The Different Stages of Labor Pain
From Braxton Hicks to active labor to the urge to push, here’s what you can expect to feel as your baby makes its way into the world.
There’s a reason they call the hours leading up to childbirth labor—it’s hard work! Labor is tricky to predict and often difficult to describe because every parent’s birth experience is unique. Still, while it’s impossible to truly understand what labor and the pain of contractions feel like until you experience it firsthand, it’s helpful to have at least an inkling of what you’re in for. Here’s an idea of what you can expect.
Well before your body begins going into labor, it starts preparing you for the real thing. Sometimes called “practice contractions,” Braxton Hicks contractions feel similar to actual contractions and, according to the American College of Obstetrics and Gynecology (ACOG), can be quite uncomfortable, or even painful. These contractions will feel like a tight cramp in your abdomen, but unlike labor contractions, they aren’t constructive. You’ll be able to tell they’re not the real thing because they typically subside with rest and a bit of hydration, plus they don’t come in regular intervals or intensify as true labor contractions do.
The good news is that once you’ve experienced Braxton Hicks contractions, you’ll know what kind of pain to expect with early labor contractions. Though early labor can feel like Braxton Hicks contractions, these are different because they actually advance the body toward delivery. During this time, the cervix is dilating (opening) and effacing (thinning out) to eventually allow the baby to enter the birth canal. These contractions will come in regular intervals and gradually become more powerful and closer together. Each contraction should last around one minute.
For many parents, contractions during early labor are mild (though still uncomfortable) and might drag on for many hours. You might notice pain in your back or pelvis that feels similar to menstrual cramps, but you will still likely be comfortable enough to continue with your daily routine. Go for a walk, take a rest, bounce on your birthing ball, practice your breathing techniques, and stay hydrated. As long as your water hasn’t broken and your contractions are still more than five minutes apart, you can try to ride out this part at home. (Of course, if you are in a high-risk situation, your OB may give you different instructions, which you should always follow.)
As you progress from early labor into active labor, which is the second of the three stages of labor, you’ll notice your contractions become even more painful and frequent, as they’ll happen every five minutes or less (if you aren’t already on your way to the hospital or birthing center, head that way now). At this point, the contractions will be incredibly intense, usually requiring you to breathe deeply—and maybe squeeze a partner’s hand with a death grip—to get through them. Compared to early labor, these contractions are longer, stronger, closer together, and more regular. Your cervix continues to dilate and efface as you get closer to delivering baby.
Labor contractions are movements in the muscles of the womb, preparing to send baby down the birth canal and out into the world. However, rarely do you hear a laboring parent hollering, “Ow! My uterus!” The pain of labor registers as tightening, cramping, or even pounding (yes, pounding), and it can be felt along the top or bottom of the belly, often in the lower back, and sometimes in the hips or legs.
Contractions have a way of rising, peaking, and falling. Sometimes the intensity seems to travel throughout the rise and fall—moving from the lower abdomen to the top of the uterus, or from the top to the bottom, or radiating around the back. There may be a clenching or tightening sensation, followed by a sense of relief as the contraction passes and the body relaxes. (FYI: You’ll be able to watch the rise and fall of each contraction on the monitor.)
Again, labor contractions are often compared to menstrual cramps—though they are much more intense. They’re also sometimes said to feel like severe gas pains. We don’t all feel labor the same way, and each of us has our own level of pain tolerance, so while one parent may rate this stage of labor as a three on a 10-point pain scale, another may give it a solid nine.
If you are planning to get an epidural (or even if you aren’t but you end up changing your mind for any reason), it will be administered by the on-call anesthesiologist during active labor, before you’re fully dilated. An epidural block (often called simply an epidural) can allow you to get some rest before delivery; otherwise, exhaustion can become a side effect. (Note: there are other forms of pain relief besides an epidural, including nitrous oxide and analgesics.)
At the end of active labor, you will enter the transition phase as the cervix makes its final stretch from 8 to 10 centimeters. You’re almost at the finish line but, unfortunately, the transition from waiting on the cervix to time-to-push is often the roughest part. Contractions are so powerful that the intensity can be all-consuming. Flu-like symptoms such as sweating, shaking, and shivering can accompany these contractions, and nausea and vomiting are not uncommon during this phase.
Rectal pressure becomes intense as baby descends into the pelvis. This feels strangely like a large bowel movement waiting to happen. The urge to push can be overwhelming. If you’re not yet fully dilated, your health care provider may tell you not to push, which is a tall order when your body wants to take over and produce a baby.
“The hardest part was not pushing before I was fully dilated,” says Leah Inman, a mom in Faribault, Minnesota. “I had such a huge urge to push that my body would push even when I was telling myself to relax.” It can come as quite a relief when you’re allowed to push and lean into the pressure, even though it means an exertion of energy and a burning sensation down below during vaginal delivery.
If you’ve reached transition without requesting an epidural, it may be too late to do so, depending upon how quickly you reach 10 centimeters’ dilation. When you’re at 10 centimeters and ready to push, you might be surprised by your own animal instincts. Your body knows what to do, following the path women have labored down for millions of years. However, keep your head in the game, too—you are in control. And don’t be afraid to moan or scream if it helps.
The pain of labor and delivery is something that you can’t truly prepare yourself for because it’s unlike anything else—and that’s true no matter where you rate it on the pain or intensity scale. The best thing you can do is to make a birth plan ahead of time and listen to your body when it comes to pain management. Remember, soon enough the pain will end and you’ll have a brand-new baby to show for it.