A Practical Guide to Pain Management During Labor

Apr 1, 2025

Co-written by Deja Ramos, a Certified Doula (DONA), ICCE, and Co-Founder of The Birth Companions and Anna Morales, Co-founder of Mila Support

Why does it matter?

Pain in labor is real and so are your options. Whether you’re planning for an unmedicated birth or want to explore pain relief with medication, this guide walks you through every tool available so you can create a Birth Plan that works for you.

Two Mindsets About Pain in Labor

Understanding how to think about labor pain can help you choose your approach:

Coping with pain accepts pain as part of labor and focuses on managing it through movement, support, and non-medicated tools, and facilitating your body to release its own set of pain relieving hormones.
Pain relief focuses on using medications to reduce the sensation or pain or alter your perception of it. Nitrous Oxide, IV medications like opioids, and epidurals all work to make the sensations of labor more tolerable. Aside from nitrous oxide, these are only available in hospital birth settings.

You can combine both. Many people use coping techniques early, then request medication later. It’s your choice.

Pain ≠ Suffering

Pain is physical. Suffering is emotional.

With knowledge, support, and preparation, many people find labor painful but not overwhelming. Others may feel distress even with medications if they feel alone or unheard. That’s why emotional and physical support are equally important during labor and delivery. This is where your support people come in, think deeply about who will be best for you in the delivery room.

Your Full Pain Management Toolkit

Option	What is It?	How It Helps	Pros	Cons
Environment	Low Lights, Uplifting or Soothing Music, Aromatherapy	Low Lights, Uplifting or Soothing Music, Aromatherapy	Easy to do at home and at the hospital. Sets the tone for your support team and care providers.	May not be enough alone.
Deep Breathing	Slow, deep inhales through the nose, a brief pause, and controlled, slow exhales. Also called Box-Breathing - in for a count of 5, hold for 2, out for a count of 7.	Activates the parasympathetic nervous system to promote hormones of calm. Supports coping brain chemistry.	Portable, wherever you are laboring. No special classes - fairly intuitive. Creates rhythm and ritual during contractions.	Can require support people to coach to keep the breaths controlled and effective.
Movement	Changing positions frequently and rocking or shifting in your position during contractions.	Facilitates baby's navigation through pelvic maze. Reduces tension in muscles and soft tissues that can create more pain.	New positions are an opportunity to balance activity and rest. Rocking helps create rhythm and ritual during contractions.	Decision fatigue is real when selecting your next labor position. Takes practice to make some labor positions feel comfortable and sustainable.
Visualization, Meditation, or Self-Hypnosis	Guided mental exercises to create positive imagery or sensations in the brain.	By reducing activity in the frontal cortex, the worry brain, these techniques reduce fear and tension in the mind and body.	Portable, wherever you are laboring. Creates rhythm and ritual during contractions.	These skills take practice. Paid guided courses can be expensive.
Massage or Counterpressure	Light or medium touch from a support person, or firm pressure on particular areas of the back and pelvis.	Touch is relaxing and boosts oxytocin and the coping chemistry of the brain. Counterpressure helps ease the intensity of outward pressure caused by baby's position in the body.	In addition to the physical effects, both techniques involve close presence of a support person, which can boost the laboring person's sense of safety.	These techniques require a support person to perform. That person may also need some practice in how to best perform massage or where to place counterpressure. Good communication is key.
Warm Shower or Bath	Warm water either in a tub, in a shower, or aimed locally on the back.	The warmth and sensation of the water create a pleasurable signal that competes with the pain signals from contractions. They also ease tension in muscles, which reduces pain.	Full submersion can help with new positions and rest. Shower or localized spray can be self- or partner administered.	Full submersion can stall early labor. Overly hot water can reduce blood pressure, causing dizziness, or mask or imitate a fever.
Birth Ball or Peanut Ball	A large, inflatable ball for positioning support.	Promotes movement in labor - circles on the ball, rocking the peanut. Supports upright labor positions that are restful. Supports open pelvic positions that are restful.	Can add some fun to labor movement. Keeps the body moving, even while resting. Helps with positioning, especially with limited control situations like an epidural.	Requires the purchase or rental of a birth or peanut ball. Takes practice to make some labor positions feel comfortable and sustainable.
TENS Unit	Adhesive patches applied to the back and a machine that sends electrical pulses between them.	Sends pleasure signals that compete with the pain signals of labor.	Self-administered, can be turned up or down by laboring person as the contraction demands it. Can create a meditative focal point to support the mind in labor.	Requires the rental or purchase of a TENS machine and some instruction on how to use it,.
Nitrous Oxide	Gas inhaled through a mask during contractions only. Effective while inhaling, wears off when breathing regular air.	Relaxes the body by allowing dissociation from the sensations.	Self-administered, creates a ritual for contractions. Quick acting, and quick fading. Metabolized quickly, so no harm to baby even used during delivery.	Not available everywhere. May be only used early into labor. Not strong enough relief for some. Can be tricky to use effectively.
Opioids	Medication used for pain.	Single injection of medication into existing IV line or muscle. Effective for ~60 minutes, wears off gradually.	Can give you a brief rest, then allow you to get back to unmedicated labor after it wears off. Or you can use it while waiting for an epidural to be administered.	Temporary relief may not be what you're looking for. It is in the bloodstream, so baby is also medicated. May not be safe to use close to delivery.
Epidural	A mix of analgesic and anesthetic continuously administered through catheter placed in back, between vertebrae. Effective until turned off, after delivery. Additional medication (bolus) available for self-administration to adjust to increasing labor intensity or breakthrough pain.	Disrupts the communication of the central nervous system, blocking pain and other sensations and sometimes movement.	Very strong or even complete relief of labor sensations. Continuous through delivery. Not in the bloodstream, so no effect on baby.	Can be more challenging to stay active with epidural - changing positions often and effectively for labor progress. Can fail, or deliver an insufficient amount of relief, leading to frustration and disruption.

Tips for Building Pain Management Plan

Start with non-medicated, coping tools — they help early and set a strong foundation. Many benefit from practice, so start learning how to use them now.

Know your options and when to use them. Not everything is available at every hospital—ask in advance.
Bring a support person who knows your plan. Whether it's a partner, friend, or doula, they can speak up if you're tired, overwhelmed, or focused inward.
Stay flexible. You don’t need to pick a “natural” or “medical” route—most people use both.
Include your preferences in your birth plan, if you would like to request pain medication (vs. being offered), if you'd like to labor in water, and who you want present for support.

If You’re Considering an Epidural, Read This

You’re not alone, 60%+ women in the US get epidurals. Epidurals are the most effective form of pain relief used in labor, but here’s what many don’t realize:

You still need to move to help labor progress. Even if you can’t walk, you can shift, use a peanut ball, or have someone help reposition you.
You may need help to move. Ask your partner, doula, or nurse to assist with regular position changes (every 30–60 mins).
Make your preferences clear in your birth plan. If you are going to hold off on the epidural for as long as you can in labor, consider a phrase like this in your birth plan so you don't inadvertently get derailed by a well-meaning nurse: “Please do not ask me if I want the epidural. I will request it when I’m ready.”
Even with an epidural, there may be discomfort during pressure or pushing. It doesn’t always take away all sensation and that’s okay. It helps you stay connected and know when to push.
Epidurals aren’t just for intense pain—they’re also helpful when labor is long. Many choose an epidural not because the pain is unbearable, but because labor is dragging on and they need rest. It’s okay to make that call for endurance, not just intensity.

Final Thoughts

There’s no medal for pain—and no shame in using any tool, whether it’s breathwork, movement, or medication. Labor is intense, and you deserve to feel supported, respected, and prepared, through whatever path your birth takes. Practice coping skills ahead of time so you can use what works best for you in the moment.

Let this guide be your starting point. Your body is capable. Your choices matter. And support makes all the difference.

‹ Guide to Cesarean Birth: Preparing for Planned and Unplanned

Choosing Between an Obstetrician (OB) and a Midwife ›

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