Labor is almost always painful, due to muscle contractions in your uterus, which are the transmission of sensations along nerve pathways to your brain and the impact of various chemicals in the brain. It is natural, physiological pain and is not a result of disease or illness, which causes unnatural or pathological pain. Labor also allows you a period of mental adjustment as you realize that your pregnancy is almost over and that you are going to become a parent – surprisingly, those few mothers who have a pain-free labor often feel that they have missed out and that the transition from being pregnant to being a parent is too sudden.
The extent to which you will feel pain during your labor is influenced by your personal perception, based on your personality and your attitude to labor and the arrival of your baby. Various factors, both positive and negative, can affect your perception of the pain, including how prepared, in control and well supported you feel, fear and anxiety about the anticipated pain, previous experiences of pain, cultural perspectives, concern about either your own or your baby’s health, as well as existing illness or the development of problems during labor. You need to work with the pain rather than fight against it – think of it as a means to an end, with every contraction bringing you closer to meeting your baby.
One of the most important hormones involved in labor is oxytocin, produced from the pituitary gland in your brain, which also plays a part in sexual intercourse and in breastfeeding. During sex, oxytocin enhances ovulation (and, in men, increases sperm production) to facilitate conception, causes uterine contractions during orgasm and triggers the cervix to suck in the semen to meet the egg and, in conjunction with other hormones, makes you feel good afterwards. In pregnancy, the oxytocin enables good blood flow to the placenta and your baby through the Braxton Hicks contractions. During labor, oxytocin stimulates the onset of contractions in your uterus and, in the second stage, also facilitates relaxation of the muscles of the pelvic floor and vaginal walls to allow space for your baby to be delivered. It helps to control hemorrhage by contracting your uterus and, later, aids the return of your uterus to its non-pregnant size, shape and position. After delivery, oxytocin plays a part in lactation by contracting special cells surrounding the milk cells, thereby helping to eject milk into your baby’s mouth.
Other chemicals – endorphins – also need to be released to aid labor progress. Endorphins are naturally-occurring, pain-relieving chemicals and act as your body’s ‘feel good’ factors. They appear to have a slightly amnesiac property, perhaps helping you to forget the worst of the pain in a previous labor so that you can approach a subsequent birth without that memory. However, endorphins are released in response to pain, so in order to be produced in sufficient quantities, it is necessary first to feel the pain of early labor contractions. This is why, if you have labor induced, it is inappropriate to have an epidural or spinal anaesthetic before adequate contractions are established since insufficient endorphins are produced. This could adversely affect labor progress and, later, leave you with a sense of depression and dissatisfaction, which could affect your relationship with your new baby.
Oxytocin release in labor can be affected by fear and anxiety as well as other negative emotions such as embarrassment. Unresolved psychological and emotional issues related to previous experiences, such as excessive pain or complications in your last labor, or more profound issues such as sexual abuse, can prevent adequate oxytocin release. Unfortunately, fear of anticipated pain in labor can trigger some of the endorphins to be produced prematurely in an attempt to make you feel better, but this in turn inhibits the release of oxytocin so that your contractions do not become powerful enough to trigger sufficient beneficial endorphins to subdue the pain.
It is therefore important to try to reduce any anxiety you have about your labor by finding out as much as you can beforehand and preparing mentally for the work to come. Oxytocin production is also affected by the use of some drugs, including anaesthetics, which interfere with oxytocin-sensitive areas in the body. Inadequate release of oxytocin leads to a more prolonged labor and may increase the chance of needing intervention to speed up your labor and of having an instrumental delivery such as a forceps or Caesarean section. It also increases the risks of excessive haemorrhage after the birth of your baby because there is inadequate uterine contraction to shut off the blood vessels. This is why it is necessary to ensure that you are as fit and healthy as possible during pregnancy to facilitate good progress in labor.
If your labor progresses normally, it is easier to cope with the contractions than if problems develop, when you may need stronger pain relief such as an epidural. However, if this becomes necessary, stay positive and tell yourself that you have done the best you can and it is now time to ask for something more to help you. It is much better if you have help to cope with the pain so that your labor remains as near normal as possible – trying to ‘soldier on’ with what may seem to you to be unbearable pain can sometimes lead to other complications because it reduces both the oxytocin and the endorphins so necessary to good progress. If you are sensitive to the way your body works stronger pain relief can accomplish the task much more quickly and efficiently.
Deal with one contraction at a time. Labor pain is normal and quite different from the pain of disease or injury – your body is designed to cope with it and it is necessary to help your progress towards a normal labor and birth.
During pregnancy, ask your midwife or doctor to clarify anything you do not understand. If a partner or friend is going to accompany you during labor, ask him/her to be prepared to act as your advocate, taking your wishes into account, even when you are not in a fit state to be assertive yourself. If you are due to have your baby in hospital, stay at home as long as you feel reasonably comfortable – if you go into the maternity unit too early, you will have only your contractions to think about and this will make them seem more painful. Also, there is a tendency of some midwives and doctors to feel that they must ‘do something’ once you are in the labor ward, which may mean you are advised to have your labor speed up sooner than might have been the case had you stayed at home.