Overview

Your body must go through a lot of work to birth a baby. During labor, nerves send messages to your spinal cord and brain, and your brain interprets those signals into the feeling of pain. The good news is that you can access many pain relief options during labor as long as you know what those options are. The more tools you have available in your labor toolbox, the better you can manage contractions and confidently navigate your labor. Explore all of your pain management options for labor, from interventions like an epidural to non-pharmacological techniques.

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Labor Pain

Your body has to go through a lot of work to birth a baby. As your baby descends, your uterus contracts, and your vagina and perineum stretch. During labor, nerves send messages to your spinal cord and brain, and your brain interprets those signals into the feeling of pain. Since each of our brains is different, pain is subjective. Pain is entirely created in our brains, meaning it is more than the sensation that goes into how we experience it. Your experience of pain is also influenced by your expectations, emotional state, surroundings, and past experiences.

Hormones During Labor

The hormones your body produces during labor can significantly impact how you experience pain. Oxytocin is the hormone responsible for contractions. Your body also releases beta-endorphin, a stress hormone that acts as an opiate or pain killer. High levels of beta-endorphin reduce oxytocin levels, slowing down your contractions. While this may seem counterproductive to birth, it allows you to experience the positive effects and relief from beta-endorphins at a pace where your body can handle the stress. It is important to keep in mind that you have a built in system to help you cope with pain in labor.

You Have Options for Pain Relief

While some expecting mothers may opt for an unmedicated birth, you do have access to many pain relief options. According to the American College of Obstetricians and Gynecologists, there is no other circumstance in which it is considered acceptable for an individual to experience untreated severe pain that is amenable to safe intervention while the individual is under a physician’s care.

Epidural

Epidurals are used in 76% of births in the United States. Epidurals are available in all hospitals but are not an option if you opt for a home birth or a birth center. An epidural administers medication into the epidural space around the spinal cord. An epidural blocks the nerve impulses from the lower spinal segments, resulting in decreased sensation in the lower half of the body. A tiny catheter is inserted into a space between your vertebrae and the spinal fluid. Once it is in place, medication is delivered through the tube. Epidurals take around 15 minutes or less to take effect, and if more pain relief is needed or desired, more medication can be delivered through the catheter.

An epidural is an ideal pain medication for labor and birth because it affects the area from your belly button to your upper legs. While it numbs pain, you can still feel pressure, which is helpful during the second (pushing) labor stage. Technically, three different methods are widely referred to as an epidural – epidurals, spinals, and the combined spinal epidural.

A spinal block is a one-time injection directly into your spinal fluid. This takes effect quickly, usually within about five minutes, and lasts about one or two hours. A spinal is frequently used with an epidural to make a combined spinal-epidural. This takes effect within about five minutes, like a spinal, and then works to deliver continuous medication like an epidural. While they differ, both provide continuous medication and everything we discuss today applies to both.

Medications Used in Epidurals

The medications in an epidural can be a combination of more than one drug. What medications are used, in what amounts, and for how long will all depend on many factors. Generally, the medication you will receive is a combination of a local anesthetic and an opioid. A local anesthetic decreases feeling in a specific area. An opioid reduces the required anesthetic dose and prolongs the effects while stabilizing your blood pressure.

Walking and Patient-Controlled Epidural

A “walking” epidural is a lower dose of medication from an epidural that allows you to maintain more feeling. Despite the name, you may not be able to stand or walk. A lower dose of medication also means you have more sensation, and it may be easier to feel when you are having a contraction or when you need to push during the second stage of labor. You may also have the option of patient-controlled epidural analgesia. Patient-controlled means the epidural has a pump with a button to push if you would like more medication. You don’t need to worry about overdosing because the pump limits how much medicine can be delivered within specific time frames.

What to Expect with an Epidural

Many doctors previously wanted you to be in active labor before starting an epidural. Their concern was that an epidural might slow down your contractions. Today, most care providers will support starting an epidural whenever you request it. This procedure requires an anesthesiologist, and it can take 30-45 minutes from when you request an epidural until it is in place and working.

The window of opportunity to get an epidural is until your baby’s head is crowning. If you want an epidural the second you get to the hospital, ask for one. You also have the option of the anesthesiologist putting the catheter in place and waiting to start the medication until your labor becomes more active.

Epidural Benefits

The most significant benefit of an epidural is the ability to block or decrease pain. An epidural can also allow you to rest. This could be a considerable benefit if you have had a particularly long labor. Labor is a marathon and can be exhausting. Some moms can even sleep through some of their earlier labor with an epidural. Another benefit is that an epidural does not knock you out, so you will still be alert and actively participating in your birth. As your needs change during labor, the type and amounts of medications can be adjusted.

Epidural Effectiveness

According to one study, 98.8% of participants reported adequate labor anesthesia with an epidural. A tiny percentage of expecting mothers may not find the relief they seek with an epidural. Initially, 12% of epidurals failed; most could be corrected with adjustments. Some scenarios in which an epidural may be ineffective are if the baby is in an especially uncomfortable position. Occasionally, the epidural may only work on one side of your body. This is caused by the catheter not being appropriately positioned, becoming dislodged, or if you remain in the same position for too long. Your anesthesiologist can quickly correct most of these issues. In some cases, if your epidural is inadequate, you may require a higher dose of medications. Please speak up and let your care provider know how you are feeling.

Epidural Side Effects

As with any medication, there are possible side effects. A few of these are shivering, ringing in your ears, backache, or soreness at the insertion site. The narcotics delivered through an epidural can cause itchiness, particularly in your face. The medications used may also make you nauseous.

According to the American College of Obstetricians and Gynecologists, approximately 30% of mothers with an epidural will experience a fever. Unfortunately, we do not know exactly why this happens. An epidural may cause your blood pressure to drop suddenly; this occurs in about 10% of women receiving an epidural. The issue with your blood pressure dropping is that it also affects blood flow to your baby. A drop in blood pressure is often treated with IV fluids, medications, and oxygen.

One side effect affecting less than 0.7% of women is a severe headache caused by spinal fluid leakage. This can be treated with a “blood patch,” in which a small amount of your blood is injected into the epidural space.

In rare instances, an epidural could affect your breathing and very rarely could cause permanent nerve damage or result in an infection. This is an overview of the side effects; this list is not specific to particular medications. You want to discuss any possible side effects of the medications you will be given with your care provider.

Labor Limitations

An epidural can affect the natural flow of hormones that happens during birth. The use of an epidural decreases your oxytocin levels. Oxytocin is the hormone that drives your contractions. For an in-depth analysis of how an epidural may affect hormones during labor, see this article. A Cochrane review that examined studies comparing epidurals to other pain medications and non-medicated births found that Pitocin was slightly higher in the participants receiving an epidural.

The medicines in an epidural decrease your sensation in the lower half of your body. This is beneficial for relieving pain, but it may bring additional challenges. Depending on how numb you are with an epidural, you may have difficulty telling when you are having a contraction, making pushing difficult to control. You may also be restricted to a hospital bed if you cannot stand safely. Thankfully, nurses and hospital staff are very helpful in assisting you with positions within your limitations.

Additional interventions that accompany an epidural may limit your mobility. This includes being hooked to an IV, having a catheter, and continuous electronic fetal monitoring. There is evidence that some labor positions are more effective than others. Upright and squatting positions tend to be more effective and may even reduce your time in labor. It may be challenging to utilize these positions with limited mobility.

How an Epidural Affects Your Baby

It is tough to assess exactly what the impact of an epidural on your baby is. There is limited research isolating this intervention alone. Any medication you use during labor enters your baby’s bloodstream through the umbilical cord. Many of the effects on your baby directly result from the possible side effects the epidural can have on you, like running a fever or having a drop in your blood pressure.

There are some conflicting studies on the effects of an epidural on breastfeeding. Research is about split in half between those that showed a negative association between epidurals and breastfeeding and about half showing no effect. If you are planning on an epidural and are concerned about your baby breastfeeding, take advantage of being in a hospital and ask to see a lactation consultant to ensure you get off on the right foot with breastfeeding. See this episode for more in-depth information and evidence on epidurals.

Nitrous Oxide (N₂O)

Nitrous oxide is a nonflammable, tasteless, odorless gas commonly known as laughing gas. This is an anxiolytic and decreases anxiety to help you be more relaxed. The nitrous oxide used during labor is a blend of 50% nitrous oxide and 50% oxygen. This differs from the nitrous oxide commonly used in dentist offices, which allows for a higher concentration of nitrous oxide, up to 70%. In a dental setting, nitrous oxide is often continuous, with a mask strapped to your face while continuously breathing it. During labor, the use of nitrous oxide is intermittent.

Over 50% of births in Finland, Norway, England, Australia, and New Zealand, 60% in the United Kingdom, and 70% in Sweden involve nitrous oxide. In the United States, the use of nitrous oxide has decreased with the rise in epidural use since the 1970s. Although it has not been widely available, access to nitrous oxide during labor is expanding in hospitals and birth centers. The American College of Nurse-Midwives has an official position statement noting that women should have access to a variety of measures to assist them in coping with the challenges of labor. Among these should be nitrous oxide analgesia, commonly used in many other countries.

How Nitrous Oxide Works

Nitrous oxide works by increasing endorphins, dopamine, and other natural opioids in the brain while decreasing cortisol release. Inhaling this gas induces feelings of euphoria, and in labor, it can create a disassociation with the discomfort of contractions. Rather than blocking or numbing sensation, nitrous oxide changes your perception of the pain from contractions.

Nitrous oxide can be used at any stage of labor and can be started or stopped anytime. It is self-administered, and you hold a mask to your face and decide when and how much to inhale. Nitrous oxide takes effect 30-40 seconds after inhalation. The benefits dissipate quickly, within a few minutes of discontinuing inhalation. Ideally, you want to get in a rhythm of inhaling about 30 seconds before a contraction. This may take some practice through several contractions to get the timing and rhythm down.

Nitrous Oxide Benefits 

There are some benefits and advantages of nitrous oxide. You can start or stop at any time during any stage of labor. You could choose nitrous oxide, then decide you want an epidural later. In one study, 69% of participants converted to another analgesic method when they started with nitrous oxide during labor. Those who used labor induction, oxytocin augmentation, and labor after cesarean were more likely to convert to another method. Some women opt for nitrous oxide to help with anxiety or discomfort, while an anesthesiologist administers an epidural. 

Using nitrous oxide does not confine you to a bed, and you should be able to maintain your mobility. However, you will need to remain near the nitrous oxide to access it through your mask. Nitrous oxide does not affect oxytocin production, so it should not slow labor. 

Nitrous Oxide Effectiveness

A study of 463 women who used nitrous oxide rated satisfaction on an 11-point scale from 0-10, with 10 being very satisfied and the mean score was 7.4. 69% of participants converted to another type of pain relief during labor, most due to inadequate pain relief. The effectiveness of nitrous oxide or any intervention depends on your goal. An epidural may be a better option for someone who desires to feel no pain or discomfort during labor. If you want a less invasive alternative to take the edge off, nitrous oxide may be worth exploring.

Nitrous Oxide Side Effects

Some women find the sensation of breathing into a mask during contractions to be unpleasant. In one study, the most commonly reported side effects were nausea (3.7%) and dizziness (1.7%). Fatigue may occur when used for prolonged periods, and this would apply if you use it throughout a long labor. 0.7% of participants reported drowsiness.

Nitrous Oxide and MTHFR Polymorphisms

Concerns have been raised about nitrous oxide if you have an MTHFR mutation. An MTHFR mutation is a genetic mutation that affects a large percentage of the population and impairs enzyme function, impacting your health. Dr. Ben Lynch, an expert on MTHFR, advises against nitrous oxide, and you can read more on his site here.

One study found that patients with an MTHFR gene polymorphism had a higher risk of developing hyperhomocysteinemia after nitrous oxide anesthesia. This condition is when you have high levels of homocysteine, which can contribute to damage to your arteries or blood clots. This study used a concentration of 66% nitrous oxide over two hours, which differs from the levels of nitrous oxide used during labor and birth. If you have any questions about your MTHFR status and using nitrous oxide, please bring it up with your doctor or midwife.

How Nitrous Oxide Affects Your Baby Nitrous oxide is often talked about in terms of not having effects on your baby. In one study, 97.8% of babies had an APGAR score of 7 or higher at five minutes. A review found that Apgar scores in newborns whose mothers used nitrous oxide did not differ significantly from newborns whose mothers used other labor pain management methods or no analgesia.

Systemic Analgesics (Intravenous Pain Medications)

It is possible to have intravenous pain medication during labor. Opioids bind to opioid receptors in your brain, spinal cord, and gastrointestinal tract. They trigger dopamine and reduce pain messages to your brain. Opioids are a class of medications that include narcotics like fentanyl, oxycodone, morphine, and heroin. These are considered systemic analgesics and can be given intravenously or as a shot. These drugs have a calming effect and reduce awareness of pain but do not eliminate it.

Systemic Analgesics Effectiveness

Medications vary in how quickly they go to work, the half-life, and how long they last. A review of 70 studies did not have sufficient evidence to assess which opioid drug provided the best pain relief with the least adverse effects. Please talk to your doctor for more information on the specifics of the medications used. According to ACOG, opioids have little effect on maternal pain scores, provide unreliable analgesia, and commonly have adverse effects such as nausea and vomiting. Typically, intravenous medications are not the method of choice when an epidural is an option.

Side Effects and How Systemic Analgesics Affect Your Baby

Side effects for a mother in labor include nausea, vomiting, and drowsiness. All opioids cross the placenta. Alterations in the fetal heart rate tracing are common after the administration of opioids. Your doctor will be monitoring your baby’s heart rate to keep an eye on this. These drugs have risks to your baby, including lower Apgar scores, respiratory depression, decreased muscle tone, and difficulty suckling. Many of the side effects in your baby can negatively impact breastfeeding and bonding after birth. The half-life of opioids in newborns is much longer than in adults. Systemic analgesics are not typically used near the time of delivery and are limited to the first stage of labor to minimize the effects on your baby.

Pudendal Nerve Block

Your pudendal nerve has two branches, one on each side of your body, and carries sensations from your labia, clitoris, and perineum. A pudendal nerve block is an injection of an anesthetic that works to block the pudendal nerve. This shot is administered transvaginally (through your vagina) in the second stage of labor, just before your baby is born. Your doctor could use a pudendal block to repair a tear or episiotomy, although a local anesthetic is more common for these procedures. Keep in mind this block will not block any discomfort from contractions. If you are concerned about pain during the second stage in your vagina or perineum, it will help.

Pudendal Nerve Block Benefits

The benefit of a pudendal nerve block is pain relief in the second stage of labor. It is also possible to use this method with or independent of other pain medications. A double-blind study that paired a pudendal nerve block or a placebo with an epidural found a pudendal nerve block decreased drug use in an epidural and shortened the second stage of labor. The group participants who received the nerve block were more satisfied with their pain relief than the control group who received a placebo.

Pudendal Nerve Block Side Effects and Risks

The most common side effect is discomfort at the injection site. There is a small risk of bleeding or infection. Rare side effects can include damage to the pudendal nerve or damage to organs nearby, like the bladder. There is also the rare possibility of puncturing the pudendal artery, which could be fatal. This is a procedure that is considered safe by a trained medical professional. In the research reviewed for this article, I found no evidence that a pudendal nerve block affected babies.

General Anesthesia

General anesthesia is usually for emergency cesareans, where an epidural is not an option. Under general anesthesia, you are not awake and cannot see, feel, or hear anything during the birth. Just over 5% of cesarean births use general anesthesia. General anesthesia typically uses a sedative such as propofol or ketamine and a muscle relaxant. During this procedure, you are intubated with a tube inserted into your airway and placed on a ventilator. Your birth partner cannot be present for the surgery but can be with your baby after they are born until you are awake.

Local Anesthetic Injection

A local anesthetic injection is a shot of pain-relieving medication to a specific area. This is routine before performing an episiotomy or repairing a tear in your perineum or vagina. The most commonly used pain medication for a local anesthetic is lidocaine. A local anesthetic is available in all birth settings, including by a midwife in home birth. A local anesthetic works by binding to the sodium channel in cells and blocking nerve signals to your brain. You may still feel pressure, but you should not feel pain in the area where the anesthetic is injected.

Local Anesthetic Benefits, Effectiveness, and Side Effects

If you are having an episiotomy or need a tear repaired with stitches, there is no reason you should feel pain during these procedures. Even if you are planning an unmedicated birth, you would incorporate this if needed. Local anesthetics are commonly used in all medical settings and generally do not have side effects. In rare cases, you could have an allergic reaction or nerve or heart problems if the dose is too high. Since this is a standard procedure, you should trust that your care provider is skilled in performing local anesthesia. There should be no adverse effects on your baby.

Non-Pharmacological Pain Relief

In addition to medications, there are also many non-pharmacological pain relief options. Many of these can be combined or used in conjunction with medicated options. While the mechanisms of each of these tools differ, each can give you some sense of control during your labor. Any technique or tool that makes you feel more empowered during labor will positively influence your experience.

TENS (Transcutaneous Electrical Nerve Stimulation)

Transcutaneous electrical nerve stimulation is a non-pharmacological therapy for pain relief. This has been used as a pain-relieving technique for labor since the 1970s. A TENS unit is a small handheld device with wires attached to electrodes in pads that you stick on your skin. Typically, for labor, the pads are placed on your lower back. You can control the intensity of the stimulation and may have the option of a boost button. You will feel a tingling or buzzing sensation where the electrodes are stuck on your back. This method seems most helpful early on and less effective as contractions get stronger.

There are a couple of theories on how electrical pulses can help during labor. The first is that they may prevent pain signals from reaching your brain. According to this theory, applying heat, cold, or massage would have a similar effect. The other view of how TENS works is that it stimulates your body to release endorphins, which can mediate the experience of pain.

Availability and use of TENS units vary by country. TENS are utilized more often in the U.K. and Canada than in the United States. If the venue where you plan to have your baby does not offer TENS, you may be able to purchase and bring your unit. These are available without a prescription at some pharmacies and online, with costs ranging from $30 to several hundred dollars. Units differ in the settings available to control the intensity of the stimulation. Some may have a feature to boost stimulation with the push of a button, which can come in handy during a contraction. Units also differ in the number and size of the pads.

TENS Benefits

Using TENS during labor has many possible benefits compared to other pain relief methods. Using TENS does not restrict your mobility. Since it is a handheld device that is battery-operated, you can move around, remain upright, and try different positions. A TENS unit doesn’t require a trained professional like a doctor, midwife, or nurse to operate it. You could use this in early labor at home, and you control the intensity of the stimulation and can start or stop at any time.

TENS Effectiveness 

The evidence is not overwhelming that TENS machines make a big difference during labor. A Cochrane Review found limited evidence that TENS reduces labor pain. Most women using TENS said they would be willing to use it again in future labor. Researchers reported no adverse effects. Another review that looked at all available pain relief methods found insufficient evidence of TENS’ effectiveness. If you choose to utilize this device, you will need to experiment with the intensity, frequency, and timing of stimulation that works best for you.

TENS Risks

From all the research I sifted through for this article, no adverse effects are attributed to using a TENS machine, assuming you use the device as instructed. Although there are no risks, there are a few downsides. The electrical stimulation can interfere with electronic fetal monitoring. Your care provider may ask you to discontinue using TENS with an electronic fetal monitor. You cannot get the TENS unit or pads wet. If you plan to utilize any hydrotherapy, you need to remove the pads and then reapply once dry.

Breathing

Controlled breathing is a free and easy tool you can use during your labor. Controlling your breath can affect your nervous system, influencing how you cope with pain. When you are under stress, your heart rate increases, your rate of respiration increases, and this is all driven by your sympathetic nervous system. This causes your fight-or-flight response, and this communication can go both ways. You can also activate your sympathetic nervous system when breathing in short, shallow breaths. You can counter this with slow, deep breathing to increase oxygen, decrease blood pressure, lower heart rate, and activate the parasympathetic nervous system. Your rest and digest system is active when you are calm and relaxed.

Diaphragmatic Breathing

The breathing that tends to be most common during labor is diaphragmatic breathing. That sounds complex, but it is just deep breathing. This is sometimes called belly breathing or abdominal breathing because your belly expands or goes outward as you inhale. Usually, you take about 10-20 breaths per minute. With slow breathing, you want to aim closer to six. Typically, you would slowly inhale through your nose and slowly exhale through your mouth. You can imagine the air going to the bottom of your lungs and slowly filling them up, or imagine breathing all the way down to your baby. Try this out, and as you take deep breaths, you will notice your belly going out. Conversely, try taking in short, shallow breaths, and you can observe your chest rising rather than your belly.

The Evidence on Breathing During Labor

Many studies examining breathing during labor don’t isolate breathing, which is used with other methods like massage or visualization. One study found lower anxiety levels with breathing techniques. Another study found that deep breathing decreased the perception of pain and the duration of labor. A Cochrane review found that relaxation techniques, including breathing, may help women manage labor pain.

Practicing Diaphragmatic Breathing

Before going into labor, you can experiment with different breathing techniques. One way to do this is to set a timer for 60 seconds and hold an ice cube in your hand while practicing breathing. The idea is that holding an ice cube is uncomfortable, and you can experiment to find the techniques that are most helpful to either distract you from the discomfort of the ice or make the discomfort more bearable. You may want to add techniques to diaphragmatic breathing, like counting as you inhale or exhale. You can add words, a mantra, or an affirmation to each breath. You can combine breathing with visualization, like waves breaking on the shore or your baby descending.

Rapid, Shallow Breathing

There may be times in your labor when deep breathing is not the most comfortable. Breathing in and out of your mouth rapidly with shallow breaths may be more helpful during the more challenging times of a contraction.

One study compared different breathing techniques used during the pushing stage of labor. One group was instructed to take a deep breath at the start of a contraction, hold it, and push. The other group was instructed to use deep breathing, breathe out with an open mouth while pushing, and use a method called blowing when their baby was crowning. Picture blowing as if you are trying to blow out a candle. The idea is that this slows your baby coming out, giving your perineum more time to stretch and allow your baby to emerge as a result of contractions, not pushing. 40% of the women who used the breathing techniques had an intact perineum with no tearing, compared to 20% in the control group. Overall, the group who practiced breathing had more first-degree tears but fewer 2nd and 3rd-degree tears.

Hydrotherapy

Hydrotherapy is a broad term encompassing many treatments around water’s physical properties like temperature and pressure. You can include hydrotherapy in labor by birthing in water or even taking a bath or shower.

Showers

In a study of 80 participants, 39 had warm showers for 20 minutes at a time during labor. They found that warm showers improved the birth experience and decreased labor pain. Another study that utilized 30-minute showers during active labor found the showering group had statistically significant decreases in pain, discomfort, anxiety, and tension and a significant increase in relaxation. There were no differences in the use of obstetric interventions.

You can try a shower either at home or once you are in the hospital. It is easy to instantly adjust the temperature in a shower if you prefer warmer or cooler water. The sensation of the water on your back can be soothing, especially if you have a shower head with different settings. You may also want to try putting a plastic chair in the shower and sitting on it backward to feel the shower on your back. If your care provider monitors your baby with an electronic fetal monitor, you can request to remove it while in the shower. Getting in the shower at a hospital may not be an option once you get an epidural.

Water Birth

Waterbirth is when a baby is born to a mother laboring in a tub of water. Proponents of water birth claim that it is beneficial in managing discomfort from contractions promotes relaxation, and eases stress for your baby during birth. Critics of the practice raise concerns about the safety of water births, risks associated with respiratory issues for the baby, and the risk of infection for both you and your baby.

Waterbirth may be an option for you if you are planning unmedicated labor and are considered low-risk. While more hospitals are beginning to offer this as an option, most water births occur in homes or at birth centers under the care of a midwife.

Professional Organization Opinions

The American College of Nurse-Midwives states warm water immersion hydrotherapy during labor provides comfort, supports relaxation, and is a safe and effective non-pharmacologic pain relief strategy that promotes physiologic childbirth. Women should be given the opportunity to remain immersed during labor and birth if they wish to do so within the context of a shared decision-making process with their healthcare providers.

The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists agree on the official opinion on water births. The opinion states immersion in water during the first stage of labor may be associated with a shorter labor and decreased use of spinal and epidural analgesia and may be offered to healthy women with uncomplicated pregnancies between 37 0/7 weeks and 41 6/7 weeks of gestation. They state there is insufficient data on which to draw conclusions regarding the relative benefits and risks of immersion in water during the second stage of labor and delivery. Therefore, until such data are available, it is the recommendation of the American College of Obstetricians and Gynecologists that birth occurs on land, not in water. A woman who requests to give birth while submerged in water should be informed that the maternal and perinatal benefits and risks of this choice have not been studied sufficiently to either support or discourage her request. 

Effectiveness of Water Birth for Pain Relief

A Cochrane review found a small reduction in the risk of using regional analgesia (epidural) for women using water immersion in the first stage of labor. A study found that water births had shorter second and third labor stages than vaginal deliveries, both with and without an epidural. The mean second stage in the water birth group was 10.9 minutes, compared to 28.3 minutes in the epidural group and 23.9 minutes in the conventional group. By shortening the time you spend in labor, you also decrease the time you are experiencing pain.

A study of 26,684 women who gave birth at home or a birth center, included 10,252 women who gave birth in water. The mothers who gave birth in water were less likely to use pain medication, significantly less likely to experience an episiotomy or laceration, and less likely to experience an FHR abnormality. The occurrence of prolonged first and second stages of labor was lower in women having a water birth. Babies born in water were less likely to be transferred to a hospital, be admitted to the NICU, or experience respiratory complications. There were no significant differences in Apgar scores, neonatal death, or newborn readmission.

Baths

Even without access to a birthing tub, you can take a bath in the early stages of labor at home. Your body is working very hard during labor, and you may already feel on the warm side. You want the temperature warm but not scalding hot so you don’t overheat. You may find a warm bath relaxing and experience some relief during contractions. There is no downside to trying a bath. If it isn’t helpful, you can always get out.

Additional Influences on Your Perception of Pain

Some additional influences can affect how you perceive pain. Let’s explore a few more tools you can have in your toolbox to navigate labor.

Doula

A review involving over 15,000 women found that having continuous support during birth significantly impacted birth outcomes, including 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. If you want a better idea of what a doula is and how they support you during labor, check out this episode.

Your Labor Environment

There is a strong argument that the environment in which you give birth should be similar to the environment in which you make love. One study examined Snoezelen rooms for birth. Snoezelen is a Dutch term that describes a controlled multi-sensory environment. These rooms featured an overhead projector emitting green light and different images, and there was an aquarium with live fish. The rooms had oil-burning candles with the option to add a drop of lavender essential oil. Rooms also had light music playing. The Snoezelen rooms were associated with 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.

In recent years, there has been more attention to modifying hospital rooms to be more comfortable spaces. We are also seeing more sensory rooms incorporated into hospitals that focus on elements that make the environment more relaxing and help patients with pain management. You may not have access to a Snoezelen room, but you can alter any environment’s light, smell, and sounds. For more on this topic, see this article.

Labor Positions

The position you are in has a lot to do with how you experience pain, how effective your contractions are, and how you cope with pain. There is evidence in support of laboring in an upright position. A review of women during the first stage of labor 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 upright 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, more perineal muscle relaxation, shorter births, lower rates of requests for epidurals or other medication, fewer assisted deliveries, and fewer cesarean sections.

You will need to try different positions throughout your labor to find what works best. No matter what interventions you use or where you give birth, you have options regarding the positions you are in. Even limited to a hospital bed, you can sit upright and use support from your partner, a doula, or nursing staff.

You Always Have Options

You have a lot of options when it comes to pain relief. There is no one-size-fits-all, and you can combine the tools, techniques, and procedures you think will be best for you and your baby. Please advocate for yourself if there is a method you want to incorporate into your birth experience. If you have any questions about what pain relief options are available to you, please talk to your doctor or midwife.

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