Labor pains

Nicole Wendler holds a PhD in biology in the field of oncology and immunology. As a medical editor, author and proofreader, she works for various publishers, for whom she presents complex and extensive medical issues in a simple, concise and logical manner.

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Labor is painful contractions of the uterus caused by the hormone oxytocin. They change during labor and the pain increases. Read here how you can recognize the onset of real labor, how the individual phases of birth differ from one another in terms of contractions and what the after-labor is all about.

How does labor feel?

Different types of contractions occur during pregnancy, each with a specific purpose and correspondingly different. Pain is not always associated with contraction. In some cases, the contractions are so weak that they can only be determined with a contractions recorder, the so-called cardiotocograph (CTG). A slight tug in the abdomen, back pain, menstrual cramps, or a hard stomach - all of these can be signs of contraction. But then birth does not always begin. Only regular contractions indicate that it is going to start.

What contractions are there?

Most women notice the first signs of labor around the 20th week of pregnancy. These are usually irregular pregnancy pains: called Alvarez or Braxton-Hicks contractions. Towards the end of pregnancy, around the 36th week of pregnancy, so-called lowering or pre-labor pains occur. In most cases, the transitions are fluid. These early contractions usually do not affect the cervix. This only opens when real labor pains set in. However, if you feel contractions for a long time and more than three times an hour before the calculated due date, you should not hesitate to consult a doctor. You may have premature labor, which shortens the cervix and opens the cervix.

Five types of labor

Birth pains can be divided into the following five groups:

Opening labor
Expulsion pains
Labor contractions
Afterbirth pains
Aftermath

Opening pains: here we go!

Birth begins as soon as you start having regular contractions - the opening pains. At first, the intervals between the contractions are even greater - a new contraction occurs about every 20 minutes, which usually lasts only a few seconds. Over time, the contractions follow one another more quickly (about every five minutes) and each last for up to a minute. The pain intensity also increases. At the beginning you will feel the pain mainly in the area of the tailbone and in the lower back. Later the pain radiates to the lower abdomen and thighs.

The opening labor causes the upper part of your uterus to contract further and further. During the breaks, however, the muscles do not expand again, so that the lower part of the uterus also retreats further (retraction). Your cervix will soften and open, and your baby's head will slide lower. The cervix and vagina form a kind of funnel, the cervix dilates and the amniotic sac bulges. At the end of the opening phase, the cervix is ten centimeters open. In two-thirds of women, the amniotic sac ruptures at this point (the urine ruptures in good time). This allows the child to slide further into the birth canal or into the pelvis.

If it is your first birth, the opening period can last up to twelve hours. In the case of a subsequent birth, on the other hand, the second phase often begins after around two to eight hours - the expulsion period.

Expulsion pains: It becomes exhausting

The so-called expulsion contractions follow the opening contractions. They start when the cervix is fully open. The hormone oxytocin is now increasingly released. The contractions become a little stronger and more frequent - the uterus contracts about every four minutes. You are now in the most strenuous part of labor, which ends with the labor contractions. It will take about 50 minutes until your baby is born, if it is your first birth. If you have already given birth at least one time, it goes faster - it then takes up to 20 minutes.

Labor pains: the finale

When the contractions start, you and your child are almost there. The baby's head now presses on the rectum and automatically triggers an urge to press. Usually, your bowel will also empty itself, which is completely normal. If you find this uncomfortable, you can ask for an enema to defecate before giving birth.

Compared to the onset of labor, the pressure in the uterus increases by about four times during press labor. The contractions, which are often very painful, come about every two to three minutes. For the child, this is the most dangerous part of childbirth as blood flow to the placenta and oxygen supply decrease during labor. With your active participation you can shorten this strenuous pressing phase. You should therefore carefully follow the instructions of your midwife.

Initially, the baby's head becomes visible during a contraction and disappears again during the pause in labor ("cut in"). Doctors speak of "cutting through" if the head kicks through the perineum during a renewed squeeze. Sometimes the skin on the perineum (perineal tear) or on the labia tears during this phase. The doctor may also make a perineal incision beforehand to prevent uncontrolled tearing of the tissue.

As soon as the child's head looks out, usually only one contraction is necessary and the rest of the body appears: your child is born!

It's not over after the birth

But even if the baby is there, it's not quite over yet. The so-called afterbirth pains are still missing. They are significantly weaker than the previously experienced pressing contractions and ensure that the placenta loosens and is expelled. It does this by causing the placenta to release a large amount of the hormone prostaglandin. The hormone causes the uterus to contract strongly, causing the placenta to peel off.

In addition, postpartum labor, and with it the contractions of the uterus after the baby is born, is also important to minimize blood loss. If everything goes without complications, a woman will only lose around 300 milliliters of blood in the postpartum period. This part of the birth is also over after about ten to 20 minutes.

Labor in the puerperium

About one to three days after the birth (even after a caesarean section) it becomes painful again, especially after the second or third child: the so-called post-pains or still pains set in. The baby's sucking on the nipples stimulates the production of oxytocin again. The hormone not only promotes milk production, but also the contractions or regression of the uterus. A uterus that grew to around 1,000 grams during pregnancy will now shrink back to its original size (around 50 to 70 grams). In addition, the after-pains support hemostasis and stimulate the weekly flow.

But how do after-pains feel? Once you have given birth to your first child, you may notice a pulling sensation or slight menstrual pain in the lower abdomen. In subsequent births, the uterus has stretched further and now has to regress more than the first time. The muscles contract more strongly, which makes the after-pains much more painful and uncomfortable. It is particularly unpleasant that this pain occurs when breastfeeding.But these contractions will also be over after three days at the latest.

What is it that eases the pain?

Labor pains are especially painful. The following promises relief:

Breathing technique ("breathe away")
Relaxation exercise (autogenic training)
Massage: hedgehog ball or gentle pressure on the sacrum
Warmth: hot water bottle in the back
Change of position: Follow your instinct and change your position if necessary: back, side, quadruped, squatting position (birthing stool).
Medication: painkillers (suppositories, tablets), epidural anesthesia (PDA)

40th week of pregnancy: No contractions

If the calculated date of birth is exceeded, you will have to check it regularly. The doctor checks at short intervals whether the child is doing well. When your body is ready, and only then, to give birth, a few things can help induce labor. Which includes: