Dealing With Pain During Birth in Berlin - Overview of Available Methods
- Anne Matei
- Mar 13
- 9 min read
Updated: Mar 20
When you’re preparing for birth, one of the most empowering things you can do is understand your "toolbox." You don't have options if you do not know they exist.
As a doula, I often tell my clients: you don’t have to choose a "side" beforehand and stick to it... but rather, I encourage you to be informed about your options and open and to what works best for you in the moment.
In this article I break down the different pain management methods available to you in Berlin.
Make sure you take some time to get familiar with these options, "try" some (for the unmedicated ones), prepare your birth plan, and communicate your preferences to your birth team (partner/doula/midwives).
Understanding the 4 Levels of Pain Management
I have categorized the different methods into four levels, moving from the least interventionist to the most medicalized.
Level 1: Natural Methods (Natürliche Methoden)
Level 2: Analgesics (Analgetika)
Level 3: Opiates & Laughing Gas (Opiate & Lachgas)
Level 4: Epidural (PDA / Periduralanästhesie)
It is important to note that if you choose to give birth at home (Hausgeburt) or in a birth center (Geburtshaus) or in a Hebammenkreisssaal (read about it here) you will typically have access only to Level 1 and 2 methods.
However if you feel you need stronger pain management during labor, you can choose to transfer to a hospital to access Level 3 and 4 options.
On my interactive Berlin birth map you can see what pain management methods are available in which clinic. But the best thing is always to ask specifically about these methods during information evenings or upon registration.
LEVEL 1: Natural Methods (Natürliche Mittel)
This is the foundation of every birth. These methods focus on supporting your body’s own capability to deal with the intensity of childbirth, and protect your body and your baby's natural rythm, without interfering with the special balance of your birth hormones.
Shifting your mindset on childbirth pain: Keep this basic thing in mind: Childbirth pain is probably the only pain in the world that is not pathological.
Unlike a broken leg (which says "Stop, something is wrong"), labor pain says "Go, something is happening."
Childbirth pain is the only pain in the human experience that is linked to a healthy, natural process rather than an injury or illness.
Your body is literally stretching and moving to bring your baby out. When you frame it as a "tool" instead of a "threat," your body stays relaxed, which actually helps the process go faster.
This is why I believe one of the most effective tool here, is to shift your mindset on how you perceive this pain. Instead of thinking "Ow, this hurts, something is wrong," try reframing the thought to:
"This sensation is my body opening to birth my baby."
"Every wave brings my baby closer."
"My body is doing exactly what it was built to do."
"Pain melts on me like butter, I let pain melt me, I am not in danger"
You can also explore hypnobirthing: this method uses self-hypnosis, breathing, and relaxation techniques to reduce fear, anxiety, and pain. It empowers parents to trust their body's natural abilities, aiming for a calmer, more positive, and often shorter birth experience.
I recorded a free meditation for you here that you can test :)
Many midwives (or other professionals such as doulas for example) are trained in hynobirthing and can give you classes before labour.
Water & Heat: Most Berlin delivery rooms (Kreißsaal) feature large tubs. Warm water from a hot shower or immersion into a water tub is super useful to help with pain! You can do it at home when you are in early labour (then, I recommend a shower), or during active labour, to give yourself a bit of relaxation. Read more on water birth in Berlin and use of water during labour here.
Movement & Gravity: Using birthing balls, wall bars (Sprossenwand), or simply walking, dancing, slow movement, birth balls... try to find a "rhythm", your body will naturally try and find comfort in rhythms such as rocking, breathing, lean into it, this will be a key coping mechanism! Movement is also absolutely key to support baby making its way, rotating down your pelvis.
1-1 Support: Evidence consistently shows that one-to-one support is one of the most powerful "pain killers" available. At the clinic, usually midwives are juggling several births at once, but choosing a Beleghebamme (attending midwife), a Geburtshaus (birth center), or a Home Birth guarantees that dedicated 1:1 presence.
Having a doula provides an additional layer of continuous emotional and physical support that doesn't change with shift rotations. Evidence showed how the presence of a doula can reduce the requests for an epidural by 60%...
Sensory distraction aka "Gate Control Theory" : for example from counter-pressure, TENS machine, acupuncture, massage...
credit: the birth hour The gate control theory of pain asserts that non-painful input closes the nerve "gates" to painful input, which prevents pain sensation from traveling to the central nervous system.
When you use a TENS machine, a warm shower, or have someone massage you or put counter pressure on you, those pleasant sensations trick your brain. When using these positive sensations, you create a "traffic jam" that blocks the slower pain signals from getting through.
Ask your birth setting what they have: acupuncture? TENS?
You can test and try some of these ahead of time, prepare with your doula and partner.
Rhythms & Rituals : for example rhythmic breathing or chanting, dancing, rhythmic movement ... When you focus on rhythmic breathing, you provide your muscles and your baby with a steady supply of oxygen.
Adding sound, like low, guttural chanting (oooooOOOOAAAAAaaaOOOOO) or "horse lips" (vibrating your lips) serves two purposes: it forces a long, controlled exhale and physically relaxes your jaw.
A relaxed, open jaw is neurologically connected to a relaxed, open pelvic floor. By keeping your sounds deep and "low" rather than high-pitched screams, you direct your energy downward, helping your body open up.
These are typically exercises I explore with my clients during birth preparation. It can feel really reassuring to have tried some of these techniques so that you have them in your "toolbox" for labour.
The Environment: Dim lights and a quiet atmosphere help keep your "thinking brain" off so your "birthing brain" can take over. Birth requires an environment that is intimate and safe, just like sex! Read here why.
Many other things to explore such as aromatherapy (often used in Berlin), using a vibrator (yes! A sex toy! read more here...)
LEVEL 2: Analgesics (Analgetika)
If natural methods aren't quite enough to help you stay relaxed, midwives may suggest mild medical support. Often these are antispasmodics or mild painkillers like Paracetamol. Usually given via intravenous drip. These are frequently used in early labor or the "latent phase" to help your muscles relax between contractions so you don’t exhaust yourself too early.
LEVEL 3: Opiates & Nitrous Oxide (Opiate und Lachgas)
Moving up the scale, we find options that offer a stronger "buffer" against the intensity.
Lachgas (Laughing Gas): This is a mixture of oxygen and nitrous oxide inhaled via a mask. It helps reduce anxiety and takes the "peak" off contractions. It does not take the pain away... but makes you feel "high", a bit more relaxed and distant. Sometimes things feel funny ;)
In Berlin it is not available at all clinics: and even when it is on site, it may not be available if patients are already using it. Some women don't like the sensation and can become nauseous. Apart from that, there is evidence on it being relatively safe and harmless for mother and baby.
Laughing gas in labour credit https://www.twincitiesbc.com/ Opioids: Stronger painkillers can be administered to provide more intense relief, though they may make you feel a bit drowsy. This can be done via an intravenous or an injection in the muscles. Usually the effects stays 2-3 hours. You will still feel some pain, but it is often less strong, maybe allowing you to rest a little bit and relax more. My clients often describe it as "having had a bit too much Prosecco and feeling relaxed and tipsy".
It is important to note that you often will be asked to do more monitoring/vaginal exams when your receive this. Because this is a strong drug and it affects your birth physiology and your baby too.
Based on evidence, here are the main drawbacks of injectable opioids include the fact that they’re not that effective (some report feeling only moderate relief).
You might feel nauseous. They can also cause breathing problems, confusion, forgetfulness, sedation, or slowed reflexes. These side effects could interfere with your ability to nurse your baby shortly after birth and they might not be the best option if you are rapidly dilating or you’re really close to delivery and they don’t want the medications to be in the baby’s system when the baby is born.
For the newborn, all opioids have been shown to cross the placenta and can get into the baby’s circulation. So potential harms include changes to the baby’s heart during labor, which could potentially lead to a need for a C-section, slowed breathing after birth, and low Apgar scores.
However, this can be a good card to play if you want to avoid an epidural but feel the need for some support from medication. Keep in mind these pros/cons and discuss this option with your team in the moment.
Level 4: The Epidural (PDA - Periduralanästhesie)
The "PDA" is considered the highest level of medical pain management.
It is a regional anesthesia, where you get injected numbing medication through a catheter into the lower back to block pain signals from the spine.
While it offers the most significant relief, it is a major medical intervention that changes the natural physiology of birth. Because it numbs the lower body, it often requires extra interventions such as: continuous fetal monitoring, more frequent vaginal exams, a bladder catheter, and significantly reduced mobility....
I wrote more on the epidural and its risks/benefits here.
It’s important to understand how one intervention can lead to another, a process often called the "Cascade of Intervention." This chain of events is why epidurals are statistically linked to a higher use of vacuum extraction, forceps, or even C-sections.
For example, an epidural often cause contractions to slow down or stall, and leads to longer pushing stages on average. To counter this, medical providers may need to administer synthetic oxytocin to speed things up, or manually break your bag of water; or use instruments to deliver your baby faster.
There is no "right" or "wrong" choice here. For some, a PDA is a welcome tool that allows for necessary rest; for others, it may lead to complications they hadn't anticipated.
As a doula I support you in the moment, whatever your choice is, but I find it important that you understand the benefits, risks, and alternatives.
Feeling Prepared for the Unknown
Even if your plan is to get an epidural as soon as possible, having level 1 skills is still essential.
In most hospitals, an epidural is typically administered once you are in active labor (usually around 4-5 cm dilation). There is often a waiting period while the anaesthesiologist is getting on your way.
Being mentally prepared to navigate that intensity with breathing and movement ensures you stay in control until the medical relief arrives or that you have resources to avoid these interventions if this becomes your choice in the moment.
Doula Tips: Staying Active with an Epidural
A common myth is that an epidural means you have to lie flat on your back until the baby arrives. This isn't true and this is very counterproductive! Staying mobile is vital because your baby is still performing a complex "internal dance" to navigate your pelvic bones.
If you choose a PDA, we can still optimize your birth by:
Dosage: Ask for a pump so that you can self dose your epidural. When you are getting closer to pushing, and feeling baby drop down lower, you could try to not get new doses in your body so that you can be more active during the pushing phase.
The "Roll Over": Change your position from side to side every 30 to 60 minutes, opening different part of your pelvis. See an example here.
The Peanut Ball/ or just using big pillows: Placing this peanut-shaped ball or big pillows between your knees opens the pelvic outlet, giving the baby more room even while you rest.
Staying mobile is super important! Your baby is trying to navigate your pelvis; down a narrow passage, movement helps baby navigate and come out.
Gravity-Neutral Pushing: You do not have to push on your back. With the help of your doula and midwife, we can explore side-lying or upright positions (using the back of the bed for support) to help gravity do the work. The beds in the the Kreisssaaal offer a variety of props and positions that can be adjusted so that you find a good way to push even "in bed".
Crucially, having an epidural does not mean you are restricted to pushing on your back; with the support of your team and a doula, you can explore upright or side-lying positions that use gravity. See here for a lovely post on this
And my video tip here
Are you still wondering? You may need some space to express your questions without judgment and gather objective information based on facts rather than opinions.
As a doula in Berlin, I offer free 1-1 introductory calls to help you find clarity, as well as online consultations, birth ed sessions and full doula companionship (for both vaginal births and C-sections)
Anne Matei is a birth and postpartum doula based in Berlin, supporting French-, English-, and German-speaking families. She accompanies births in hospitals, birth centers, and home births alongside midwives. Read what families say about working with her in client testimonials. Feel free to get in touch to schedule a non-binding introductory call.
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