Understanding Pain during Labour and Birth

"Rain, after all is only rain; it is not bad weather. So also, pain is only pain; unless we resist it, then it becomes torment."  I Ching​

This is most probably what most woman fear in birth … pain.  

  • What is my pain threshold?
  • Will I be able to do it?
  • What if?

Understanding why it happens and how best it could be managed, will assist all mothers to have a more positive birthing experience. Pain in labour is a mixture of physiological changes in the body and emotional experiences.  How we react to it and how we perceive it is how we will experience it. Understanding this, allows the mind to work with these sensations and using the tools to our disposal, will allow the mother to manage this amazing working of the body!

But first, what makes labour pain different from any other pain?

  • It is not a symptom of an injury or illness:  Simply a sign that your body is working hard and well. Uterine muscles are like most muscles in the body, they do not hurt unless they have to work harder and stretch more. The sensation of pain mostly originates in the stretching of the cervix, vagina and surrounding tissues as baby passes through. The uterus gets shorter and pulls the cervical muscle up and out of the way for baby to pass through, very much like a turtleneck sweater being slowly stretched over your head.  These are all muscles movements that your body is not used to! The muscles and ligaments in the pelvic area are supplied with many pressure and pain receptors in the nerves and the stretching produces powerful sensations that are the cause of labour pain.
  • It is self-limiting: There is an end to labour.  It does not last for ever. Labour rarely takes more than 24 hours. Active labour is usually between 6-12 hours.  This is when you will start working harder.
  • It is rhythmic: Contractions last no longer than a minute or so and come in a regular pattern with one to several (usually) pain-free minutes in between them. This means you can predict and prepare for each contraction and rest between them. So clever!
  • It intensifies gradually over time: Contractions almost always start off mild and gradually grow longer, stronger, and closer together, thus allowing you time to adapt, but, having said all this, our bodies have wonderful pain control systems that allow our bodies to naturally deal with how we interpret the pain.

The Gate Control Theory, Endorphin release and Oxytocin release.

  • The Gate Control Theory
    • The 'Gate Control Theory' was first proposed by Melzack and Wall in 1965. It is a theory  based on the fact that when the larger A - b (beta) skin nerves (that sense touch, heat, cold and pressure) are stimulated, they are capable of overriding the smaller A - d (delta) and C nerve fibres that sense the sharp, burning or aching pains.
    • The larger fibres carry the 'sensory message' to the spinal cord more rapidly and get priority, shutting 'the gate' , to the pain messages being carried by the smaller fibres. If the pain intensifies to a higher level the 'gate' can be pushed back open to a degree, making the pain sensation more felt.
    • This is why it is our natural instinct to 'rub' or massage our bodies when we hurt ourselves. It is also the reason why natural therapies such as massage, cold or hot packs being used during labour can alter the conscious pain sensation, changing or modifying the pain you experience.
  • Endorphins
    • When you face stress or pain, your body produces calming and pain-relieving hormones called endorphins, more specifically beta-endorphins.  For women who don’t use pain medication during labour, the level of endorphins continues to rise steadily and steeply through the labour and birth of the baby.
    • High endorphin levels during labour and birth can produce an altered state of consciousness that can help you deal with the process of giving birth, even if it is long and challenging. These high endorphin levels can make you feel alert, attentive and even euphoric (very happy) after birth, as you begin to get to know and care for your baby.
  • Oxytocin
    • Oxytocin is aslo known as the "love hormone" because it is involved with lovemaking, fertility, uterine contractions during labour and birth and the release of milk in breastfeeding. It helps us feel content, and it triggers nurturing feelings and behaviours.
    • The receptor cells that allow your body to respond to oxytocin, increase gradually in pregnancy and then increase more during labour. Oxytocin stimulates powerful uterine contractions that help to thin and open (dilate) the cervix, move the baby down and out of the birth canal, push out the placenta, and limit bleeding.
    • These hormones are shy.  It can be disrupted with medication or when the labouring women feels threatened or unsafe or anxious.

Ways to support women during labour contractions

  • Positive companionship and support.
  • Having someone supporting you in a positive way and who understands the process is vital.  Using the right language and words of encouragement and listening to her.
  • Environment; this plays an important role on your hormone release.  You need an environment where you feel safe, comfortable, supported and peaceful. Low light is important. The same atmosphere as when you want to fall asleep.
  • Movement, position and position changes; this encourages baby to move down and move into position. Especially in active labour. "Following" your body.
  • Water; drinking enough water to stay hydrated is vital for your body to work at is optimum level.  It is advised to consume at least 250ml per hour.
  • Submerging in warm water helps reduce the discomfort and has a calming effect.
  • Massage, counter pressure and acupressure; this helps release endorphins, which is nature’s morphine.
  • Aromatherapy and essential oils; studies have shown that aromatherapy reduces anxiety and pain in labour. Lavender, Rose, Geranium, Camomile, Jasmine, Peppermint, Wild Orange and Clary Sage are the most popular essential oils in labour and birth.
  • Hot or Cold compresses; cold helps with inflammation and heat numbs the pain.
  • Breathing and relaxation; conscious breathing and relaxation is the most effective form of pain relief.  Your body needs oxygen to work well.  When we are in shock or scared, we tend to hold our breath.  It is very helpful to do conscious breathing, where you focus on breathing in as well as breathing out, while relaxing your body. The more relaxed you are in your body, the less pain you will feel.

If a woman says her labour was painful, she does not necessarily mean it was an unpleasant experience.  Many women describe it as: hard work, intense, powerful, transcending or rewarding.

So go for it! Block the brain’s pain receptors with loads of understanding, support and letting yourself go and allow your body and nature to do what it does best! By actively working with your body, the experience will be one you can excel in! Your knowledge and attitude towards the process and you positive mind-set is of utmost importance in how you will experience the discomforts in labour.


Article written by Tertia Alkema, Private Doula, who also offers Antenatal Classes at Genesis Maternity Clinic.

For more information on her services, please view here.

Contact Tertia 

Tertia 061 778 1327

support@motherinstinct.co.za


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