School of Labor Pain

Study up before the sensations of labor take over, and you’ll be well prepared to handle the intensity of delivery day.

They don’t call it “labor” for nothing! The moments leading up to bringing baby earthside require hard, painful work. Labor is tricky to predict or even describe because every woman’s birth experience is unique. And while it’s impossible to truly understand how labor and the pain of contractions feel until you go through it, it’s helpful to have at least an inkling of what you will be facing. One thing is for certain: You’ve never felt discomfort quite like this before.

Ouch Orientation of Early Labor

The contractions before the contractions are “early labor.” Early labor can feel like Braxton Hicks contractions—also called false labor—but these contractions are different because they’re actually constructive. The cervix is dilating (opening) and effacing (thinning out) to create labor progress and eventually allow baby to enter the birth canal. Contractions are somewhat regular and gradually become more powerful and closer together. Each contraction should last about 30 to 90 seconds.

For most women, contractions during early labor are mild and may drag on for many hours. You will probably be comfortable enough to continue 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 contractions are still more than five minutes apart, you can try to handle this part at home. (Of course, if you are in a high-risk scenario, your obstetrician may give you different instructions. Follow her counsel!)

Take It Up a Notch with Active Labor

When contractions become more painful and occur every five minutes or less, it’s time to call your doctor and doula (if using one for labor support), and if you haven’t already, hitch a ride to the hospital or birthing center. You’re now in “active labor,” and you’re likely experiencing some real knee-buckling, deep-breathing pain. It hurts so bad, but it hurts so good—this is productive pain. Contractions are now longer, stronger, closer together and more regular than they were during early labor. 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 woman hollering, “Ow! My uterus!” The pain of labor registers as tightening, cramping or even 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.

Women frequently compare labor pains to menstrual cramps—only on steroids. In fact, your history with menstrual cramps can predict where you’ll feel labor contractions. For example, if you have always felt menstrual cramps in your back, you’re likely to labor in your back as well.

Those who don’t relate contractions to menstrual cramps might say they feel like intense gas pains, a heavy pounding or sharp stabbing. We don’t all feel labor the same way, and we have varied levels of pain tolerance. One person’s 3 could be another person’s 9 on the 1-to-10 pain scale.

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 is a clenching, tightening feeling, followed by a sense of relief as the contraction passes and the body relaxes.

If you are planning to get an epidural (or even if you aren’t but change your mind on pain management once labor revs up), request it from the on-call anesthesiologist during active labor, before you’re fully dilated. A spinal-epidural can allow you to get some rest before delivery; otherwise, exhaustion can become a side effect. (There are other forms of pain relief besides anesthetics that block all feelings of labor, including nitrous oxide or laughing gas and analgesics.)

Some hospitals will allow you to drink water or possibly take in a few calories during labor. But others limit laboring moms to ice chips only when interventions are involved, adding thirst and fatigue to the list of labor complaints. (The reason for this is policy derives from mid-20th century documentation of pregnant women who were put under general anesthesia and had an increased risk for aspiration, which can cause a severe inflammatory reaction or even death.)

Preparing For the Finale of Transition

At the end of active labor, you will enter the “transition” phase as the cervix makes its final stretch from 8 to 10 centimeters. The transition from waiting-on-the-cervix to time-to-push is often the roughest segment. Contractions are so powerful that the intensity can become all-consuming. Stacie Rupp, a mom in Bountiful, Utah, says, “The pain is indescribable. In some ways, it felt like drowning. The contractions came so fast, one after the other, that I couldn’t catch my breath or regain any energy.” Flu-like symptoms such as sweating, shaking and shivering can accompany the contractions, and nausea and vomiting are not uncommon.

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 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 a 10 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.

By Ginny Butler

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