Pain occurs during a normal vaginal birth for basically three reasons. It can happen during transition, which is simply the most cervical dilation in the shortest period of time. Nature, however, makes the most painful period also the shortest. A typical transition rarely lasts more than about 15 minutes. If the labouring mother is told that she is in transition, and knows that she is almost through, she may be able to continue with out an epidural. If she were to have an epidural during transition, she would have to remain curled up on her side with a needle in her back, without moving, and would not receive any pain relief for transition itself, as an epidural takes 20 to 30 minutes to become effective. She would then have the added risk during second-stage Labor of not being able to push as effectively. Most doctors will recommend against having an epidural this late in Labor for that very reason. The key to dealing with the pain of transition is to know it doesn't last for long, and to choose one position that feels right; to relax completely, surrendering to and trusting in the process.
Another reason for pain in a normal childbirth is back Labor. Most women experience contractions low and in the front, similar to a menstrual cramp. But when the baby is in a posterior presenting position (the baby is facing the mother's pubic bone), pressure can be more intense on the mother's lower back and even tailbone during contractions (however, this is not always the case). By getting on her hands and knees, which pulls the baby away from her back, and having her coach give her counter-pressure (an intense circular pressure with the fist into the painful spot), the birthing mother can effectively minimise back Labor. Also, walking and changing positions can help to rotate the baby out of the posterior position, relieving back Labor completely.
Crowning -- the point at which the baby emerges from the vagina during secondstage Labor -- can also cause pain. During this time, the mother's perineum (the skin and muscles between the rectum and vagina) are being stretched to their maximum. Again, nature makes the most difficult moments the shortest. Crowning rarely lasts longer than one to three pushes in an unmedicated birth. By choosing her own birthing position and avoiding the traditional hospital pushing positions, the mother can make crowning far less painful. Squatting widens the pelvic outlet by up to 28 percent in a pregnant woman and utilises gravity to assist the birth. By using effective pushing techniques learned in a good childbirth class, staying in good physical condition, doing Kegel exercises during pregnancy, and having her healthcare provider perform perineal massage or support during the birth, the mother can minimise the pain of crowning.
Other reasons for pain during childbirth are the result of abnormal Labor and birth complications. It is during these circumstances that we can be truly thankful for medical technology.
Once women are educated about epidurals it becomes clear that avoiding one during childbirth may be well worth it to both mother and baby. Truly needing one, or deciding to have one as an informed choice at the time of the birth, on the other hand, need not leave the new mother feeling guilty.