The end of your pregnancy comes with plenty of gain (you get a baby when you’re done!) but also, plenty of pain. There’s no getting around the fact that, no matter how you give birth, labor hurts.
The bright side, of course, is that there are plenty of ways to manage the pain, from taking pain and numbing medications to utilizing alternative therapies. (And in more and more cases, employing a combination of both!) All of these options have the potential to be effective and ultimately create a more comfortable, enjoyable birth experience.
Settling on the right option (or options) might not happen overnight. In fact, it’s worth talking through your thoughts about managing labor pain with your doctor or midwife.
That all starts with knowing what’s available, how the treatment or therapy works, and how you can expect it to help you. From the epidural to hypnobirthing techniques, here’s an overview of your labor pain management options.
How painful is childbirth?
Here’s the truth: Many women say that childbirth is the most painful thing they’ve ever done. But don’t let that scare you. Unlike most severe pain — say from a kidney stone or a broken bone — you get the most incredible reward at the finish line. So incredible, in fact, that plenty of moms willingly go through the whole experience again (and again, and again)!
Contractions are often described as a feeling of cramping or pressure in your abdomen and pelvis that grows more and more intense as labor progresses. As the baby’s head starts to emerge and the tissues around your vagina stretch, the sensation can become more of a deep burning.
That said, the particulars of the pain are different for everyone. How your labor feels for you will depend on your body, the details of your pregnancy, your threshold for tolerating discomfort and of course, whether you opt to use medications or alternative strategies (or both) to manage the pain. And you won’t really know how it will be for you until you go through it.
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Every woman — and every labor — is different. Some women find the experience to be less painful than they expected, while some find it more painful. Many of those in the latter category who might have planned to forego pain meds opt to take them partway through labor. There’s nothing wrong with changing your mind or the details of your birth plan.
Bottom line? There are lots of options for managing your pain during labor, and ultimately, there’s no right or wrong choice when it comes to picking a therapy or treatment.
Complementary and alternative medicine therapies for labor pain
Everyone wants their labor to be as comfortable as possible, but not all moms-to-be want pain medication — some hope to deliver with little to no medications or interventions.
Whether or not you're hoping for an unmedicated birth, however, you might consider complementary and alternative medicine (CAM). CAM involves the use of drug-free therapies to reduce pain or manage health conditions. In the case of labor pain management, CAM typically consists of mind-body practices rather than herbal treatments or supplements.
CAM can be used either as an alternative to pain medication, or as a relaxing supplement to it.
Even if you’re sure that there’s an epidural with your name on it waiting at the hospital, you may want to explore the world of CAM, too. (And to explore it well before your due date, since many of the techniques take practice — or even classes — to perfect.) After all, the more pain management tools you have to choose from in your toolkit, the better!
Your doctor or midwife can help you explore your options and find the right techniques for you. Just remember to go only to CAM practitioners who are licensed and certified, not to mention have plenty of experience with pregnancy, labor and delivery, and to get the green light from your provider before trying a CAM therapy.
Breathing techniques
What they are: Controlled breathing techniques often involve slow, deep breathing and faster, shallower breathing employed at strategic points during labor. They were first made popular via the Lamaze and Bradley Methods, which plenty of women and their partners still use today. Many moms-to-be opt to learn the techniques in-person at a childbirth class, but you can also practice at home with books or virtual classes.
How they can help: Slow, deep breathing can help ease stress and promote feelings of calm and relaxation. And when done with a partner, they’ve been shown to help ease the perception of pain during labor. While specific techniques like Lamaze and Bradley exist, research suggests that there’s no one “best” breathing method. As long as you’re practicing consciously, any form of deep breathing can be helpful, especially when you pair it with other comfort strategies.
Acupuncture and acupressure
What they are: Two therapies used in traditional Chinese medicine, acupuncture and acupressure involve stimulating invisible paths or meridians at prescribed points on the body. According to ancient practice, the paths are the channels through which qi, the body’s life force, flows. Acupuncture can involve inserting dozens of thin needles. Acupressure (or shiatsu) works on the same principle as acupuncture, except that instead of needles, your practitioner will use thumb or finger pressure, or will apply pressure with small beads, to stimulate the points along the meridians.
How they can help: Researchers have found that acupuncture points correspond to deep-seated nerves, so that when the needles are twirled (or electrically stimulated, in a procedure known as electropuncture), the nerves are activated, leading to the release of endorphins — and pain relief. Acupressure on the center of the ball of the foot is said to help back labor. Plenty of studies have been conducted on both, and there’s good evidence to suggest that the therapies can make labor pain less intense and possibly even reduce the need for conventional pain medications.
Reflexology
What it is: This CAM therapy is similar to acupressure, except the pressure is applied only to the feet and sometimes the hands (and ears). Certified reflexologists believe that the internal organs — including the uterus — can be accessed through points on the feet.
How it can help: According to some, labor can be shortened dramatically with the aid of a reflexologist. Some of the pressure points are so powerful, reflexologists say, that you should avoid stimulating them unless you are in labor, because you might trigger contractions. However, there’s not much quality evidence showing reflexology as useful for relieving pain.
Transcutaneous electrical nerve stimulation (TENS)
What it is: In TENS, electrodes are placed on the skin and deliver low-volt electrical pulses. The pulses are believed to stimulate nerve pathways to the uterus and cervix, blocking pain. TENS is widely used in Scandinavia, the United Kingdom and other parts of Europe, and also in Canada, but isn’t common in the United States (although more and more hospitals are making it available to laboring women). The electrodes are placed not on the uterus but on either side of the spine, at about mid-back level. The mother-to-be is given a handheld switch to set off the electrodes; the intensity can be controlled by a dial on the TENS machine. The pulses are said to feel like a slight buzzing.
How it can help: Scientists are still uncertain of the effectiveness of TENS at reducing labor pain. But a recent review of the evidence suggests that using TENS on acupressure points is likely to reduce severe labor pain and increase a woman’s satisfaction with her labor experience. Using TENS on the lower back doesn’t seem to be as effective.
Physical therapy or massage
What it is: Just what it sounds like – massage techniques, employed either by a loved one or a professional – to ease discomfort and soreness. Massage is often used to help women get through contractions.
How it can help: Massage can bring relaxing relief and can help diminish pain (just be careful where you get massaged; your uterus — and baby inside — should not be massaged). If you’re experiencing back labor (in which the back of your baby’s head is pressing against your sacrum) you can try as many physical therapy tricks as you can to ease your aching back, from a hot water bottle wrapped in a towel or hot compresses, to ice packs, to intense counterpressure on the sore spots (have your partner press his palms or knuckles — or even tennis balls — into your back).
Hydrotherapy
What it is: Hydrotherapy is the fancy name for massage treatments that employ the power of water. During labor, that can mean soaking in a jet-powered hot tub or even running a warm shower head or hot compress on your back.
How it can help: Hydrotherapy seems to reduce pain and definitely relaxes women during labor — which is why many hospitals now provide Jacuzzi tubs. (If you’re laboring in a birthing center, you’ll likely find a tub, which some women choose to deliver their baby in; if you’re at home, you can use your own). A caveat: Keep the jets of water directed away from your vagina (you don’t want to force water inside) and make sure the temperature is warm instead of hot (you need to keep your body temperature in a safe range).
Hypnosis
What it is: More and more women these days are seeking the help of a medically certified hypnotherapist (you should make sure they have these credentials) to train them to get through labor by self-hypnosis; sometimes, you can have a hypnotherapist with you during the process. One big benefit of hypnotherapy (sometimes called hypnobirthing) is that while you’re completely relaxed, you’re also completely awake and aware of every moment of your baby’s birth. There are also no known physical effects on the baby (or on you). It’s not something you can just start when that first contraction hits; you’ll have to practice quite a bit to be able to achieve total relaxation, even with a certified therapist at your side.
How it can help: Hypnosis usually won’t mask your pain (unless you’re very suggestible), numb your nerves or quell contractions. What it can do is get you so deeply relaxed (some women describe it as becoming like a floppy rag doll) that you are totally unaware of any discomfort — your mind is separated from the sensations. (Sort of like when you get engrossed in a good book and don’t hear the telephone ring.) Hypnosis isn’t for everyone, though; some people are highly resistant to hypnotic suggestion.
Medication for labor pain
Pain-relieving drugs and anesthetics, substances that cause some loss of sensation, have long been the most common form of pain relief medication for labor and delivery.
These meds aren’t cure-all — even with an epidural, you’ll still feel a sense of pressure while you labor. But many women find that a pain reliever or anesthetic helps to take the edge off and make contractions and pushing more manageable. Experiencing less pain can help some women get more rest between contractions and feel more relaxed overall.
Epidural
What it is: This anesthetic is injected directly into the spine, so it bypasses the bloodstream — making it safer for your baby. It’s the pain relief of choice for about two-thirds of all laboring women delivering (both vaginal and cesarean) at hospitals. An anesthesiologist inserts a thin catheter into your back to deliver the anesthetics. It could take 15 minutes (or longer) for them to kick in, but they can be given to you as soon as you ask — no need to wait until you’re dilated a certain amount. You’ll also have a catheter inserted into your urethra (the procedure causes you to lose lower body sensation, so you’ll have no idea when you need to pee).
How it makes you feel: Once the epidural starts working, your entire lower body will feel numb, including the nerves of your uterus — so you won’t feel the pain of contractions (you’ll note the tensing of your uterus and some pressure). Some women have trouble pushing on an epidural; others report no trouble. Afterward, you might feel cold, experience numbness on one side of your body, and you’ll be a bit rubbery-legged.
Spinal block
What it is: These regional blocks, which are rarely used for vaginal birth these days, are regional anesthetics generally administered in a single dose just prior to delivery (in other words, if you didn’t have an epidural during labor but want pain relief for the delivery, you’ll get the fast-acting spinal block). Like an epidural, spinal blocks are administered with you sitting up or lying on your side while an anesthetic is injected into the fluid around the spinal cord. The spinal block is often used for cesarean delivery, though it can also be used in a vaginal delivery.
How it makes you feel: As with an epidural, you’ll be numb and may feel queasy afterward. With a spinal, you’ll have to stay flat on your back for about eight hours after delivery.
Pudendal block
What it is: Occasionally used to relieve early second-stage labor pain, a pudendal block is an anesthetic usually reserved for the vaginal delivery itself. It’s useful when forceps or vacuum vaginal extraction is used. It’s injected through a needle inserted into the perineal or vaginal area.
How it makes you feel: A pudendal block reduces pain in the injection area but not uterine discomfort — so you’ll still feel the full force of your contractions.
Nitrous oxide (laughing gas)
What it is: Also called laughing gas, nitrous oxide is a colorless, odorless gas that's usually mixed 50/50 with oxygen for women during labor, administered through a mask that you breathe in. Nitrous oxide used to be more common in the U.S. before the epidural became the gold standard for labor pain relief in the 1970s, but it has remained popular in countries like Australia, Canada and the UK — and in more recent years, nitrous oxide has again become more common in U.S. hospitals.
How it makes you feel: Nitrous oxide won't completely numb your body or prevent you from feeling pain. But it will help you disassociate from the pain so you feel more relaxed and less anxious.
Tranquilizers
What they are: If you’re extremely nervous or anxious, you might need a tranquilizer (Phenergan or Vistaril are common) to get through labor and delivery — especially if anxiety is stopping the progression of labor. You’ll usually only receive a shot of tranquilizer once labor is well-established, and well before delivery (though they are occasionally used if anxiety is slowing down the progress of labor).
How they make you feel: As with analgesics, the effects will vary from person to person — and, of course, depend upon dosage. Low doses might make you pleasantly drowsy; high doses could cause you to drop off to sleep between contractions. Although the risks to baby are minimal, most practitioners prefer to stay away from tranquilizers unless they’re really necessary.
General anesthesia
What it is: General anesthesia, which can be inhaled or given intravenously, involves being fully unconscious and unable to move, while regional anesthesia blocks pain to part of the body while a woman remains awake. Though it’s extremely safe, it is as extreme as it sounds — which is why it isn’t used today for childbirth unless an emergency cesarean is required and there’s no time to give a regional anesthetic (like a spinal block). It can also be required in a difficult vaginal breech birth, to deliver the baby’s head.
How it makes you feel: Expect to be totally knocked out for the entire birth (usually a matter of minutes). You’ll wake up groggy, disoriented, perhaps restless and with a sore throat from the endotracheal tube (used to ensure that you don’t breathe the contents of your stomach into your lungs). You’ll also probably be rather queasy and may vomit, and you’ll have sluggish bowel and bladder movements. The effects vary from person to person. Just as you’re sedated temporarily, your baby will be too (temporarily). To reduce the effect, the anesthesiologist will try to put you out very close to your actual delivery, reducing the amount of drugs that get through your system and into the baby. The doctor might also tilt you to your side or give you oxygen to get more oxygen to your baby, minimizing the drug’s temporary effect.
Ultimately, can choose an unmedicated labor, opt for medications, or you may decide that a combination of traditional and CAM techniques will work best for you. So do your research, talk to your practitioner and keep in mind that you don't just have to choose just one.
Remember, too, that not all forms of pain relief may be offered at your hospital or birthing center, so ask your practitioner ahead of time what your options are.
Most important? Approach the idea of pain relief during labor with an open mind. After all, giving birth for the first time is a brand-new experience, and you can’t know exactly how you’ll feel until you’re actually doing it.
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