Labor and delivery are the joyous culmination of 40 weeks of pregnancy that ends with the birth of a child. However, the reality is that labor and delivery are painful for most women. Therefore, expectant mothers should prepare in advance for this discomfort and plan strategies for addressing the pain when it arrives.

Uterine muscle contractions and pressure on the cervix are the chief causes of pain during labor. The baby’s position also can create pressure on the bladder, bowels, lower back and groin muscles. In addition, pain may result from stretching of the birth canal.

For some women, labor is among the most intense pains they will feel in their lifetime, but others may feel less intense sensations. Most women experience the pain of labor as cramping in the abdomen, groin and back. They may also experience a tired, achy feeling all over, and pain in their sides or thighs. The pain may resemble menstrual cramps, severe pressure or extremely strong waves that feel like diarrheal cramps. First-time mothers are likely to feel more intense pain than women who have previously given birth.

Intense pain experienced during labor often leads to hyperventilation, which is abnormally fast or deep respiration that causes loss of carbon dioxide from the blood. This in turn causes blood pressure to fall. The body’s response to stress and pain may also cause decreased blood flow to the placenta and decreased oxygen flow to the fetus. Finally, significant pain may cause deep emotional trauma for the mother that may contribute to postpartum depression. All of these symptoms can be minimized by controlling pain levels during labor and delivery.

Pregnant women should consider their options for pain relief in advance and inform their physician about the possible choices. It is recommended that women compose a birth plan that includes their preferences for pain relief during labor. They should provide their obstetrician (OB) with a copy of the plan, as well as the medical facility staff.

Some women prefer to have natural childbirth, in which breathing techniques and other pain-coping strategies are used to handle the pain of labor. Other women may be more comfortable choosing a form of medication that will bring them substantial relief from the pain of childbirth. There are several types of medications that are commonly used during labor and delivery. Some of these drugs reduce pain brought on by contractions, and some help during delivery. Certain medications do not relieve pain, but instead relieve anxiety and promote relaxation.

Some women who initially choose natural childbirth may find the pain so intense that they change their minds during delivery and decide to use medications. Many partners also experience difficulty observing the woman in pain and are more at ease once the mother is more comfortable. In other cases, the way in which labor and delivery unfold may create medical circumstances that dictate the method of pain relief regardless of the patient’s desires.