Managing Labor Pain During Childbirth

While most parents-to-be can't wait to meet their new baby, they might dread going through labor and delivery. And they have a valid reason—labor can be physically painful for some people.

Labor pain happens when your uterus tightens and relaxes to squeeze your baby out (called contractions). Besides intense muscle tightening throughout your abdomen and, sometimes, your entire torso and pelvic area, you may feel pressure in your back, perineum, bladder, and bowels.

"All that combines to ratchet up pain," says Jay O'Brien, MD, medical director of inpatient obstetric services at Women and Infants Hospital of Rhode Island in Providence.

Labor pain usually comes on gradually and builds up as you progress through the stages of labor. Here's what you can expect throughout the childbirth process, with tips for managing the discomfort.

What Does Labor Pain Feel Like?

People might describe labor pains as cramping, stabbing, aching, throbbing, tightening, or burning. That said, childbirth isn't a one-size-fits-all experience. Labor pain can range from mild to severe, and it changes throughout each stage of labor (and between each pregnancy), making it hard to predict exactly how you'll feel.

Many different factors can influence a person's perception of labor pain, including the following:

• The strength of your contractions
• Whether you have had Pitocin, which can cause stronger uterine contractions
• Your baby's size and position in your pelvis
• Whether the baby is faceup or facedown
• The speed of your labor
• Your personal pain tolerance and experience

A combination of life experiences and genetics determines your pain threshold, or ability to withstand pain, and this also plays a part in your labor experience. Your perception might also be altered by your social support (or lack of it), fear, anxiety, and even the positive or negative labor stories you've heard. You probably can't change your inborn capacity to withstand pain, which is why labor can be so different for everyone, even between their own pregnancies.

The Stages of Labor Pain

Again, everyone experiences labor and delivery pain differently. But in general, here are some things that you may encounter during the stages of labor.

Early labor pain

Length: Up to 6 hours (or even longer, especially for first pregnancies)

What's happening: Your cervix opens (dilates) 3 centimeters to 4 centimeters and begins to thin (efface). Typically, mild-to-moderate contractions last 30 to 60 seconds and occur every five to 20 minutes, becoming stronger and occurring more frequently with time.

Active labor pain

Length: Approximately 2 to 8 hours

What's happening: Contractions continue to become longer, stronger, and closer together, and your cervix dilates to 7 centimeters. This is when most people request pain relief with medication, though sometimes it's given earlier. (Remember, pain is very individual and there is never a "wrong" time to request pain medicine when you're in labor, so be sure to let your nurse know so they can help you stay as comfortable as possible.)

Transition labor pain

Length: Up to 1 hour

What's happening: Pain tends to be strongest as your cervix finishes dilating to 10 centimeters. In addition to intense, closely spaced contractions, you may feel pain in your back, groin, and even your sides or thighs, as well as nausea. You'll also experience more increased pressure as your baby moves down the birth canal.

Pushing labor pain

Length: A few minutes to 3 hours

What's happening: Intense pain is eclipsed by major pressure as you feel a great urge to bear down and push your baby out—some describe it as "like pooping a watermelon or bowling ball." Although pain continues, many birthing people say it's a relief to push because it helps relieve the pressure. When the baby's head crowns, or becomes visible, you may experience a burning, stinging sensation around the vaginal opening as it stretches (sometimes referred to as the ring of fire).

Placenta delivery pain

Length: Typically under 30 minutes but up to 60 minutes

What's happening: This stage tends to be relatively easy, as mild, crampy contractions ease the placenta out. For most people, the placenta is expelled easily in a short amount of time. If there are any complications during this stage, your health care team should help manage your pain as best as possible.

How to Prepare for Pain in Childbirth

Looking for ways to relieve labor pains? Some advanced preparation might help you feel better during the childbirth experience.

Attend childbirth classes. Whether you choose the Lamaze technique, HypnoBirthing, or the Bradley method, childbirth classes can teach you how to manage labor pain through natural methods.

Exercise regularly. With your doctor's approval, you should maintain a moderate exercise routine during pregnancy. This will build your strength and endurance for childbirth—and some studies show it can shorten labor duration. You can also try workouts designed specifically to prepare your body for labor.

Research pain management techniques. Gain knowledge of various pain management techniques that can get you through contractions. Think deep breathing exercises, stretches, massage, meditation, position changes, and visualization.

Decide on pain medications. When creating your birth plan, decide whether you might want pain medications during labor. There are a few options available—including analgesics, spinal block, and epidurals—so it pays to do your research.

Managing Labor Pains During Childbirth

No matter your pain tolerance, there are ways to get some relief during labor. These can be either medical or non-medical. And while there's no right option, we broke down some information about both.

Labor medication

People have different feelings about pain medication during labor. Some say "bring it on," while others wish to avoid it at all costs. Still more are open to going with the flow.

If you're on the fence, it should be reassuring to hear that epidurals and other pain-relief drugs are quite safe, says William Camann, MD, director of obstetric anesthesia at Brigham and Women's Hospital in Boston and co-author of Easy Labor: Every Woman's Guide to Choosing Less Pain and More Joy During Childbirth. "There's lots of misinformation—the risks and complications are overblown, and women suffer unnecessarily," he says.

Indeed, the American College of Obstetricians and Gynecologists says labor medications aren't shown to have long-term effects on your baby, and they don't impact childhood development down the line.

Relaxation techniques

Whether you opt for an epidural or other medication or not, using relaxation techniques can boost your ability to handle the pain, says Leslie Ludka, CNM, director of midwifery at the Cambridge Health Alliance Hospital and Birth Center in Massachusetts. "Tensing up just gets in the way of labor progress," she explains.

Rhythmic breathing, visualization, meditation, self-hypnosis, and other relaxation strategies taught in classes such as HypnoBirthing, Lamaze, or Bradley Method may help keep your mind calm and your muscles loose. Other effective techniques include massage, counterpressure, movement, walking, taking a bath or shower, and applying ice or heat.

Choosing labor pain management tactics

Whether you plan to use or avoid labor pain medications, try to be flexible. "No one really knows what they will need until they are actually having the experience," says Ludka. "Give yourself permission to change your plan whenever you need to."

Keep in mind that each birthing option has its advantages. Medicated birth can help you progress if labor becomes stalled as a result of tension, medication-free birth can carry a lower risk of interventions, and a C-section birth can be life-saving.

In the end, remember, there is no "right" way to give birth and labor is a journey that only you can go through, so you have to be your own advocate in your pain management. Always talk to your health care provider for more information.