Pain in Childbirth
What causes pain in labor?
Natural Result of Physical Processes. During labor and birth, there are several physical processes occurring that lead to childbirth pain: the strong uterine contractions and the tension they place on supporting ligaments; pressure of the baby on the cervix, vagina, urethra, bladder, and rectum; stretching of the cervix, pelvic floor muscles, and vagina. These processes are unavoidable, and the pain caused by them is a positive sign that labor is progressing. We don’t want to stop these processes from happening, we just have to figure out how to minimize the pain we experience as a result.
Pain-intensifying factors that we can influence.
Gate Theory of Pain
The nerve fibers which transmit labor pain sensations unmyelinated and carry nerve impulses more slowly than the nerve fibers which carry sensations of light pressure, soft touch and vibration. If you transmit pleasurable impulses (such as light, soft touch), those will reach the brain first, and that can modulate, or interfere with, the pain sensations.
Fear –Tension – Pain Triangle
During labor, fear and anxiety can worsen our pain: they cause the release of stress hormones (catecholamines: epinephrine, etc.) which place us in a hyper-aroused state that makes us hypersensitive to pain. Catecholamines increase our heart rate, increase blood pressure, slow down digestion, and shunt blood supply away from internal organs and toward skeletal muscles and skin. All of these things in excess can cause complications in labor, and prolong the labor.
Fear also leads to muscular tension, which increases our experience of pain. Using relaxation techniques can help to reduce the muscle tension.
The concept of the fear-tension-pain triangle has arisen: when fear increases, tension increases, which then increases pain. Then the increased pain increases fear, and the situation continues to worsen.
The uterus contains two opposing
muscle groups – one to induce and continue labor, and another to stop labor if
the birthing mother is in danger and afraid. When we are frightened, we release
adrenaline, which causes the short, circular muscle fibers in the lower third
of the uterus to contract, stopping labor by closing and tightening the cervix.
At the same time, the long straight muscle fibers of the uterus are contracting
to dilate the cervix. The two powerful muscles pulling in opposite directions
during every contraction causes more severe pain. (
Thus, anything that can be done during labor to help the mother feel calm, relaxed, and safe can help to minimize the pain that mother’s experience in labor. Some specific things you can do. Prior to labor: educate yourself about labor so there’s less fear of the unknown. Throughout labor: Think about environmental factors such as dim lights, quiet music, and nice smells. Bring to the hospital: favorite clothing or blanket, etc. Use relaxation techniques and breathing techniques.
Sources: Pregnancy, Childbirth, and the Newborn by Simkin, Whalley, and Keppler (2001 edition). “Epidural Express” by Nancy Griffin, Mothering, Spring 1997. “The Pain and Discomfort of Labor and Birth” by Nancy Lowe, JOGNN, 25: 82-92, 1996. “Nonpharmaceutical Pain Relief” by Hilbers and Gennaro, source unknown, perhaps published as conference proceedings.