March 08, 2023

Why do women report less pain when they give birth at home?


During labour, a cocktail of hormones is released from the woman’s brain into her body.  The 3 main ingredients in this hormonal cocktail are: oxytocin, endorphin, and adrenaline.

Oxytocin is the hormone responsible for contractions in labour. Oxytocin tends to be a ‘shy’ hormone.  It doesn’t like bright lights, loud noises, or unfamiliar places, people, sounds or smells.  Oxytocin is more effectively released when the labouring woman feels loved and protected in a safe, familiar environment, like home.

Endorphin isn’t technically a hormone, it is a naturally occurring opiate which is released in response to the physical sensations of labour.  Endorphin is nature’s version of morphine or pethidine (without the side effects of course) and helps the labouring woman to feel relaxed and euphoric, and it reduces pain.  Endorphin is also shy and sensitive to an unfamiliar environment.

These hormones are the driving force behind labour, and for things to progress smoothly and effectively these hormones need to flow freely.

Often, women will experience a lull in their contractions when they transfer to hospital, which is often followed by contractions that are felt more painfully than when they were at home. This pattern is often very clear to the labouring woman in hindsight, although the reasons for it can be misunderstood.  Have you ever heard a birth story where the woman says something like: “Thank goodness I got to hospital when I did!  As soon as I got there my contractions became almost unbearable!”?  

Just leaving your home during labour can be enough to disrupt the optimal flow of oxytocin and endorphin.  

Leaving your safe, familiar ‘nest’ and moving to hospital, which is full of unfamiliar people, sights, sounds, and smells, can trigger the release of a less helpful hormone, adrenalin.

Adrenalin is the ‘fight, flight, freeze, or fawn’ hormone. Disturbances or a change in environment in labour can cause adrenalin to be released which can inhibit the release of oxytocin and endorphin.

Adrenalin isn’t all bad, however.  In late labour there is a helpful burst of adrenalin which is released to help you feel more energetic and alert during the pushing phase of labour, but it is best kept at bay in early - mid labour.

At home there are fewer disturbances than in hospital, so women are more likely to achieve deeper levels of comfort, privacy, and relaxation.  During home birth you will only have your chosen support people, your midwife, and her back-up midwife.

In hospital there are more people and more disturbances, for example: Other women giving birth, their babies, their partners, midwives, hospital staff, visitors, cleaners, etc.  This can make it hard to achieve the same level of comfort, privacy, and relaxation needed for the hormones of labour to flow freely and effectively.

Humans are the only mammals that spend time, often months, ‘nesting’ before the arrival of their baby, only to leave their nest at what is often the most vulnerable time in their life.  When you understand how the hormones of labour work together (or against each other) and what helps and hinders the release of these hormones it becomes easy to see that leaving your ‘nest’ at this vulnerable time can affect how your birthing hormones are released, and how this can impact the flow of labour. 

There are, of course, some women who crave a home birth, but due to health or medical reasons they need to give birth in hospital.  This doesn’t mean these women need to miss out on all of the benefits of home birth.  There are a lot of home birth techniques that can translate to a hospital setting when birthing at home is not the best choice for these women.

For more information please see ‘Home birth in hospital’