Ask 100 women about childbirth pain, and you are likely to get 100 different answers. Nan, who believes in natural childbirth, had no medication and says she did not notice the pain. Her sister, Shirley, shakes her head, “I took all the classes, learned all the breathing exercises. But all that went out the window in the middle of labor.”

Labor involves cramping and pressure that can range from mild to severe. And when the baby’s head moves down the birth canal, there is a intense stretching feeling. Compared to other mammals, human females have a small pelvic opening through which the large head and shoulders of a fetus must travel. In centuries past, there were times when women either gritted their teeth and screamed or were given drugs that knocked them out, giving them little to remember of the birth experience.

British obstetrician Grantley Dick-Read introduced the idea of natural childbirth with his book Childbirth Without Fear. His book was first published in 1933 but not widely known in the United States until the 1950s. Followers of Dick-Read argue against use of any pain medication. More widely followed today are the Lamaze and Bradley methods. Lamaze stresses relaxation and controlled breathing with a neutral stance toward pain medication. Bradley, or “husband-coached birth,” supports a medication-free birth but accepts that parents should be prepared for unexpected complications.

Over the past few decades, anesthesia options have also improved greatly, and it can be said that a woman does not have to choose between gritting her teeth and missing out on the beauty of the birth experience. A good part of the pain linked with childbirth is related to anxiety, fear and other emotional factors. Dr. Dick-Read wrote about the Fear Tension Pain Cycle. Lack of knowledge leads to fear which causes tension and increases pain. Whatever method is chosen, prepared childbirth is designed to help the mother handle that fear. An informed mother should know what is happening to her own body and that of her baby throughout pregnancy, labor and delivery. This knowledge can go a long way toward reducing anxiety.

Building confidence is easier when the mother has the support of the father or another person during labor and delivery. Lamaze uses the partner as a coach; the Bradley method asks for parents to work as a team. Classes, starting midway through the pregnancy, provide detailed information about the stages of birth and teach use of controlled breathing, concentration points and other techniques to distract pain messages and keep the focus on the birth process.

Another way to manage labor pain is through changes of position. Lying flat on the back is the traditional position, but, in most cases, it has no medical benefits and perhaps a few risks. With the help of gravity, contractions are stronger and the baby moves with less resistance. One study of Latin American women found that first-time mothers who stayed in an upright position had 36 percent shorter labor than women lying down. A British study found that walking not only shortened labor but reduced pain and the need for medication. While all of the above strategies may be helpful, many women still feel pain associated with pressure and stretching of the cervix.

The resistance to pain medication that developed along with the trend toward natural childbirth was based on the possible negative effects to mother and child. Anesthesia available today has been shown to be safe on both accounts. Anesthesia used for pain during labor, usually an epidural, blocks nerve impulses from the lower body, decreasing feeling without affecting awareness. More than half of women delivering babies in U.S. hospitals today use epidural anesthesia.

One disadvantage of an epidural is that it lessens the woman’s ability to push. It may also limit her movement and ability to change positions. Those who choose an epidural say that it relieves the discomfort enough to allow them to have a positive birth experience.

The most recent advance is patient-controlled epidural–allowing the woman to adjust the dose continually to meet her changing needs. Studies indicate that women use 30 percent less medication through this method.

There are some, who still argue strongly for a medication-free birth, but options are available, and it is important for a woman to be firm about choosing whatever combination gives her the greatest comfort and peace of mind.

Kerri Musselman, PharmD—Rev. 5/19/2010 TNK