Managing pain during labor

April 25, 2014 Erin M. Hurley Waters

One of the most common concerns women have during their pregnancy is how to manage pain during labor and delivery.  Labor pain may be more or less intense than you expected, or may hurt in a different way. It is hard to predict how any labor will go or how anyone will respond to pain.

Labor pain is due to contractions of the muscles of the uterus and by pressure on the cervix. This can feel like strong cramping in the abdomen, groin, and back. Some women experience pain in their sides or thighs as well. Women can also feel pressure on the bladder and bowels by the baby's head and the stretching of the birth canal and vagina. Some find the hardest part is not the contraction itself, but the fact that the contractions keep coming.  

One of the best ways to alleviate fears for women is to learn about the available strategies for coping with pain. There are both medical and non-medical tools that may be a good match for you.

While you are deciding, think about what appeals to you most. Ask your health care provider these questions:

  • What's involved in the method?
  • How will it affect me? Will I be able to walk, or will I be confined to bed?
  • How will it affect my baby?
  • What are the possible side effects?
  • How quickly will it work?
  • How long will the pain relief last?
  • Can I combine it with other methods of pain relief?
  • When during labor is the method available?
  • What if it doesn't work?
  • Will I remember everything?
  • Will I be able to breast-feed my baby after delivery?

Here is a list of some strategies women use who want to avoid medication. You may have to learn some of these techniques (*) weeks before you are in labor:

  • Prenatal physical therapy*
  • Hypnosis*
  • Prenatal yoga*
  • Meditation*
  • Walking
  • Massage or counter-pressure (by your partner and/or support person)
  • Changing position
  • Taking a bath or shower
  • Listening to music
  • Distracting yourself by counting or performing an activity that keeps your mind otherwise occupied 

Medical management of labor pain includes two options:

Analgesics.  Medicine can be given intravenously (through an IV) or through a shot into a muscle and can affect the whole body. There may be side effects in the mother, including drowsiness and nausea. They work quickly, but the effect does not last long. These medications can make the baby “sleepy” if given close to delivery. We do not offer this medication once you are beyond a certain stage in labor to prevent this side effect.

Regional anesthesia. This is what most women think of when they consider pain management during labor. Regional anesthesia blocks the feeling from specific regions of the body. This method can be used for pain relief in both vaginal and cesarean section deliveries, if necessary.

Epidurals, a form of local anesthesia, relieve most of the pain from the entire body below the belly button, including the vaginal walls. An epidural involves medicine given by an anesthesiologist through a thin, tube-like catheter that's inserted in the woman's lower back. The amount of medication can be modified according to a woman's needs. Very little medication reaches the baby, so usually there are no effects on the baby from this method of pain relief.

Epidurals do have some drawbacks — they can cause a woman's blood pressure to drop and can make it difficult to urinate. They can also cause itching, nausea, and headaches in the mother. The risks to the baby are minimal, but include problems caused by low blood pressure in the mother.


Remember, birth is not a contest in how much pain you can tolerate. You have not failed if you decide to ask for help or if you end up using a technique that you had not planned on using. Your ability to endure the pain of childbirth has nothing to do with your worth as a mother. By preparing and educating yourself, you can be ready to decide what pain management works best for you.

Talk about your plan for pain relief before you go into labor. Review your plan with your health care team when you arrive at the hospital. Remember, you're free to request pain relief at any point during labor and delivery. Trust your health care team to provide you with information about your options as your labor progresses — and trust yourself to make your own choices when it comes to pain management.

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