Comfort Measures During Labor and Delivery: Pain

What Is Pain?
Childbirth pain does not indicate a physical problem or injury. Labor pain is the result of physical effort. The uterus is contracting, the cervix is dilating (opening), and labor is progressing. Childbirth pain may be tolerated more effectively if you are able to make the mental “jump” from pain as a warning signal to pain as an indicator of progress.

Pain is both sensory and emotional. As a sensation, pain is interpreted by each of us based on our personal, cultural, and social experiences. Emotionally, we each select personal coping mechanisms based on our individual experiences. Sharing your expectations with your caregivers will enhance your childbirth experience.

The physiologic basis of pain changes as labor progresses. During the first stage of labor, pain results from the uterus contracting and “pulling” on the cervix, which causes effacement and dilatation. Pain intensity increases with the progression of labor. During the second stage of labor, pain is caused by the descent of the baby through the cervix into the vagina. Many women describe this pain as pressure and welcome the opportunity to actively work with the pain/pressure during the pushing phase, which results in the birth of their child.

Some methods of pain control do not involve the use of medications (non-pharmacologic), and others do involve the use of medication (pharmacologic). Non-pharmacologic methods may be helpful to all women in the early stages of labor before pharmacologic methods are appropriate.

Labor is a process that is experienced differently by every woman. It is important to select options that reflect your individual approach to birth. Learning as much as you can before labor is the best way to be prepared and to decide about your preferences. The following factors affect pain. Understanding these may assist you in making decisions about pain management during your labor.

What Factors Influence Pain?
Desire. Each woman’s perception of how they wish to labor will be unique. If you really desire to labor using specific comfort therapies, you will be more likely to do so. Most women are surprised by the power of their labors and the empowerment they feel as they work through their labor.

Childbirth Preparation. Classes that explain a variety of comfort therapies provide answers and information that can help you form ideas best suited to your individual approach to birth. Your values and self-image, along with the facts about benefits and risks of each intervention, will help you make your individual decisions.

Emotional Support. You need competent and caring support from your loved ones and from the professional staff assisting you. Labor is a time when you are highly perceptive of either the positive or negative attitudes projected by those around you. Spend time reflecting on how you want to interact with those helping you during labor and how you would want them to interact with you. Touch is a good example. Some women wish to be held or touched inlabor while others do not. If you know ahead of time what you want, share that information with your support person and let your caregivers know in your birth plan.

Flexibility. An uncomplicated labor does not require medications or anesthesia for safety. However, it is important to prepare for unforeseen circumstances in which medications or anesthesia may become medically necessary. Make the choices that are right for you, but remain flexible. The course of labor can never be predicted. For instance, you and your partner may have decided on natural childbirth, but your labor is longer and more intense than you expected, which may cause you to choose epidural anesthesia. Conversely, you may have anticipated asking for medication, but discover that your discomfort is manageable without it.