Labor Contractions vs. Pushing: What Hurts More?

It's common to worry about the pain of childbirth. Here's the lowdown on the difference between labor contractions and pushing so you can go in fully prepared.

Pregnant woman having labor contractions
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By and large, pregnancy is often a time of wonder and excitement. However, it's also very common for pregnant people to worry about how much it will hurt to give birth. Some people even fear the pain of labor and delivery. And since giving birth happens in stages, you might naturally be wondering which stage of labor hurts the most: contractions, pushing, or crowning?

According to a survey conducted by the American Society of Anesthesiologists, around 50% of birthing people between 18 and 39 said that contractions were the most painful part of labor and delivery. But 1 in 5 had a different take and said that pushing and post-delivery hurt the worst. Most survey participants compared the worst pain to "extreme menstrual cramps," "bad back pain," and "a broken bone."

Research also shows that the intensity of pain you experience during labor and delivery is highly variable and unique to you and your situation. While everyone's pain tolerance and birth experience are different, there are some commonalities that many birthing people share. Here's what you need to know about the difference between contraction pain, pushing pain, and crowing pain during labor and delivery.

Contractions Are Often Perceived as the Most Painful Part of Labor

The most commonly reported labor experience for birthing people is that contractions are more painful than pushing. For many pregnant people, active labor is more painful than the pushing phase because it lasts longer, gets more and more intense as it progresses, and involves many muscles, ligaments, organs, nerves, and skin surfaces.

The uterus is a powerful, hollow muscle that houses your growing baby during pregnancy. When the time comes and labor begins, the uterus will start to contract. As it does, the cervix will begin to dilate to 10 centimeters, which is roughly the size of a cantaloupe and large enough to allow your baby to pass through.

Everything from the chest/rib area down works hard during labor, contracting as tightly as possible with every contraction (which can occur every few minutes for hours on end during the active stage). Comparatively, pushing tends to go a lot quicker, and you may have a bit more control. Plus, when you're pushing you know that you're close to the end and have the job of pushing to focus on.

According to the American College of Obstetricians and Gynecologists (ACOG), contractions can feel like they come in waves lasting 60 to 90 seconds at a time, and labor typically lasts between 12 and 18 hours for first pregnancies. Labor is typically a bit quicker for subsequent births.

Contractions with an unmedicated birth

Although labor and delivery can be intensely painful, not all parents opt for medical pain management. However, even if a laboring person doesn't have access to or declines medicated pain relief options, that doesn't rule out using other helpful pain management techniques. In fact, there are numerous ways to reduce perceptions of pain with and without using medications.

With no epidural or narcotics in use, most birthing people rate active-phase labor a 10 on the pain scale of 1 to 10. However, when pregnant people receive labor support and use effective pain management techniques like those learned in childbirth education classes, the intensity of the pain experienced during labor, pushing, and crowning can be reduced.

A few tried and true methods for managing the pain of contractions without medication or epidurals include:

  • Acupuncture or acupressure
  • Aromatherapy
  • Assistance from a trained doula or coaching from a birthing partner
  • Breathing techniques
  • Movement and changing positions
  • Childbirth education
  • Hydrotherapy
  • Hypnosis
  • Massage and counterpressure
  • Relaxation techniques like visualization

Talk to your health care provider about the possible pain management options that will be available to you during your labor.

Contractions with an epidural

An epidural is a popular pain management choice during labor because it effectively and safely blunts sensation from the waist down. This allows you to still feel contractions and pressure of labor without the intense pain. Still, the statistical chance of having one largely depends on which state you live in, according to a study published in the JAMA Network. For example, 36% of birthing parents in Maine receive an epidural compared to 80% of parents in Nevada.

Epidurals are administered by anesthesiologists who inject a pain blocker into your lower back. The epidural creates a numbing sensation to help relax and numb your body while you experience contractions. This medication does not prevent you from being able to push; it just stops you from feeling the immense pain of labor and delivery.

Epidurals can decrease labor pain dramatically, in some cases all the way to zero. However, since pain is a partially a subjective experience (and people respond differently to anesthesia), there is no guarantee that every person will see all of their labor pain dissolve after having an epidural. If you opt for an epidural, you should talk to your provider about what to expect, including possible side effects. Additionally, other pain medications—such as opioids or more rarely, nitrous oxide (laughing gas)—can be used as well.

Pushing Hurts But Can Feel Like Relief

While still painful, for many, pushing can feel like a relief from labor pain. When you're ready to push, and the baby presses into the birth canal, most of the hard work of labor is done. Your baby's head may even press on nerves that desensitize the pelvis. This is why many people report feeling a numb sensation before the "ring of fire" (when the baby's head begins to emerge from the vaginal opening, a stage known as "crowning").

Pushing may also feel like a reprieve from active labor contractions because it's a natural urge you can give in to. For many, it feels more active than passive. And after all those contractions, when the pain may have felt like it was relentless or never-ending, pushing along with contractions can finally make you feel like you can do something to get the baby out.

Crowning Is a Unique Type of Pain

Once the baby's head is crowning, you are close to pushing the baby all the way out. In this position, the top of the head can be seen at the vaginal opening—and the full girth of the baby is in your vaginal canal.

If you get an epidural, then you likely won't feel the pain of crowning, or at least it won't be nearly as severe as with an unmedicated birth. For those who go without pain medication, crowning is often described as a burning, stinging pain. Some even say it feels good, similar to an orgasm, however, most describe it as very painful.

This "ring of fire" sensation is due to all the pressure put on the nerves in the pelvic area by the baby's head as well as the stretching and trauma caused by the baby moving through the vaginal canal. Perineal massage and/or placing warm or cold packs on the vaginal opening can help to alleviate this feeling. Thankfully, this burning pressure doesn't usually last long and is relieved by pushing the baby out.

The Power of Preparing for Labor Pain

Because pain is subjective, no two birthing people will have the same experience with contractions, pushing, or crowning. For some, contractions might not feel unbearable; for others, labor contractions are the most intense pain they've ever experienced.

And it's not just pain tolerance at play. For example, the baby's position during labor can greatly influence the birthing person's pain levels as can any complications and resulting interventions. The support received as well as the pain medications and/or management tools used can also impact how much pain is felt. Research even suggests that feelings like fear and anxiety can impact a laboring person's perception of pain.

One of the best ways to prepare for childbirth and confront any fears or concerns you may have about labor and delivery pain is to talk to your doctor or midwife. Make sure to ask about all the options available to you. Your prenatal health care provider can help you understand the pros and cons of getting an epidural or using other pain medications and even recommend classes that teach breathing and relaxation exercises.

Additionally, honor that you may not know which pain relief techniques you want until you're in the midst of labor. And there is no right or wrong, just what works best (and feels right) to you.

Key Takeaways

When it comes to comparing the pain of labor contractions, pushing, and crowning, it can be a little bit like comparing apples, pears, and oranges. The pain is often different, and not necessarily better or worse. Ultimately, every birthing person has their own unique experience of pain in labor—and usually, each stage is intense. However, there are many effective, safe ways to manage discomfort, including using pain medications and/or unmedicated approaches like breathing exercises, massage, and changing birthing positions.

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Sources
Parents uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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