Many expectant mothers worry about the pain of childbirth, especially the final pushing stage when the baby exits the birth canal. This is a valid concern, as giving birth can be very painful. However, there are many factors that impact the level of pain felt during delivery. Keep reading for a deep dive into what causes pain during the pushing stage, techniques to manage it, and what to expect if you have an epidural.
What causes pain during the pushing stage?
Pain during the pushing stage is primarily caused by pressure on the vagina and perineum as the baby moves through the birth canal. Here are some key reasons it may hurt:
- Stretching of the vaginal opening – As the baby’s head emerges, the vaginal opening must stretch significantly, which can sting and burn.
- Tearing – The perineum (area between vagina and anus) may tear as the baby’s head passes through. This causes a burning, stinging pain.
- Baby’s position – If the baby is sunny side up or in a difficult position, it puts more pressure on the lower back, tailbone and perineum, increasing pain.
- Baby’s size – A larger than average baby may stretch the vaginal opening more, making tearing more likely.
- Pelvic floor muscle spasms – The pelvic floor will contract powerfully during pushing, which may cause painful spasms.
- Fatigue – Pushing for a long time leads to exhaustion, lowering your pain tolerance.
So in summary, the main causes of pain include extreme stretching of the vaginal opening, intense pelvic floor contractions, and potential tearing of delicate tissues in the perineum or vagina. All of this strains muscles and nerves in the region during the final stretch before delivery.
Pain management techniques
If you are hoping to avoid an epidural, there are some methods you can try to manage the discomfort of pushing:
- Stay in an upright position – Squatting, kneeling, or standing take pressure off the perineum.
- Water birth – Being in a birthing tub can ease pressure and provide comfort.
- Massage showerhead on perineum – This can reduce stinging or burning.
- Warm compresses on perineum – Helps soothe the area between pushes.
- Relax pelvic floor between contractions – Consciously relax muscles to reduce spasms.
- Calm breathing – Stay focused on breathing slowly to reduce anxiety and improve relaxation.
- Have an experienced doula or midiwfe – Their emotional support and guidance can boost comfort.
- Hold squatting bar or partner’s hands – Gives you something to grip during intense moments.
Using these techniques may help take the edge off and make pushing more bearable. But for many women, the pain still becomes too much to handle without an epidural.
Epidural pain relief
If you opt for an epidural, this will significantly reduce discomfort during the pushing stage. However, you may still feel some pressure. Here’s what to expect with an epidural:
- Numbing from ribs down – You’ll be unable to walk but remain awake.
- Allows rest before pushing – Helps conserve energy for active labor.
- Ring of Fire – Some women still feel burning at the vaginal opening as baby crowns.
- Dull pressure – You may still sense some downward pressure but little pain.
- Coached pushing – You’ll need instructions on when and how to push effectively.
- Possible weak feeling – Some moms have trouble figuring out how/when to push.
- Longer pushing stage – Numbed sensations can prolong the pushing phase.
So while an epidural does not take all sensation away, most women experience significant pain relief. Many describe it as feeling pressure but not the intense burning or stinging pain. This makes the final leg of labor much more bearable.
Pain after delivery
Once the baby arrives, the worst is over in terms of pain. However, you may still experience the following for 1-2 weeks postpartum:
- Perineal soreness – This can be severe if you experienced tearing.
- Hemorrhoids – Pushing commonly aggravates this condition.
- Vaginal swelling – It may be sensitive and uncomfortable for several days.
- Lower back pain – Lingering muscular strain is common.
- Cramps – The uterus contracting back down causes discomfort.
- Numbness – Some moms have lingering epidural-related numbness.
Proper rest, ice packs, over-the-counter pain medication, and sitz baths can help treat this discomfort. But it’s good to know it may not disappear immediately after birth. Be patient with your body as it recovers.
When to call the doctor
While some tenderness and achiness is normal after delivery, call your doctor if you experience:
- Fever over 100.4 degrees F.
- Heavy bleeding that soaks more than one pad per hour.
- Foul-smelling vaginal discharge.
- Burning urination.
- Uncontrolled pain.
- Large blood clots.
These could signal an infection or complication that requires prompt medical care. Don’t hesitate to call, even if it seems minor. New moms often downplay postpartum health issues. Your provider wants to know about any concerning symptoms.
Pain medication options
If discomfort lingers more than a week after delivery, talk to your doctor about medication options. Some possibilities include:
- Ibuprofen – An anti-inflammatory that reduces swelling and eases cramping.
- Acetaminophen – A milder pain reliever without anti-inflammatory effects.
- Stool softeners – Can make bowel movements less painful after delivery.
- Topical sprays/creams – Some numbing options are deemed safe for postpartum recovery.
- Sitz bath salts – These can help soothe pain if hemorrhoids are an issue.
Avoid any medication your provider advises against. Be sure to stay well hydrated and eat regularly so pain medication does not upset your stomach. A healthy diet supports healing.
Managing discomfort after vaginal birth
Here are some additional tips to manage discomfort following a vaginal delivery:
- Apply cold packs to the perineum to reduce swelling.
- Use a squirt bottle instead of toilet paper after using the bathroom.
- Sit on a donut pillow to take pressure off sensitive tissues.
- Wear loose, breathable underwear and clothing.
- Do Kegel exercises to strengthen your pelvic floor.
- Shower using a handheld showerhead set on low pressure.
- Try sitz baths with warm water to soothe the perineum.
- Get light exercise like short walks to improve blood flow.
With time, care, and rest, the postpartum body remarkably recovers. But be kind to yourself and allow adequate healing. Pushing a baby out is hard work! Give your body the break it deserves.
Does a C-section hurt less?
Some moms take comfort in knowing a C-section spares them from the pushing and delivery pain of a vaginal birth. But keep in mind, cesareans still involve major abdominal surgery and a 6+ week recovery.
Here’s how the pain may compare:
- More intense initial pain – C-sections involve significant incisional pain.
- Shorter duration – Vaginal birth involves prolonged labor then residual soreness.
- Less perineal pain – No stretching and tearing down below with surgery.
- Different limitations – C-section moms have lifting restrictions and can’t drive.
- More numbness – Epidurals often accompany C-sections.
- Higher risk of infection – Incisions are prone to this complication.
- Same postpartum cramping – The uterus contracting and shrinking hurts either way.
So while a C-section spares you the pushing stage, it brings significant discomfort of its own. There are pros and cons to both delivery methods. Don’t assume one is drastically more comfortable or easier than the other.
Conclusion
Pushing during childbirth can indeed be very painful due to intense stretching and pressure on the vagina and perineum. However, techniques like optimal positioning, warm compresses, relaxation methods, and coached pushing can help manage discomfort. And getting an epidural provides significant pain relief for most women. While you’ll likely feel some burning, stinging, or dull pressure, the pain is often less traumatic with an epidural. If you have a high pain tolerance and proper support, it is possible to endure pushing without pain medication. But there is no shame in opting for an epidural – your comfort is most important! So go into delivery with an open mind, utilize available pain relief, and do what feels right in the moment.