Fear of pain during labor is very common, especially as your due date approaches. Whether you are planning an unmedicated birth or know you want an epidural, this episode will help you better understand how to manage labor pain with confidence. Learn how factors like your mindset, support system, and birth environment can shape your experience. In addition to exploring pain management options, this episode covers a wide range of techniques, strategies, and tools to support you during labor. Plus, get tips to build a resilient mindset to face your fears and go into birth feeling calm, capable, and prepared.

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Hi Vanessa,

Thank you so much for the Pregnancy Podcast. It has been such a huge source of support for me throughout my pregnancy, and I really appreciate the way you explain everything so clearly.

I’m 35 weeks pregnant and hoping to have an unmedicated birth. I’ve been preparing and learning as much as I can, and I really want to try to get through labor without an epidural if possible. At the same time, I’m not ruling it out completely if I feel like I really need it in the moment.

Even with all of the preparation I’m doing, I’m still really scared about how painful labor might be. I’m worried that fear itself could make everything harder. Do you have any advice on managing the fear of labor pain and setting myself up for the best chance at an unmedicated birth? I’d love to hear your thoughts on balancing being open to pain relief while still aiming for an unmedicated experience.

Thank you again for all that you do!

Best,
Samantha

Samantha, thank you for your email. It is wonderful that you are preparing for your birth and clearly know what you want. It’s equally important to stay open to other options with a backup plan. Focusing solely on one approach can leave you feeling unprepared if things do not go as expected. Let’s start by addressing your fear of labor pain, and then we’ll go over some practical strategies to support an unmedicated birth.

Understanding Pain and Perception During Labor
There are occasional anecdotes about pain-free births, but for most expecting mothers, some level of pain or discomfort is part of the experience. In Western culture, we often see childbirth portrayed in movies and television as an excruciating event, with the mother screaming in agony, usually at the father. These dramatic portrayals do little to help expecting parents form a realistic or positive image of what birth might actually feel like.

Pain itself is a complex process. Our bodies sense pain when nerves send messages to the spinal cord and brain, which then interpret those signals into the sensation of pain. Each person’s brain is unique, and as a result, pain is highly subjective. Beyond the physiological aspect, many other factors influence how you experience and cope with labor pain. Your mindset, your expectations, the amount of support you have, and your level of fear or anxiety all play a role. Fear can heighten the perception of pain by activating your body’s stress response, making contractions more intense and difficult to manage.

Although you may be a bit afraid right now, we can discuss some tips so that you feel more confident going into your birth. Hopefully, you will feel more prepared, supported, and calm, which can help lessen the intensity of your feelings and improve your ability to cope during labor.

Focus on Positive Birth Stories

Unfortunately, so many birth stories emphasize negative experiences. Step one is to cut out negative influences on how things in labor can go wrong, and avoid negative stories from others. If you watch a movie with an intense birth scene, skip through it. If you are talking to a friend and they start telling you about their 47-hour labor, politely cut them off. The next step is to replace these negative influences by hearing positive birth stories. The Birth Hour Podcast is a great resource for birth stories from mothers of all backgrounds and all scenarios. You should also be mindful of the accounts you follow on social media. If you are following someone whose content does not make you feel optimistic and excited about becoming a mother, stop following them.

Just as you should be aware of the information from outside sources, you must also be mindful of what you tell yourself. How you speak to yourself can powerfully affect how you approach labor. If you constantly reinforce the idea that birth will be terrifying or unbearably painful, you may unintentionally heighten your fear and anxiety. On the other hand, positively affirming that your body is capable and prepared can shift your mindset in a helpful direction. The thoughts you repeat shape your expectations and influence how you cope. Make space for encouragement, self-trust, and confidence in your internal dialogue.

Planning for an Unmedicated Birth

You said you are preparing and learning as much as you can, which is fantastic. Regardless of what type of birth you plan, the more prepared you are, the better the likelihood of getting the birth experience you want. This is especially true with an unmedicated birth.

Building Your Labor Toolkit

If you plan to give birth without pain medication, it is essential to prepare for how you will manage labor. No single strategy works for everyone. You want to go into your birth with a wide variety of tools you can rely on. While each tool may not make a dramatic difference on its own, they can significantly improve your ability to cope and stay in control when used together. Think of each strategy or technique as a tool in your labor toolkit. If one approach does not work in the moment, you can switch to another. Having a variety of options will help you feel more confident and better equipped to handle whatever your labor brings.

You can start learning and practicing many tools now, including labor positions, meditation or visualization, breathing exercises, or hypnobirthing. Taking a birth class can be incredibly helpful in preparing you and your birth partner. If you plan an unmedicated birth find a birth class with that focus. There are also physical tools you may want to bring or ask about at your hospital or birth center. This could include a birthing ball or stool, a rebozo, massage tools, and heating or cooling pads. Some tools are already at your fingertips, like your favorite music or sound apps on your phone. Even simple items, when used intentionally, can make a meaningful impact during labor.

Build a Support System

Strong emotional support during labor can make a meaningful difference in your experience. For most moms, this is their spouse or partner. If you do not have a partner present, a friend or family member can be an excellent source of support. The more involved your birth partner is during your pregnancy, by attending birth classes, joining you for prenatal appointments, and learning what to expect, the better prepared they will be. Your birth partner should expect to be present and actively engaged. They need to offer comfort and encouragement and serve as an advocate to help ensure your birth preferences are respected and prioritized.

If you plan an unmedicated birth, one of the best things you can do is get a doula. A review involving over 15,000 women found that having continuous support during birth significantly impacted birth outcomes. This included decreasing the likelihood of using pain medications and reducing the length of labor. The best way to ensure you have continuous support is to include a doula on your birth team.

Rest Early On
Labor can be a marathon. It is impossible to know in advance how long you will be in labor. Exhaustion and sleep deprivation are common challenges and often a deciding factor for those who originally planned to avoid an epidural. Some providers even refer to a “resting epidural,” where the primary goal is to help you get some sleep rather than just manage pain. It will make a significant difference to enter labor well-rested. If you’re experiencing early signs of labor and can sleep, take advantage of that time. Even a short nap during the day can make a big difference later. The same goes for your partner. They need to be well-rested to support you through labor, too.

Pain Management Methods

You said you are open to an epidural, and you are not ruling it out completely if you feel like you really need it in the moment. Epidurals are the most common form of pain relief and in the United States are used by 77.2% of mothers. This is the most popular choice because it is extremely effective. According to one study, 98.8% of participants reported adequate labor anesthesia with an epidural.

While the most commonly used form of pain relief is an epidural, there are many other options available. As you plan for your birth you may consider other interventions. This includes nitrous oxide, TENS (transcutaneous electrical nerve stimulation), hydrotherapy, breathing techniques, or hypnobirthing.

Other Factors that Can Influence Your Perception of Pain

In addition to pain management tools, other factors can influence your perception of pain. One significant influence is your birth environment. A study examined Snoezelen rooms for birth. Snoezelen is a Dutch term that describes a controlled multi-sensory environment. These rooms featured colored lights and projected images, aquariums, oil-burning candles with essential oils, and music. The Snoezelen rooms had a lower mean pain intensity score than the control group. The mean pain score of participants in the Snoezelen rooms was 5.26, compared to 9.56 for those in the control group. You may not have access to a Snoezelen room. However, no matter where you have your baby, you can adjust the lights, smells, sounds, and surroundings to create the best environment for you. 

The positions you labor in can also impact your experience of pain. In a review of women during the first stage of labor, overall, it was concluded that there is clear and important evidence that walking and upright positions in the first stage of labor reduce labor duration, the risk of cesarean birth, and the need for an epidural. Another study compared women giving birth in an upright position to women who labored and gave birth lying down. Women who used upright positions more than 50% of the time had more effective uterine contractions and more perineal muscle relaxation, and their births were significantly shorter. Also, they had lower rates of requests for epidurals or other medication, fewer assisted deliveries, and fewer cesarean sections.

Building a Resilient Mindset

There are several ideas for you to keep in mind as you think about your upcoming birth. These are not evidence-based techniques for coping with pain, but they may help you build a positive mindset going into labor.

Many people view labor and birth as a transformation and a rite of passage. In the book, Ancient Map for a Modern Birth, Pam England writes about the birth of a child and a new self. You are embarking on a journey of becoming a mother, which will forever change who you are and how you exist in the world. Even if this is not your first baby, you are still going through a transformation as you grow your family. The journey and energy it takes to hold your baby in your arms can be challenging. Please give yourself and your body some credit.

Even when contractions are strongest, it is not one continuous contraction. There are breaks. Try to enjoy the breaks in between contractions. Also remember that any pain and discomfort you may experience during birth is finite. It will not last forever. At the end of your labor, the reward of holding the baby that you created and brought into the world is worth every single contraction and all of the hard work in labor.

Lastly, you are not going through this alone. You may have moments where you feel alone, and labor feels hard because you are the only one feeling contractions. Your baby is with you. Every contraction you have, every millimeter they descend, all their movements, and the positions you try. You and your baby are doing this together. Plus, you have additional support in a birth partner, potentially a doula, nurses, doctors, midwives, and other staff.

Creating Your Birth Plan

When you create a birth plan, you have a concise sheet of paper with your requests. More importantly, everything you do leading up to that final printed piece of paper will set you up for success. Creating your birth plan will lay the foundation to prepare you for the scenario in which everything goes exactly as planned. Creating a backup plan will prepare you for what should happen if things do not go as planned. Samantha, in your case you may want a second birth plan that incorporates an epidural.

The Pregnancy Podcast has many resources for creating your birth plan:

Working with Your Doctor or Midwife

It is critical to have the support of your doctor or midwife. Ideally, you are working with a care provider with a lot of experience with an unmedicated birth. They will be better equipped to help you navigate any challenges without encouraging interventions. You should discuss your preferences for birth in your prenatal appointments throughout your pregnancy. That way when you go into labor, you are on the same page and work together to get you as close as possible to the birth you plan for.

Additional Resources:

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