Managing pain during childbirth

When a woman goes into labor, her womb begins to contract (tighten and loosen). As a result, the cervix gradually opens and then the baby is slowly pushed out of the womb. So contractions are a sign that the baby is on its way.

The strength of the contractions and where the pain is felt typically change as the birth progresses. At the beginning, the contractions tend to feel like period pain. They cause a stabbing or cramping pain, and a feeling of pressure. The pain might spread to your back, sides, pelvis and thighs.

Contractions come and go in waves. So labor usually alternates between phases with contractions and phases without them. The “breaks” in between are typically pain-free and often last longer than the contractions. That gives you a chance to gather strength for the next contraction.

The baby's head moves further down the pelvis as the birth progresses. For this to happen, the vagina, pelvic floor and perineum (the area between the anus and the vagina) stretch, causing the pain to get worse. It often feels like an intense stabbing or stinging sensation.

Different women experience labor pain very differently. There are various reasons for this, including the woman’s expectations, experiences of previous births, and her concerns. The important thing is to be able to place your trust in the childbirth team looking after you.

It is important to have good support throughout the birth process. This can be provided by someone like your partner, a friend, a family member or a doula. Doulas are experienced birth companions who provide emotional support and help with things beyond what's medically necessary. You usually have to pay for them yourself (they’re not covered by health insurance).

People who are there for support can give you encouragement and make you feel as comfortable as possible – perhaps by massaging your back or bringing you a heating pad.

Reliable support and understanding can help you cope better with the physical strain and pain. Research has shown that good support can help improve the experience of giving birth and shorten labor a little. It can also reduce the likelihood of needing pain-relief medication.

When helping a woman during labor, it's important to

• make sure she’s not left on her own (unless she wants to be alone) and always has someone by her side to take care of her.
• remain attentive and flexible, and focus on her needs – but also be willing to give her some space if that's what she wants.
• encourage her and reassure her that she’s doing a good job.
• make the experience as pleasant as possible for her. Little things like making sure she's warm enough or giving her a gentle massage mean a lot and can really go a long way.
• help her keep track of what’s going on and, for example, encourage her to ask questions. Or she might prefer it if you ask the midwife or doctor for her instead. It sometimes takes quite a bit of persistence to get answers from the childbirth team.

Midwives give birthing classes, where they provide detailed information about what happens during childbirth and what options there are for coping with the pain. They help expectant mothers practice things like breathing techniques, mental strategies, and body positions that can help relieve labor pain.

Midwives are well-trained and very experienced in working with women during childbirth to find the best way for them to manage the pain. They can react quickly to the changing situations and needs in labor, and explain what the options are.

Moving around, frequently changing positions, and controlled breathing can help to cope with labor pain. Together with the midwife, you can find out what makes you feel more comfortable at different times during labor – like standing, sitting, squatting, lying down, walking around, or moving your hips in a circle.

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.

If your baby’s heartbeat and your contractions are being monitored using a CTG (cardiotocograph), the wires will limit how much you can move around. Some hospitals have devices with portable transmitters, which allow you to move more.

Besides moving around, changing position and controlling your breathing, there are a number of other ways to cope with labor pain. 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 help you to relax, breathe calmly, and cope with the contractions. These techniques are taught in birthing classes, for example. Listening to music sometimes helps too.
• Taking a bath: Warm water can help you relax and make it easier to cope with the pain.
• Heating pads: These can particularly help to relieve back pain.
• Massages: Having a back massage or foot massage can relax and soothe your muscles. Your partner or another support person can learn some gentle massage techniques before the birth.
• Exercise ball: Many women use an exercise ball (also known as a Swiss ball) during pregnancy to strengthen the muscles in their back and pelvic floor. Research suggests that doing exercises with the ball during labor can help to relieve the pain too.
• Aromatherapy: Many women find the scent of essential oils pleasant. Some say it helps them to relax and feel less pain during childbirth. The oil can either be inhaled in the air, massaged into your skin or added to a warm bath. Some people are allergic to essential oils, so it’s important to talk to your medical team and support person before using them.
• Transcutaneous electrical nerve stimulation (TENS): In TENS, electrodes that send out weak electrical signals are placed on your skin. This makes your skin feel a little tingly, and may have a pain-relieving effect too. You can adjust the intensity and frequency of the electrical 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 typically uses their fingertips to apply gentle or stronger pressure to specific points on your body. Both of these approaches might help to reduce labor pain, but there’s a lack of good research in this area.
• Virtual reality (VR): This technology can be a useful way to keep your mind off the pain – for example, by going on virtual walks along the beach or in a forest. Research into the use of VR goggles has shown that they can reduce the level of pain women feel during labor. But they aren’t commonly used for this purpose yet.
• Sterile water injections: Here, sterile water is typically injected into the skin or fatty tissue on your back to relieve back pain during childbirth. Research has found that women who have these injections report less pain, but they actually need the same amount of painkillers as women who don't have the injections.

There's no scientific proof that other treatments help, including hypnosis, biofeedback and homeopathy.

Labor pain can be relieved with various types of medications.

The most effective one is a 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 labor pain relief in Germany.

If the epidural dose is low enough, you can stand up and walk around. Your legs might feel a bit numb and wobbly, though. If they do, you won't be able to get into certain positions or you might need help to do so. In addition to the epidural, you’ll be given a drip and CTG monitoring. These can affect your ability to move around too.

Pain-relief medication like opioids can be delivered directly into a vein or injected into a muscle. 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 – both for the mother and the child. Although “gas and air” (nitrous oxide) is still commonly used in some other countries, it is rarely used in Germany nowadays.

Women and couples who’ve had children often say it was helpful to know about the pain management options beforehand, but that the birth was actually completely different to what they had expected. In other words, it’s usually not possible to be fully prepared. Pain is just one aspect of the experience of giving birth. Despite the pain, many women feel that childbirth was a positive experience and they’re happy with how they were looked after.

Some women are anxious that they might not “do everything right” and that their behavior might not be appropriate – especially toward other people. 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 is totally okay to scream or wail while giving birth. It is also completely normal to pass gas or stool (fart or poop) because of all the pressure on your lower body. The midwives and doctors have seen it all before and won't be surprised. The main thing is that you feel as comfortable as possible and bring your baby into the world.