Thanks to the media’s constant depiction of labour as something to scream and thrash your way through, it’s no surprise that pregnant mamas-to-be rate labour pain as one of their biggest fears.
Pain has an important role to play during labour, and it's one that isn’t well understood by many women before they give birth.
Most pregnant women spend time worrying about the pain of labour and how they will cope. Feeling anxious about labour pain is very normal, but it can actually make things worse when you are in labour.
While most women do experience some level of pain when giving birth, how much is dependent on many factors.
What Causes Labour Pain?
The two main ways pain is created in our body is by injury or a change in bodily function.
If you cut your finger with a knife, your brain receives a message that tissue or nerves have been damaged. Your brain interprets the information available (knife, amount of bleeding, depth of cut) and you feel a sensation of pain in your finger.
Labour brings about a change in body function. The uterus, which is a large muscle, is contracting and relaxing. The cervix is stretching and opening. Pelvic joints and ligaments are moving and stretching. The pelvic floor muscles and perineum are stretching as well. The whole process is a change of body function which can cause discomfort and pain.
The former is almost a warning signal, something needs to be done to solve an unexpected danger/injury. The latter is more simply the effect of a body function changing, which can naturally lead to discomfort and pain, but may not need immediate action to solve something, as you’re not in danger.
The Process Of Labour Pain – The First Stage
When labour begins, oxytocin is released to stimulate the uterus to contract. This is known as the first stage of labour, and is when the cervix begins to open or dilate.
During the very early stage of labour you may feel nothing at all for some time as your cervix begins to thin (efface). Eventually you may begin to feel some pain and discomfort as the cervix begins to open (dilate).
As the tissues in the cervix stretch, pressure receptors in the nerves send messages to the brain. In response to these signals, your brain will release more oxytocin. Rising levels of oxytocin causes contractions to step up and become longer, stronger and closer together.
Most women describe labour contractions as being like intense period pain. These contractions are usually around 30 seconds long and can be quite localised in the area of your cervix.
As contractions become more intense, more messages are sent to the brain, which signals the release of endorphins. Endorphins act as pain relief, and also signal to the brain to release more oxytocin – increasing the tempo of labour.
Contractions will begin to require more focus. You may need to stop and concentrate on each one. During the later part of the first stage of labour, contractions are around one minute long and have a noticeable ‘peak’ toward the end.
Every contraction puts pressure and strain on the surrounding ligaments and muscles. Pressure from your baby being pushed down onto the cervix and onto organs like your bladder and bowel can increase the sensations you experience.
The Process Of Labour Pain – The Second Stage and Birth
When the cervix is fully dilated, this is known as the start of the second stage of labour. This is when contractions are no longer opening the cervix, but pushing the baby down into the vagina and out of your body. Most women during this stage will describe these contractions as powerful, and a pressure sensation rather than painful.
Contractions during the pushing stage are often spaced out and involuntary. You don’t have to actively push your baby out, but work with your body each time a contraction happens. Pressure can be felt as your baby’s head moves through the pelvis and down into your vagina.
Your bladder and bowel are being pushed against, and ligaments are stretching to make room. Your coccyx bone (tailbone) is shifting out of the way. These changes to your body function cause different sensations that can be felt as discomfort, pressure, and even pain.
The second stage of labour can take some time, which allows your vagina and perineum to stretch slowly. This reduces the chances of tearing and damage to the pelvic floor.
The final moments of labour and birth bring with it new sensations. The perineum — the area between the vagina and anus — are stretching to accommodate the baby’s head (crowning). If you put fingers on either side of your mouth and stretch outward you can get some idea of the sensation your perineum experiences when your baby’s head is passing through.
Often called the ‘ring of fire’, this can feel like stinging or burning. Usually this is very short lived and passes once the biggest part of the baby’s head has been born.
What Increases Pain Perception?
During labour, we want to promote oxytocin and endorphin production. Both hormones work together to influence effective contractions (making labour progress to birth) and alter our perception of pain.
How you perceive the pain of labour depends on many factors:
- Previous experiences of pain
- Self confidence
- Your environment and the support you receive
- Social and cultural beliefs about labour pain
It’s important to remember that today’s birth culture promotes the idea women who have little pain during labour have a ‘better’ or more positive birth than those who do experience pain.
Yet, labour pain is unlike any other kinds of pain. It’s not caused by injury, but is created by your body for a purpose. Pain can act as a guide to change positions, to promote more efficient contractions, and to assist your baby to move into a better position for birth.
Pain does not have to involve suffering. Women who are coping well with their contractions often feel a greater sense of empowerment and satisfaction. If the conditions for an undisturbed labour are being met, it’s not only promoting a healthy labour, but is also allowing the mother to feel a positive connection to her pain. She is less likely to be tense and increasing her perception of pain.
Things To Remember
- Contractions come in a regular pattern with one to several (usually) pain-free minutes in between them. This means you can predict and prepare for each contraction and rest between them.
- It intensifies gradually over time: contractions almost always start off mild and gradually grow longer, stronger, and closer together, thus allowing you time to adapt.
- It’s self-limiting: labour rarely takes more than 24 hours once you're in active labour (read more about early or pre-labour).
Most women hope their labour isn’t too painful, and are not aware just how much influence they can have over the pain they will or won’t experience. BellyBelly has this great article about what makes labour pain worse. Or you might like to know more about how to have an undisturbed labour.