important than might be expected. Many women are very satisfied with their birth and care, even if they were in a lot of pain.

Some women worry far too much about whether other people think they are coping well or “doing everything right” during labor. But when you are giving birth, it's not important what others think: The only thing that matters is what works best for you and your baby. For instance, screaming or wailing during the birth is completely acceptable. The midwives and doctors will have seen it all before and won't be easily shocked. The main thing is that you feel good, and that you deliver a healthy baby. You can do whatever you feel like doing to make the birth easier for you.