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
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.