Pain management during childbirth is the treatment or prevention of pain that a woman may experience during labor and delivery. The amount of pain a woman feels during labor depends partly on the size and position of her baby, the size of her pelvis, her emotions, the strength of the contractions, and her outlook. Tension increases pain during labor. Virtually all women worry about how they will cope with the pain of labor and delivery. Childbirth is different for each woman and predicting the amount of pain experienced during birth and delivery can not be certain.

Some women do fine with "natural methods" of pain relief alone. Many women blend "natural methods" with medications and medical interventions that relieve pain. Building a positive outlook on childbirth and managing fear may also help some women cope with the pain. Labor pain is not like pain due to illness or injury. Instead, it is caused by contractions of the uterus that are pushing the baby down and out of the birth canal. In other words, labor pain has a purpose.

Pelvic girdle pain is complex and multi-factorial and likely to be represented by a series of sub-groups with different underlying pain drivers from peripheral or central nervous system, altered laxity/stiffness of muscles, laxity to injury of tendinous/ligamentous structures to 'mal-adaptive' body mechanics. Musculo-skeletal mechanics involved in gait and weightbearing activities can be mild to grossly impaired. PGP can begin peri or postpartum. Land or water based exercise may help prevent and treat lower back and pelvic pain but research on this subject is low quality. There is pain, instability or dysfunction in the symphysis pubis and/or sacroiliac joints. Moderate-quality evidence from a systematic review suggest that exercise or acupuncture reduced pelvic pain or lumbo-pelvic pain more than usual care.

These are also called narcotics and are medicines given through an IV or by injection into a muscle. Sometimes, opioids also are given with an epidural or a spinal block. Opioids can make the pain bearable, and doesn't affect the ability to push. Opioids don't get rid of all the pain. They

- are short-acting.

- cause drowsiness.

- cause nausea and vomiting.

- can cause itchiness.

- cannot be given right before delivery because they may slow the baby's breathing and heart rate at birth.

Occurs in between an estimated 21% to 62% of cases, possibly due to edema.

PGP in pregnancy seriously interferes with participation in society and activities of daily life; the average sick leave due to posterior pelvic pain during pregnancy is 7 to 12 weeks.

In some cases women with PGP may also experience emotional problems such as anxiety over the cause of pain, resentment, anger, lack of self-esteem, frustration and depression; she is three times more likely to suffer postpartum depressive symptoms. Other psychosocial risk factors associated with woman experiencing PGP include higher level of stress, low job satisfaction and poorer relationship with spouse.

Sometimes there is no obvious explanation for the cause of PGP but usually there is a combination of factors such as:

1. The pelvic joints moving unevenly.

2. A change in the activity of the muscles in the pelvis, hip, abdomen, back and pelvic floor.

3. A history of pelvic trauma.

4. The position of the baby altering the loading stresses on the pelvic ligaments and joints.

5. Strenuous work.

6. Previous lower back pain.

7. Previous pelvic girdle pain during pregnancy.

8. Hypermobility, genetical ability to stretch joints beyond normal range.

9. An event during the pregnancy or birth that caused injury or strain to the pelvic joints or rupture of the fibrocartilage.

10. The occurrence of PGP is associated with twin pregnancy, first pregnancy and a higher age at first pregnancy.

Recurrent pain is pain that arises periodically and can result in absences from school, outside activities, etc. This type of pain may be the most common.

Descriptions are:

- periodic instead of persistent

- consisting of tension and migraine headaches

- abdominal pains

- chest pain and limb pains

Cancer pain can differ from other types of pain. The level of pain experienced by a child that has this disease is related to the stage or extent of the cancer. Children with cancer may have no pain at all, it varies. One child may have a different threshold for pain than another may.

Sources of cancer pain are:

- a growing tumor pressing on a body organ or nerves

- inadequate blood circulation because of blocked blood vessels

- blockage of an organ or a 'tube' of the organ

- the spread of the cancer to other places

- infection

- inflammation

- side effects of chemotherapy, radiation treatment or surgery

- inactivity and stiffness

- depression and anxiety

Uterine inversion is a potentially fatal childbirth complication with a maternal survival rate of about 85%. It occurs when the placenta fails to detach from the uterus as it exits, pulls on the inside surface, and turns the organ inside out. It is very rare.

The most common cause is the mismanagement of 3rd stage of labor, such as:

- Fundal pressure

- Excess cord traction during the 3rd stage of labor

Other natural causes can be:

- Uterine weakness, congenital or not

- Precipitate delivery

- Short umbilical cord

It is more common in multiple gestation than in singleton pregnancies.

The incidence is of 1/2000 pregnancies.

Signs and symptoms may initially include: an increased heart rate, feeling faint upon standing, and an increased breath rate. As more blood is lost the women may feel cold, their blood pressure may drop, and they may become unconscious.

Postpartum chills is a physiological response that occurs within two hours of childbirth. It appears as uncontrollable shivering that is not under voluntary control. It is seen in many women after delivery and can be unpleasant. It lasts for a short time. It is thought to be a result of a nervous system response. It may also be related to fluid shifts and the actual strenuous work of labor. It is considered a normal response and there is no accompanying fever. If a fever does develop further assessments may reveal the presence of an infection. Treatment consists of an explanation from clinicians that the shivering is a normal response and that it only lasts for a short time. Warm blankets are given to the women and fluid replacement is encouraged. It has been described as a fairly common and normal occurrence.

After discharge to home with the baby, chills that accompany uncontrolled bleeding, shortness of breath, cold clammy skin, dizziness, heart pain, and racing heart can be a sign of shock that needs immediate medical attention. Mastitis can also cause shivering.

Postpartum bleeding or postpartum hemorrhage (PPH) is often defined as the loss of more than 500 ml or 1,000 ml of blood within the first 24 hours following childbirth. Some have added the requirement that there also be signs or symptoms of low blood volume for the condition to exist. Signs and symptoms may initially include: an increased heart rate, feeling faint upon standing, and an increased breath rate. As more blood is lost the women may feel cold, their blood pressure may drop, and they may become restless or unconscious. The condition can occur up to six weeks following delivery.

The most common cause is poor contraction of the uterus following childbirth. Not all of the placenta being delivered, a tear of the uterus, or poor blood clotting are other possible causes. It occurs more commonly in those who: already have a low amount of red blood, are Asian, with bigger or more than one baby, are obese or are older than 40 years of age. It also occurs more commonly following caesarean sections, those in whom medications are used to start labor, and those who have an episiotomy.

Prevention involves decreasing known risk factors including if possible procedures associated with the condition and giving the medication oxytocin to stimulate the uterus to contract shortly after the baby is born. Misoprostol may be used instead of oxytocin in resource poor settings. Treatments may include: intravenous fluids, blood transfusions, and the medication ergotamine to cause further uterine contraction. Efforts to compress the uterus using the hands may be effective if other treatments do not work. The aorta may also be compressed by pressing on the abdomen. The World Health Organization has recommended non-pneumatic anti-shock garment to help until other measures such as surgery can be carried out. In 2017 study found that tranexamic acid decreased a woman's risk of death.

In the developing world about 1.2% of deliveries are associated with PPH and when PPH occurred about 3% of women died. Globally it occurs about 8.7 million times and results in 44,000 to 86,000 deaths per year making it the leading cause of death during pregnancy. About 0.4 women per 100,000 deliveries die from PPH in the United Kingdom while about 150 women per 100,000 deliveries die in sub-Saharan Africa. Rates of death have decreased substantially since at least the late 1800s in the United Kingdom.

Obstructed labour may be diagnosed based on physical examination.

Obstructed labour, also known as labour dystocia, is when, even though the uterus is contracting normally, the baby does not exit the pelvis during childbirth due to being physically blocked. Complications for the baby include not getting enough oxygen which may result in death. It increases the risk of the mother getting an infection, having uterine rupture, or having post-partum bleeding. Long term complications for the mother include obstetrical fistula. Obstructed labour is said to result in prolonged labour, when the active phase of labour is longer than twelve hours.

The main causes of obstructed labour include: a large or abnormally positioned baby, a small pelvis, and problems with the birth canal. Abnormal positioning includes shoulder dystocia where the anterior shoulder does not pass easily below the pubic bone. Risk factors for a small pelvis include malnutrition and a lack of exposure to sunlight causing vitamin D deficiency. It is also more common in adolescence as the pelvis may not have finished growing. Problems with the birth canal include a narrow vagina and perineum which may be due to female genital mutilation or tumors. A partograph is often used to track labour progression and diagnose problems. This combined with physical examination may identify obstructed labour.

The treatment of obstructed labour may require cesarean section or vacuum extraction with possible surgical opening of the symphysis pubis. Other measures include: keeping the women hydrated and antibiotics if the membranes have been ruptured for more than 18 hours. In Africa and Asia obstructed labor affects between two and five percent of deliveries. In 2015 about 6.5 million cases of obstructed labour or uterine rupture occurred. This resulted in 23,000 maternal deaths down from 29,000 deaths in 1990 (about 8% of all deaths related to pregnancy). It is also one of the leading causes of stillbirth. Most deaths due to this condition occur in the developing world.

The major concern of shoulder dystocia is damage to the upper brachial plexus nerves. These supply the sensory and motor components of the shoulder, arm and hands. The ventral roots (motor pathway) are most prone to injury. The cause of injury to the baby is debated, but a probable mechanism is manual stretching of the nerves, which in itself can cause injury. Excess tension may physically tear the nerve roots out from the neonatal spinal column, resulting in total dysfunction.

- Klumpke paralysis

- Erb's Palsy

- Fetal hypoxia

- Fetal death

- Cerebral palsy

- Maternal post partum hemorrhage (11%)

- Vaginal lacerations and 3rd/4th degree tears, extended episiotomies

- uterine rupture

Bloody show is the passage of a small amount of blood or blood-tinged mucus through the vagina near the end of pregnancy. It can occur just before labor or in early labor as the cervix changes shape, freeing mucus and blood that occupied the cervical glands or cervical os. Bloody show is a relatively common feature of pregnancy, and it does not signify increased risk to the mother or baby . A larger amount of bleeding, however, may signify a more dangerous, abnormal complication of pregnancy, such as placental abruption or placenta previa. Large amounts of bleeding during or after childbirth itself may come from uterine atony or laceration of the cervix, vagina, or perineum.

Three common signs of the onset of labor are:

1. A bloody show

2. Rupture of membranes ("Water breaking")

3. Onset of tightenings or contractions

However, these may occur at any time and in any order. Some women neither experience a bloody show nor have their "water break" until well into advanced labor. Therefore, neither bloody show nor rupture of membranes are required to establish labor.

Symptoms of a rupture may be initially quite subtle. An old cesarean scar may undergo dehiscence; but with further labor the woman may experience abdominal pain and vaginal bleeding, though these signs are difficult to distinguish from normal labor. Often a deterioration of the fetal heart rate is a leading sign, but the cardinal sign of uterine rupture is loss of fetal station on manual vaginal exam. Intra-abdominal bleeding can lead to hypovolemic shock and death. Although the associated maternal mortality is now less than one percent, the fetal mortality rate is between two and six percent when rupture occurs in the hospital.

In pregnancy uterine rupture may cause a viable abdominal pregnancy. This is what accounts for most abdominal pregnancy births.

- Abdominal pain and tenderness. The pain may not be severe; it may occur suddenly at the peak of a contraction. The woman may describe a feeling that something "gave way" or "ripped."

- Chest pain, pain between the scapulae, or pain on inspiration—Pain occurs because of the irritation of blood below the woman's diaphragm

- Hypovolemic shock caused by haemorrhage— Falling blood pressure, tachycardia, tachypnea, pallor, cool and clammy skin, and anxiety. The fall in blood pressure is often a late sign of haemorrhage

- Signs associated with fetal oxygenation, such as late deceleration, reduced variability, tachycardia, and bradycardia

- Absent fetal heart sounds with a large disruption of the placenta; absent fetal heart activity by ultrasound examination

- Cessation of uterine contractions

- Palpation of the fetus outside the uterus (usually occurs only with a large, complete rupture). The fetus is likely to be dead at this point.

- Signs of an abdominal pregnancy

- Post-term pregnancy

Vaginal gas that involves strong odor or fecal matter may be a result of colovaginal fistula, a serious condition involving a tear between the vagina and colon, which can result from surgery, child birth, diseases (such as Crohn's disease), and other causes. This condition can lead to urinary tract infection and other complications. Vaginal gas can also be a symptom of an internal female genital prolapse, a condition most often caused by childbirth.

Puffs or small amounts of air passed into the vaginal cavity during cunnilingus will not cause any known issues, however "forcing" or purposely blowing air at force into the vaginal cavity can cause an air embolism, which in very rare cases can be potentially dangerous for the woman, and if pregnant, for the fetus.

One way of classifying coccydynia is whether the onset was traumatic versus non-traumatic. In many cases the exact cause is unknown and is referred to as idiopathic coccydynia.

Coccydynia is a fairly common injury which can often result from falls, particularly in leisure activities such as cycling and skateboarding.

Coccydynia is often reported following a fall or after childbirth. In some cases, persistent pressure from activities like bicycling may cause the onset of coccyx pain. Coccydynia due to these causes usually is not permanent, but it may become very persistent and chronic if not controlled. Coccydynia may also be caused by sitting improperly thereby straining the coccyx.

Rarely, coccydynia is due to the undiagnosed presence of a sacrococcygeal teratoma or other tumor in the vicinity of the coccyx.

Coccydynia is also known as coccygodynia, coccygeal pain, coccyx pain, or coccalgia.

The symptoms and discomforts of pregnancy are those presentations and conditions that result from pregnancy but do not significantly interfere with activities of daily living or pose a threat to the health of the mother or baby. This is in contrast to pregnancy complications. Sometimes a symptom that is considered a discomfort can be considered a complication when it is more severe. For example, nausea (morning sickness) can be a discomfort, but if, in combination with significant vomiting it causes a water-electrolyte imbalance, it is a complication known as hyperemesis gravidarum.

Common symptoms and discomforts of pregnancy include:

- Tiredness.

- Constipation

- Pelvic girdle pain

- Back pain

- Braxton Hicks contractions. Occasional, irregular, and often painless contractions that occur several times per day.

- Edema (swelling). Common complaint in advancing pregnancy. Caused by compression of the inferior vena cava and pelvic veins by the uterus leads to increased hydrostatic pressure in lower extremities.

- Increased urinary frequency. A common complaint, caused by increased intravascular volume, elevated glomerular filtration rate, and compression of the bladder by the expanding uterus.

- Urinary tract infection

- Varicose veins. Common complaint caused by relaxation of the venous smooth muscle and increased intravascular pressure.

- Haemorrhoids (piles). Swollen veins at or inside the anal area. Caused by impaired venous return, straining associated with constipation, or increased intra-abdominal pressure in later pregnancy.

- Regurgitation, heartburn, and nausea.

- Stretch marks

- Breast tenderness is common during the first trimester, and is more common in women who are pregnant at a young age.

In addition, pregnancy may result in pregnancy complication such as deep vein thrombosis or worsening of an intercurrent disease in pregnancy.

The condition may be asymptomatic. The predominant symptoms are:

- Abnormal lochial discharge either excessive or prolonged

- Irregular or at times excessive uterine bleeding

- Irregular cramp like pain is cases of retained products or rise of temperature in sepsis

In 1994, responding to the need for a more useful system for describing chronic pain, the International Association for the Study of Pain (IASP) classified pain according to specific characteristics:

1. region of the body involved (e.g. abdomen, lower limbs),

2. system whose dysfunction may be causing the pain (e.g., nervous, gastrointestinal),

3. duration and pattern of occurrence,

4. intensity and time since onset, and

5. cause

However, this system has been criticized by Clifford J. Woolf and others as inadequate for guiding research and treatment.

Woolf suggests three classes of pain:

1. nociceptive pain,

2. inflammatory pain which is associated with tissue damage and the infiltration of immune cells, and

3. pathological pain which is a disease state caused by damage to the nervous system or by its abnormal function (e.g. fibromyalgia, peripheral neuropathy, tension type headache, etc.).

Childbirth-related posttraumatic stress disorder is a psychological disorder that can develop in women who have recently given birth. Its symptoms are not distinct from posttraumatic stress disorder (PTSD).