Pain and pain management during labour

Find out about the process of labour and the different methods of pain relief and pain management during birth preparation sessions. A better understanding of this can increase your confidence and your ability to manage pain.

Make sure your partner and the healthcare professionals supporting you on the day understand your preferences regarding pain management. Clear communication can strengthen your confidence and help you to overcome your fears about labour. 

Feel supported and comforted by someone you trust. This could be your partner, a family member, a friend, or even a doula. This presence will do you good and encourage you throughout the labour process.

Write a birth plan that sets out your choices for pain management and other aspects of labour. This will help your medical team to better respond to your needs.

Deep breathing is one of the relaxation techniques used to reduce pain and its intensity. By stimulating the central nervous system, breathing contributes to the production of endorphins by your body, which act as pain inhibitors (4). 

During painful contractions, it is common to tense up and hold your breath, which only intensifies the pain. By learning to breathe in a fluid, steady way, you will learn to release tension in your body, relax, and manage contractions more effectively. Antenatal classes during pregnancy are particularly beneficial in this regard, as they teach you breathing techniques tailored to labour.

According to one study, certain relaxation and massage techniques act as distractors to help reduce the pain associated with contractions, leading to greater satisfaction with pain relief (5).

During labour, massage carried out by your partner or a healthcare professional may help induce relaxation, reduce the severity of pain, relieve muscle spasms, channel the expectant mother's attention and contribute to overall relaxation (6).

Similarly, regularly practising relaxation exercises (prenatal yoga, meditation, hypnosis) during pregnancy increases the likelihood of achieving relaxation during labour. Relaxation and visualisation of the birth in advance can strengthen the mother's emotional bond with her unborn baby and contribute to her engagement with the process (7). 

Aromatherapy stimulates receptors located in the olfactory bulb, which transmit a signal to the limbic system. The limbic system is the brain's emotional centre and can respond to stress by releasing hormones, helping to create a sense of calm. The use of lavender may reduce fear and anxiety in expectant mothers and decrease the need for epidural anaesthesia (8). 

Furthermore, earlier studies have shown that music is an easy and effective method for relieving pain and anxiety during labour. It has also been suggested that music therapy be incorporated into maternity care protocols to improve their quality and effectiveness (9).

If you are well prepared and well supported, you have every chance of experiencing this exceptional moment in the best possible conditions, of delivering your baby and managing the pain.

The process of labour and its progression are deeply linked to the hormones oxytocin, adrenaline, and beta-endorphins. While oxytocin is responsible for increasing uterine contractions, adrenaline can modulate the perception of pain (10), and beta-endorphins act as natural analgesics by relieving pain and producing a sense of pleasure and excitement (11).

These hormones, which play a role throughout labour, are also involved in the sexual experience, particularly during orgasm. It is therefore not surprising that some women experience during labour voluntary or involuntary sensations, provoked or not, similar to those of an orgasm — a phenomenon sometimes called "birthgasm" (12).

Stimulation of certain erogenous zones such as the clitoris and vagina during labour could increase pain tolerance by up to 75% when the internal walls of the vagina and the clitoris are stimulated, thus contributing to a significant reduction in pain (13). This stimulation may act as a natural analgesic by promoting the release of beta-endorphins (14). Finally, nipple stimulation or any type of stimulation can help labour progress if it has stalled (15).

Do whatever feels good to you! Beyond physical stimulation, other factors can influence the birth experience and make it more enjoyable: a massage or simple physical and emotional contact with your partner, a comfortable environment (16), or even the support of a doula. Like love, everything goes better when you feel good and safe. 

Studies cited have shown that applying cold gel pads to the perineum could significantly reduce the intensity of pain experienced by the mother, particularly during activities such as sitting, walking and breastfeeding (23). Furthermore, the use of cold gel packs appears to result in a significant reduction in the use of analgesics, which may be beneficial for mothers looking to minimise their use (24).

Cold may help support the healing of perineal wounds, particularly following an episiotomy or a tear. Study results suggest that the use of cold gel pads can not only reduce pain, but also promote faster and more effective healing (25).

However, please note that the application of cold may also cause unwanted side effects (26). Recent research highlights sensations of excessive cold, numbness and even temporary anaesthesia following the application of cold (27). Although these are temporary and do not cause perineal injury, it is essential to weigh the benefits against the potential side effects and to explore other treatment options to meet each mother's individual needs.