When you’re pregnant, it’s natural to be nervous about labor pain. It’s a big unknown of the birth experience — What will it feel like? How intense will the pain be? How will I react? — and often features prominently in friends’ and family members’ birth stories. But here’s the thing: everybody and every birth are different. While you can’t know exactly how yours will respond, we can assure you that our bodies were made to do this.
Successful pain management starts with minimizing fear. Fear breeds tension, which increases pain, which causes more fear, operating in a negative cycle that can make birthing more challenging. To break that cycle, it helps to have several tools in your tool kit that replace fear with proven techniques for pain management.
Most pregnant people lean one way or another on epidurals, either certain that they will want to request one as soon as possible during labor or hoping to avoid an epidural for an unmedicated birth. The good news is that you don’t need to commit to an epidural beforehand, so consider it an option that you can rely on if and when you choose to.
What exactly is an epidural? It’s a procedure during which medication is administered into the back through a catheter that numbs the body from the waist to the pubic bone. Epidurals do require that you are hooked to an IV, get frequent vital checks, and receive continuous fetal monitoring. Most people describe getting an epidural as uncomfortable but not painful.
When is an epidural usually administered? It depends. Even if you plan to get one as soon as you walk in the door, we recommend waiting until you’re in a steady labor pattern, making cervical change, and having a difficult time coping with each contraction. This gives you time to understand how your body is responding to labor pain.
Epidurals are considered the most effective form of pain relief during labor. They eliminate pain while allowing you to remain mentally alert and able to push when the time comes. Epidurals also give you a chance to rest and can potentially lower the chances of cesarean birth. While they have a few drawbacks — some people experience nausea, itching, headaches, or shakes and shivering — epidurals typically work when it comes to pain management.
It’s worth noting, however, that epidurals don’t work for everyone (to learn more, read the studies here and here). It’s smart to review all of your options with your provider before you go into labor, as well as tell your care team right away if you’ve had an epidural and it doesn’t seem to be working. There are alternatives and things they can try to make it more effective.
2. Nitrous oxide
If you want something to manage the pain but are unsure about an epidural, consider nitrous oxide. Nitrous oxide also called laughing gas, is delivered through a mask and inhaled by the birthing parent. It helps manage pain throughout the entire body without causing a total loss of feeling or any loss of muscle movement.
Interestingly, the nitrous oxide used during labor is different than what you get at the dentist. Dentistry uses a higher percentage of nitrous oxide to oxygen — 70% and 30% respectively — while birthplaces use a more balanced 50/50 split. Why does it matter? If you’ve had nitrous oxide at the dentist, rest assured that it won’t feel as strong if you use it while in labor.
Many birthing parents like nitrous oxide because it’s less invasive than epidurals. It works quickly and wears off quickly, so if you don’t like it, it won’t last long. Nitrous oxide can be used during all stages of labor, so it can be helpful for situations like repairing a perineal tear after birth.
Nitrous oxide has been proven to be one of the safest comfort measures during labor. It doesn’t affect the baby and studies have shown that it has no impact on APGAR scoring, which is a scale used to measure the baby’s condition right after birth.
It’s important to note that nitrous oxide does not eliminate pain, it just softens it. It can make it easier to relax and work through labor, but can also give you a sense of fuzziness, drowsiness, or detachment. Nitrous oxide is also not available from all providers or at all birthplaces.
3. Relaxation techniques
Whether you decide to use medication or not during your birth, everyone can benefit from relaxation techniques. These exercises help manage labor using your mind and body and are great to practice at home before labor.
Popular relaxation techniques include:
• A soothing environment.
You may prefer your space quiet and dark, or want it bright with music. Think about what type of environment will help you relax. Playlists can be especially powerful; put together a list of songs that focuses and inspires you.
Smells can play a significant role in creating that soothing environment. With the wide variety of essential oils available, you can calibrate the scent of your space to be grounding, calming, or energizing — whatever feels right to you.
Making sounds can also help you relax and recenter. Some people count, chant, moan or yell. Whatever feels good to your body at the time, let it out, and don’t be embarrassed. The staff at your birthplace has seen it all.
Visualization techniques include focusing on a specific item, like a photo or your partner’s face, or imagining a particular scene. Think of each contraction as an ocean wave or picture baby’s head moving further down with contraction.
• Guided imagery
Like visualization, guided imagery uses the power of your mind to relax your body and relieve pain. Picture yourself in a place that brings you serenity, like the beach, the woods, or a cozy room. Practice creating that space in your mind before labor begins, so you can bring it up easily when you need to. When sensations increase, go to your happy place.
Massage has been proven to lower pain scores, decrease anxiety, increase a sense of control, and improve rates of satisfaction with birth. Your partner can offer a gentle massage or a deeper massage with a tennis or golf ball, depending on what feels good to your body. And if you don’t want to be touched, that’s just fine as well.
Acupressure works like acupuncture, but instead of needles, uses hands to put pressure on specific areas of the body. Like massage, acupressure is proven to work, linked to less intense pain, shorter labors, and less anxiety. (Learn about specific acupressure points that help labor pain in our Childbirth 101 course.)
• Progressive relaxation
Progressive relaxation involves tensing and relaxing one muscle group at a time to eventually bring relaxation and consciousness to your entire body. It can be a great way to re-center and connect with your birth partner, who can participate as well.
• Water therapy
Never underestimate the power of a hot shower or bath. Water therapy can be used throughout the labor process, from taking a warm tub in the early stages of labor at home, to sitting on a birthing ball in the shower during active labor, to even giving birth in a birthing tub, if it’s something you want and your birthplace allows. Be sure to check in with your care provider before turning to water therapy as some might have you hold off to prevent the risk of infection
4. Breathing techniques
Conscious breathing during labor calms the body, relieves pain, lowers stress, and gives you a sense of control. It’s an incredibly effective way to connect your mind to your body and send that fear-tension-pain cycle packing.
Breathing techniques during labor fall into three categories: slow-paced breathing, moderate-paced breathing, and paced or patterned breathing.
Slow-paced breathing helps calm your body. Start with a cleansing breath, then breathe at half your normal breathing rate, in through the nose, out through the mouth. Breathe slowly and evenly. End with a cleansing breath.
Moderate-paced breathing is often used during active labor. Start with a deep cleansing breath, then speed up your breathing rate as the contraction peaks (but not faster than twice your normal rate). Slow your breathing as the contraction fades, and end with a cleansing breath.
During the final stages of labor, many birthing parents use paced or patterned breathing. This starts with deep breaths that become more shallow as the contraction intensifies. It is particularly helpful with longer, more erratic contractions.
To see these breathing techniques in action, check out the Tinyhood Childbirth 101 course.
5. Labor positions
Finally, positions and props during labor can make a significant impact on pain relief. In general, the more you move during labor, the more comfortable you will be and the more quickly your labor will progress.
A birthing ball can be a laboring person's best friend (and useful during pregnancy too!). Studies have shown that birthing balls open the pelvis, shortening the overall labor time and leading to fewer epidurals and cesarean births.
Using a birthing ball can be as simple as just sitting on it, bouncing on it, or moving your hips in circles. Your partner can also help with specific exercises on the birthing ball to relieve contraction pain. These include applying counter pressure to your back, squeezing your hips together, or pushing into your knees, all while you sit on the ball during a contraction.
Peanut balls are another effective tool. Peanut balls are similar to birthing balls, but instead of being round, they’re shaped like — you guessed it — a peanut. Working with a peanut ball also increases the size of the pelvis and gets baby into a good birth position to shorten labor, lessen pushing, and result in fewer Cesarean births.
Last but not least, you can use your bed at your birth place to make labor more comfortable. The “throne” position, in which you sit up with your legs on the floor, heels together, knees apart, helps the pelvis to open and the baby to move toward the birth canal. Being on hands and knees while on your bed works well too, especially for unmedicated births.
Pain can be a part of the birth experience, but it should never define it. Using the techniques above, you can manage pain in the way that’s right for your body and this particular birth. When it comes to pain relief, the only right answer is the one that feels right to you.
For a deep dive into pain management and more, watch the Tinyhood Childbirth 101 course.
About our Expert
Ashley Derderian Sousa is a board-certified lactation consultant and registered nurse with nearly ten years of experience in labor, delivery, and postpartum units. Through approachable methods and open and honest philosophy, she believes each journey to becoming a parent is a personal one that should be met with self-compassion. She is currently completing a Masters of Health Education.