Labor Pain Explained: Stages, Symptoms, and Pain Relief

If you've wondered why labor can be painful here's why: The uterus is a muscular organ that contracts powerfully to squeeze your baby out, and those contractions are the primary source of labor pain. Besides intense muscle tightening throughout your abdomen and, sometimes, your entire torso and pelvic area, you may feel pressure in your back, perineum, bladder, and bowels. "All that combines to ratchet up pain," says Jay O'Brien, M.D., medical director of inpatient obstetric services at Women and Infants Hospital of Rhode Island in Providence.

Labor pain usually comes on gradually and builds up as you progress through the stages of labor. Here's what you can expect.

What Affects Labor Pain?

How much labor pain you experience depends on a variety of factors, including:

• The strength of your contractions
• Whether you have had Pitocin, which can cause stronger uterine contractions
• Your baby's size and position in your pelvis
• Whether the baby is faceup or facedown
• The speed of your labor
• Your personal pain tolerance and experience

A combination of genetics and life experiences determines your pain threshold, or ability to withstand pain, and this also plays a part in your labor pain experience. Social support (or lack of it), fear, anxiety, and even the positive or negative labor stories you've heard can contribute to your perception of pain. What's more, you probably can't change your inborn capacity to withstand pain, which is why labor can be so different for everyone, even between their own pregnancies.

So if your pain threshold is low, consider lining up a labor helper now. Studies show that those who give birth with a supportive doula or midwife report shorter labors, less use of pain medication, fewer cesarean sections, and greater satisfaction with their birth experiences than those who don't. "When a woman feels vulnerable and in pain, a doula can help her feel cared for, which extends her capacity to handle labor," says Seattle doula Penny Simkin, co-author of Pregnancy, Childbirth, and the Newborn: The Complete Guide.

The Stages of Labor Pain

Again, everyone is different in how they may or may not experience pain during labor and delivery, but in general, here are some things that you may encounter during the different stages of labor.

Early labor pain

Length: Up to 6 hours (or even longer, especially for first pregnancies)

What's happening: Your cervix opens (dilates) 3 centimeters to 4 centimeters and begins to thin (efface). Typically, mild-to-moderate contractions last 30 to 60 seconds and occur every five to 20 minutes, becoming stronger and occurring more frequently with time.

Active labor pain

Length: Approximately 2 to 8 hours

What's happening: Contractions continue to become longer, stronger, and closer together, and your cervix dilates to 7 centimeters. This is when most people request pain relief with medication, though sometimes it's given earlier. (Remember, pain is very individual and there is never a "wrong" time to request pain medicine when you're in labor, so be sure to let your nurse know so they can help you stay as comfortable as possible.)

Transition labor pain

Length: Up to 1 hour

What's happening: Pain tends to be strongest as your cervix finishes dilating to 10 centimeters. In addition to intense, closely spaced contractions, you may feel pain in your back, groin, even your sides or thighs, as well as nausea. You'll also likely feel more increased pressure as your baby moves down the birth canal.

Pushing labor pain

Length: A few minutes to 3 hours

What's happening: Intense pain is eclipsed by major pressure as you feel a great urge to bear down and push your baby out—some describe it as "like pooping a watermelon or bowling ball." Although pain continues, many birthing people say it's a relief to push because it helps relieve the pressure. When the baby's head crowns, or becomes visible, you may experience a burning, stinging sensation around the vaginal opening as it stretches (sometimes referred to as the ring of fire).

Placenta delivery pain

Length: Typically under 30 minutes but up to 60 minutes

What's happening: This stage tends to be relatively easy, as mild, crampy contractions ease the placenta out. For most people, the placenta is expelled easily in a short amount of time. If there are any complications during this stage, your health care team should help manage your pain as best as possible.

How to Manage Labor Pain

People have a lot of different feelings about pain medication during labor. Some say bring it on, while others wish to avoid it at all costs. Still, others are open to going with the flow.

Some people may feel guilty if they opt for labor pain medication, as though they've somehow failed or put their babies' or their own well-being at risk. This pressure may be intensified for people with strong desires for an unmedicated "natural" birth.

However, it should be reassuring to hear that in fact, epidurals and other pain-relief drugs are quite safe, says William Camann, M.D., director of obstetric anesthesia at Brigham and Women's Hospital in Boston and co-author of Easy Labor: Every Woman's Guide to Choosing Less Pain and More Joy During Childbirth. "There's lots of misinformation—the risks and complications are overblown, and women suffer unnecessarily," he says.

Whether you opt for an epidural or other medication or not, using relaxation techniques can boost your ability to handle the pain, says Leslie Ludka, C.N.M., director of midwifery at the Cambridge Health Alliance Hospital and Birth Center in Massachusetts. "Tensing up just gets in the way of labor progress," she explains.

Rhythmic breathing, visualization, meditation, self-hypnosis, and other relaxation strategies taught in classes such as Lamaze, Bradley Method, or HypnoBirthing may help keep your mind calm and your muscles loose. Other effective techniques include massage, counterpressure, movement, walking, taking a bath or shower, and applying ice or heat.

Whether you plan to use labor pain medication or opt out of pain medications, try to be flexible. "No one really knows what they will need until they are actually having the experience," says Ludka. "Give yourself permission to change your plan whenever you need to."

Keep in mind that each birthing option has its advantages. Medicated birth can help you progress if labor becomes stalled as a result of tension, medication-free birth can carry a lower risk of interventions, and a C-section birth can be life-saving. In the end, remember, there is no one "right" way to give birth and labor is a journey that only you can go through, so you have to be your own advocate in your pain management. Here's Ludka's advice: "Differentiate between pain and suffering. Pain can be managed, but if it becomes overwhelming, medication may prevent suffering."