Ep 60: The Role of Pain and Hormones During Labor

Did you know that pain serves an important role during labor and birth? Pain is Purposeful, Anticipated, Intermittent, and Necessary. In this episode, Doula Rachael breaks down the important role that pain serves during labor and birth and what you can do to help flip the script on perception of pain when preparing for labor. Pulling back this veil of fear surrounding pain can help you feel more confident and prepared as you navigate the sometimes unpredictable path to giving birth. The more you know about what is normal during labor, the less fear you can have as you are experiencing the intense sensations and surges of labor.

Doula Rachael also shares about the orchestra of hormones during childbirth as well as tips for supporting the flow of birth in a meaningful and effective way.  

Other helpful Aligned Birth Podcast episodes:

Episode 14: Choosing a Care Provider For Your Birth

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Transcript

The # 1 concern or fear for expecting parents is the greatly anticipated pain of labor and birth.  

Here is a cool fact for you...pain during labor is different from everyday pain!  Pain during labor is not like hitting your toe on the coffee table.

I am going to share more information about the role of pain during labor and how the mind-body connection plays a vital role in helping you birth your baby.  Learning this will help you feel less fearful and more confident in your body and the normal process of giving birth.

Learning what is normal and what you can expect as labor begins and intensifies, will help you feel more confident to labor at home longer, to trust your body and baby, and it will ultimately help reduce your overall risk for unnecessary interventions.

Part of this process is to discover your own personal preferences surrounding pain management.  There is no perfect formula for how to labor because each individual person is unique and comes into birth with their own set of circumstances, history, needs, and wants.  So this process applies to all types of birth.

When you think about your birth..I want you to focus less on the anticipation of the pain and more on how you want to FEEL during your birth.  Focusing on how you want to feel can help guide your decision making in a productive and meaningful way.  When you focus on the fear of the pain, that tends to guide your decision making in a fear-based way which is less productive.  

How you FEEL during your birth has the potential to stick with you for the rest of your life.  The manner in which you give birth whether it be medicated, unmedicated, vaginal, cesarean, on land or in the water...that matters less...what matters is how you FEEL giving birth and how you are treated during this time!

The Fear-Tension-Pain Cycle exists in and outside of giving birth.  How it works is that when you are in a state of fear, your body creates tension, and that tension results in feeling the pain in a more significant way.  Which then confirms the fear of the pain and the cycle repeats itself.

So how do we break this cycle?  How do we flip the script?  This can be achieved by increasing knowledge about the normal process of giving birth (which is what you are doing here) the more you know the better you will feel about things.  Then you add in focused relaxation techniques and use comfort methods such as deep breathing, massage, and movement...these steps will help reduce your overall perception of pain and help you have a more positive and satisfying birth experience.    

I want you to practice these steps during your pregnancy.  When you begin to feel the fear creep in, or the stress consumes you, or the increase in anxiety...stop and remind yourself that you can break the cycle.  This is something that gets easier the more you practice it.

Use your time during pregnancy to become aware of how you and your body respond to fearful or stressful situations.

Does your heart rate increase, do your muscles tense, do you take shorter breaths, are you less able to focus, do you feel paralyzed….these are the physical and emotional responses to fear and pain.  Take a moment, take a deep breath, and a long exhale….do this 4-5 times….and then see how you feel afterward.  In those stressful moments, are you able to flip the script and reduce the tension, pain, and anxiety. I hope so! 

With practice, you will be able to easily tap into those helpful techniques during labor.

So you may have heard me say that “pain serves a role during labor”....and you may be wondering “how on earth can pain be helpful?”  I totally get it.  I’ve done a lot of learning about pregnancy and giving birth and this is not something that is usually shared by your care provider or friends and family.  So I am glad you are here learning about all the important things you need to know about giving birth...including about the role of pain during labor and birth!

This acronym is super helpful in flipping the script on pain in labor.  

P-A-I-N 

Purposeful - Pain in labor guides you!  It tells you what to do and when. If you are uninhibited, the pain of labor can guide you into different positions that are more comfortable for you...it can guide you to make the sounds you need to make to help vibrate your cervix open.  It can help you know how to sense something is “different” or “wrong”.  You can come up with different words to call it...surges, expansion, intense sensations...whatever works for you!

Anticipated - So unlike hitting your toe on the coffee table or breaking a bone...the pain of labor is anticipated...once it starts, you know it’s coming.  You are able to anticipate...therefore you can prepare for it mentally and emotionally….whereas pain that occurs out of nowhere is very different.  It goes from 0-100 very quickly...for most labor builds up slowly over time.

Intermittent - that leads me to the next one...pain in labor is intermittent...you get breaks!  You can breathe a little easier, take a sip of water, change positions, kiss your partner, whatever feels good to you...you are able to take a break between contractions and do that thing. For most, labor starts slowly and builds up overtime. This is helpful because as your pain increases, so do your endorphins which are natural pain relievers.  So with time and the gradual and intermittent increase in pain, your endorphins also increase providing natural pain relief. With everyday pain like breaking a bone...that pain doesn’t stop.  So try not to compare how you handle everyday pain with labor pain because it is very different.

Necessary - The pain of labor is necessary in order to bring your baby earthside and into your arms, your uterus has to contract and your cervix has to expand.  Your hips and pelvis have to widen.  Your pelvic floor and vaginal tissues have to stretch.  With each of these things, there is pain, discomfort, intense sensations, sensations you’ve never experienced before…but they are necessary in order to give birth to your baby.

When you can view labor and birth as necessary and positive work, it can help you flip the script in a way that reduces your fear and increases your confidence.

A cool thing to know about managing pain during labor is about Gate theory.  Can you recall a time you hit your elbow really hard on something...what was your first instinct to do?  Most likely it is to rub or massage your elbow with the opposite hand until the pain subsides.  This is called Gate Theory.  What it means is that, the brain can only receive so many signals at once and the pathways for comfort are larger than the pathways for pain.  So when you rub your elbow, it disrupts the pain signal and your perception of pain decreases.  This is why we talk so much about comfort techniques because the massage, counter pressure, hot/cold therapies, changing positions can all help interfere with the pain signals going to the brain therefore reducing your overall pain experience.  How cool is that?!

Next slide - Hormones of labor

Pregnancy, labor, and birth is a physiological experience - meaning there are many parts of the body working together to create, grow, nourish, and birth your baby

And for most birthing people, these events happen on their own and without much need for assistance or intervention.

I want you to understand the normal physiological birth process and learn how you can support the flow of birth so that your labor can start and unfold smoothly and safely.  

An important part of this incredible process is your HORMONES - your hormones may feel elusive and hard to fully comprehend because we can’t SEE them...but there are many important hormones working around the clock…these hormones are fundamental in conception, pregnancy, your labor beginning, your labor progressing, and birthing your baby.  As well as after the birth to facilitate mother-baby bonding and breastfeeding.

Prostaglandins - When your baby’s lungs are fully mature and ready to breathe outside the womb, a hormone is triggered in your body called prostaglandins.  These prostaglandins settle in the cervical mucus and begin to soften the cervix which sends the signal to your body that the baby is ready.  Prostaglandins helps to soften the cervix which as we learned about previously is one of the 6 ways labor progresses.  Prostaglandins are also found in semen. So the phrase from Ina May Gaskin is so very true “what gets the baby in, gets the baby out”.  This is one of the reasons sex is recommended in late pregnancy to help get things going.  

Oxytocin is a hormone that occurs when we feel happy, loved, connected, safe, joy...and is commonly known as the love hormone and is an important player in labor - oxytocin causes the uterus to contract - oxytocin is needed for labor to begin and progress effectively, it plays a role in the birth of your placenta, as well as mother-baby bonding and breastfeeding. When you make a love connection, you get that tingly feeling...that is oxytocin.  When you make eye contact with your baby, you will get the same feeling...that is oxytocin.

When oxytocin is flowing during labor, your uterus will contract effectively which helps your cervix to thin and dilate as well as to help push your baby out...you need very strong uterine contractions to expel your baby out of your body and into your arms...and the primary hormone at play during this event is oxytocin.  Then, after the birth, when you are skin-to-skin with your baby and kissing and snuggling your baby, the oxytocin is flowing which helps your uterus to again contract and expel your placenta.  Then when your baby takes their first latch...the oxytocin will flow...this sends the signal to your body to let down your milk.  

So as you can see, oxytocin is a key player in the normal physiological birth process.  

Endorphins - endorphins can also occur outside of pregnancy and you may be familiar with endorphins if you’ve ever done a long race or any physically challenging event like that.  Endorphins are natures painkillers and they can help reduce the perception of pain when your brain receives a pain signal.

How they work during labor is….as your body is progressing and the surges are coming on more intensely, your endorphins will increase overtime...this helps to reduce your perception of pain...and as things continue to progress and get more intense, your endorphins will also increase.

For most birthing people, labor will begin and unfold in a slow and steady pattern...getting more intense overtime...labor is not a 0-10 pain level in an instant.

When you experience pain such as hitting your toe on the coffee table or breaking a bone...that is a 10 out of 10 in an instant...your body hasn’t had a chance to produce the endorphins to help numb the pain.  Labor is different.

Endorphins produced during labor are there to help you cope with the pain.  Interventions such as IV narcotics and the epidural will interfere with the production of endorphins because if the brain is not receiving the pain signal it won’t produce the endorphins. 

Catecholamines - these are your fight or flight hormones.  Catecholamines occur at two different points during labor.  The first way they can show up is if you are feeling fearful or unsafe, your body will increase the production of catecholamines which disrupts the production of oxytocin...which in turn will slow or stop labor until you feel safe again. This is a protective mechanism and mammals in nature use it to stop labor when they sense a predator.  

Catecholamines show up again during the pushing stage.  They increase during this time because your body knows that you are to the point of no return and getting the baby out quickly is necessary for the safety and well being of you and your baby.  And again, going back to the mammals in nature example...they need to push their baby out so they can quickly get to safety.  

I think this is the coolest hormone of labor and how it can work in two different ways to protect us during labor is awesome.  

After the birth, catecholamines drop dramatically so that oxytocin can flow freely again to promote mother-baby bonding. This big drop in catecholamines will cause a shaky feeling.  Try not to fight the shakiness...this is your body regulating after the birth...and it will stop after a few moments.  

Cortisol is a disruptor hormone also known as the stress hormone.  This can show up during pregnancy and impact how labor begins.  It can impact labor in two ways...if it can increase the risk of preterm labor - which is labor occurring before 37 weeks.  OR once labor has begun, cortisol can slow or stall labor.  Cortisol production during labor can disrupt the flow of the other hormones we have just discussed.  

Cortisol is also a hormone you can experience outside of pregnancy.  Cortisol increases when we feel stressed, anxious, or fearful.  Can you think of a time when you have felt stressed, anxious, or fearful?  How does your body respond physiologically?  

Does your heart rate speed up, do you take shorter breaths, do your muscles tense up?  These are common and normal responses to stress.  A time to check-in with your body and mind and how you are responding physiologically is when you have a visit with your doctor or midwife.  How do you FEEL during this time?  I want you to envision them supporting you for your birth.  How do you think you will feel?  And if it is anything other than safe, trusted, comfortable, respected….you may want to consider a different provider.  

Another time cortisol can show up is when you are arriving at the hospital and shifting from the privacy and comfort and safety of your own home and into a big hospital that is sterile, bright, and full of strangers.  This shift can increase cortisol...which is normal.  Arriving to the hospital requires you to be in your thinking brain...navigating parking, answering questions, getting checked or monitored.  And you need to be in your primal brain for labor to progress smoothly.  

Being aware of this can help you protect your space and mindset during this time to reduce the chance of this shift to the hospital slowing or stalling labor. And once you are admitted and in your labor and delivery room, you and your partner and/or doula can help get you back into your flow and set the room up in a way that supports the flow of birth.

Next we will learn how to support the flow of birth to maximize birth hormones for a safer labor and birth.

Next Slide - Facilitate the birth flow (hormones)

Whether you choose an unmedicated or medicate birth, it is very important to consider ways you can best support the flow of birth and protect the flow of birth hormones so that labor can begin and unfold smoothly, safely, and with as little disruption as possible.

You may be wondering, “how do I achieve this?”

1. Provider + Birth Location - this has the greatest influence on the outcome of your birth. Pay attention to how your provider makes you feel during your prenatal appointments and try to envision how you will feel with them supporting you during labor and birth...which is an incredibly vulnerable time and you want the people around you to always make you feel safe, trusted, and supported.    Remember that feeling anxious, fearful, and tense will disrupt the flow of birth hormones so you want a provider who you trust and who trusts you and sees you as the decision maker!

1. Birth team (doula + partner + fam/friends) - besides your care provider, the next greatest influence in your birth space is your partner, doula (if you have one), and any close family members or friends you invite into your birth space.  Sometimes other people unintentionally project their own fears and stresses on us...and while their feelings are real...your birth space is NOT the place for them.  So before your birth, be sure to have open conversations with anyone who you intend to invite into your birth space and share with them the importance of creating a calm, private, quiet, safe space...and if at any point they feel the fears creeping in and can’t control them….to quietly excuse themselves and come back with they are in a better head space. If there is anyone you aren’t sure about, maybe consider not including them in this very intimate and vulnerable experience.  Your birth is not about other people...it is about YOU!  And you are the one who will remember this experience for the rest of your life, not them. 

1. Birth environment - we have discussed the people surrounding you during birth, next I want to talk about setting up your birth environment to support and facilitate your labor. I want you to create your very own “birth cave”. A space where you feel safe, comfortable, and private. I want you to consider these 3 senses: sight, sounds, and scent.  So for sight, you can dim the lights, hang twinkle lights, hang a poster with positive birth affirmations, quotes, reminders, and even include pictures that help you focus or go to visualize your happy place.  So think about what your eyes are taking in and set the environment accordingly.  Then I want you to consider what you are hearing. You can drown out the noise from the hallway by using a sound machine, you can put in headphones and listen to music, podcasts, or guided visualizations.  And then I want you to think about the smells you like...scents that make you feel calm, happy, joyful.  And diffuse those in the air. A helpful tip is to set your room at home or your bathroom at home up with these things.  Use these things to help you get into a state of calmness and relaxation.  And bring these elements with you to your birth location...that way it will be easier for you to tap into when you are in labor.

1. Positive mindset - the last tip I will share for supporting the flow of birth hormones is to consider your mindset.  Where a thought goes, energy flows.  Spend some time each day thinking and/or writing about the things that are going good for you...the things you are grateful for...even if they are tiny.  And acknowledge the things that aren’t going well too.  Allow space for those to both exist. Try to counter each negative thought or feeling with something you are grateful for and then say or read a  positive affirmation such as “i can do hard things”, or “i was made for this”, or “i trust my body” or “inhale peace, exhale fear”. I like to write positive affirmations on post-it notes and hang them on my mirror in the bathroom or stick them to my computer to remind me of what I already know. Negative thoughts, feelings, and fear may never go away...but it is how we address and navigate them that matters.  I am also not going to say that a positive mindset is all you need to feel better. If negative thoughts, feelings, anxiety, or depression persits, please contact your care provider or a professional trained in perinatal mental health.  Positive mindset is just one component to many multifaceted things at play during pregnancy and birth.  And during labor, focusing on staying focused, centered, and grounded can help facilitate labor progress….as well as help you have more positive experience overall.