Learning all you can about labor and delivery is one of the best ways to help you manage the pain of childbirth when the time comes.
Pain During Labor and Delivery
Pain during labor is caused by contractions of the muscles of the uterus and by pressure on the cervix. This pain can be felt as strong cramping in the abdomen, groin, and back, as well as an achy feeling. Some women experience pain in their sides or thighs as well.
Other causes of pain during labor include pressure on the bladder and bowels by the baby's head and the stretching of the birth canal and vagina.
Pain during labor is different for every woman. It varies widely from woman to woman and even from pregnancy to pregnancy.
It's often not the pain of each contraction on its own that women find the hardest, but the fact that the contractions keep coming — and that as labor progresses, there is less and less time between contractions to relax.
To help with pain during labor, here are some things you can start doing before or during your pregnancy:
Regular and reasonable exercise (that your doctor says is OK) can help strengthen your muscles and prepare your body for the stress of labor. Exercise also can increase your endurance, which will come in handy if you have a long labor. The important thing to remember with any exercise is not to overdo it — and this is especially true if you're pregnant. Talk to your doctor about what he or she considers to be a safe exercise plan for you.
If you and your partner attend childbirth classes, you'll learn different techniques for handling pain, from visualization to stretches designed to strengthen the muscles that support your uterus. The two most common childbirth philosophies in the United States are the Lamaze technique and the Bradley method.
The Lamaze technique is the most widely used method in the United States. The Lamaze philosophy teaches that birth is a normal, natural, and healthy process and that women should be empowered to approach it with confidence. Lamaze classes educate women about the ways they can decrease their perception of pain, such as through relaxation techniques, breathing exercises, distraction, or massage by a supportive coach. Lamaze takes a neutral position toward pain medicine, encouraging women to make an informed decision about whether it's right for them.
The Bradley method (also called Husband-Coached Birth) emphasizes a natural approach to birth and the active participation of the baby's father as birth coach. A major goal of this method is the avoidance of medicines unless absolutely necessary. The Bradley method also focuses on good nutrition and exercise during pregnancy and relaxation and deep-breathing techniques as a method of coping with labor. Although the Bradley method advocates a medicine-free birth experience, the classes do discuss unexpected complications or situations, like emergency cesarean sections.
Medicine-free ways to handle pain during labor include:
massage or counterpressure
taking a bath or shower
listening to music
distracting yourself by counting or performing an activity that keeps your mind otherwise occupied
A variety of pain medicines can be used during labor and delivery, depending on the situation. Many women rely on such medicines, and it can be a huge relief when pain is quickly eased and energy can be focused on getting through the contractions. Talk to your health care provider about the risks and benefits of each type of medicine.
Analgesics. Analgesics ease pain, but don't numb it completely. They don’t affect sensation or muscle movement. They can be given many ways. If they are given intravenously (through an IV into a vein) or through a shot into a muscle, they can affect the whole body. These medicines can cause side effects in the mother, including drowsiness and nausea. They also can have effects on the baby.
Regional anesthesia. This is what most women think of when they consider pain medicine during labor. By blocking the feeling from specific regions of the body, these methods can be used for pain relief in both vaginal and cesarean section deliveries.
Epidurals, a form of local anesthesia, relieve most of the pain from the entire body below the belly button, including the vaginal walls, during labor and delivery. 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 medicine can be increased or decreased according to a woman's needs. Very little medicine 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 pee. 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.
Tranquilizers. These drugs don't relieve pain, but they may help to calm and relax women who are very anxious. Sometimes they are used along with analgesics. These drugs can have effects on both the mother and baby, and are not often used. They also can make it difficult for women to remember the details of the birth. Discuss the risks of tranquilizers with your doctor.
Some women choose to give birth using no medicine at all, relying instead on relaxation techniques and controlled breathing for pain. If you'd like to experience childbirth without pain medicine, discuss this with your health care provider.
Things to Consider
Here are some things to think about when considering pain control during labor:
Medicines can relieve much of your pain, but probably won't relieve all of it.
Labor may hurt more than you expected. Some women who had said they want no pain medicine whatsoever end up changing their minds when they're actually in labor.
Some medicines can affect your baby, making the baby drowsy or causing changes in the heart rate.
Talking to Your Health Care Provider
You'll want to review your pain control options with the person who'll be delivering your baby. Find out what's available, how effective they're likely to be, and when it's best not to use some medicines.
If you want to use pain-control methods other than medicine, make sure your health care provider and the hospital staff know. You might want to also consider writing a birth plan that makes your preferences clear.
Remember, many women make decisions about pain relief that they abandon — often for very good reason — at the last minute. 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.
Signs that labour has begun
Know the signs
There are several signs that labour might be starting, including:
contractions or tightenings
a "show", when the plug of mucus from your cervix (entrance to your womb, or uterus) comes away
an urge to go to the toilet, which is caused by your baby's head pressing on your bowel
your waters breaking
The early (latent) stage of labour can take some time.
Urgent advice: Call your midwife or maternity unit if:
your waters break
you have vaginal bleeding
your baby is moving less than usual
you're less than 37 weeks pregnant and think you might be in labour
These signs mean you need to see a midwife or doctor.
Latent phase of labour
The start of labour is called the latent phase. This is when your cervix becomes soft and thin, and starts opening for your baby to be born. This can take hours or sometimes days.
You'll probably be advised to stay at home during this time. If you go to the hospital or maternity unit, they may suggest you go back home.
Find out more about the stages of labour and what you can do at home during the latent phase.
Call your midwife if you're unsure or worried about anything.
What do contractions feel like
When you have a contraction, your womb tightens and then relaxes. For some people, contractions may feel like extreme period pains.
You may have had contractions during your pregnancy, particularly towards the end. These tightenings are called Braxton Hicks contractions and are usually painless.
Your contractions tend to become longer, stronger and more frequent as your labour progresses. During a contraction, the muscles tighten and the pain increases. If you put your hand on your abdomen, you'll feel it getting harder; when the muscles relax, the pain fades and you will feel the hardness ease.
The contractions are pushing your baby down and opening the entrance to your womb (the cervix), ready for your baby to go through.
Your midwife will probably advise you to stay at home until your contractions become frequent.
Call your midwife or maternity unit for guidance when your contractions are in a regular pattern and:
last at least 60 seconds
come every 5 minutes or
you think you are in labour
Read more information on when to go to hospital
Backache often comes on in labour
You may get backache or a heavy, aching feeling.
A "show" can signal the start of labour
During pregnancy, there's a plug of mucus in your cervix. This mucus comes away just before labour starts, or when in early labour, and it may pass out of your vagina. This sticky, jelly-like pink mucus is called a show.
It may come away in 1 blob or in several pieces. It's pink because it contains a small amount of blood.
If you're losing more blood, it may be a sign something is wrong, so phone your hospital or midwife straight away.
A show indicates that the cervix is starting to open. Labour may quickly follow or may take a few days. Sometimes there is no show.
What happens when my waters break
It's likely your waters will break during labour, but it can also happen before labour starts.
Your baby develops and grows inside a bag of fluid called the amniotic sac. When it's time for your baby to be born, the sac usually breaks and the amniotic fluid drains out through your vagina. This is your waters breaking. Sometimes when you're in labour, a midwife or doctor may offer to break your waters.
If your waters break naturally, you may feel a slow trickle or a sudden gush of water you cannot control. To prepare for this, you could keep a sanitary towel (but not a tampon) handy if you're going out, and put a protective sheet on your bed.
Amniotic fluid is clear and pale. Sometimes it's difficult to tell amniotic fluid from urine. When your waters break, the water may be a little bloodstained to begin with.
Tell your midwife immediately if:
the waters are smelly or coloured
you're losing blood
This could mean you and your baby need urgent attention.
If your waters break before labour starts, call your midwife. Use a sanitary pad (not a tampon) so your midwife can check the colour of the waters.
If labour does not start after your waters break
It's usual to go into labour within 24 hours of the waters breaking. You'll be offered an induction if you do not because, without amniotic fluid, there's an increased risk of infection for your baby.
Until your induction, or if you choose to wait for labour to start naturally, tell your midwife immediately if:
your baby moves less than usual
there's any change in the colour or smell of any fluid coming from your vagina
You should take your temperature every 4 hours when you're awake, and tell your midwife if it's raised. A raised temperature is usually above 37.5C, but you may need to call before this – check with your midwife.
There's no evidence that having a bath or shower after your waters have broken increases your risk of infection, but having sex might.
How to cope when labour begins
At the beginning of labour, you can:
walk or move about, if you feel like it
drink fluids – you may find sports (isotonic) drinks help keep your energy levels up
have a snack, if you feel like it
try any relaxation and breathing exercises you've learned to deal with contractions as they get stronger and more painful – your birth partner can help by doing these with you
have your birth partner rub your back – this can help relieve pain
take paracetamol according to the instructions on the packet – paracetamol is safe to take in labour
have a warm bath
Find out what happens during labour and birth, and what you can do for pain relief in the early stages of labour.
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Video: How will I know I am in labour?
In this video, a midwife describes the signs that mean labour may be starting.
Media last reviewed: 1 November 2019 Media review due: 1 November 2022
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Contractions: false or real / “Waiting for a baby”
Shortly before the birth, the expectant mother may be disturbed by training contractions, rhythmic contractions of the uterus, which quickly pass and appear occasionally. How to distinguish them from real contractions, and why they are needed, we will try to find out.
The phenomenon of temporary contractions was first described by the English doctor John Braxton Hicks. That is why they are called - Braxton Hicks contractions or false, training contractions, precursor contractions. In his scientific work of 1872, he argued that these contractions are short-term (from half a minute to 2 minutes) contractions of the muscles of the uterus, which are felt by a pregnant woman as an increase in the tone of the uterus. They appear after the 20th week of pregnancy. And during the day they happen often, but the expectant mother in the daytime may not even notice them. However, as time goes on, they intensify, becoming more and more obvious.
WHAT DO YOU NEED FALSE BROUGHT
The uterus is a muscular organ. And like any muscle that has to perform the work allotted to it in the body, it needs training. After all, if she hangs for all forty weeks like a bag, she will not cope with the load in childbirth. Thus, the purpose of training or false contractions is to prepare the uterus and cervix for childbirth. That is why one of the names of training bouts is contractions harbingers - harbingers of an approaching birth.
ARE FALSE PARTS PAINFUL?
As a rule, false contractions are painless, but with increasing duration they become more noticeable and bring more discomfort. However, in all women, they manifest themselves in different ways, someone does not feel them at all, and someone does not sleep at night, tossing and turning and trying to find a comfortable position for sleeping. It all depends on the pain threshold. The main thing in this situation is to stop being nervous about this and calm yourself with the thought that such training is necessary for the most important upcoming event - the birth of your crumbs. And to calm down a little and sleep better, ask your doctor to prescribe a sedative for you and get a special pillow for expectant and nursing mothers. With her, falling asleep and experiencing the discomfort of the last weeks of pregnancy will be much easier!
HOW TO LIVE WITH FREQUENT PARTS
Some expectant mothers complain that their Braxton Hicks contractions are frequent and cause significant discomfort, even when they are doing housework or other light physical activity. In such a situation, obstetricians are advised to lie down or vice versa, take an easy walk, in any case, change the type of activity. If training contractions bother you a lot, it is recommended to drink a glass of water, juice or herbal tea, calm down and get some rest. Ask someone close to give you a massage. Lie in silence. And to also benefit from training fights, try doing breathing exercises: practice breathing techniques in childbirth in practice.
HOW TO DIFFERENTIATE TRAINING FROM LIVING
The most important thing to understand is that real contractions are much more painful than Braxton Hicks contractions. You will understand it right away. In addition, the contractions that bring you closer to childbirth are more regular. The contractions begin in the lower back, spread to the front of the abdomen, and occur every 10 minutes (or more than 5 contractions per hour). Then they occur with an interval of about 30-70 seconds and over time the intervals between them are reduced. Some women describe the sensations of labor pains as severe menstrual cramps, or sensations during diarrhea, when the pain rolls in waves in the abdomen. These contractions, unlike false ones, continue even after a change in position and when walking, constantly intensifying. As soon as you feel all these symptoms, call your ob-gyn - hour X has arrived. If in doubt, also do not be afraid to disturb the doctor. The doctor will ask you a few questions that will help him determine the type of contractions and eliminate all your doubts and worries. After all, it is always better to consult a doctor and trust his professional experience.
You should seek help if:
• you have more than four contractions an hour and they happen regularly • contractions are accompanied by pain in the lower spine • contractions are accompanied by watery or bloody vaginal discharge • the contractions are so strong that it is very difficult for you to endure them • there is a marked change in the child's movement, or less than 10 movements every 2 hours • you think your waters have started to break
Alla Misyutina, Consultant Physician, Independent Laboratory INVITRO
Dear women, during labor, the body needs a lot of oxygen, so proper breathing is very important. A large influx of oxygen into the blood of mother and baby alleviates the condition of the crumbs, which during childbirth experiences oxygen starvation. Special breathing techniques help to properly open the birth canal and make contractions and attempts as effective as possible.
Different types of breathing should be used at different stages of labor.
• During "false" contractions, breathing should be deep and slow. During the period when the contractions become more intense, it is necessary to use "pain-relieving breathing". This breathing is slow, deep, the inhalation is done through the nose, it should be longer than the exhalation through the mouth. More details: inhale is done at the expense of 1-2-3-4, and exhale - at the expense of 1-2-3-4-5-6. With the help of such breathing: mom relaxes, distracts from pain, focuses on the score; the baby receives as much as possible, so he needs oxygen. • In breaks from contractions, you need to rest and breathe evenly without any effort, so that you can then easily follow the doctor's recommendations. • During attempts, you need to exhale all the air from the lungs, then take a deep breath and push for up to 6-9 seconds. Quickly exhale all the air, quickly take a deep breath and again hold your breath for 6-9 seconds, and so on - about three times per attempt. • In breaks from attempts to rest and breathe deeply, evenly and relaxed. • It is very important to only push on the perineum and never push on the head. In this case, all efforts are wasted and will appear in the form of burst vessels in the eyes and on the face. • In the period after the birth of the head, it is necessary to stop pushing and breathing shallowly, some call this breathing “dog-like”, deep breathing can harm both mom and baby. Then everything goes on as usual, the main thing is to obey the doctor. • After the baby was born, within half an hour the last stage of labor begins - the birth of the placenta. Special breathing is no longer required, at the doctor's command, push a little into the perineum and EVERYTHING! Dear women, pain during childbirth is good, it means that your baby will be born soon. There is no need to resist the pain, this is a mistake that brings a woman and a child nothing but fatigue. On the contrary, it is necessary to concentrate and help in every possible way to give birth to a healthy baby.
So, you have decided that this is no longer a “teaching”, but the beginning of childbirth. In addition to contractions, the onset of labor can be indicated by the outflow of amniotic fluid and the passage of a mucous plug that closes the lumen of the cervix. The mucous plug can also come off 2-3 days before delivery. However, her departure does not always mean that it is time to go to the hospital. During pregnancy, the cervix is tightly closed. With the onset of labor pains, its opening begins: the cervix of the uterus gradually expands to 10-12 cm in diameter (full disclosure). The birth canal is preparing to "release" the child from the womb. Intrauterine pressure increases during contractions as the uterus shrinks. And in the end, this leads to rupture of the fetal bladder and the outflow of part of the amniotic fluid.
The first, preparatory, period of labor for women giving birth for the first time takes an average of 12 hours, and 2-4 hours less for those who have second births. At the beginning of the second stage of labor, contractions join the contractions - contractions of the muscles of the abdominal wall and diaphragm. In addition to the fact that different muscle groups are involved in contractions and attempts, they have one more important difference: contractions are an involuntary and uncontrollable phenomenon, neither their strength nor frequency depend on the woman in labor, while attempts to a certain extent obey her will , it can delay or strengthen them. Therefore, at this stage of childbirth, a lot depends on the expectant mother and her ability to quickly and correctly follow the commands of the obstetrician taking delivery. And most importantly - to tune in correctly and not allow panic and thoughts about something bad. Obstetricians and gynecologists recommend that mothers perceive childbirth as a holiday, a baby's birthday. Then it will be easier to concentrate on the fact that now your main task is to help the baby be born. If, during childbirth, the expectant mother panics, the concentration of adrenaline in her blood will increase significantly. Which will not have a very good effect on the process of childbirth. Adrenaline affects the synthesis of oxytocin, which significantly weakens contractions and slows down the process of childbirth. In addition, adrenaline completely blocks the production of endorphins, which will increase the feeling of pain during contractions and attempts. That is why it is so important to properly tune in, concentrate and help the baby to be born as soon as possible.
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How to distinguish real contractions from training ones?
Shemyakina Natalya Nikolaevna, head of the obstetric department of the maternity hospital "Leleka" will help you figure it out.
Training contractions, or as they are also called, fake, or Braxton-Hicks contractions, are irregular contractions that do not have increasing intensity. The uterus may tone up, but normally, it should pass quickly.
For example, the tone appeared once in half an hour and the uterus relaxed rather quickly. Then the tone reappeared only after two hours and again passed. These are training contractions, they do not increase in intensity and do not become more frequent.
Training bouts are physiologically provided by our body. So the uterus is preparing to do the hard work in the process of childbirth. Normally, training contractions appear in terms of pregnancy close to childbirth - from the 37th week of pregnancy.
The appearance of training contractions in the early stages of pregnancy is not the norm
The uterus can tone up with an active lifestyle, physical activity, with a change in body position, but this tone should quickly pass. Normally, the uterus should not often come into tone. And even more so, contractions, as such, should not be until the 37th week of pregnancy. Braxton Hicks contractions in the early stages are a threat of preterm labor. If a woman has contractions periodically during the day: after an hour, after 2, then again after an hour, (even if they are not regular), for periods up to 37 weeks, such a tone should alert the expectant mother. Because this is not the norm, but the threat of premature birth. This is an occasion to contact a specialist and change your rhythm of life, put on a bandage. The causes of premature birth are most often internal, caused by hormonal disorders and a violation of the physical health of a woman. But significant physical activity and stress can also cause premature birth.
Unlike training pains, labor pains are regular. The uterus comes to tone first once every 15 minutes, and after a while - once every 7-10 minutes. Contractions gradually become more frequent, longer and stronger. And already occur every 5 minutes, then 3 and finally every 2 minutes.
True labor pains are contractions every 2 minutes, 40 seconds. If within an hour or two the contractions intensify - pains that begin in the lower abdomen or in the lower back and spread to the stomach - most likely, these are real labor pains.
Training contractions are NOT so much painful as unusual for a woman. When the expectant mother sees how the stomach comes into tone, its shape changes and it becomes dense, like an inflated ball. This might scare you a little. But a woman must understand that in real, labor pains, there must be a clear periodicity, intensification and acceleration over a certain period of time. Real fights never stop, but practice fights do. The uterus then comes to tone, then relaxes. Women often confuse contractions with tone, which is caused by other physiological processes in the body. For example, increased intestinal motility, intestinal infections, colic, etc.
What else should alert a woman?! If within an hour or two the uterus periodically comes into tone and mucous, bloody (streaked with blood or brown) discharge appears, then most likely there are structural changes in the cervix - it opens. Also an important sign to seek help is the discharge of the mucous plug long before childbirth. Her departure in terms of childbirth, a week or two before childbirth is normal.
Tracking labor pains
There are several methods for determining the types of contractions. A woman can do this herself, writing down the frequency and duration of contractions on paper or tracking them using special programs for a computer and phone. Or you can contact a doctor at antenatal clinic or at the maternity hospital, where a specialist will conduct fetal monitoring (fetal CTG). With the help of 2 sensors, the fetal heartbeat, uterine contractions are monitored and it is determined whether these are training contractions or labor.