The good, the bad and the ugly

The painful side of labor


As I was getting a patient ready for an induction this morning, she asked, "How bad is labor, really?" That's a classic question, ladies. "Bad" means, painful, scary, messy and gross. "Really" means, "come on, tell it to me straight—I can take it." OK, here it is, straight up. Most women find labor to be the most painful experience they've ever been through. On a scale of one to ten, one being almost no pain and ten being the most possible most will tell you that labor (before an epidural) becomes a ten. However, labor doesn't start at 10, doesn't have to be a 10 and isn't a 10 for every woman.

Inductions are essentially labor-in-a-bottle and a good way to describe how labor pain progresses. When a woman comes in to be induced, we're usually starting labor from scratch. We start an IV and infuse a small amount of pitocin (the synthetic version of oxytocin—the hormone that makes the uterus contract). At first, she'll feel nothing. Little by little, we'll increase the amount of pitocin we give her and eventually she'll start feeling the contractions. For most women, it starts out feeling like tightening and pressure then menstrual cramps, sometimes accompanied by intestinal cramps. Eventually, we reach an adequate level of medication (hormones) to cause effective contractions. Effective means they cause cervical change (effacement and dilation).

The discomfort women experience is completely subjective and usually gradual. It's not like on soap operas where, in the middle of a wedding, the slightly pregnant woman suddenly grabs her belly, yelps delicately and declares to the congregation, "I'm in labor. The baby's coming." 10 minutes and 2 commercial interruptions later, she's freshly made up, dressed in a negligee with a 3-month-old baby in her arms. You wish. It's more like a marathon. It starts out easy then ends up hard. It takes time—lots of it. An average first time mom is in labor for 12 hours or more. That's just average. Some take a lot longer. Second (or more) labors go through the same process but it's usually quicker. Does that mean she's in level 10 pain that whole time? No, remember, it's gradual.

Some women don't feel much pain until labor is well under way. Some—not many, but a few—feel relatively no pain in labor. Most however, hurt like hell for quite a while. That's why we invented pain medication, epidurals and hypnosis (among a few other coping mechanisms).

Hypnobirthers say they don't feel "pain." They call contractions "surges," that feel like pressure or tingling. It requires a lot of training and practice but many hypnobirthers get through birth without a lick of pain medication. It's intense but manageable. Some however, quit calling them surges and call for an epidural. That's OK too. Whatever works.

When labor gets really uncomfortable—OK, painful, there's plenty you can do about it. You can jacuzzi, change positions, get out of bed, walk, cry, carry on and swear. Next step is pain medication through the IV. After that (or sometimes instead of that) there are epidurals. Once you have an epidural—you feel pretty good. That pain level drops way down. The goal is to keep it at a 2 or below. Some women feel no pain at all. Some feel pressure, some feel minimal pain. If you feel much more than that—your epidural's not doing its job and you need to talk with your anesthetist or medical provider about that. You might need more medication in the epidural or even a new one. Not every epidural is perfect.

As far as scary, messy and gross—wellll! Scary can be alleviated by education and support. If you know what to expecting when you're laboring and have a supportive labor coach you'll feel less frightened. Let your practitioner know if you have specific concerns or fears. Women with history of abuse sometimes find labor more traumatic than others. Your labor nurses can help. Flexibility is the key to success in labor and parenting so go in with a game plan and an open mind—you'll be fine. As for messy and gross—tell your nurse if you need to clean up. That's our job. We won't think it's gross. We're used to it.

