Labor Pain

Sources of Pain

At the most basic level, labor is a physiological process the mother completes to get her child out of her body and into her arms. As such, there are a wide variety of factors that contribute to the way this physiological process feels to the mother and how she perceives the sensations. To help you understand, let us think for a moment about a physiological process you are more familiar with, digestion.

The process of digestion requires several organs, a large percentage of the body and can produce a wide variety of pains. When all is working well, the discomforts you feel from an empty stomach or full bladder are gentle indications to you of your body's needs. When all is not well you may feel pressure, muscle constriction, muscle spasm, nausea or even damage to the tissues of your mouth such as a burnt tongue.

The process of labor uses fewer body parts than digestion, but can produce just as wide a variety of pains. Like digestion, the intensity of the sensations felt by a mother can range from gentle indications something needs to be done to pressure, muscle spasm or even tissue damage in rare instances.

With digestion, the behavior of the person can affect the level of comfort. Eating known triggers can cause heartburn and decrease comfort. Eating high fiber foods can improve the functioning of the digestive system and therefore increase comfort. The laboring mother has a similar ability to affect the level of her comfort. Changing positions is commonly known to increase comfort, while lying on the back is known to decrease comfort.

While there are some factors the laboring mother can control, such as what position she is in, there are other factors affecting her discomfort she is not able to control. With digestion some women are not able to tolerate certain foods or are prone to heartburn. With labor, some women are slower to produce hormones necessary for the process and other women have narrower pelvises requiring a larger stretch. Additionally, labor comfort is affected by the position of the baby, amount of rest the mother has had, the mother's overall health and the mother's confidence. Because of this, different women can go through the same process of labor and experience different sensations.

Understanding all that, here are the commonly accepted theories for the physical sources of pain in childbirth, and theories about how they can be overcome (where possible). Please remember the extent to which these cause pain in labor varies from woman to woman and from labor to labor.

The Uterus

During contractions, the blood flow to the uterus is blocked. This deprives the uterine muscle (and the baby) of oxygen for a few seconds. As the contractions become longer and closer together, the blood flow is blocked for longer amounts of time and more frequently. Muscles use oxygen to operate effeciently. When oxygen is not available muscles use a different mechanism tht causes a build up of lactic acid, therefore the decrease in oxygen to the uterus may be a source of pain. Allowing the uterus to relax completely between contractions will allow the highest level of blood flow to the uterus. Help the mother use relaxation exercises to help improve the oxygenation and avoid using labor stimulants such as oxytocin which give unnaturally long and frequent contractions.

The Cervix

During labor, the baby's head puts pressure on the cervix and stretches it open. Keeping the bag of water intact as long as possible helps to equalize the pressure on the cervix, opening it evenly and avoiding high pressure areas.

Surrounding Tissues

The ligaments, nerves, muscles and joints surrounding the uterus are stretched and may be exposed to pressure during labor. Use position that minimizes pressure and use relaxation to keep muscles soft and flexible to move with contractions.

Pelvic Pressure

The pelvic floor, bladder, rectum and urethra are put under pressure during labor. Use positions that increase the size of the pelvis and decrease pressure on the pelvic floor. Keep the bladder empty to minimize pressure.

Stress Hormones

The body's natural response to stress, anxiety and fear causes the uterine muscle to work to constrict the cervix, causing unproductive contractions and increasing pain. Prevent the release of stress hormones by being prepared for labor and using relaxation techniques to stay calm.

Unnecessary Pain in Childbirth

There are things women do during labor that actually cause the pain to be intensified. Unfortunately, many women do not know what these things are. Understanding how they affect your labor can help you in preventing labor pain.

Tension

If you are skeptical of this, try it while you labor. During one contraction, do whatever you want, tensing your muscles. Then, during the next contraction actively relax your muscles. You will feel a difference.

Paying Attention Too Soon

Many women become obsessed with timing contractions from the very first contraction. For some, there is a fear that if you do not pay attention, you may miss something. Some of the signs of progress in labor can be subtle, but you will not miss the major signs. When contractions begin, ignore them and go about your day for as long as you can. When the contractions demand more attention, give them only as much as they demand. Contractions will demand your full attention by the time you are in good active labor, which will require a lot of energy. Don't waste your energy by paying attention too early.

Lack of Sleep

A tired body is less able to deal with the stress of labor, causing everything to "feel" more even though your body is not doing more work. Be sure to get plenty of rest in the days leading up to your labor. When contractions begin, don't be afraid to take a nap. I promise you will NOT sleep through the birth of your baby. If you have the luxury of a slow starting labor, use the early mild contractions to get some sleep.

Thirst

If you do not take sips of water or juice between your contractions, you stand a good chance of becoming dehydrated. When your body is dehydrated, your muscle output is decreased by 30%. That means that your uterus will contract just as hard, but it will do 30% less work. Dehydration also heightens feelings of exhaustion and can elevate your temperature. If your temperature goes up, your medical team, intent on ensuring your baby is healthy, will assume this "fever" is caused by an infection and you may begin to receive antibiotics via injection or IV (which is a pain in and of itself).

Hunger

Your body uses food as its energy source. If you are not eating during labor, you are depriving your body of energy it needs to labor. Many hospitals now allow you to eat during labor. If your birthplace does not allow eating, understand that most women lose their desire to eat during active labor, so simply stay home until your desire to eat is gone.

Need to urinate

There will be a lot of activity going on in your pelvic region. During active labor you may not be able to distinguish the need to urinate from the other pressures you feel. Your uterus will put pressure on your bladder as contracts, so the best way to prevent pain from an over-full bladder is to urinate frequently (at least every two hours).

Performance Anxiety

Also known as going to the hospital too soon. Some women believe that if they can just get to the hospital, everything will happen faster. That is not true. In fact, the move to the hospital can actually be stressful enough to temporarily slow down or stop your contractions. Waiting until you are in good active labor can help prevent this. Being in the hospital too early makes the labor seem slower than if you had stayed at home and busied yourself with your life. Having nurses and doctors checking on you can make the "seeming slow" labor seem even slower, causing the mom to feel that she has to perform better, labor must get moving. This anxiety can be enough to send some women into the fear/tension/pain cycle.

Lying on your Back

When you are on your back, the contracting uterus has to move "up" against gravity, which is much more work than simply moving forward. Also, you can constrict the blood flow to the heart, causing you to be light-headed. Staying off you back can help in preventing labor pain.