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Info Centre - Working with pain in labour

Pain in labour

Giving birth is a natural process and even if you haven’t spent the past nine months reading medical textbooks, your body and your baby know exactly what to do. That’s why although your baby isn’t ticking off the days on a calendar, he or she can tell when it’s time to be born.  

And when that day arrives, your baby sends a signal – the hormone, oxytocin - across the placenta that triggers contractions and keeps them coming. Alongside oxytocin, another substance, prostaglandin, gets to work, softening the neck of the womb (the cervix) so it can open up (dilate) to allow your body know how to make labour happen.

Your body also knows you need to cope with pain, so it produces its own painkiller. Endorphins not only limit pain but lower stress and have a feel good factor too. The pain of labour however has a very important function, giving you important clues about ways of moving and positions that may help the baby turn and move down inside the pelvis. It can also let you know how your labour is progressing.

Labour is complex, but your body is in control. You just need to let it do what comes naturally. The problem is that fear upsets this amazing process.

In fact, fear makes you release another hormone altogether – adrenaline – which slows down the production of oxytocin and prepares your body to fight or run away (not helpful when you’re trying to give birth). In this state of tension and alertness (and strange environments such as modern, busy labour wards full of unfamiliar people can unfortunately give rise to these kinds of feelings) your contractions are less efficient and you focus on the pain and feel worse. So staying calm is the key to coping with pain. To help you feel relaxed, read up on what happens during labour, choose a place to give birth where you feel safe, and have a birth partner you know and trust. Practice relaxation techniques learnt in antenatal classes or from a book or CD frequently so they become almost second nature.

Working with pain in labour

Labour can last a long time, so at the beginning try movement, upright positions, massage, water…

If you head straight for maximum pain relief you’ll never discover how other things can help – plus your labour may end up being even longer. If you do feel you can’t cope, you can move up through the options. If it feels really tough, ask your midwife how you are getting on. Positive encouragement – knowing you are coping really well and making good progress – can make all the difference. 

The following tips have been found useful by women in labour:

  • Before labour spend some time imagining being 15 minutes after the birth with your new baby in your arms and that all is well. Imagining that you did it, and that you did it as you wanted, creates a positive picture to focus on in labour.
  • Moving about helps labour to progress and women have said they were better able to work with the pain while rocking and leaning forwards (the pressure of the baby’s head on the cervix will promote the release of oxytocin as well as endorphins - the body’s natural pain relievers). Focus on letting go and relaxing any muscles that aren’t needed to hold you in position
  • Focus on the out breath during a contraction. Keep the breathing calm and rhythmical
  • Make a noise if you want to – be somewhere with people that are happy for you to moan, grunt, sigh or even swear if that helps.
  • Belly-dancing, hip-wriggling and stepping movements all help your baby settle into a good position to be born
  • Massage or pressure on the lower part of your back just above the top of your bottom can help
  • Water helps women relax and move more easily; being in a pool can give women a feeling of safety and security
  • Positive, affirmative thoughts and supportive comments from labour companions help to promote confidence in the process: ‘You are doing well – your body is made for this – feel the power of your body – your body knows how to do this- each pain is progress’; ‘I’m already 3 centimetres dilated - my body is working well, in the way it is meant to’.
  • During labour, think about welcoming each contraction. As your contractions become stronger, longer and closer together your body is getting ready to give birth
  • Rest, relax and conserve energy between contractions as labour progresses.
  • Have confidence in your own self-help resources
  • Acknowledge that labour is unpredictable and that uncertainty is difficult to go along with. Try to let go and let things be patiently. It’s like falling in love – you can’t make it happen – you have to get the conditions right then go with the flow
  • Recognise the point at which it feels worst – when you have had enough is often the point just before you are ready to start pushing your baby out
  • Have people with you who help you feel strong and capable – and will be empathic and sympathetic but do not want to do it for you or take the pain away for you.
Types of pain reliefTo help you make the choice that is right for you, you need to find out the pros and cons of each type of pain relief.

Position and movement

Gravity is powerful, so go with it. Staying upright (for example, standing or kneeling) keeps labour hormones flowing and gives your baby maximum room to manoeuvre. You can lean forward to rest your weight on your partner, a bean bag, or any convenient surface at the right height. Movement – walking, swaying – also lends labour a helping hand.

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Maximises your body’s ability to give birth.

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No downside – you’re doing what comes naturally. 

Water

Water soothes pain and, in a large birthing pool, enables you to glide into any position. A hot shower on your back or a warm bath at home can help too. (You may want to block your bath’s overflow so the water’s as deep as possible, but watch the taps!)

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Drug-free.

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Water’s great, but sometimes it can slow down labour, particularly if you get in too early. Also make sure the water feels warm but not hot. 

TENS

A TENS machine transmits mild electrical impulses to pads on your back. These block pain signals and help your body to produce endorphins.

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Many mums find TENS helpful, especially in early labour.

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It is less effective in established labour. You also won’t be able to use it in water.

Complementary therapies

Various therapies are available – acupuncture, aromatherapy, homeopathy, yoga, self-hypnosis and massage. On the whole, little research has been done, but studies show acupuncture is helpful and the results of massage are promising.

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Your birth partner may help with massage. (Find a registered practitioner for other therapies).

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Though many mums find some therapies help, there is little research to show what is most helpful. With many therapies you may need someone else to apply it to you. 

‘Gas and air’ (Entonox)

Breathed through a tube or a mask, this 50:50 mixture of nitrous oxide and oxygen takes 20–30 seconds to take effect. It takes most women a few contractions to get the hang of it, so don’t give up after one contraction. It makes you feel light-headed, so although it doesn’t remove the pain, it makes you less aware of it.

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You control when and how deeply you breathe, and the effects wear off once you stop inhaling. Most women find it really helps.

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It may make you feel sick and light-headed initially, before you get used to it, but this usually passes. 

Pethidine

This strong morphine-like analgesic is given by injection. It doesn’t alter the pain as it is not an anaesthetic. (Other opiates such as meptid, diamorphine and morphine may be offered, especially in Scotland.)

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Pethidine changes awareness and may help you to relax.

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You can’t control it. Once you’ve had the injection the effects last for up to four hours, so if you don’t like the sensation  you can’t do anything about it. Pethidine passes through to your baby, and can make babies slower to breathe at birth. If you take pethidine, your baby may also stay sleepy for several days, making breastfeeding harder to establish. For mums, pethidine may make you feel out of control, and make you feel sick. Opiates vary in their effectiveness and the extent to which they may make you feel sick. 

Epidural

A local anaesthetic is injected into the space between two vertebra in your back. The local bathes the nerves in that area usually removing all pain and most feeling from the waist down.

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It gives total pain relief in 90% of cases; partial pain relief in the remainder.

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Depending on the mixture of drugs used, your labour may slow down as you’ll be less able to move around and you won’t feel the contractions or – later on – the baby moving down so there is an increased chance that you will need forceps or suction (ventouse) to help your baby out.

You’ll also need to be constantly monitored, you may have to have a catheter inserted to empty your bladder (as you won’t feel when you need to wee) and have a drip to stop your blood pressure dropping. Some low-dose (mobile) epidurals now contain less anaesthetic but a mixture of drugs which can cross the placenta and can make the baby sleepy. 

Remember every labour is different and each woman should be able to choose whatever she needs to help her work with the pain of labour. ·        

  • Find out as much as you can about this amazing physiological process that is labour
  • Trust your own body and rely on your own self-help resources 
  • Have supportive carers around to encourage you and minimise the fear  
  • Remember each contraction is taking you closer to your baby. Just focus on one at a time.

Page lasted updated 2008.