Coping with labor pain: breathing, movement and epidurals

Every woman experiences labor pain differently, and there is no single right way to cope with it. Getting to know your options in advance, from drug-free methods to epidurals, makes it easier to decide what suits you when the time comes.

Drug-free methods

Learning how labor progresses, relaxing and breathing deeply help many women feel more in control and cope better with pain. You can try:

• Breathing slowly and deeply during contractions and trying to relax in between
• Changing position, such as walking, rocking, kneeling or sitting on a birthing ball
• A warm shower or bath; some hospitals also have a birth pool
• Massage and calming music
• A partner, relative or doula who supports you throughout

These methods don't take the pain away completely, but they can help you relax and can be combined with medication if needed. A TENS machine, which sends mild electrical pulses through pads stuck on your back, may help with lower back pain in early labor, but it hasn't been shown to work in active labor. Most methods such as acupuncture, aromatherapy or hypnosis haven't been proven to relieve labor pain either.

Gas and pain-relieving injections

Some hospitals offer a mix of oxygen and nitrous oxide (often called laughing gas) that you breathe in yourself through a mask. It doesn't remove all the pain but can make it more bearable; it can cause light-headedness, nausea and sleepiness. Opioid painkillers given into a muscle or a vein also reduce pain but don't stop it. They can make you and your baby sleepy and, if given close to birth, can affect your baby's breathing, so your care team decides when they're appropriate.

What is an epidural?

An epidural numbs the pain coming from the birth canal with medicine given through a thin tube (catheter) placed in your lower back, and it often relieves most of the pain. Only an anesthesiologist can give one, and it takes some time to set up and start working. During an epidural, your contractions and your baby's heartbeat are monitored continuously. Many studies have shown that regional anesthesia is safe for you and your baby, but it can still have some effects:

• A heavy feeling in your legs
• A drop in blood pressure, itching or a headache
• Difficulty peeing; sometimes a catheter is needed
• Temporary tenderness for a few days where the needle went in
• A longer pushing stage and a higher chance of needing a vacuum or forceps

Major lower-back surgery in the past or certain health conditions can make an epidural unsuitable. Asking for one too late may also mean it can't be given.

“There's no single right way to cope with pain; the right way is the one you choose knowingly and freely.”

Talk ahead, stay flexible

The options available vary from hospital to hospital. The World Health Organization recommends that women take part in decisions about pain relief and about positions for labor and pushing, and that they have a companion of their choice with them during birth. Talk to your doctor before the final weeks: What options does your hospital offer? Is an anesthesiologist available around the clock? Are companions allowed? You can also note your preferences in your birth plan. You may change your mind during labor, and that's completely natural.

In the days after an epidural, if you have a severe headache that gets worse when you stand up and eases when you lie down, a fever, problems controlling your bladder or bowels, or leg numbness or weakness that doesn't go away, tell your doctor right away.