Labor Contractions vs. Pushing: What Hurts More?

For many first-time parents, pregnancy can be a time of wonder. Everything from that positive test to the first signs of a bump can feel like a big deal—because they are! But while there is plenty to be excited about, there is also a common worry about how much it will hurt to actually give birth. But since giving birth happens in stages, you might naturally be wondering what stage hurts worse: contractions or pushing?

According to a survey conducted by the American Society of Anesthesiologists, around 50% of birthing parents between 18 and 39 said that contractions were the most painful part of labor and delivery. But 1 in 5 had a different take and said that pushing and post-delivery were the most painful. The survey also notes that most participants compared the worst pain to "extreme menstrual cramps," "bad back pain," and "a broken bone."

While everyone's pain tolerance and birth experience are different, here's what you need to know about the difference between contraction pain and pushing pain during labor.

Many Say Contractions Are Worse Than Pushing

Engaging surveys aside, the most common labor experience for birthing parents is that contractions are more painful than pushing. For most people, active labor is more painful than pushing because it lasts longer, gets more and more intense as it progresses, and involves many muscles, ligaments, organs, nerves, and skin surfaces.

Everything from the breast/rib area down works hard, contracting as tightly as possible with every contraction (which can occur every few minutes for hours on end during the active stage). Comparatively, pushing tends to go a lot quicker.

The uterus is a powerful, hollow muscle that houses your growing baby during pregnancy. When the time comes and labor begins, the uterus will start to contract, and as it does, the cervix will begin to dilate to 10 cm, which is roughly the size of a cantaloupe—large enough to allow your baby to pass through the birth canal.

According to the American College of Obstetricians and Gynecologists (ACOG), contractions can feel like they come in waves lasting 60 to 90 seconds at a time, and labor can last between 12 and 18 hours for first-time birthing parents.

Non-medicated birth

Although labor and delivery can be intensely painful, not all parents will opt for medical pain management. Even if a parent declines medicated pain relief options, that doesn't mean no pain management is involved.

With no epidural or narcotics on board, most birthing parents rate active-phase labor a 10 on the pain scale of 1 to 10. With pain management techniques taught in childbirth education, however, laboring parents can greatly reduce the intensity of the pain they experience.

A few tried and true methods for reducing pain without medication or epidurals include:

• Breathing techniques
• Relaxation techniques
• Massage
• Hypnosis
• Assistance from a trained doula or coaching from a birthing partner

Many pain management options available don't require medication intervention. Talk to your provider about the options that will best for you.

Birth with an epidural

Epidurals have become increasingly popular in hospitals across the country. Still, the statistical chance of being recommended for one largely depends on which state you live in, according to a study published in the JAMA Network. For example, 36% of birthing parents in Maine receive an epidural compared to 80% of parents in Nevada.

Epidurals are administered by anesthesiologists who inject a pain blocker into your lower back. The epidural creates a numbing sensation to help relax your body while you still experience contractions. It does not prevent you from being able to push; it just stops you from feeling the intense pain of contractions.

Epidurals can decrease labor pain dramatically, in some cases all the way to zero. But since pain is a subjective experience (and anesthesia is as much an art as it is a science), there is no guarantee that every person will see all of their labor pain dissolve after having an epidural. If you opt for an epidural, you should talk to your provider about what to expect, including side effects.

Pushing Can Feel Like Relief

When you're ready to push, and the baby presses into the birth canal, most of the hard work of labor is done. Your baby's head may press on nerves that desensitize the pelvis, and many people report feeling a numb sensation before the "ring of fire" (when the baby's head begins to emerge from the vaginal opening, a stage known as "crowning"). Some even say it feels good, similar to orgasm.

Pushing is often described as relief from active labor contractions because it's a natural urge you can give in to. For many, it feels more active than passive. And after all those contractions, when the pain may have felt like it was relentless or never-ending, pushing can finally make you feel like you can do something to get the baby out.

The Power of Preparing for Birth

Because pain is entirely subjective, however, no two birthing parents will have the same experience with contractions and pushing. For some, contractions might not be that bad; for others, labor contractions are the most intense experience they've ever had.

And it's not just pain tolerance at play in a person's birth experience. For example, the baby's position during labor can greatly influence the birthing parent's pain levels as can any complications and resulting interventions.

When it comes to comparing the pain of labor contractions and pushing, however, it can be a little bit like comparing apples and oranges. The pain is often different, and not always better or worse.

The best way to confront any fears or concerns you may have around pain associated with contractions and pushing is to talk to your doctor or midwife. Make sure to ask about all the options available to you including classes that teach you breathing and relaxation exercises, creating a birth plan, and how you feel about medicated pain relief.