Pregnancy & Birth

Coping with Labor Pain: Introduction

When we are pregnant, most of us wonder how we will cope with the intensity and pain of labor and birth. It is useful to learn about the pros and cons of different comfort measures, coping strategies, and medications. This helps us be better prepared for decisions we will make before and during labor and birth.

Pain can vary during different times in the same labor and during different births by the same woman. Many techniques are available to ease labor pain and to help you cope with it. The techniques range from comfort measures such as walking or touch or relaxing in water, to mental strategies such as focused breathing or hypnosis, to medication such as narcotics or epidurals. This chapter covers the whole range, starting with the least invasive, nondrug approaches and ending with medication.

Planning Ahead

The pain relief methods you choose to use can affect your experience and memories of labor. Learning about the potential advantages and disadvantages of different methods, thinking about your preferences with regard to pain control, and talking with your provider and support people about what you want before you go into labor will help you make sound decisions. Many midwives, childbirth educators, and other health care professionals are skilled at helping women sort through culturally prevalent notions about pain during labor and birth, some of which are misleading and unnecessarily frightening.

While preparing is important, labor itself is unpredictable. You can’t know in advance what you will experience or what you will want or need. Your labor may be easier or more complicated than you imagine. You might plan to give birth without medication and find yourself needing greater relief, or you might plan on an epidural but find you don’t need one. A good guiding principle is to know what your options are; choose the simplest, least invasive option first; and progress to more complicated approaches only if you need them. It’s also helpful to rest as much as possible during early labor and conserve your energy, as exhaustion can diminish your capacity to tolerate pain and thus increase the need for pain medication. The support of trusted individuals throughout your labor is key to making good decisions along the way.

I was open to pain meds if I needed them, was a bit squeamish about getting an epidural, but was aiming for a nonmedicated birth if possible. At one point I did ask about narcotics, but when we checked, I was ready to push . . . so I didn’t need them!

I was determined to have a total “medical buffet” during my delivery. I’d start with Nubain and then move to an epidural and be blissfully pain free. However, when I arrived at the hospital, my OB told me that it was too late for any medical intervention and it was time to push. In fact, I had been lucky not to have had him in the car on the way. I swore at my OB so atrociously that when I returned to the same hospital three years later for baby number two, the nurses remembered me. I had to throw my “imagined delivery” out of the window and have this baby. I labored for 64 minutes in the hospital and he was born. I was swearing like a sailor and yelled at everyone within a two-foot radius, including my husband. At one point my OB nonchalantly said, “If you focused that energy on pushing, instead of yelling at us, you’d have a baby by now.” I got all huffed up at her and my husband and then my son crowned. She smiled and said, “I told you.” It was the most powerful moment of my life; I delivered him, cut the cord, and held him in my arms . . . all before breakfast.

Thinking About Pain

In everyday life, physical pain, especially intense pain, is usually a warning that something is wrong in our bodies. But the pain of labor and birth is not a sign of danger, nor is it a symptom of injury or illness. It is a sign that your body is working hard to birth your baby.

Labor pain is different from other experiences of pain in several ways. Labor pain is self-limiting— it will end when the baby is born. It is also intermittent, not continuous, which means you will usually have periods of less pain or no pain between contractions. In addition, labor pain intensifies gradually over time, and this allows your body time to adapt. These differences often make labor pain easier to cope with than other kinds of pain.

I could feel the contractions in front but the strongest pain was in my back. . . . It hurt! I spent most of this time . . . leaning on the rail . . . moaning loudly. I felt like I had to go to the bathroom with each contraction but I decided that must be birth- related, since when I tried to go nothing would come out. . . . During the contractions I needed Brian to press on my sacrum to ease the pain in my back. I also needed him to remind me that it was only pain, a physical sensation, and that it would end soon. Even more importantly, I needed him to remind me that this is what needed to happen for our baby to be born, that soon I would be holding our new baby in my arms.

Because pain and suffering often go hand in hand, we tend to think they’re the same thing. But they’re not. Pain is a physical sensation, while suffering is an emotional experience. We may suffer (feel helplessness, anguish, remorse, fear, panic, or loss of control) even when there is no physical sensation of pain. And we may experience physical pain without suffering. As Penny Simkin and April Bolding, longtime advocates for birthing women, write, “one can have pain coexisting with satisfaction, enjoyment, and empowerment.”³  By the same token, they say, suffering can be caused or increased by factors other than physical pain: “loneliness, ignorance, unkind or insensitive treatment during labor, along with unresolved past psychological or physical distress, increase the chance that the woman will suffer.”⁴

While it is commonly believed that a woman’s satisfaction with her birth experience is linked to how much or how little pain she feels, this isn’t typically so. Our satisfaction seems to be highest when we trust that we are getting good information, we are given opportunities to participate in decisions regarding our care, and our caregivers treat us with kindness and respect.⁵  In the long run, pain and pain relief seem to have less effect on our overall satisfaction than the quality of support we receive from our caregivers. Whatever kind of pain relief options we choose to use during labor, it is important to remember that pain relief alone does not address our fears, worries, feelings of helplessness, or other emotions that might lead to distress or dissatisfaction. To prevent suffering, women need more than relief of pain. We need to trust in our strength and feel cared for as we respond to labor pain, and we need humane, nurturing, confident people giving us continuous support throughout labor.

My labor felt like a marathon that lasted over two days. There were easy periods, where I sailed along (I was even able to sleep), but there were stretches when it felt like a steep, uphill climb that would never end. But just like in a marathon, you just keep putting one foot in front of the other. You don’t think about reaching the end, you just think about taking the next step. Having the support of a great midwife, my husband, and a few close loved ones made all the difference. I had such a HUGE sense of accomplishment when my daughter emerged and made her first tiny sounds. I was exhilarated by meeting such a great physical (and mental) challenge and felt I had earned a marathon “crown.”

End of Excerpt.

Endnotes

3. Penny Simkin and April Bolding, “Update on Nonpharmacologic Approaches to Relieve Labor Pain and
Prevent Suffering,” Journal of Midwifery & Women’s Health 49, no. 6 (November–December 2004): 489–504. [return to text]

4. Ibid. [return to text]

5. E. D. Hodnett, “Pain and Women’s Satisfaction with the Experience of Childbirth: A Systematic Review,” American Journal of Obstetrics and Gynecology 186, no. 5 (2002) S160–172. [return to text]

Excerpted from Chapter 11: Coping with Pain in Our Bodies, Ourselves: Pregnancy and Birth  © 2008 Boston Women's Health Book Collective.