Am Fam Physician. 2003;68(6):1121-1122
This is my first baby. What will labor feel like?
Almost all women find childbirth painful. During the first stage of labor, the opening to the uterus (called the cervix) slowly opens. Pain usually is felt in the abdomen or back during contractions (labor pains). In the second stage of labor, the cervix is open, and you can push your baby through the vagina. The pain usually moves down to the pelvic and vaginal area. The area between the vagina and anus (called the perineum) stretches during childbirth. As your baby's head is being delivered, there might be a burning feeling in your perineum.
How can I prepare for the pain of labor?
Childbirth classes give you a chance to learn more about what happens during pregnancy and labor. Most classes include information about natural childbirth. This is birth without the use of pain medicines. You will learn different ways to deal with pain during labor, such as walking, changing positions, taking showers or warm baths, and using breathing exercises, hypnosis, relaxation, and massage. You can ask questions about the kinds of pain medicines that are available, and you will learn about the benefits and risks of each one.
What is a doula? How might a doula help me?
A doula (say: doo-lah) is a woman who is trained to give emotional support to women during labor. If you use a doula, you might be less likely to need pain medicines. You also might be less likely to have a cesarean delivery. Your hospital or birth center might provide a doula, or you can hire one while you are pregnant. Some women like to have their partner, friends, or family members with them during labor. However, these people may not provide the same benefits as a trained doula.
I have heard that I might have many hours of contractions before my cervix starts opening. What can I do during this time? Is it best to be in the hospital during this time?
During the earliest stage of labor, the cervix opens very slowly. Doctors usually ask women to stay home during this time unless there is a problem.
Walking, breathing exercises, and taking baths or showers might be helpful during this time. If your contractions are too painful, your doctor might give you medicine to help you relax and sleep until your labor progresses.
How helpful are intravenous medicines during labor? Which medicines help the most?
Intravenous medicines (also called IV medicines) are put into your veins. If you use IV medicines, you probably will still feel some pain during contractions. But many women find that these medicines take the edge off the pain and help them relax between labor pains. No one medicine works better than others, and each hospital or birth center uses different medicines.
If you use IV medicines, you might feel sleepy or a little sick to your stomach. The medicines also might make your baby sleepy.
How does an epidural work? Are there different kinds?
Epidurals are the most common way to ease labor pain. They are used in more than half of women during labor. If you get an epidural, a needle with a thin, plastic tube inside it will be put into your lower back. The tube is placed next to the membranes that cover the spinal cord. Then the needle is removed. Pain medicine runs through the tube and numbs the nerves that cause pain. In most women, an epidural almost completely relieves labor pain, but about one in 10 women who get an epidural still feel some pain.
The types and amount of medicines used in epidurals have changed over the past 10 years. These changes may give you more control of your leg muscles and the ability to push your baby out during the second stage of labor. One type of epidural is called the walking epidural because many women who get it are able to get out of bed and walk during labor.
How will epidural pain medicine affect my labor? Are there risks or side effects?
If you have an epidural, you will be connected to a machine that will monitor your baby's heartbeat. You might not be able to urinate on your own, so your doctor might put a catheter into your bladder. Most women with an epidural have to stay in bed until their baby is born.
Doctors are not sure whether women who use epidurals are more likely to need a cesarean delivery. But epidurals might make your labor last longer, especially the second stage, when you are pushing your baby out of your body. Women who use epidurals are more likely to need a vacuum extractor or forceps put on their baby's head to help pull the baby out of their body. These steps make your perineum more likely to tear during delivery. Using an epidural might make you get a fever; then your baby might need blood tests and antibiotics.
Are there other medicines that can relieve labor pain?
Most hospitals use IV medicines or epidurals for pain relief. Some hospitals also use other methods. Some of these include nitrous oxide (also called laughing gas) and different kinds of injections, some of which put sterile water under the skin. Talk to your doctor to find out more about these kinds of pain relief.
Web Sites with Information About Labor Pain
American Society of Anesthesiologists: www.asahq.org/patientEducation.htm
Doulas of North America: www.dona.org/FindingABirthDoula.html
Maternity Center Association: www.maternitywise.org/mw/topics/pain
How do I decide whether to use a doula, medicine, or other ways to relieve labor pain?
You can learn more by going to childbirth classes, reading books, and visiting Web sites. You might decide to use one or all of these methods. Your choice will depend on the kind of birth you want and your own experience with labor.