Labour pain comes in two kinds, and only one yields easily to opioids
About 132 million babies were born worldwide in 2023. For the mothers, labour pain is not one sensation but two: a deep, visceral ache as the cervix stretches open, and a sharper somatic pain near the end as surrounding tissues stretch. The second type resists opioid drugs, which is one reason hospitals also offer nitrous oxide.
Labour runs in three stages. First the cervix shortens and opens, with cramps or back pain lasting around half a minute and returning every 10 to 30 minutes, growing stronger and closer together. The second stage is the descent and birth of the baby, and the third delivers the placenta. Somewhere along the way the fluid-filled amniotic sac usually ruptures, the event known as the waters breaking; if it does not, a clinician may open it with a thin plastic hook. When the sac breaks before labour, contractions usually begin within a day.
Pain has cultural and psychological layers as well as physical ones. It is experienced differently across cultures, and practices such as having female relatives present can ease it. Later births may hurt less, which has been linked to reduced fear. Relief ranges from epidural injections and spinal blocks to coping methods like Lamaze breathing. A baby lying bottom-first can cause back labour, with lower-back pain persisting between contractions.
Hormones do more than drive contractions. Oxytocin, associated with calm and contentment, rises in late pregnancy and surges as the baby presses on the cervix, and it is thought to play a big part in bonding between mother and infant. Fathers' oxytocin also climbs after contact with their baby, and parents with higher levels tend to interact more responsively with their infants. Nursing releases more of it, helping milk flow. Major health organisations advise placing the newborn on the mother's chest straight after birth and delaying routine procedures for an hour or two.
The stakes remain high. Complications of pregnancy and childbirth cause about 260,000 deaths among those giving birth each year and leave around seven million women with serious long-term problems, mostly in the developing world, where most births still happen at home. Dangers include obstructed labour, heavy bleeding, eclampsia and infection for mothers, and oxygen deprivation, injury and prematurity for babies.
Source: Childbirth
