Pain is your body's way of telling you to take action. Consider the pain you feel when you burn yourself. The pain tells you to take your hand away from the flame! Similarly, when you sustain an injury, pain might influence you to apply ice or to get an X-ray.
Childbirth pain gives you a message: the time of birth is near. It encourages you to take action: to choose a safe place to give birth, gather your support people, and bring your baby into the world.
Yet childbirth pain is very different from most other types of pain.
Recognizing the powerful effect that language can play on our perception, some childbirth experts suggest renaming childbirth pain to provide a positive association related to the work being done by the body, rather than the negative association that accompanies the word pain. One noted midwife, Ina Mae Gaskins, uses the term "rushes," and in HypnoBirthing® classes, women are encouraged to talk about "surges" instead of contraction pain.
Learning to cope with pain is not a new concept for most women. Everyone has experienced pain, and most of us already have identified measures that help. Here are some ideas that may help with childbirth.
Give yourself permission to have your own experience with, and response to, the pain associated with childbirth. The best preparation is to remain open and receptive to the experience, as it is impossible to predict exactly what your labor will be like.
There are three basic types of pain in childbirth. Understanding what is causing pain during the different parts of labor helps you identify the work that your body is doing. Different techniques may be necessary to cope with these different sensations.
In the 1920s, Grantley Dick-Read described what has become known as the "Fear-Tension-Pain" cycle. He suggested that fear causes a woman to become tense, and that tension increases pain. The increased pain, in turn, increases fear, and the cycle repeats.
Dick-Read suggested interrupting this cycle in two ways:
Most modern childbirth preparation methods have evolved from this theory.
There are many things you can do to minimize the amount of pain from contractions and to cope with the pain you do feel.
Several weeks of practice will help these techniques become ingrained habits and easier to use during times of stress or pain. See the Mind Body Therapies  topic for an explanation of several relaxation techniques. .
If you find that your contractions are particularly painful in your back, this can be a signal that your baby is facing your front, or "sunny-side up," also called a posterior position. For some babies, this is the way they fit best through the bones of the pelvis, but most babies fit better if they are facing your back, called the anterior position.
If you experience back pain or if your midwife, doctor or labor nurse tells you that they think the baby is in a posterior position, use this pain as a message, and try some forward leaning positions that might encourage your baby to turn. You may try lying on your side, tipped far over almost onto your stomach. Or try spending time resting on your knees and forearms, or standing and bending forward at the waist. These positions also let your partner apply firm counter-pressure to your back or hips, which may greatly help alleviate the back pain. Ice packs or warm packs applied to your back may also help. You can combine therapies, by using these forward leaning positions in the shower or tub. Your midwife or doctor could also help alleviate back pain by the use of sterile water papules, which are small injections of water just beneath the skin in your low back.
The books listed below under Additional Readings describe these and many other techniques for coping well with childbirth. Another resource is easily available on the web: Penny Simkin is a physical therapist and childbirth expert who has written several books and journal articles. She has also published a downloadable pamphlet Comfort in Labor . When you reach the website, it will ask you to register, which is free.
Acupressure is another method of pain reduction some women have used very effectively during labor. A variety of pressure points may be used, and if you are interested in these techniques, you should do some advanced planning. While you or your partner may do them during labor, you might want to visit an acupressure practitioner with your partner before labor begins to make sure you understand the technique. An excellent resource for using acupressure in labor can be found in the web publication Natural Pain Relief Techniques for Childbirth Using Acupressure , by acupuncturist Debra Betts.
Other alternatives for reducing pain include the use of a transcutaneous electrical nerve stimulation unit or TENS unit. This is a device with small electrodes that you place on your skin, and then use to deliver electrical impulses during your contractions. You can rent one of these units ahead of time. Ask your provider for a referral to a physical therapist or chiropractor who can help you obtain one and show you how to use it.
Other complementary therapies such as Reiki , Healing Touch, or Reflexology  may also be used during labor. You may include a practitioner of one of these methods on your birth team, or, if you have planned in advance, you may learn techniques such as Reiki yourself.
Finally, consider the addition of a doula to your support team. A doula is a person who provides continuous support to a woman in labor. She may be certified through a doula training organization and has studied a variety of techniques for coping with labor. She remains with you throughout labor, and can help you and your partner use the right technique at the right time during labor. The use of a doula has been consistently shown to be associated with shorter labors, less use of pain medication, and fewer cesarean sections. The topic How Can I Arrange the Best Birth Support has additional information about how to find a doula.
As your labor progresses, and your baby moves further down in the pelvis, your feelings of pressure may increase. Eventually, this feeling of pressure will change, and you may begin to feel a need to push or bear down. For some women, this feeling is subtle, for others, it is overwhelming. Again this feeling is a signal or message, telling you that it may be time to begin pushing during your contractions, to help bring your baby down further. Some women feel this phase of labor is a relief from the pain of labor contractions, as they can start responding to the contractions by bearing down, helping with the downward movement of the baby.
Generally, you may follow your body's messages and push as you feel comfortable. You may do this in a variety of positions; view examples of effective birthing positions. Your midwife, doctor, or labor nurse may help give you guidance to push effectively.
Finally, as your baby is being born, you may feel intense burning as the baby comes out. While this is normal, and signals that your vagina and skin are stretching to make room for the baby, many women feel that they are tearing. Using warm wet compresses on your perineum (the skin between your vagina and anus) as you push may help guide you in knowing where to push and can alleviate some of the pain with crowning.
Your midwife or doctor can provide verbal guidance as you to push gently as the head is being born (called crowning) to help minimize any tears. The good news about this burning is that it is short lived, lasting only a few contractions at most.
Especially for first time mothers, doing perineal massage (massage of the skin around the back of the vagina) during pregnancy can help prevent tears, and give you some feeling of what this stretching sensation feels like. You can read about performing perineal massage  and see some pictures at the University of Michigan's School of Nursing website. Either you or your partner may perform the massage.
In United States hospitals, pain management is usually a nursing performance goal, and nurses in hospitals are expected to assess and treat pain. Hospital funding from sources such as Medicare is dependent on hospitals meeting pain management requirements.
Given this, you may be asked to "rate" your pain on a scale and offered medication if your pain is above a certain level. These measures help the hospital staff to not only treat pain, but also to meet the requirements of their review committees.
Your labor nurses might suggest medication or epidurals as measures to help cope with labor pain. Because these options are popular among laboring women, your nurses might have little experience with some holistic measures for coping with labor. On the other hand, your nurses might have a wealth of experience with alternative methods for helping women with labor.
You can help your labor nurse and other hospital staff by:
You can also ask your nurses for their help in maximizing your freedom of movement and your ability to choose comfortable positions. Some hospital practices, such as continuous fetal monitoring or IVs can limit your activity. You can ask for intermittent monitoring or a saline lock instead of a continuous IV. If continuous monitoring becomes necessary, it does not mean you must stay in bed. You can ask to have rocking chairs and birthing balls moved close to the monitor, or to use telemetry monitoring if you wish to get into a tub or shower or walk.
Not every technique will work for every woman, and each labor is unique. Adopting a holistic approach to childbirth, by the very definition of the word "whole," may also mean considering the use of pain medication, or epidural or intrathecal (spinal) anesthesia.
Even if you don't think you will use them, ask your midwife or doctor what pain relief methods they commonly use, so that you can read about their benefits and risks before labor begins. Be sure to review the topics Why Should I Consider Holistic Childbirth  and What Factors Influence the Natural Progression of Childbirth , as they contain information about the potential risks and benefits of pain medications and epidural anesthesia. If you begin to think about using medication during labor, keep the following guidelines in mind.