Introduction

We hope that this leaflet will help you understand why you have pain in labour and give you some helpful suggestions to help you manage through your birth experience.

Why we have pain in labour

Pain during labour is normal and is due to “waves of contractions” as your womb tightens and relaxes, giving you the sensation of a strong ‘period’ type pain.  As labour develops the muscles in the womb shorten and the cervix (opening of the womb) stretches to allow your baby to be born.

Coping with your contractions


You will have probably developed ways of coping with your contractions such as a hot water bottle for a tummy ache or paracetamol for a headache.   We associate pain with illness but the feeling of pain from your contractions in labour is very different as it is a natural process as your baby makes its way to be born. 

During labour your body releases endorphins which act as a natural method of pain relief which helps you cope with the experiences you are feeling.

The difference between other pain and labour pain is that contractions come in waves. There is a resting period between the contractions which allows you time to rest and gain energy.  Being relaxed and breathing through your contractions will help you in labour. 

Understanding what affects pain in labour

The main hormone that helps labour progress is called Oxytocin.  Oxytocin keeps you feeling calm and relaxed during labour.  The release of Oxytocin production is helped by:

  • A relaxed birth environment
  • 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/Relaxation techniques

Breathing and relaxation is the key to help you cope with labour.  When we are in pain and stressed, we naturally hold our breath or breathing increases and 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 will help enable you to cope with each contraction.  It may be helpful for you and your birthing partner to practice breathing techniques during your pregnancy.

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 giving you something else to focus on.  Music can help when being upright and mobile due to the rhythm.  Dim lighting can also help.

Get your birthing partner to massage your back, especially the lower back with the heel of a 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 invaluable once the contractions become stronger. As soon as you start to feel the contraction, take in a breath from the top of your tummy. As you breathe out concentrate on relaxing the muscles in your shoulders, tummy and legs.  With each breath you take, follow this pattern until the contraction eases. The midwife will also show you ways how to help you cope with your contractions.

It is important to keep hydrated and keep energy levels up 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 decrease the discomfort you feel and reduce tension.  Massage helps in releasing the hormone Oxytocin which helps you relax

The benefit of massage
  • Reduces stress
  • Encourages effective digestion and breathing
  • Lowers blood pressure
  • Reduces anxiety
  • Reduces pain and increases range of motion
  • Can stimulate 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 allow you to achieve a state of total relaxation during labour.  Many women report shorter labours, significantly less pain, relaxed and 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 associated with this service.

Active birth positions for labour

Gravity helps in labour; the space within the pelvis is increased with standing and being upright during labour.  Research has shown that women who stay mobile and remain 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
  • Take the dog for a walk
  • Supported squatting using a birthing stool or toilet, standing and leaning – against the wall, over a sink or window sill.

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 mobility, water increases relaxation and makes birth a more comfortable and satisfying experience.

Water is warm and buoyant, this helps carries your body’s weight and keeps you freer to change position in the water. The therapeutic warm water can be beneficial 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 mobility
  • 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 4-5cms 
Disadvantages
  • Limited availability of pools
  • Not all women meet the criteria for use of the pool as your pregnancy should be uncomplicated
  • May slow labour if used too early
  • Does not take the pain away completely
TENS – Transcutaneous Electrical Nerve Stimulation

A TENS machine can be hired by you. 

They work by interrupting pain messages to the brain and also by stimulating the production of your own endorphins (body’s own natural pain relief).

Four pads are applied to your back; the pads are 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 increased pain.

 Benefits
  • You have control
  • You can remain mobile
  • 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 take the pain away completely

Entonox (Gas and Air)

Entonox is where you take in a breath of gas mixture containing nitrous oxide and oxygen through a mouth piece or mask.  At the beginning of a contraction you start to breathe in the gas so that it is at its maximum 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 mobile
  • It will take the edge off the pain
  • 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/Diamorphine/Meptid
Pethidine and Diamorphine are morphine based drugs which can help you to relax.  It is administered by intramuscular injection into the muscle of the thigh by the midwife. 

Meptid is an alternative to Pethidine and Diamorphine that can be used at homebirths and in midwife led units. The effects of Meptid are very similar to Pethidine and Diamorphine but it can be used more frequently if required.

Benefits
  • Pethidine and Diamorphine makes you sleepy and this may allow you to rest for a while
  • When relaxed your womb will be able to work more efficiently 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 establish
  • It is a sedative and may have little effect in very strong labour
  • It will not take the pain away completely
Epidural

The anaesthetist inserts a hollow needle into the lower part of the back and uses it to place a very fine tube near the nerves of the spine.  The needle is taken out and the tube 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
  • If you need stitches after your baby is born you will not need added local anaesthetic
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 6-8 women may need the epidural repositioned
  • You will be immobile and the urge to push is numbed
  • You need a drip to help maintain your blood pressure
  • You need blood pressure and pulse monitoring every 15 minutes
  • Your baby needs to be continually monitored, so you will have two straps around your abdomen to attach the transducers (round discs) to monitor baby’s heart rate and also your contractions
  • You will most likely need a tube (catheter) passed into your bladder as you cannot get up to pass urine
  • You are more likely to need help with the birth; the chance of an obstetrician having to use forceps or ventouse to birth your baby is increased.
  •  Loss of mobility – you will need to be on the bed
  • You may get a headache afterwards
  • You cannot go straight home – you will need to wait until your legs are back to full strength
  • You will not be able to birthing a midwifery led venue

Ten steps to successful labour and birth

Be Confident: Many women consider 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 really important that you feel secure so stay at home as long as possible with your home comforts/distractions. Once in hospital take along with you things that are familiar like an IPAD with photographs, music, and perhaps something comfortable 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 so let go of those inhibitions and let it happen.

Keep upright and mobile: 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 increases anxiety and pain which can be alleviated by understanding what is happening. 

Eat, drink and empty your bladder: It is really 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 provisions such as 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. Your job is to know what works for her and drop what is not working.

Encourage mobility:  Be prepared to do some hard work as you may try massage, mopping her brow, 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 speak so be prepared to speak up for her. Do not be aggressive if things are not going to plan, but ask for explanations and gently remind her of her choices/wishes

Remember to eat and drink: You will also need refreshments and snacks as you may be there for a while. Remind her to drink and eat throughout, offering fluids/isotonic drinks and light snacks. Remind her to empty her bladder regularly.

Get involved but know your limits: Birth should be a satisfying experience for you also, therefore 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

‘The Trust’s vision is to keep your information safe in our hands.’ We promise to use your information fairly and legally, and in-line with local and national policies. You have a right to understand how your information is used and you can request a copy of the information we hold about you at any time.

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