Why we have pain in labour
Pain during labour is normal. And is due to your womb tightening and relaxing. Giving you the feeling of a strong ‘period’ type pain. As labour develops the muscles in the womb shorten. The cervix (opening of the womb) stretches so your baby can be born.
Coping with your contractions
We often link pain with illness. But the pain you may experience from your contractions in labour is very different. It is a natural process as your baby is born.
During labour your body releases endorphins. Which act as a natural method of pain relief. And helps you cope with the experience. You can use a hot water bottle or simple analgesia (painkiller) such as paracetamol. As you would for a headache or stomach pain.
The difference between other pain and labour pain is that contractions come in waves. There is a resting period between the contractions. That will let you time to rest and gain energy. It helps in labour being relaxed and breathing through your contractions.
Understanding what affects pain in labour
Oxytocin is the main hormone that helps labour progress. Oxytocin keeps you feeling calm and relaxed during labour. Oxytocin production is helped by:
- A relaxed birth space
- Breathing techniques
- Antenatal education
- Birth supporter
- Keeping mobile in labour
- Eating and drinking (hydration is important)
- Massage
- Complimentary therapies
- Involvement in decision making (feeling in control)
- Confidence in your midwife
Breathing and Relaxation techniques
Breathing and relaxation is key to help you cope with labour. When we are in pain and stressed, we naturally hold our breath. Or you’re breathing increases. We tend to tense our muscles. This produces adrenaline. Which can slow labour down and make us feel less in control.
Most physical activity involves some form of control of breath. So why do we forget that in labour? Learning how to control your breathing in labour. May let you to cope with each contraction. It may be helpful for you and your birthing partner to practice breathing techniques.
Helping yourself
Relaxing in a warm bath or shower may help with your contractions. Playing your favourite music will help both distract and relax you. By giving you something else to focus on. Dim lighting can also help.
Your birthing partner can massage your back. Mostly the lower back with the heel of their hand in a circular motion. Your birthing partner can also help you concentrate on your breathing pattern.
Concentrate on your breathing pattern. Try this early in the labour. As this will be useful once the contractions become stronger. As soon as you start to feel the contraction. Take in a breath from the top of your belly. As you breathe out concentrate on relaxing the muscles. In your shoulders, belly and legs. With each breath you take, follow this pattern until the contraction eases. The midwife will also show you coping strategies in your labour.
It is important to keep hydrated and keep energy levels high. By drinking fluids and eating small regular snacks. Stay at home as long as you can as you enjoy your home comforts.
Massage
Massage techniques in labour can reduce the discomfort you feel and reduce tension. Massage helps in releasing the hormone Oxytocin. Which helps you relax.
The benefit of massage
- Reduces stress
- Supports effective digestion and breathing
- Lowers blood pressure
- Reduces anxiety
- Reduces pain and increases range of motion
- Can trigger the body’s natural endorphin production. To act as a natural pain relief
Hypnobirthing
Hypnobirthing is a unique programme of antenatal education combined with self- hypnosis. To let you to achieve a state of total relaxation during labour. Many women report shorter labours, significantly less pain, relaxation and a more positive experience. We advise you to contact a Hypnobirthing Practitioner. Who will have classes to support you and your partner with these skills? There will be a cost linked with this service.
Active birth positions for labour
Gravity helps in labour. By standing the space within the pelvis is increased. And being upright during labour. Research shows that women who move around and upright in labour have shorter labours. Experience less pain and experience quicker recovery times.
To help you find comfortable positions you may consider;
- Leaning forward over a chair and swaying your hips during a contraction
- Walking, swaying or dancing
- Using a birthing ball to sit and bounce
- Kneeling on all fours, perhaps on the bed or cushions on the floor
- Kneeling over a bean bag or birthing ball
- Sitting ‘cowboy style’ on a chair facing backwards
- Supported squatting using a birthing stool or toilet. Or standing and leaning – against the wall, over a sink or windowsill.
Water birth and using the birthing pool during labour
Relaxing in water or using a birthing pool is popular. As a good form of relief in labour. In addition to pain relief and ability to move around. Water increases relaxation. And makes birth a more comfortable and happy experience.
Water is warm and buoyant. This helps carry your body’s weight. And allows you to change position in the water. The therapeutic warm water can be helpful in labour.
Benefits
- 75% body weight is supported by the water. This conserves energy and makes it easier to rest in between the contractions
- Promotes moving
- Promotes endorphins
- Effective from of pain relief
- No side effects for baby
- A gentle transition from the womb to water for baby
- Can speed up labour after your cervix reaches 4cms
Disadvantages
- Limited availability of pools
- Not all women meet the criteria for use of the pool
- May slow labour if used too early
- Does not diminish all pain
TENS – Transcutaneous Electrical Nerve Stimulation
A TENS machine can be hired by you.
They work by interrupting pain messages to the brain. By triggering the production of your own endorphins (body’s own natural pain relief).
Four pads are placed on your back and are then attached by wires to a small unit. Which delivers pulsed waves at low intensity and low frequency. During a contraction you can press a button. To deliver a boost of high intensity and high frequency. To help cope with the greater pain.
Benefits
- You have control
- You can stay able to move around
- Does not affect the baby
- Can be used in early labour
- Can be used alongside other forms of pain relief
- Can be used without a healthcare professional
- Very good for backache in labour
- Easily removed if not effective
Disadvantages
- Not all women find it helpful
- It does not diminish all pain
Entonox (Gas and Air)
Entonox is a mixture of nitrous oxide and oxygen. Inhaled through a mouthpiece or mask. At the beginning of a contraction, you start to breathe in the gas. So that it is at its most effect at the height of the contraction.
Benefits
- You have control
- Does not affect the baby
- Its’ effects wear off quickly between contractions
- You can stay able to move around
- It will take the edge off the pain
- It can be used at a home birth
Disadvantages
- You will still feel your contractions
- It may make your mouth feel dry
- It may make you feel sick or/and lightheaded
- If used too early, the effects will wear off. For best results use later in labour
Pethidine and Morphine
Pethidine and morphine are opiate based drugs which can help you to relax. Administered by a midwife into your thigh by intramuscular injection (in a muscle).
Benefits
- Pethidine and morphine may make you drowsy. And this may let you rest for a while
- When relaxed your womb will be able to work more smoothly. And aid your progress in labour
- It may take some of the pain away
Disadvantages
- It may make you feel sick or lightheaded
- It cannot be used with the birthing pool
- It may affect the baby’s breathing
- The baby may be sleepy for a couple of days. And so breastfeeding may be difficult to do
- It is a sedative and may have little effect in advanced labour
- It will not take the pain away completely
Epidural
The anaesthetist inserts a hollow needle into the lower part of the back. Uses it to place a very fine tube near the nerves of the spine. The needle is then taken out. The tube then remains in place. To deliver pain relieving drugs throughout the rest of your labour
Benefits
- Most women get good or complete pain relief
- Women with high blood pressure may benefit. As it tends to reduce blood pressure
- It may be topped up with stronger medicine if required for anaesthetic purposes
Disadvantages
- Takes time to set up
- You may not get complete pain relief. The effect may be patchy. And the anaesthetist may need to reposition the tube if not effective
- 1 in 6 to 8 women may need the epidural repositioned
- You will be immobile. The urge to push is all so numbed
- You may require intravenous fluids to maintain your blood pressure
- You need blood pressure monitoring every 30 minutes and continuous pulse monitoring
- Your baby needs continuous fetal monitoring. You will have two straps around your belly. To attach the transducers (round discs) to monitor baby’s heart rate and your contractions
- You will most likely need a catheter tube passed into your bladder. As you may be unable to pee on your own
- You are more likely to need help with the birth. There is an increased chance an obstetrician having to use forceps or ventouse to birth your baby
- Loss of mobility. You will be less able to move around. Changing positions on the bed will still be encouraged
- You may get a headache afterwards
- You cannot go straight home. You will need to wait until the medication has worn off. And you have full strength in your legs
- You will not be able to birth in a midwifery led venue
Ten steps to successful labour and birth
- Be Confident. Many women think about childbirth with fear and anxiety. It is important to overcome this fear. By finding out as much as you can. So that you feel prepared. Make a birth plan or preference list. And make sure your birth partner and midwife are aware of these.
- Build your nest. It is important that you feel secure. So, stay at home as long as possible with your home comforts and distractions. Once in hospital take along with your things that are comforting. For example, an IPAD with photographs and music. And perhaps something like a favourite pillow.
- Get the right support. Choose your birth supporter wisely. They will be able to do and say the right things.
- Trust your instincts. Listen to your body
- Keep upright and able to move around. Labour progresses better in upright and mobile positions. Keep off the bed as much as you can. Walk around the hospital grounds, use the stairs.
- Be patient. Labour can take time. So, try various distractions such as breathing, relaxation, massage and music.
- Feel free to ask. Fear of the unknown cause's anxiety and pain. Which can be helped by understanding what is happening.
- Eat, drink and empty your bladder. It is important to have energy for labour. So, keep yourself nourished and hydrated. Emptying your bladder will protect your pelvic floor muscles.
- Welcome your baby. Welcome your baby with skin-to-skin contact following the birth.
- Feel proud of your achievement. Take time to enjoy this special moment with your baby. Before telling family and friends about the new addition.
Ten ways to be a supportive birthing partner
- Keep calm and supportive. Discuss what she wants and be aware of the birth plan beforehand.
- Help her build her nest. Discuss where she wishes to give birth. What things she wants to bring with her. You will also need to bring your own items. Including comfortable clothes, slippers, books and snacks.
- Know what to expect. Attend the antenatal classes with her. So, you feel more informed and know what to expect.
- Trust her. Help her with trying out different coping mechanisms. Let her move around.
- Be prepared to do some hard work. As you may try massage and supporting her in upright positions.
- Be prepared for surprises. Be patient as she may say things she does not mean. Offer her affection and help her relax and breathe through her pain.
- Be supportive. There may be questions she has but feels she cannot ask. Be prepared to speak up for her. Ask for answers and gently remind her of her choices and wishes
- Remember to eat and drink you may be there for a while. Remind her to drink and eat. Offer fluids and isotonic drinks and light snacks. Remind her to pee regularly.
- Get involved but know your limits. Birth should be a happy experience for you also. So, welcome your baby to the world. Ask to cut the cord if you wish. Be prepared for skin-to-skin contact when your partner is unable to do it.
- Feel proud. Greet your baby together. Feel the achievement in your support and enjoy one of life’s greatest moments.
Confidentiality
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For further information on confidentiality contact the Information Governance Team:
Information.Governance@ncic.nhs.uk | 01228 603961
Feedback
We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:
pals@ncic.nhs.uk | 01228 814008 or 01946 523818
If you would like to raise a complaint regarding your care, please contact the Complaints Department:
complaints@ncic.nhs.uk | 01228 936302